RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU,

KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

NAME OF THE AN RAJAT BHUSHAN

1. CANDIDATE AND ARVIND SKYLANDS, J-604,SURABHI LAYOUT,OFF
ADDRESS BELLARY ROAD,SHIVANAHALLI JAKKUR BANGALORE-
560064

NAME OF THE ACHARYA INSTITUTE OF HEALTH

2. INSTITUTION SCIENCES KARNATAKA

COURSE OF STUDY MASTER OF PHYSIOTHERAPY IN

3. AND MUSCULOSKELETAL SCIENCES
SUBJECT

DATE OF
4. ADMISSION 31/05/2023

TITLE OF THE EFFECTIVENESS OF WILLIAM’S EXERCISES FOR THE

5. TOPIC TREATMENT OF PATIENTS WITH LOW BACK PAIN IN
ELDERLY
6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

6.1 NEED FOR THE STUDY

Low back pain (LBP) is a prevalent complaint in the productive and geriatric age group. The
estimated global prevalence of LBP is about 31%, and it is common in women aged 40– 80
years old [1]. The prevalence of specific chronic LBP in Japan is 9.3% and of non-specific
chronic LBP is 15.4% [2]. Meanwhile, in Thailand, the prevalence of LBP is 30%, nearly the
same with global prevalence [3]. In Indonesia, there was only one study regarding the
prevalence of LBP. The prevalence of LBP among the productive age group was nearly 40%
[4]. The disability caused by LBP is the highest compared to any other condition globally [1].
In the USA, more than 100 million USD is spent each year treating LBP. Cases of LBP are
expected to rise to an estimated 843 million by 2050 globally (WHO guidelines)
The most common treatments for LBP are pain medication with NSAID or oral/intra-articular
steroid [5]. Other forms of treatment such as physiotherapy or physical exercise are still rarely
advised to patients with LBP, especially to the elderly. About 75% of all LBP patients never
get treatment other than oral medication.
Although physiotherapy had proven to reduce the economic burden of LBP by 20%, it is
regrettable that most general practitioner rarely recommends physiotherapy to treat LBP. The
reluctance to prescribe physical activity stemmed from the lack of education regarding non-
pharmaceutical therapy [6].
A systematic review regarding the cost-effective analysis of LBP therapy found that exercise
or referral to such service by GPs may improve the cost-effectiveness of their treatment [7]
Among the available exercises, Williams flexion exercise (WFE) is one of the simplest and
most commonly used physiotherapy exercises to treat LBP patients. It is proven to reduce
pain and improve spinal range of motion (ROM) in LBP patients by strengthening the para
spinal muscles to support the degenerated facet joints [8]

RESEARCH QUESTION
Will William's Flexion Exercise be helpful to treat Low Back Pain in Elderly?

HYPOTHESIS:

NULL HYPOTHESIS:
William's Flexion Exercise will be ineffective in treating Low Back Pain in Elderly.

ALTERNATIVE HYPOTHESIS:
William's Flexion Exercise will be effective in treating Low Back Pain in Elderly.
6.2 REVIEW OF LITERATURE
1. William Putera Sukmajaya1*, Firas Farisi Alkaff2, Alina Oen3, Alverina Cynthia
Sukmajaya4(2020)
This study aimed to evaluate the effects of Williams flexion exercise (WFE) in patients with
low back pain. Study design, Java, Indonesia, June 2018 to July 2018. Participants' basic
medical information and Oswestry Disability Index (ODI) were obtained through a self-
administered questionnaire. Introduce WFE to attendees through demonstrations, videos and
live demonstrations. After 1 month, participants were re-evaluated at ODI. There was a
significant difference in ODI before and after WFE use (31.05 ± 17.40 vs.14.10 ± 11.78, p =
0.019). More exercise (>1 exercise/day) was associated with a greater reduction in ODI
compared to the lower group (1 exercise/day) (22.09 ± 19.09 vs. 7.38 ± 12.58, p = 0.017).
There was no significant difference in the reduction of ODI between elderly and non-elderly
subjects (p = 0.24). The study concluded that these activities could be used in primary care in
the future to reduce the cost of low back pain treatment. [9]

