Virtual Reality Versus Intradialytic Neuromuscular Electrical Stimulation on Renin Hormone in Chronic Kidney Patients

Adly A Adam60 enrolled

Overview

Worldwide accelerated advances in physical rehabilitation of chronic kidney disease; particularly whom undergoing hemodialysis. Multimodal therapeutic approaches may maximize their recovery through preliminary evidence indicating both intradialytic neuromuscular electrical stimulation or Virtual reality-based rehabilitation (VRBR) is a relatively new method that might make it easier to simulate doing functional tasks than conventional rehabilitation.

In line to determine efficacy of virtual reality versus intradialytic neuromuscular electrical stimulation on renin hormone levels in patients with chronic kidney disease, a 60-patients of both genders with chronic kidney disease whom undergoing hemodialysis three times per week their age (50-60y) were randomly allocated into two groups. Group A received Virtual reality, plus conventional physical therapy protocol, Group B received intradialytic neuromuscular electrical stimulation protocol; 3 session per week. Group C received Conventional Physical Therapy protocol. Treatment protocol extended for eight weeks, where evaluation involving renin hormone test, upper extremity musculature strength using dynamometer, kidney glomerular filtration rate.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

Conditions

Chronic Kidney Disease (Stages 3b-5)

Interventions

Virtual Reality sessionOTHER

virtual reality exercise programs that was applied in form of a series of kinect adventure games and designed for Xbox 360 kinect console, and projected onto a 24-inch screen LED-Lit monitor; along 30-40 min, 3 sets/ week along 8 weeks

intradialytic neuromuscular electrical stimulationOTHER

The portable Chattanooga electric stimulation device has been switched on and adjusted the current amplitude/ strength from 5-140 mA according to each patients' targeted strength, frequency seated at 5Hz over shoulder musculatures under direct supervision along 30 minutes for each session, 3 sessions per week over 8 weeks

Maitland MobilizationOTHER

maitland graded oscillation technique that was applied to the glenohumeral (GH) joint in form of anteroposterior (A-P), posteroanterior (P-A), and longitudinal caudal glides; as well regarding sternoclavicular joint 'Posterior and anterior glide', plus acromioclavicular joint; anterior glide, only fifteen glides, along 30-40 min, 3 sets/ week along 8 weeks

Conventional Physical Therapy protocolOTHER

Active range of motion exercises; along 30-40 min, 3 sets/ week along 8 weeks

Eligibility

Sex: ALLMin age: 40 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: Patient underwent modified radical mastectomy from one month earlier, suffering from shoulder pain and limited range of motion were included in current study. Patients' age ranged from 40 to 65 years. Patients of both genders. All patients were free of any comorbidities such as systemic or neurological diseases. Exclusion Criteria: Patient underwent modified radical mastectomy from one month earlier, suffering from shoulder pain and limited range of motion were included in current study. Patients' age ranged from 40 to 65 years. Patients of both genders. All patients were free of any comorbidities such as systemic or neurological diseases.

Outcomes

Primary Outcomes

Renin Hormone test

SIEMENS, Blood Analyzer, Model: DCA Vantage, MPN: 4.6.0.0, USA; Hemostasis system equipment is manufactured by Siemens manumitted company, Germany for both renin hormone test and glomerular filtration rate monitoring among CKD patients collected samples early morning by responsible nursing staff from renal vein through the already inserted catheter/ or directly from patients' veins

Time frame: At pretreatment At post treatment after 8 weeks of the study protocol

Secondary Outcomes

Shoulder Range of Motion

Digital goniometer tool6 inches, 2.53 oz, 1x360 degree stainless steel device is a 180 °or 360 ° protractor with one axis that joins two arms. One arm is stationary and the other arm is movable around the axis or fulcrum of the protractor. It used for measurement of shoulder ROM (flexion, abduction and external rotation)

Time frame: At pretreatment At posttreatment after 8 weeks of the study protocol

Shoulder muscular strength

digital dynamometers (5710e/5715, Takei Scientific Instruments Co. Ltd., Niigata, Japan) measuring range is 0-300 kilogram per force, minimum measurement unit 1 kilogram per force, display on scale plate, with dimensions approximately 315 millimeters width, 315 millimeters depth, and 328 millimeters height, and the total weight approximately 3.7 kilograms including weight of handle for shoulder flexors, abductors, and external rotator strength assessment

Time frame: At pretreatment At posttreatment after 8 weeks of study protocol

The shoulder pain intensity and functional disability assessment

The shoulder pain intensity and functional disability assessment using the Shoulder pain and disability index questionnaire with 13 items assessing pain level and extent of difficulty with ADLs requiring the use of the upper extremities. The pain subscale has 5-items and the Disability subscale has 8-items. The total SPADI score was expressed as a percentage. A score of 0 indicates best 100 indicates worst. A higher score showed more disability. In scoring , any question missed was taken out of the total score of each subscale; if one question was omitted in the pain section, the total score was divided by 40

Time frame: At pretreatment At posttreatment of 8 weeks of the study protocol