फिजिओथेरेपी, आजच्या आरोग्यासाठी काळाची संजीवनी....

फिजिओथेरेपी म्हणजे काय?

आपलं आरोग्य हे आपले सर्वोत्तम धन आहे. आजकालच्या धकाधकीच्या जीवनात आणि व्यवसाय जोपासण्याच्या नादात आपण आपल्या ह्या आरोग्यस्वरूपी धनाकडे सर्वात जास्त दुर्लक्ष्य करत आहोत. या आरोग्याला जोपासण्यासाठी आधुनिक वैद्यकीय शास्त्राची एक सर्वोत्तम उपचार पध्दती म्हणजेच फिजिओथेरेपी. फिजिओथेरेपी म्हणजेच भौतिक उपचार. या विज्ञानात भौतिक शास्त्रातिल सिद्धांत मानवी शरीरासाठी योग्य रुपात वापरले जातात जेणेकरून सारीराची क्रीयापाद्दती सुधारून कार्यक्षमता वाढते. फिजिओथेरेपीस्ट हे एक वैद्यकीय तज्ञ असतात जे ह्या उपचार पद्धतीचा वापर करून रुग्णांना बरे करतात. तसेच सर्वसाधारण लोकांना सुद्धा व्यायामाचे महत्व आणि प्रकार दाखवून आजारांपासून दूर ठेवतात. भारतात देखील जागतिक पातळीवरील ज्ञानसंपन्न आणि आंतरराष्ट्रीय ख्यातीचे फिजिओथेरेपीस्ट आहेत.

विश्वभरात फिजिओथेरेपीचा उगम जरी १०० वर्षांपूर्वी झाला असला तरीही भारतात त्याला ६३ वर्ष झाली आहेत. १९५३ मध्ये मुंबईच्या के.ई.एम. रुग्णायालामध्ये भारतातील पहिले फिजिओथेरेपी कॉलेज सुरु झाले होते. आज भारतभर फिजिओथेरेपीच्या ३०० हून अधिक शिक्षण संस्था आहेत. आपल्या देशात फिजिओथेरेपी शिकण्यासाठी १२वी विज्ञानानंतरचा यु.जी.सी. आणि भारत सरकार आखीत ४ १/२ वर्षाचा फिजिओथेरेपी स्नातक (बी.पी.टी.) कोर्स आहे ज्यात शरीर रचना, शरीर क्रिया, शरीर कार्य, शस्त्रक्रिया, औषधशास्त्र, स्त्रीरोग आणि प्रसूती शास्त्र, अस्थिरोग शास्त्र, बालरोग शास्त्र, मज्जातंतू शास्त्र, हृदयरोग आणि श्वासनरोग शास्त्र आदी बरेच विषय असतात आणि या सर्व व्याधींवर कशा प्रकारे फिजिओथेरेपीने उपाय करावे हे वैज्ञानिक दृष्टीकोनातून आणि संशोधनातून शिकवलं जातं. तसेच फिजिओथेरेपी मास्टर्स (एम.पी.टी.) चा २ वर्षांचा पद्विउत्तर कोर्स आहे ज्यात ओर्थोपेडीक, न्युरोलोजी, कार्डीऑलॉजी आणि रेस्पीरेटरी, कम्युनिटी, स्पोर्ट्स फिजिओथेरेपी आदी विषयांचा समावेश असतो. तसेच फिजिओथेरेपी मध्ये डॉक्टरेट (पी.एच.डी.) सुद्धा करता येतं.

फिजिओथेरेपीस्ट आपल्या आरोग्याची काळजी २ प्रकारे घेतात. १. आपल्याला काहीही आजार किव्वा दुखापत होऊ नयेत म्हणून कशा प्रकारे काळजी घ्यावी, उत्तम स्वास्थ्यासाठी कोणकोणते, का आणि कशे व्यायाम करावेत, आपल्या शरीराची आणि सर्व अवयवांची काळजी कशी घ्यावी याबद्दल मार्गदर्शन करतात. २. किंबहुना काहीही इजा अथवा दुखापत झाल्यास ती कमी करण्यासाठी कोणते उपाय करावेत, स्नायू बरे होण्यासाठी कोणते इलाज करावेत, आखडलेल्या सांध्यांची कशी हालचाल करावी, शरीराची कार्यक्षमता कशी वाढवावी या सर्व गोष्टींबद्दल माहिती देतात आणि इलाज देखील करतात.

खरच, फिजिओथेरेपी म्हणजे २१व्या शतकाला मिळालेले एक वरदानच आहे. फिजिओथेरेपी मुळे आपल्याला नुसतेच आपले आयुष्याच नव्हे, तर त्याची गुणवत्ता देखील सुधरवता येते आणि नुसतेच आयुष्यातील वर्ष न वाढवता, त्या वर्षांमधील आयुष्य देखील जगता येतं.

फिजिओथेरेपीमधील प्रकार

फिजिओथेरेपीस्ट आपल्या स्वास्थ्यासाठी आणि आरोग्यासाठी विविध शारीरिक व्याधींवर इलाज करतात. यात प्रामुख्यानं हाडांसाठी, मेंदू आणि नासांसाठी (मज्जातंतू), हृदयासाठी, श्वासन आणि फुफुसंच्या कार्यासाठी, खेळांमधील दुखापातींसाठी, लहान मुलांसाठी, स्त्रियांसाठी, वर्धाक्यामधील त्रासांसाठी, काम करतांना होणाऱ्या त्रासांसाठी आणि सामाजिक आरोग्यासाठी अनेक उपाय योजना केल्या जातात.