2. Amila1, Henny Syapitri2, Evariana Sembiring3(2020)

The aim of this study was to evaluate the effect of William's flexion exercise on reducing the
severity of pain in elderly people with low back pain in Hisosu Binjai Residential House,
Indonesia. The research design is a quasi-experimental experiment conducted in 2017 using a
pre-test and post-test control group. The sampling method is continuous sampling. In this
study, the Numerical Pain Rating Scale was used to measure the intensity of pain perceived by
the patients. Data were analyzed by correlation and independent t-test; meaningfulness? The
effect detected a difference in low back pain in the intervention group before and after the
intervention (p value = 0.000). On the other hand, there was no significant difference in the
control group (p value = 0.081). The results of the independent t test showed that there was a
significant difference in back pain between the intervention group and the control group.The
study concluded that William's flexion exercises benefited the majority of study participants,
so reducing pain and increasing range of motion would be a good way to go.[10]

3. Zita Lachika Anung Poltekkes Kemenkes Surakarta1, Mei Kusumaningtyas

Poltekkes Kemenkes Surakarta2, Yoga Handita Windiastoni Poltekkes Kemenkes
Surakarta3(2023)

The aim of the study was to determine the effect of the addition of william flexion exercise on
functional abilities in patients with myogenic low back pain at Banyumas General
Hospital.This type of research was one group pre-test & post test with control design, subjects
were randomly selected into the treatment group and the control group. The subjects were 31
patients at the Banyumas General Hospital who included the inclusion criteria.The paired t-
test and independent t-test which were carried out in both groups after receiving the
intervention obtained a value of p = 0.000 (p <0.05) which means that there was an increase in
functional ability and there was a significant difference in the two groups. Difference in mean
pre-post test treatment group 7.5 and control 2.4.The study concluded that the addition of
William's flexion exercise has an effect on increasing functional ability in patients with
myogenic low back pain.[11]
4. Stefani A. Nelvin1*, Anderias Umbu Roga2 , Jacob Ratu3, Noorce Ch. Berek4 ,
Imelda F.
E. Manurung5(2021)

The purpose of this study was to determine the effectiveness of the William flexion exercise in
reducing low back pain. This study was a quasi-experimental study using a group pretest-
posttest design. William flexion exercise is done as abdominal strengthening for 30-40
minutes. The sample of the study consisted of 23 individuals identified through random
sampling technique from rice farmers in Lembor Selatan District of West Manggarai District.
Lumbar pressure levels were measured using the Oswestry Questionnaire before and after the
intervention. Differences between pre- and post-intervention data were tested using the
Wilcoxon signed-rank test. The results showed that the William flexion exercise was able to
reduce the farmer's lumbar score from an average of 64.26 points to 47.96 points, a 25.36%
reduction, p = 0.000. This study concluded that the William flexion exercise can reduce back
pain.[12]

5. A.A Istri Dalem Hana Yundari1*, Putu Puspita Wulandari Mas2(2018)

This study aimed to evaluate the effectiveness of William's flexion exercise in reducing low
back pain using a tree trunk in Bali, Indonesia. Among 42 wood carvers in Gianyamas Village
in Bali, Indonesia, 20 wood carvers were selected by purposive sampling and then matched
with control and treatment groups. William's flexion exercises were applied to the treatment
group twice a week for 4 weeks. Pain intensity was measured as mild pain (1-3), moderate
pain (4-6) and severe pain (7-10). Statistical analysis was done with Wilcoxon and Mann
Whitney tests. Wood carvers are advised to do William's flexion exercises to reduce back
pain.The study concluded that William’s flexion exercise is effective in reducing the low back
pain.[13 ]

6. A Akbar1,R Zainuddin2(2020)
The purpose of this literature review was to determine the effectiveness of the use of
William's flexion exercises in patients with back pain. Using the search strategy, we identified
32 articles related to potential and research targets, but only reviewed 5 articles in this
literature. We can see that the participant's pain decreased after taking William's flexion
exercise. Conclusion: The results of this study, which reviewed many articles in the literature,
concluded that William's flexion exercise program is effective in reducing pain in patients
with back pain.[14]

