A Comparative Study of Therapeutic Efficacy of Double – Modality Therapy, Phonophoresis and Cryotherapy in the Management of Musculoskeletal Injuries in Jos.
ABSTRACT
Musculoskeletal injuries ( MSIs ) account for approximately 25% of patients‟ complaints in the primary health care settings and are a leading cause of work absenteeism world-wide.
Physical treatments like phonophoresis ( PH ) and cryotherapy ( CRYO ) are being used to reduce pain, control swelling and improve function.
The recognition of the importance of pain control in the recovery from MSIs has prompted clinicians to continue to explore more aggressive pain management strategies.
It is suggested that PH and CRYO could be combined ( doublemodality therapy – DMT ) in managing MSIs for better outcome. There is dearth of information in the literature to support the practise or demonstrate its ( DMT ) efficacy or superiority over the single treatment protocol.
This work was a prospective study therefore, designed to investigate the therapeutic efficacy of DMT in the management of pain among participants who suffered from MSIs.
Participants were assigned randomly to one of three groups: DMT group ( n=20 ) received cryotherapy and 15% methyl salicylate phonophoresis, PHONO group ( n=20 ) received 15% methyl salicylate phonophoresis and CRYO group ( n=20 ) received cryotherapy and „sham‟ phonophoresis.
Pre-and post-treatment pain perception scores ( PPS ) among the participants using visual analogue scale ( VAS ) and the duration of treatment in all groups were recorded.
Treatment was administered on alternate days in all groups. The result shows a total of 275 treatment sessions was recorded in the three groups – 72 ( 26.2% ) in DMT, 105 ( 38.2% ) in PHONO and 98 ( 35.6% ) in CRYO group which indicates no significant difference ( p > 0.05 ) in treatment sessions in favour of DMT.
The difference in the severity of pain before and after treatment was remarkable and statistically significant ( p < 0.05 ) in each group which suggests that DMT, phonophoresis and cryotherapy were equally effective.
DMT protocol was significantly ( P < 0.05 ) effective in its group, but could not significantly produce more pain relief among the participants when compared with the two other groups.
In conclusion, the current study has indicated the significant therapeutic efficacy of DMT, but it could not produce more pain relief than the two other protocols ( PHONO and CRYO ).
However, the result has indicated that it might take less or fewer sessions to treat and make the participants included in this study pain free and fit to return to active performance when DMT is considered
TABLE OF CONTENTS
TITLE PAGE
DECLARATION ii
CERTIFICATION iii
ACKNOWLEDGEMENTS iv
DEDICATION vii
TABLE OF CONTENTS viii
LIST OF TABLES xii
LIST OF FIGURES xiii
ABSTRACT xiv
CHAPTER ONE INTRODUCTION
1.1 BACKGROUND TO THE STUDY 1
1.2 RESEARCH PROBLEM 5
1.3 RESEARCH AIM 6
1.4 RESEARCH OBJECTIVE 7
1.5 RESEARCH HYPOTHESIS 7
1.5.1Null Hypothesis 7
1.5.2 Alternative Hypothesis 7
1.6 JUSTIFICATION OF THE STUDY 8
1.7 INCLUSION AND EXCLUSION CRITERIA 9
1.8 LIMITATIONS 9
CHAPTER TWO LITERATURE REVIEW
2.1 PHONOPHORESIS 10
2.1.1 Definition 10
2.1.2 Historical Background of Ultrasonophoresis 11
2.1.3 Topical Drugs, Couplants and Transmissivity in Phonophoresis 11
2.1.4 Methods of Application – Therapeutic Ultrasound 17
2.1.5 Treatment Settings for Phonophoresis 20
2.1.6 Passage of Drugs across the Skin – Mechanism of action 21
2.1.7 Uses of Ultrasound 24
2.1.8 Indications for Phonophoresis 24
2.1.9 Dangers/Contraindications of Therapeutic Ultrasound 25
2.1.10 Effectiveness of Phonophoresis 27
2.2 CRYOTHERAPY 33
2.2.1 Definition 33
2.2.2 Mode and Method of Cryotherapy Application 34
2.2.3 Length/Duration of Application 39
2.2.4 Indications/Contraindications for Cryotherapy 39
2.2.5 Precautions/Side-Effects of Cryotherapy 40
2.2.6 Pathophysiologic Effect of Cryotherapy 42
2.2.7 Effectiveness of Cryotherapy 46
2.3 MUSCULOSKELETAL INJURIES 48
2.3.1 Definition/Epidemiology 48
2.3.2 Causes of Musculoskeletal Injuries 50
2.3.3 Signs and Symptoms of Musculoskeletal Pain 52
2.3.4 Treatment and Management of Musculoskeletal Pain 52
2.4 MEASUREMENT OF PAIN/PHYSIOLOGY OF NOCICEPTION 56
2.4.1 Definition of Pain 56
2.4.2 Types of Pain 58
2.4.3 Measurement of Pain 63
2.4.4 Physiology of Nociceptive Transmission Pathways 71