१. ओर्थोपेडीक फिजिओथेरेपी: ह्यात सांध्यांची आणि मणक्याची झीज, उदा. संधिवात (आर्थ्रायटीस), स्पोंडीलायटीस, सायटिका, अपघात, सांधेरोपण, स्नायूंची आणि तंतूंची दुखापत, फ्रोजन शोल्डर अशा बऱ्याच व्याधींवर इलाज करतात. सर्वप्रथम रुग्णांचे दुखणे कमी करण्यासाठी विविध उपकरणांचा वापर केला जातो जेणेकरून रुग्ण दुखणे विरहित दैनंदिन काम आणि व्यायाम करू शकतात. तसेच स्नायूंची ताकद वाढवण्यासाठी आणि सांध्यांची हालचाल राखण्यासाठी देखरेखीखाली नियमित ताकद वाढवण्याचे व्यायाम दिले जातात.

२. न्युरोलोजी फिजिओथेरेपी: ह्यात परालीसीस (अर्धांगवायू), अधरपक्ष्याघात, पर्किंसंस, स्मृतीभ्रम, मेंदूंचे विकार, सेरीब्रल पाल्सी, नसंचे विकार, अशा बऱ्याच व्याधींवर फिजिओथेरेपीस्ट इलाज करतात. अशा रुग्णांना बऱ्याच वेळी आपलं शरीर किव्वा त्याचा भाग हलवता येत नाही, अथवा हालचाल करण्यास त्रास होतो. या रुग्णांना फिजिओथेरेपीस्ट हालचाल करण्यास मदत करतात. यासाठी ते बऱ्याच उच्च दर्जाच्या नाविन्यपूर्ण प्रकारांचे तंत्र वापर करतात. यामध्ये शरीराच्या विविध भागांचा कसा वापर करावा, स्नायूंचा कडकपणा कसा कमी करावा, कमजोर स्नायू कसे हलवावेत, कमजोर स्नायुंना कसा आधार द्यावा या संबंधी मार्गदर्शन करतात.

३. कार्डीऑलॉजी आणि रेस्पीरेटरी फिजिओथेरेपी: हे फ़िजिओथेरपिस्ट हृदय विकाराचा झटका, बायपास शस्त्रक्रिया, हृदयात छिद्र, दमा, श्वासनाचे विकार, अशा बऱ्याच व्याधींवर फ़िजिओथेरपी द्वारे इलाज करतात. हे सर्व इलाज इतर डॉक्टरांच्या औषधोपचारा बरोबर करावे लागतात. तसेच श्वास आणि फुफुसंच्या कार्यासाठी आय.सी.यु. मध्ये आणि इतर वेळी देखील करण्याचे व्यायाम सांगितले जातात. या रुग्णांना प्रामुख्याने श्वास (दम) लागण्याचा त्रास होतो. त्यामुळे या रुग्णांना श्वासावर नियंत्रण ठेवण्याचे व्यायाम अत्यंत उपयोगी आहेत. याच बरोबर बर्गाड्यांची हालचालीचे व्यायाम, हृदयाची आणि फुफुसाची कार्यक्षमता वाढवण्याचे व्यायाम, उच्च रक्तदाब नियंत्रण करण्याचे व्यायाम शिकवले जातात.

४. स्पोर्ट्स फिजिओथेरेपी: यात खेळांमधील दुखापतींवर इलाज केले जातात. तसेच खेळाडूंना दुखापती होऊ नयेत म्हणून उपाय योजना सांगून खेळाडूंना अधिक कार्याक्ष्याम बनवले जाते. फ़िजिओथेरपिस्टचा क्रिकेट, भाला फेक, तबकडी फेक, शोर्ट पट, तसेच ‘कॉनटेक स्पोर्ट्स’ जसे रग्बी, सायकल, डायविंग, स्केटिंग, फुटबॉल, हॉकी, धावण्याची शर्यत, रेकेट स्पोर्ट्स, खोखो, कब्बडी अशा बऱ्याच खेळांमधे समावेश असतो. हाड मोडणे, सांधा निखळणे/ निसटणे आणि स्नायूंना (मास-पेशी, तंतू) सूज येणे किव्वा ते फाटणे या सर्व दुखापतींवर ते डॉक्टरांच्या बरोबर इलाज करतात. क्रीडाप्रकार आणि तीव्रतेनुसार खांदा, मनगट, हात, खुबा, गुडघा, घोटा आणि मणक्याला इजा होऊ शकते. स्पोर्ट्स फिजिओथेरेपीस्ट खेळाडूंच्या फिटनेस वर अधिक भर देतात ज्यात ताकद, स्टेमीना, लवचिकता आणि कौशल्य महत्वाचे घटक आहेत.

५. कम्युनिटी फिजिओथेरेपी: यात वार्धक्यातील त्रास, काम करतांना होणाऱ्या त्रास, पसूती मधील त्रास आणि सामाजिक आरोग्य आणि स्वास्थ्यासाठी उपाय सांगितले जातात. तसेच गर्भावस्थेत करायचे व्यायाम, प्रसुतीनंतरचे व्यायाम, मधुमेह आणि स्थुलतेसाठीचे व्यायाम, काम करण्याच्या योग्य पध्दती (अर्गोनोमिक्स) आदी बाबत मार्गदर्शन केले जाते.