7. W Hasmar1, AS Junaidi2(2020)

Conducted a study that, Education William flexion exercises to quantify back pain in the
community. The method used was the Gift leaflet Core Stability Exercise performed at
Mayang Manurai Community. Citizens then answer and discuss the benefits expected from
using the service so that citizens can carry out the application correctly and independently.
There were 3 stages.
a) Stage of implementation, where permission was obtained,
b) Stage of preparation where William's flexion exercises were taught. WFE which consists
of pelvic tilting, single knee to chest, double knee to chest , repeated 8 times, demonstrated
and corrected if the movement were incorrect.
c) Stage of socialisation and education about WFE.
They evaluated William's community service through discussion and response about mobility
and back pain. Public Awareness was created. This would increase awareness of IRT and
William's flexion exercises that can be done independently at home to reduce back pain.
Permission to send paper was obtained. The results of the exercise were shown and how to fix
problems if problems arise during the exercise and a demonstration of William's flexion
exercises, followed by a Q&A session, in the hope that Batik could perform these exercises
correctly, independently, and accurately to reduce back pain. Physical therapy was performed
by a team of 2 instructors and supported by 3 students studying D-III physical therapy
STikesBaiturrahim Jambi. They received a gift leaflet and demonstration to perform the
William's Bend exercise and increase understanding and awareness of the William's Bend
exercise to reduce back pain.[15]

8. Mohan Kumar.G1, Revathi R2, Ramachandran S3(2015)

Conducted a study to evaluate the effectiveness of William flexion exercise in the treatment of
low back pain. Thirty male and female patients were recruited from ACS Medical College and
Chennai -77 Hospital and the study duration was 4 weeks. Visual Analogue Scale and
Oswestry Disability Index Questionnaire pre- and post-exercise test [5.06] and post-test [3.56]
were found to be highly significant with p[< 0.001] Comparison of the Oswestry Disability
Index Questionnaire before [28.80] and after [17.6] showed p [<0.001] to be highly significant
with the study. William's flexion exercise is effective in treating lower back pain People who
do more William's flexion exercise produces positive results for participants, especially
reducing the severity of pain. The study shows that this will be an important factor in reducing
pain including good ideas for strength and increased range of motion.[16]
9. Septiyanti1, Milda Putri Dinanty2, Hermansya3(2023)
The purpose of this study was to determine whether William's Flexion Exercise (WFE) is
effective in low back pain in RSUD. Dr.M. The city of Yunus Bengkulu. This type of study is
quasi-experimental, using pre-test and post-test samples, and a control group and sample by
RSUD Dr. M. Yunus, use the target in Bengkulu City. sampling process. The results showed
that the mean pre-intervention low back pain in the intervention group was 6.00, while the
mean pre-intervention low back pain in the control group was 5.00. The mean difference in
low back pain was 1.00 in the intervention group and 2.00 in the control group. The study
concluded that William's flexion exercise is more effective than McKenzie's extension
exercise.[17]

10. S. Abinaya1,M Manikandan2,V Dhivyadharshini3,S.Bharath kumar4(2023)

Conducted a study at AVMCH Physiotherapy Clinic. This study consisted of non-specific low
back pain patients selected according to the study's selection criteria and measured pain using
VAS one week before the intervention and at the end of the last intervention recorded more
pain. Since this study is limited to a single result and does not take into account psychological
effects, it was recommended to add other results in the future to achieve a high level of
confidence. The results showed that William's pain decreased after doing the flexion exercise.
The study shows the value of William's flexion exercise for patients with low back pain is
effective.[18]

11. Anjali Atmaram More1, Sanket Nagarale2, Sucheta Golhar3(2020)

Conducted a study to evaluate the effectiveness of William flexion exercise on ,pain
function and lumbar range of motion in physical therapy university students with chronic low
back pain. unidentified low back pain. VAS (visual analogue scale) for pre- and post-
pain ,(Roland Morris Disability Questionnaire) for functional disability, and lumbar ROM
of the lumbar range (using the Schober test) were measured.
All subjects performed 7 movements
VAS mean values were 4.63 ± 1.40 and 1.86 ± 1.0
and lumbar ROM –
Lumbar flexion: 54.76 ± 2.83 and 64.08 ± 2.63. The study shows that
this exercise is effective for chronic flexion pain other than back pain in home college physic
al therapy students.[19]
12. Dwi Wardianti1, W Wahyuni2(2021)

