Search

Study design: We conducted a mixed-methods sequential explanatory study. In India, most spinal cord injuries (SCI) occur within low socioeconomic status populations, typically resulting in poor vocational outcomes post-injury and difficulty reintegrating into the community. This study will increase our understanding of how vocational rehabilitation affects patients with SCI. Objectives: This study aims to understand the factors affecting vocational outcomes, quality of life and social inclusion for patients who have completed the Amar Seva Sangam (ASSA's) rehabilitation program, by examining both quantitative and qualitative measures. Methods: Conducted at the University of Toronto, we used self-administered questionnaires via REDCap for quantitative data collection and semi-structured interviews for qualitative data collection to capture aspects of lived SCI experience for five participants. Results: Thirty-two participants completed the quantitative phone questionnaire of which 17 were paraplegic and 15 were quadriplegic. Four themes emerged including physical barriers to employment, social inclusion of SCI patients, low income, and state of mental health. Conclusion: This study provided a detailed examination of demographic information and lived experiences of ASSA participants. The findings will be relevant and applicable to both clinical and public health sectors in SCI rehabilitation in India and other low- and middle-income countries by directing rehabilitation programs to better address areas of function that allow patients to find success following rehabilitation. [ABSTRACT FROM AUTHOR]

In India, where institutional-based mental health care is common, gender and other intersecting marginalized identities along with absent familial support contribute to women's admission and prolonged confinement to psychiatric institutions. However, an intersectional analysis of factors that prevent women with limited familial support from returning to their communities is lacking. This article is based on narratives of eleven women residing at a halfway home in an urban city in India, awaiting return to their communities. We include descriptions and an intersectional analysis of women's pathways to psychiatric institutions, their experiences receiving institutional-based mental health care, and the challenges they face as they contemplate returning to their communities. This study adds to the minimal research examining women's gendered pathways to psychiatric institutions in India. Women's narratives highlight that gender and illness-related disadvantages coupled with economic adversity that led to the initial admission also serve as deterrents to reentering the community. [ABSTRACT FROM AUTHOR]

Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties. [ABSTRACT FROM AUTHOR]

Background: An increase in the on-field intensity in modern cricket, results in an increased number of player injuries. Integration and easy access to professional physiotherapy, technology, rehab protocols, and mental/physical conditioning aid in early return to sports in the injured; however, at the grassroots, these facilities may not be available with untrained support staff and limited funds. Injuries can go unnoticed and, therefore, there is a need for an easy process of identification and documentation of such injuries. We devised a questionnaire-based survey to evaluate its effectiveness at the junior level of professional cricket. Materials and Methods: An Online self-administered questionnaire was prepared and the link was given to active Union Territory Cricket Academy (UTCA), Chandigarh, cricketers of any gender between 15 and 35 years of age, through different online platforms like WhatsApp, Telegram and emails, for the submission of their responses. Results: The questionnaire was administered to 98 participants out of which 77 participants' responses were evaluated (41 males and 36 females). 74/77 participants were below 30 years of age. There were 18 wicketkeepers, 33 bowlers and 26 batsmen as per their major role in the team. 37/77 cricketers (20 males, 17 females) had injuries during the previous 2 years; this included 17 bowlers, 11 batsmen and 9 wicketkeepers. The most common body part injured in the survey were fingers (12) followed by the back (7). The amount of training time lost, reported in the survey ranged from a week up to 1 year. Conclusion: Online surveys could be the first step to accumulating data and making initial player profiles, starting even at junior levels of cricket. Further detailed evaluations may be performed after this, and coaches and administrators could potentially profile cricket injuries and identify chronic issues. [ABSTRACT FROM AUTHOR]

Background: Expenditure for rehabilitation following knee arthroplasty for osteoarthritis- and rehabilitation-related challenges following discharge to home after surgery is not available in the Indian context. Objectives: To estimate cost of rehabilitation and document challenges in following rehabilitation advices, from a patient perspective. Methods: We conducted a hospital-based cross-sectional study of patients visiting the orthopedic department at a tertiary care public-funded hospital in New Delhi and included those who recently (less than 4 months) underwent primary knee arthroplasty for osteoarthritis. A trained physiotherapist not involved in clinical care collected information on expenditures incurred after discharge from hospital, patient's ability to recall the advices given by the physician and challenges they experienced using a semi-structured questionnaire. We report median costs by category of direct and indirect cost and used linear regression to explore determinants of cost. Results: We interviewed 82 consecutive patients (mean age 60.8 years and 68% females) with median time since surgery of 28 days. More than half (52%) sought some support for physiotherapy. The median cost of rehabilitation was INR 18,395 (Interquartile-range 11,325–27,775). Direct medical cost contributed to 74% of total cost (32% fee for services, 21% medications and lab investigations, 21% assistive devices). Twenty percent higher costs were incurred among those undergoing bilateral knee surgery after adjusting for age, sex, income, and type of physiotherapy support sought. Challenges were related to recall of advices, not understanding the recovery process and pain management. Conclusion: About half patients undergoing knee arthroplasty seek support for rehabilitation after discharge to home contributing to a major portion of expenses incurred during rehabilitation. Cost-effective support mechanism for home-based rehabilitation is required for improving patient rehabilitation experiences. [ABSTRACT FROM AUTHOR]