फिजिओथेरेपीमधील उपचार पध्दती

आपले आरोग्य उत्तम ठेवण्यासाठी फिजिओथेरेपीस्ट वेगवेगळ्या उपचार पद्दतींचा वापर करतात. यात प्रामुख्याने व्यायाम आणि इलेक्ट्रिक उपकरणे यांचा समावेश असतो. तसेच सांध्यांची कार्यक्षमता, स्नायूंची कार्यक्षमता, रोगनिदान आणि कार्यनिदानपद्धती वाढवण्यासाठी बऱ्याच अत्याधुनिक उपचारपध्दती सुद्धा वापरतात.

१. व्यायाम: हृदयाची, फुफुसांची आणि स्नायूंची गती आणि शक्ती वाढवणाऱ्या व्यायामाला एरोबिक व्यायाम म्हणतात. अशा व्यायामामध्ये हृदयाचे ठोके आणि श्वासाचे प्रमाण २० ते ३० टक्क्यांनी वाढले पाहिजे आणि ते २० ते ३० मिनीटे करायला हवं. अशा व्यायामामुळे शरीराची कार्यक्षमता वाढते, म्हणजेच न थकता काम करता येण्याची शक्ती वाढते. 

ताकद म्हणजे कुठलीही क्रिया करण्याची स्थिती. ताकद वाढण्यासाठीच्या व्यायामाला अनएरोबिक व्यायाम म्हणतात. ह्यात वजन उचलणे, बैठका, जोर, सूर्यनमस्कार, आदी प्रकारांचा समावेश असतो. अशा प्रकारच्या व्यायामामुळे आपण अनेक कामे सहजतेने करू शकतो. ह्या व्यायामामुळे आपले स्नायू पिळदार व डौलदार दिसतात. 

दुखापत न होता आपल्या शरीराला कोणत्याही स्थितीत नेता येणे म्हणजेच लवचिकता. वयोमानाने व योग्य व्यायामाच्या अभावी स्नायू ताठरतात आणि त्यांची कार्यक्षमता कमी होते. ह्यामुळे आपल्याला इजा आणि दुखापत देखील होऊ शकते. लवचिकता राखण्यासाठी स्नायूंना ताण देण्याचे व्यायाम उपयुक्त आहेत. 

चपळता म्हणजेच कुशलता. कोणत्याही प्रसंगी योग्य आणि चटकन निर्णय घेणं. ह्यासाठी ताकद व लवचिकता ह्या दोघांची सांगड घालणे महत्वाची ठरते. स्थिरता व योग्य शरीर ठेवण म्हणजे सध्या स्तीतीत शरीराचे तोल सांभाळता येणे. 

फिजिओथेरेपीस्ट हे सर्व व्यायाम प्रकार रुग्णांकडून गरजेनुसार करून घेतात आणि त्यांचे आरोग्य आणि राहणीमान सुधारतात. या सर्व व्यायाम प्रकारांसाठी जिम बॉल, स्टेबीलीटी ट्रेनर, थेरा-बेंड, थेरा-ट्युब्स, टेप, हस्तोपचार पद्धती (मेनुअल थेरेपी) आणि ओर्थोसीस यांचा वापर केला जातो.

२. इलेक्ट्रिक उपकरणे: स्नायूंना आराम अथवा उत्तेजना मिळण्यासाठी, चालना मिळण्यासाठी, जखमा बऱ्या होण्यासाठी किव्वा दुखणे कमी होण्यासाठी विविध इलेक्ट्रिक उपकरणांचा वापर केला जातो. यात अल्ट्रासाऊंड थेरपी, डायथरमी, टेन्स, आय.एफ.टी., ट्रेक्षन, लेजर, इंफ्रा रेड, विविध करंट ह्यांचा उपयोग केला जातो. अल्ट्रासाऊंड थेरपी, डायथरमी, लेजर आणि इंफ्रा रेड हि प्रामुख्याने शेक देण्याची उपकरणे आहेत. हि उपकरणे दुखापत कमी करून त्या भागाला लवकर बर होण्यास मदत करतात. टेन्स आणि  आय.एफ.टी. हे नसंचे दुखणे कमी करण्यास खूप उपयोगी आहेत. ट्रेक्षन हि उपचार पध्दती मानेला अथवा कमरेला देता येते. हि उपचार पध्दती दुखणे कमी करण्यास आणि स्नायूंची ताठरता कमी करण्यास मदत करते. विविध करंट चेतना नसलेल्या स्नायूंना पुन्हा हालचाल करण्यास आणि त्यांची कार्यक्षमता राखण्यास मदत करतात.

३. मेनुअल थेरेपी, निडलिंग, न्युरो टेकनिक आणि टेपिंग: या अत्याधुनिक उपचार पध्दती आहेत ज्यामध्ये फिजिओथेरेपीस्ट त्यांच्या हातांचा, सुईचा, टेपचा आणि इतर अवजारांचा वापर करून स्नायुंना आणि सांध्यांना चालना देऊ शकतात. तसेच या उपचार पद्दतींनी ताठर्लेल्या स्नायूंना आणि मासपेशींना सुद्धा चालना देता येते.

