Eccentric Training Versus Active Release Technique On Quadriceps In Patients With Dynamic Hip Screw

Study Overview
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Brief Summary
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This study will compare the effects of Eccentric training and Strength training with priory applied Active Release Technique on Quadriceps muscle in post operative patients of Dynamic Hip screw. Participants would be equally divided into two groups each receiving specific type of protocol besides standard post operative protocol of Dynamic Hip screw

Detailed Description
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The study is Randomized Control Trial, being conducted at Fauji Foundation Hospital Rawalpindi .This study will compare the effects of two techniques addressing the contractile as well as non-contractile element of Quadriceps in early phase of Rehabilitation. Sample size of 18 was calculated using software Epitool with 95% confidence interval and 80% power. Individuals of selected population will be randomly allocated as 9 in Eccentric group and 9 in Active Release Technique group by sealed enveloped method.

Official Title
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Comparison Of Eccentric Training And Active Release Technique On Quadriceps Muscle In Patients With Dynamic Hip Screw

Conditions
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Hip Surgery

Intervention / Treatment
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* Other: Eccentric Training
* Other: Active Release Technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: 40-65 years Patient with stable vitals on 3rd post-operative day Postero-Lateral Hip surgical approach Exclusion Criteria: History of prior fracture History of fall Multiple fractures Cognitive impairment (Score ˂26 on Montreal cognitive assessment) Co-morbid disease

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: There will be two treatment groups of participants, One group will be trained on eccentric graded protocol whereas the other will receive active release technique of quadriceps.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Eccentric Training Group<br>Eccentric training will be performed for quadriceps muscle along with strengthening protocol taken from Clinical Guidelines of NHS for post operative Dynamic Hip Screw rehabilitation. | Other: Eccentric Training<br>* First session will be performed 24 hours after pre-training tests i.e. on 4th post- operative day and subsequent sessions will be performed with lapse of 48 hours. During pre-testing, weight for the eccentric training will be determined using Standardized Brzycki formulas for lower limb. Participants will perform one set of 10 repetitions with selected weight. Intensity will be increased every week by decreasing the time of performance. Volume will be increased by increasing one set after two weeks. Eccentric training will be performed in sitting position on dynamic constant external resistance equipment.After session, patient will perform strengthening of quadriceps muscle as per clinical practice guidelines of National Health Service (UK).<br>|
| Active Comparator: Active Release Technique Group<br>Active release technique will be performed for quadriceps muscle along with strengthening protocol taken from Clinical Guidelines of NHS for post operative Dynamic Hip Screw rehabilitation. | Other: Active Release Technique<br>* Isometric Quadriceps' contractions against therapist's resistance lasting for 10 seconds will be performed by the patient in inner range of knee extension and after relaxing; actively perform maximum full knee flexion. Patient will perform extension at knee joint again; when reaches the innermost range, therapist will apply pressure on deep fascia either through knuckles/fingers or forearm in the direction towards the hip joint and patient is asked to perform knee flexion simultaneously. The procedure is applied onto vastus lateralis, rectus femoris and vastus intermedialis thrice in a session. After session, patient will perform strengthening of quadriceps muscle as per clinical practice guidelines of National Health Service (UK).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | Numeric Pain Rating Scale (NPRS) is used to assess pain. It scores ranges from 0-10, 0 means No pain and 10 means Severe pain. Patient will be asked to verbally report the pain score. | Baseline | 
| Numeric Pain Rating Scale (NPRS) | Numeric Pain Rating Scale (NPRS) is used to assess pain. It scores ranges from 0-10, 0 means No pain and 10 means Severe pain. Patient will be asked to verbally report the pain score. | post 6th week | 
| Knee Range of Motion (ROM) | To assess Knee range of motion (ROM), Goniometer will be use to measure knee range of motion in flexion & extension. Participants will be seated upright and asked to actively move their knee in each direction. | Baseline | 
| Knee Range of Motion (ROM) | To assess Knee range of motion (ROM), Goniometer will be use to measure knee range of motion in flexion & extension. Participants will be seated upright and asked to actively move their knee in each direction. | post 6th week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Harris Hip score(MHHS) | The modified Harris hip score (MHHS) is used to assess functional outcomes of hip joint. It is scored from 0 (worst functional outcome and maximum pain) to 100 points (best functional outcome and least pain). | Baseline | 
| Modified Harris Hip score(MHHS) | The modified Harris hip score (MHHS) is used to assess functional outcomes of hip joint. It is scored from 0 (worst functional outcome and maximum pain) to 100 points (best functional outcome and least pain). | post 6th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Eccentric training, Active Release Technique