Background: The ultimate success of a total hip replacement lies in patients forgetting about their artificial joints during routine activities. "Forgotten Joint Score (FJS)" is emerging as an important tool in assessing outcomes of total hip arthroplasty. There has been no version of this score available in commonly spoken vernaculars in India. This study aims to formulate and validate the Hindi version of FJS in Indian population. Methods: A total of 136 patients with a minimum follow-up of 6 months and a maximum follow-up of 18 months after total hip arthroplasty were asked to fill the translated and adapted version of FJS questionnaire, at two points of time 2 weeks apart. The Hindi version of FJS (I-FJS) was tested for reliability and responsiveness, floor and ceiling effect and validity against modified Harris Hip Score (mHHS). Construct validity was expressed as the Pearson correlation coefficient. Internal consistency was expressed as Cronbach's alpha and test–retest reliability as the intra-class correlation coefficient (ICC). Results: I-FJS showed excellent internal consistency with Cronbach's alpha of 0.88. Intra-class correlation coefficient (ICC) was 0.94. I-FJS showed good correlation with m-HHS (r = 0.8, p = 0.001). The standard error of measurement was 3.6 and the smallest detectable change was 9.97. There was no floor or ceiling effect observed with I-FJS. Data from this study were insufficient to establish adequate responsiveness of I-FJS. Conclusion: I-FJS is a valid, reliable and reproducible score for hip function in post-THA patients. It is devoid of any floor or ceiling effect. Hindi version of FJS could be an effective tool for studying hip function in the Indian population. [ABSTRACT FROM AUTHOR]

In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world. [ABSTRACT FROM AUTHOR]

Objectives: To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through Burks and Schaffer's approach when combined with a rehabilitation programme, which emphasizes early range of motion. Design: Retrospective study Setting: Level 1 trauma centre, All India Institute of Medical Sciences (AIIMS), New Delhi Patients: From December 2006 to June 2009, 18 cases of PCL tibial avulsion injuries presented to our institution and underwent surgical intervention. Patients were followed up for 10 to 16 months (mean 12 months). Intervention: Fixation of tibial PCL avulsion fractures was with one or two 4-mm partially threaded cannulated screw and washer placed through a Burks and Schaffer's approach. Range of motion was begun on postoperative day 2. Main outcome measurements: Range of motion, clinical stability, radiographic appearance, each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) and gastrocnemius muscle strength were evaluated at final follow-up. Results: Union was achieved in all the cases, and all of them were having clinically stable knee at the time of last follow-up. The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) [ABSTRACT FROM AUTHOR]

Background: The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup. Materials and Methods: Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed. Results: Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years). Twenty-nine (48.33%) of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days) of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5%) cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33%) patients were given injection solumedrol with conservative treatment, 35 (60%) patients were given only conservative treatment and seven patients were operated (11.66%) upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42%) and two (28.57%) were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance. Conclusion: Awareness on the part of the general population, attendants of the patients, clinical and paraclinical team regarding spinal cord injury needs to be addressed. Safe mode of transportation of spinal cord injured patient and early presentation at tertiary spinal care center with comprehensive spinal trauma care team should be stressed upon. [ABSTRACT FROM AUTHOR]

Rational methods for setting priorities for maintenance of irrigation systems are developed. The methods, which are aimed for use by irrigation system managers, describe the link between maintenance activities and the consequent improvement in the performance of an irrigation system. Hydraulic analysis methods are developed for assessing potential `restorative maintenance' tasks, which are usually undertaken to increase the deliveries of water to the outlets. The new methods use inputs that have been limited to those easily available from scheme records, the knowledge of irrigation agency staff and from infrastructure inspections. Two alternative methods are developed, one based on Fuzzy Logic and one on numerical modelling. Risk analysis methods are also developed for assessing `preventative maintenance', to reduce the probability of supply failures. Benefit-cost ratios are derived that allow direct comparison between maintenance tasks of each type. The methods are tested at two irrigation systems in Tamil Nadu, India. [ABSTRACT FROM AUTHOR]

The author reflects on trauma care which has been an integral part of any fighting force, and the considerable variation in the approach to trauma care in the Armed Forces establishments and in the civilian setting. He mentions that comprehensive rehabilitative care is the single most important hallmark of total trauma care. He also opines that though trauma training is given to the medical professionals in the Army at various levels, there is still some scope for refinement.