आपल्या शरीराची निगा ठेवण्यासाठी प्रत्येक अवयवांची देखील देखभाल खूप जरुरी आहे. आपल्या शरीरातील प्रमुख अवयव म्हणजे मेंदू, हृदय, फुफुस, पोटातील अवयव, स्नायू, हाडे आणि सांधे. फिजिओथेरेपीस्ट या सर्व उपचार पद्दतींचा वापर करून या सर्व अवयवांची कार्यक्षमता वाढविण्यास मदत करतात. व्यायामामुळे मेंदू ला उत्तम चालना मिळते, मस्तक व मनाला शांती आणि समाधान मिळत, हृदय आणि फुफुसाची कार्यक्षमता वाढते, शरीरात रक्तभिसारण वाढते, थकवा जाणवत नाही, पोटातील अवयव जसे जठर, आतड्या, मूत्रपिंड आदि यांचे विकार आणि निष्क्रीयता होत नाही, स्नायू, हाडे आणि सांधे ह्यांच्या आरोग्य आणि ताकद, लवचिकता आणि चपळता उत्तम राहते.

आजच्या राहणीमानातील चुका आणि फिजिओथेरेपी

आपण व्यायाम आपले स्वास्थ्य जपण्यासाठी करतो. आपण सर्वजण मानतो की आपले स्वास्थ्य चांगले आहे आणि आपण विकार विरहित आहोत. मुळात स्वास्थ्य म्हणजे काय हे जाणून घेणे खूप महत्वाचे आहे. जागतिक स्वास्थ्य संस्था ह्यांच्या नुसार स्वास्थ्य म्हणजे परिपूर्णता. ही परिपूर्णता फक्त शारीरिक स्वास्थ्या मध्ये नसून मानसिक, आध्यात्मिक, सांस्कृतिक आणि सामाजिक स्वास्थ्या मध्ये देखील आहे. केवळ आपल्याला काही आजार नाही म्हणून आपले स्वास्थ्य उत्तम आहे असे म्हणून चालणार नाही.

आजच्या काळातील कित्येक आजार हे आपल्या चुकीच्या जीवनशैलीमुळे होणारे आहेत. मधुमेह, उच्च रक्तदाब, स्थूलता, संधीवात, मानसिक ताण, कर्करोग, कंबरदुखी असे अनेक आजार आज सामान्य झाले आहेत. आपण त्यांना आपल्या जीवनाचा घटक म्हणून मान्य देखील केले आहेत. पण खरी बाब ही आहे की हे सर्व आजार पूर्णपणी रोख्ण्यासारखे आहेत ज्यासाठी फिजिओथेरेपी आणि व्यायाम सर्वोत्तम गुरुमंत्र आहे. व्यायामामुळे आपल्या शरीराची कार्यक्षमता व क्रियाशक्ती वाढते. त्याच बरोबर आपली प्रतिकारशक्ती देखील वाढते. जर देशातील प्रत्येक कुटुंब स्वस्थ व निरोगी असेल तर नक्कीच आपल्या देशाची आर्थिक स्थिती देखील सुधारू शकेल. व्यायाम हा स्वास्थ्याच्या रक्षणाचा उत्तम मंत्र आहे. पण व्यायाम म्हणजे काय? आपल्या सर्वांमध्ये व्यायामाबद्दल बरेच समज/ गैरसमज आहेत. कोणतीही शारीरिक हालचाल जी आपले स्वास्थ्य व आरोग्य सुधारते ती व्यायाम होय. आपले शारीरिक आरोग्य हे अनेक घटकांनी बनलेले असते. पण ह्यामध्ये शरीराबरोबर मनाचे विकार देखील दूर व्हावेत हे सर्वात महत्त्वाचे आहे.

पुढचा प्रश्न येतो की आम्हाला व्यायाम करायला वेळ नाही, पैसा नाही आणि जागा देखील नाही!!!! पण खरं पाहता, व्यायामाला खरच एवढा वेळ, पैसा आणि जागा लागत नाही. आपल्या देशातील ऋषी मुनि हे वर्षानुवर्ष सूर्यनमस्कार करून आपल्या आरोग्याची काळजी घ्यायचे. त्याच बरोबर त्यांचा आहार देखील साधा होता व वागणुक देखील सोज्वळ होती. पतंजलीची सूत्र सांगतात की मनाची शुद्धता फार महत्वाची असते. त्याच बरोबर सदवर्तन, चांगले चारित्र आणि चांगले विचार देखील महत्वाचे आहेत. अशी अनेक योगासने आहेत जी ६ x ६ च्या खोलीत देखील करता येतात. सूर्यनमस्कार एक असा परिपूर्ण व्यायाम आहे ज्याला काहीही वेळ आणि पैसा लागत नाही. संशोधन सांगत की दिवसाला कमीत कमी १२ ते २४ सूर्यनमस्कार देखील आपल्या आरोग्याची काळजी घेण्यासाठी पुरेसे आहेत. जसं एखादा वैमानिक विमान उडवण्या आधी विमानाचा प्रत्येक भाग तपासतो, तसेच आपण अंथरुणातून उठण्याआधी आपला प्रत्येक सांधा जरी हलवून पहिला तरी एक उपयुक्त व्यायाम ठरतो.

पण आपली आजची पिढी पाश्चात्य अनुकरणापायी आरोग्याकडे पूर्ण दुर्लक्ष करत आहे. त्याच बरोबर जगण्याची स्पर्धा, कामाच्या ताणामुळे अथवा संगतीमुळे व्यसनाकडे देखील वळत आहेत. हे सर्व महत्वाचे प्रश्न मानवनिर्मित आहेत जे आज आपल्यालाच सोडवावे लागतील अन्यथा आपल्या सर्वांच्याच आरोग्यावर ह्याचे दुष्परिणाम दिसतील. व्यायाम हे एक असे सुव्यसन आहे ज्यामुळे आपण वाईट मार्गीदेखील कधीच जात नाही. आरोग्याच्या दृष्टीने आज आपल्याला मॉल्स ऐवजी बागांची जास्त गरज आहे, प्रदूषणापेक्षा स्वच्छ हवेची गरज आहे, औषधांपेक्षा व्यायामाची गरज आहे. नुसत्या आयुष्यापेक्षा सुंदर जीवनाची गरज आहे. ह्यासाठी फिजिओथेरेपीस्ट च्या मार्गदर्शनाखाली विविध व्यायाम आणि उपाययोजना शिकून आणि आजच्या जीवनशैलीतून होणारे बहुतेक से आजार रोखू शकतो आणि देशाला प्रगतीच्या मार्गाकडे नेऊ शकतो.