2.4.5 Pain Modulation – Suppression of the Nociceptive System 75
CHAPTER THREE METHODOLOGY
3.1 HUMAN PARTICIPANTS AND RECRUITMENT 79
3.2 INSTRUMENTS AND MATERIALS 80
3.3 OUTCOME MEASURES 81
3.4 EXPERIMENTAL PROCEDURE 81
3.4.1 Double-Modality Therapy Group 83
3.4.2 Phonophoresis Group 84
3.4.3 Cryotherapy Group 85
3.5 DATA ANALYSIS 87
CHAPTER FOUR RESULTS
4.1 PARTICIPANTS SEX AND AGE 88
4.2 PARTICIPANTS OCUPATION 90
4.3 TREATMENT SESSIONS 92
4.4 PARTICIPANT DISCHARGE PATTERN 94
4.5 PARTICIPANT PAIN PERCEPTION SCORES 96
4.5.1 Comparison of Pain Perception Scores in DMT Group 96
4.5.2 Comparison of Pain Perception Scores in PHONO Group 97
4.5.3 Comparison of Pain Perception Scores in CRYO Group 98
4.5.4 Comparison of Pain Perception Scores in all Groups 99
4.6 PARTICIPANT POST-TREATMENT REPORT 100
CHAPTER FIVE DISCUSSION, CONCLUSION AND CONTRIBUTION TO KNOWLEDGE
5.1 DISCUSSION 101
5.2 CONCLUSION 107
5.3 CONTRIBUTION TO KNOWLEDGE 107
REFERENCES 109
APPENDIX
INTRODUCTION
Background of the Study
Musculoskeletal injury refers to damage of muscular or skeletal systems which is usually due to a strenuous activity ( Hootman et al, 2002 ).
Musculoskeletal disorders ( MSDs ) or injuries or impairments ( MSIs ) account for roughly 25% of patient complaints in the primary health care settings ( Childs et al, 2005 ) and are a leading cause of work absenteeism worldwide ( Beebe, Barkin and Barkin, 2005 ).
Musculoskeletal problems constitute the largest proportion of injuries among athletes ( Reilly and Hardiker, 1983; Onuwe, 2001 ).
Report has indicated that more than 60% of men and women who work on the computer have complained of pain resulting from various MSDs ( Idowu, Adedoyin and Adagunodo, 2005 ).
Low back pain ( LBP ) is not only one of the most common MSDs in industrialised societies, but it is the most costly, and it is the primary cause of disability in persons under age 45 years ( DeRosa and Porterfield, 1992; Sanya and Ogwumike, 2005 ).
In the United States more than 25,000 ankle sprains occur each day and the concomitant symptoms (pains and swelling) leave the individuals with some functional disability ( Man, Morrisey and Cywinske, 2007 ).
Physical therapists ( physiotherapists ) increasingly provide direct access services ( using physical modalities ) to patients with musculoskeletal conditions, and growing evidence supports the cost-effectiveness of this 2 mode of healthcare delivery ( Childs et al, 2005 ).
These physical modalities ( ultrasound, phonophoresis, cryotherapy, electrical stimulation, laser and iontophoresis ) or treatments have been used for thousands of years and are currently being used to reduce pain, control swelling or inflammation and improve or restore function in the management of MSIs ( Bolin, 2003; Kozanoglu, Basaran, Guzel and Guler-Uysal, 2003 ).
Therapeutic ultrasound ( US ) as a deep heating modality may produce temperature elevations of 4 – 5° C at depths of 8cm ( Kozanoglu, Basaran, Guzel and Guler-Uysal, 2003 ) and thus produce a number of physiological effect which makes it a suitable modality in the treatment of MSDs ( Balogun, 1990 ).
Report has shown that ultrasound ( US ) has been widely used for more than 40 years in the treatment of musculoskeletal disorders ( MSDs ) such as tendinitis, tenosynovitis, epicondylitis, bursitis, osteoarthritis , etc ( Kozanoglu, Basaran, Guzel and Guler-Uysal, 2003 ).
When ultrasound ( US ) is therefore, used to increase the transcutaneous transmission of topical drugs or used to enhance percutaneous absorption of topical drugs in the management of musculoskeletal disorders ( MSDs ) or injuries ( MSIs ), this treatment procedure is referred to or described as phonophoresis ( Byl, 1995; Machet and Boucuad, 2002; Kozanoglu Basaran, Guzel and Guler-Uysal, 2003; Kuntz, Griffins, Rankin, Amstrong and McLaughlin, 2006 ).
Phonophoresis has been a widely applied clinical procedure for treatment of MSDs or MSIs ( Byl, 1995; Kozanoglu, Basaran, 3 Guzel and Guler-Uysal, 2003 ) and dermatological conditions ( Kozanoglu, Basaran, Guzel and Guler-Uysal, 2003 ) since the first time it was used in 1954 by Fellinger and Schmid to treat polyarthritis of the hand ( Byl, 1995 ).
It is believed to accelerate functional recovery by decreasing pain and promoting healing ( Cagnie, Vinck, Rimbaut and Vanderstraeten, 2003 ).
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