डॉ. अपूर्व शिंपी

कम्युनिटी फिजिओथेरेपीस्ट (एम.पी.टी.),

प्राध्यापक आणि कम्युनिटी फ़िजिओथेरपी विभाग प्रमुख,

संचेती हॉस्पिटल, पुणे

फ़िजिओ वन केअर फिजिओथेरेपी क्लिनिक,

मित्र मंडळ चौक, पर्वती, पुणे

Physiotherapy Thesis - Challenges, Common Fallacies and Means to Overcome Them

Introduction to Physiotherapy Research:

Physiotherapy is a Health care profession concerned with human function & movement aimed at maximizing its potential. It uses physical approaches to promote, maintain & restore physical, psychological & social wellbeing, taking account of variations in health status. The role of a Physiotherapist involves administration and interpretation of tests related to bodily functions and structures, and the provision of a range of therapeutic and preventive measures to patients suffering from disabilities, dysfunctions and pain. But by large, Physiotherapy is still a non-dosage specific field where still lot of researches are being done to understand the exact or specific dosages required in the treatments/ restoration/ prevention of various conditions.

Challenges faced by the novice researcher:

New PG Physiotherapy candidates are full of concerns regarding the application research knowledge in practice for their PG thesis. Although few of the universities in India have incorporated research at an under-graduation level, this is expected to be an observational research, more or less limited to a retrospective study. Thus, many times, they may neither be exposed to, nor be interested in research. Although the thesis in PG is mandatory, most of the young learners consider clinical learning devoid of research and Evidence Based Physical Therapy (EBPT). EBPT incorporates the application of the learners’ clinical Physiotherapy knowledge backed by latest evidences favouring the same considering the patients’ needs and necessities. This requires a thorough knowledge of the client’s functional aspects backed by the latest trends in the practice of that condition at a global level. This also necessitates the formulation of a clinical research question in current practice.

The Research Question:

The Research Question is the soul of every thesis. It not only directs the end point of the thesis, but also marks the pathway to be taken towards completion of the thesis. Research question helps to understand contents of the thesis, including the methodology, tools, outcome measures and statistical tests that may be used in the particular thesis. It helps choose an appropriate protocol to be followed in completion of the thesis and let the researcher understand the need for the study. A good research question should guide towards appropriate references; explain about the condition to be studied and treatments currently available. It should note the gaps present in the current chain of evidences and the specific treatment to be studied and guide towards collection of preliminary data in the condition to be studied. It should also help the researcher anticipate results and potential pitfalls and describe the significance of the research including potential benefit for individual subjects or society at large.

Hypothesis:

The hypothesis directs the methodology which considers the measures of exposure and outcome. It should be tested by making a comparison between the two or more groups. It guides the authors to develop a plan for data collection and management, determine the statistical methods for analysis and also estimate the magnitude of the expected difference between the two groups, as a basis for determining sample size (power calculation). This will guide to assess study feasibility, sample recruitments and analysis.

Study Title:

This is the most important part of every research as the title forms the face of the study. An improper title will be a deterrent for any study and shall not arouse interest in the readers. The title should be descriptive of the study and should be concise, clear and non-ambiguous.

Challenges in writing Introduction:

The introduction is the prima facia of the research. The introduction should be of the current study, rather than about the known knowledge of the conditions and diseases. It should always be in the funnel format, i.e. from broad global concerns to small local concern. Many times, the young researcher writes in great lengths about everything else other than their own study which may turn down review board and readers. Introduction should be short and specific incorporating the need for conducting the present research in around 2–3 pages maximum. Bold statements like “such evidences do not exist” or “there have been no studies on this topic” etc. should be avoided.

Conducting the Review:

The next challenge faced is collecting literature for reviewing. Although textbooks do give some baseline information, they can only answer background questions. For understanding research in its better aspect, answers to the foreground questions must be sought for which reading latest literature is mandatory. This can be obtained by subscribing to various peer reviewed, indexed journals or going through online databases. Database like the Google scholar may be useful to find articles, but specific databases like Pubmed, Cochrane, PEDro and CINAHL are also useful in Physiotherapy thesis. But the reader should be clear in understanding methods to navigate through them e.g., using the key words, filters, bullions, truncation symbols, MeSH terms etc.

Documentation of the reviewed literature is also an art. A review should always have a story and a flow to it. This may be from the historical to the newer perspectives or may be compartmentalised based on the research question/s. Writing briefly about the authors, their study, design, results, conclusion and applicability is desired.

Aim and Objectives:

Generally PG thesis may have a single aim to answer to a specific research question. The study objectives should be clearly and precisely stated. They should be simple, specific, and stated in advance to performing the research and should be attainable, measurable and realistic.

Research design and Statistics:

The research design should be identified and should be appropriate to answer the research question/s under study. The researcher may describe the type of research proposed (e.g. experimental, correlational, survey, qualitative) and specific study design that will be used (e.g. pre-posttest, control group, cross-sectional; prospective longitudinal, cohort; blinded randomized control). The research design, methods and procedures should help answer the specific research question/s as mentioned in the study objectives.

The sampling procedures should be specific and scientific. The researcher should always describe the sampling approach including determination and justification for sample size. A larger sample size may increase the cost and duration of the study and will be unethical to expose human subjects to any potential unnecessary risk without additional benefit. A smaller sample size can also be unethical if it exposes human subjects to risk with no benefit to scientific knowledge. Calculation of sample size has been made easy by computer software programs. The principles underlying the estimation of the software sample size should be well understood. The researchers have to identify the procedures that will be used to recruit, screen and follow study volunteers as well as specifically define the study sample (number and characteristics of subjects to be included and excluded). In intervention studies, clarification of subject allocation to treatment and comparison groups and criteria for discontinuation should be defined.

Another challenge faced is on statistics which is considered as a huge challenge. Thus, involving the statistician from the earliest part of the research is an excellent idea. Statisticians can help in understanding the basis of statistical tools, data variables and tests before actual exploration of data. Choosing good and appropriate, valid and reliable outcome measures is also an important step to a successful thesis.

Why conduct the Pilot Study?

Before the actual research, performing the pilot study is another crucial step in Physiotherapy thesis. It is useful in multiple ways. In observational studies, it may help understand the outcome measure or may help in validating the research tools. In experimental studies, it may help in rectification and finalization of the processes and the procedures which may be used in the study. Pilot study is never meant to analyse the end results. It will help the researcher understand if he is on the right track. This also helps rectify any lacunae that may weaken the study as well as prevent any potential confounders that may cause bias in the study. Permissions for obtaining/ using outcome measures can also be done in this phase.

Materials and Methods:

The methodology should be elaborate to explain every procedural detail to the level of replication of the entire study in the similar given environment. Processes of sampling, consent, measures, tests, and data entry need to be provided in elaborate details. A very important consideration in the thesis methodology is following the universal guidelines for the procedure documentation. Researchers are advised to go through CONSORT guidelines (CONsolidated Standards Of Reporting Trials) for experimental, STROBE guidelines (STrengthening the Reporting of OBservational studies in Epidemiology) for observational and STARD guidelines (STAtement for Reporting studies of Diagnostic accuracy) for diagnostic studies.

Ethical Clearance and Research Registration:

Another important step before actual initiation of the study is getting clearance from the Ethics Committee. This is mandatory for any medical research, including Physiotherapy research to ensure that the researcher shall not violate the rights and dignity of their subjects. It is advisable for every researcher to be certified in Good Clinical Practices, in order to ensure safeguarding of their subjects. Methods for data collection and for avoiding/ minimizing subject risks should be included. Always include a timeline for subject evaluations, duration of intervention and tentative budget for the project. The researcher should document the methods for maintaining subject confidentiality (plans for coding data and for securing written and electronic subject records) and should indicate duration of storage of personal information post study completion. These methods will vary with the research type (qualitative, quantitative) and thus should sufficiently describe justification of the approach for answering the defined research question. Methods should also be described in adequate detail so that IEC members may assess the potential study risks and benefits.

Also it is important to register the study with national clinical trials registry (Clinical Trials Registry of India, CTRI). Many Physiotherapy researchers are still unaware of the importance of registering their studies to safeguard their intellectual rights. CTRI does register Post graduation Physiotherapy thesis and also observational studies. Also, it is advantageous publish of your hypothesis as a defensive publications. Journals like ‘Journal of Medical Thesis’ does publish Research Hypothesis which helps protect intellectual property of the researchers.

The master chart and Scientific Misconduct:

Although the master chart seems to be the last and inconspicuous part of the research, fact is that it is the most important piece of evidence in every research. The basic analysis of the entire study data is done from the master chart and thus, it should be created properly without any fallacies. The PG candidate should be clear with the data being analysed and should make the master chart elaborately. Avoid making single headings for multiple components. E.g., for male/ female, yes/ no options, make 2 different columns rather than a single column and enter ‘1’ for every ‘yes’ or ‘no’. This is extremely important in summation and averaging. In experimental studies, it is advised to make different sheets for control and experimental groups. MS Excel has multiple, user friendly options and tools which should be learnt before making the master chart. Also, many statistical tests for parametric data can be performed in Excel, including descriptive statistics, paired and unpaired t test, ANOVA, Correlations, covariance etc. For all other tests, including non-parametric tests and Correlations etc., using statistical packages like the SPSS is beneficial. Take guidance from a good statistician help but learn your own basic test procedures as well.

Few of the researchers tend to indulge in research malpractices during this phase by falsification and fabrication of their data. This is strongly condemned and the researchers have to understand that such malpractices can easily be detected by basic analysis of the master-chart. Also ensure that the master chart does not disclose the identity of the subjects in any way as this is considered as breach of confidentiality. Hence, coding of the case report forms before making the master chart is a good practice.

Results, Discussion and Conclusion of the Study:

This is another crucial part of any Physiotherapy thesis. Often good studies lose their value due to improperly interpreted and explained results. The PG candidate should choose appropriate, self-explanatory graphs and tables for explanation of their results.

The discussion should focus on the important findings and rationalisation of these findings and should avoid repetition of results. Utilising a good reviewed literature is extremely helpful in this stage. Also, the confounders of the study should be well identified and expressed in the discussion (unless they are being written separately as limitations).

The conclusion should be a good amalgamation of the aim, objectives, research question and hypothesis. Any conclusion, whether it accepts or rejects the null hypothesis, is an important contribution to Physiotherapy research. Conclusion should only be based on the results obtained and should not have any comments outside the preview of the study, including indirect study implications. Any suggestions or added information can be written as a scope for further study.

References Guidelines:

References should always be recent, complete and preferably in the Vancouver format. The details can be found in most of the standard journal and sites. References should be given to all the published articles, books, websites (mentioning the date of viewing them), and even to unpublished but accepted works.

Summary:

Physiotherapy thesis has been an integral part of every Post Graduate Physiotherapy candidate and is association with them for a lifetime. In today’s electronic era, every published or unpublished thesis can utilised by future researchers as a reference. But it should be remembered that every research is completed only when published in a good peer reviewed indexed journal. Thus, it becomes not only important and ethical, but even legal to lay down all the facts associated with the study in a truthful and honest manner. Malpractices like plagiarism, although may seem easy, but are deterrents in the future prospects of the candidate. Almost all of the universities and journals run anti-plagiarism software’s and getting indulged in such act may not only cause rejection of this wonderful piece of literature, but may also blacklist the candidate for life. Research is all about a bit of dedication, understanding, honesty and hard work on the researchers’ side and about a lot of truth, facts and probabilities of the findings for verification of these facts, which under any costs, must not be altered, but be expressed with all its integrity. Only then can the candidate truly contribute to his professions growth and stability in a noble way.

References:

1. Nicholls DA, Gibson BE. The body and Physiotherapy. Physiother Theory Pract. 2010 Nov;26(8):497-509.

2. Shimpi A, Writer H, Shyam A, Dabadghav R. Role of Physiotherapy in India – A Cross-sectional Survey to Study the Awareness and Perspective among Referring Doctors. Journal of Medical Thesis 2014 May-Aug; 2(2) : 11-15

3. Portney LG. Evidence-based practice and clinical decision making: It’s not just the research course anymore. Journal of Physical Therapy Education. 2004;18(3):46-51.

4. Kaplan SL. Et al Developing Evidence-Based Physical Therapy Clinical Practice Guidelines. Pediatric Physical Therapy. 2013; 257-70

5. Fathalla MF. A Practical Guide for Health Researchers. WHO Regional Publications Eastern Mediterranean Series 30

6. Writing a Research Policy – WHO. Recommended format for a Research Protocol. Available at http://www.who.int/rpc/research_ethics/format_rp/en/ [Viewed on February 22, 2016]

7. Indrayan A. Statistical fallacies in orthopedic research. Indian J Orthop. 2007 Jan;41(1):37-46.

8. Amezcua M. [Myths, challenges, and fallacies in nursing research]. Rev Enferm. 2003 Sep;26(9):36-44. Spanish.

9. Babu AS, Veluswamy SK, Rao PT, Maiya AG. Clinical trial registration in physical therapy journals: a cross-sectional study. Phys Ther. 2014 Jan;94(1):83-90.

10. Shyam AK. Editorial: Hypothesis, Intellectual Property and Journal of Medical Thesis: Concept of Defensive Publication. Journal Medical Thesis 2014 Jan- April: 2(1); 1-2

Shimpi Apurv P.

Associate Professor and Head,

Department of Community Physiotherapy, Sancheti Institute College of Physiotherapy, Pune

Editorial Board member, Journal of Medical Thesis

Email: apurvshimpi@sha.edu.in

This article is Published as Guest Editorial in Journal of Medical Thesis as:

Physiotherapy Thesis - Challenges, Common Fallacies and Means to Overcome Them. Journal Medical Thesis. 2016 Jan-Apr;4(1):3-6. doi: 10.13107/jmt.2347-5595/096

http://journalmedicalthesis.com/2016/01/guest-editorial-physiotherapy-thesis-challenges-common-fallacies-and-means-to-overcome-them/

My Louisville-age Fellowship in Physiotherapy Pilgrimage: An unusual realization

With my US mentor, Dr. John Nyland, 

Director of Athletic Training Program, Spalding University, 

President of Board of Directors, JOSPT

Someone has rightly said that we all are students for our whole life and that life itself is the best teacher. And what a wonderful teacher life really is! It gives us multiple opportunities to learn, grow and progress with all its unique and practical based experiences.

It has been 12 years now that I am facilitating Physiotherapy education at this wonderful institute. And these 12 years too have been unique learning experiences from seniors, colleagues and students alike. But one of my wonderful learning opportunities was recently presented to me when I got to do my fellowship in Physiotherapy in the US. But the process for this had already started more than 2 years back when my boss and mentor Dr. Parag Sancheti had invited Dr. John Nyland for a Continuous Physiotherapy Education (CPE) session right here at Sancheti Institute College of Physiotherapy around in 2013 when even I had an opportunity to take a session on Virtual Reality Training in Sports. Our interaction and the constant support by Dr. Parag finally led to the invitation by Dr. Nyland for my visit to the US for an advanced learning experience in Orthopedics and Sports Physical Therapy.

Kosair Charities College of Health and Natural Sciences, 

Spalding University, Louisville, KY, USA

But this, by itself, was not an easy step as my pre-preparation included multiple short certificate exams on HIPAA, Blood – borne pathogens, Fire safety, workplace emergencies etc. Also the tests and shots of Influenza, Montoux, MMR, and DPT were just amazingly painful. Not to mention that previous passport expired in Feb 2015 and I woke up only in July 2015 to get new passport issues. Fortunately (and surprisingly) the US visa issuance turned out as the quickest and hassle-free process. Well, everything seemed to be finally set. My fellowship dates were from 18^th October to 7^th November 2015, a whole 3 weeks. But going to US on tourist visa and no tour? That’s when the Niagara Falls trip just dropped in like a bomb. But hey, we aren’t talking about the Niagara and the helicopter ride and the awesome wonderful experience. Right now, it’s purely my fellowship!!

Orthopedic and Sports Physical Therapy, Louisville, KY

Advanced Orthopedic Physical Therapy, Louisville, KY

So finally I took off to look forth for a wonderful 3 weeks’ vacation (oops), 3 weeks of enhanced learning experience on 17^th Oct from Mumbai to reach Louisville. Dr. Nyland was extremely gracious to receive me on the airport. My learning started immediately from the next day and continued for the next 2 weeks. I got a chance to learn and observe eminent physical therapists like Dr. Bradley Wheeldon and Dr. Alex Kent from specialty clinics like the Orthopedics and Sports Physical Therapy, Dr. Julie Snowden, Dr. Robin McNeill and Dr. Katie Elder at the Advanced Orthopedics Physical Therapy and Dr. Janelle Caudill at the Kentucky Orthopedics Rehabilitation Team clinics. The purpose of the visit was not only to learn the advances in orthopedics and sports physical therapy but also to learn the aspects of PT department functioning, administrative responsibilities and to understand their perspective and rationale of Patient treatment approach and working on the needs and necessities of the PT department functioning. 

Kentucky Orthopedics Rehabilitation Team, Louisville, KY

My clinical learning also included 2 days each with Dr. David Caborn who is a Knee and Foot Surgeon at Kentucky One Health Jewish Hospital and with Dr. Ryan Krupp who is a Shoulder surgeon at Norton Brownsboro Hospital. And last but not the least, got to see Dr. John Nyland in action at his Return to Sports clinic at Spalding University as well as assist him in Inter-university Soccer matches for Men and women. 

Dr. Nyland Return to Sports Clinic, Spalding University

Inter-University Soccer Matches

My visit also comprised of giving an interactive lecture to the DPT students at Bellarmine University and to the MSAT students at Spalding University on my favorite topic of ‘Using Suryanamaskar (Sun-Salutation) as a Yogic way for a Community Based Exercise Program – A Physical Therapists Perspective’ which was a chance to represent my Institute, University, Culture and finally my Country and was highly appreciated by the students and the faculties at both the Universities.

Lecture on Suryanamaskar (Sun Salutation)

Practical Demo of Suryanamaskar with students and Faculty of Spalding

With Dr. Patricia Gillette, School of Physical Therapy, 

Bellarmine University, Louisville, KY, USA

Many of my friends and my colleagues have asked me about the different or new things I got to learn over there. Well, to start with, I would say that Physical Therapy education in India is in every way equivalent in standards to that in the US. Infact, our current education system has 4 years of Bachelors and 2-3 years of Masters Program in Physical Therapy while US has a general bachelors program and directly a 3 years DPT program. Ofcourse every education system has their own pros and cons and I definitely am not criticizing any one of it. What I feel is that we need to make special efforts at individual level to learn the best of every system. Even in India, we are very active in clinical research which will help our profession progress and grow. But we all yet need to take research publications more seriously. One basic learning part would be the multi-planar motions training, sports specific rehabilitation and the advanced functional rehabilitation concepts which I learned over there, probably due to the increased demands of their clients for a faster rehab to meet and match their active sports specific lifestyle. Also got to learn the utilisation and applicability of some different equipments like the 'Game-ready' and the 'Hivamat' which we typically do not use over here.

Game Ready Cryo Compress Packs

Hivamat Stimulator

But what I really liked and learned over there is their attitude and positivity. During my visits to the clinics or my lectures in Bellarmine and Spalding, I had asked Dr. Nyland about what were their expectations from me. His answer was simple. He just said, “Apurv, I want you to enjoy there. If you enjoy, people around you will enjoy and only then will you and others work more productively.” I was in love with this statement of his. We all are so much used to work under pressures that we know how to perform, but not how to excel. There, people laugh, play, joke and enjoy in their work also. This helps in creating a bonding between associates as well as your start liking what you do. Infact people want to be at work as it is not a place of stress, but a place to live your life too. (I am sure we know that US is amongst the most productive country in the world). 

Second, have a family life as well. We tend to work for our family and on this pretext get so much busy in that process that we don’t have any time left for our family. The next best thing I learned over there is their support system. Everyone has their own set of tasks and duties. But everyone is always eager and supportive towards their colleagues as well. This helps in building an extremely good team character and also facilitates a positive environment. We Indians are definitely extremely hardworking and intelligent breed of people and have the potential of exceeding in every aspect. I am sure, some change in our behavior and approach will get us far ahead. And it isn’t difficult either. Keeping the roads and our environment clean, following traffic laws and rules, loving and respecting others also is not so difficult. 

And most important what I learned is how to value people. Everyone around made me feel extremely special and cared for. Even in the public transport systems, hotel, and especially in the clinics I visited. We say “Atithi Deva Bhava” (Guests are Gods). I experienced it there. Ofcourse, staying away from my family for 3 weeks was painful. But I found another family over there in all the friends that I made. And that is how finally culminated my “Louisville Combined-Service Orthopaedic Surgery and Physiotherapy Fellowship”