o Conducted a study to check for the effectiveness of William Flexion Exercise method to decrease low
back pain level. Analysis of data from various databases (PubMed, Science Direct, Web of Science).
Searches related to the terms "low back pain associated with William's flexion" or "myogenic low back
pain and William's flexion" or Medical Summary (MESH) using multiple keywords along with medical
and "low income". Criteria for inclusion in articles were patients with myogenic back pain and all
clinical studies published in English between 2000 and 2021. The quality of the included studies was
assessed using CASP (Critical Appraisal Skills Programme). William flexion exercises may improve
function, reduce pain and effort, and improve quality of life in patients with low back pain; and this is
the Benefits of Physical Therapy Treatment for the Prevention of Myogenic Low Back Pain. Several
products were selected from our warehouse and each survey received an 80% quality score. Research
shows that a three-times-per-week exercise using techniques such as hamstring stretching, pelvic tilt,
knee-to-chest, and hip flexor stretching can improve performance, reduce pain and exertion, and
improve the quality of life of patients with back pain.The study concluded that the William’s flexion
exercise is effective method to reduce the level of low back pain.[20]

13. Chin-Pang Lee#1,Tsai-Sheng Fu2, Chia-Yih Liu3,Ching-I Hung 4(2017)

This study aimed to examine the reliability, validity, and magnitude of the Chinese version of
the ODI version 2.1 in a sample of 225 elderly orthopedic outpatients with low back pain
[mean age (SD): 40.7 (11.4) years].We conducted a reliability test, explanatory two-factor
analysis, validity analysis, and Moken test on the ODI. We used the Short Form 36 (SF-36)
and the Visual Analogy Scale (VAS) to validate the ODI.The ODI has good reliability,
discriminant and construct validity.The fit statistics of the ODI unidimensional model were
inadequate.ODI is the Mokken scale (Hs =0.31).The ODI is a reliable and valid tool for
assessing disability in patients with back pain.However, ODI appears to be highly variable,
which argues against the use of ODI raw score as a measure of disability.[21]

14.Brogan Samuel Williams1,David Johnson2(2023)

Conducted a study based on the principle that effective treatment must address the root cause
of symptoms. The NeuroHAB® 8-week exercise therapy is designed to correct dysfunction by
reactivating the central nervous system through movement based on spinopelvic skill
biomechanics for activities of daily living. . Over the 8 weeks, all participants hone their
skills, develop new preliminary training and improve biomechanics, work to reduce pain,
improve injury and increase performance, creating a foundation for further progress. The main
question of this study is "How does therapeutic exercise affect chronic back pain?" Subject
participants in 10 groups were randomly selected and recruited from the NeuroHAB® 8-
week service database for 2020. Two oswestry Disability Index (ODI) scores were recorded –
the first after the 8-week program and the second score after the NeuroHAB® intervention.
ODI scores were collected and pre- and post-study results were measured and compared
through a paired test to determine the significance of improvement. The results showed a two-
tailed P = 0.05; this shows that there is a significant difference between before and after data
(0.0024). Ø The mean ODI values of the group before and after the intervention were 25.80
and 13.30, respectively, with a difference of 12.50 (95% CI: 5.73~19.27); 48.4496% yes. The
results of this study support another hypothesis, concluding that an 8- week intervention with
physical therapy represented by NeuroHAB® leads to a reduction in LBP ODI scores.[22]
6.3 OBJECTIVES

To check the effectiveness of William’s Flexion Exercise for the treatment of Low Back Pain in
Elderly.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA:

VAYU PAIN RELIEF CENTER, YELAHANKA

7.2 METHODS OF COLLECTION OF DATA:

7.2.1 STUDY DESIGN:

 EXPERIMENTAL STUDY

7.2.2 DURATION OF THE STUDY:

 3 Months

7.2.3 SAMPLE SIZE:

 Study will be done on total of 30 subjects

 For experimental study: calculating required sample size to estimate population mean
when standard deviation unknown.
n= (Zα/2)(σ )
E
Z=95%=0.95
α =1.095=0.05
α/2 =0.025=1-0.025=0.975
Zα/2 =Confidential interval=Z table=1.96
E=Error of estimation=5%=0.5
σ =Standard deviation=5
n= (1.96)2 52/(0.5)2= 3.8416 25/0.25=384.16, response percentage 10%=38.416
SAMPLING PROCEDURE:
 Convenient Sampling

7.3 Does study require any investigations to be conducted on patients or other humans or
animals?
Yes

7.4 Has ethical clearance been obtained from your institute?

Yes

MATERIALS USED
 Exercise mat
 Goniometer
 Marker
 VAS scale

INCLUSION CRITERIA:

 Gender: both male and female

 Age: 60 years and above
 People having chronic back pain

EXCLUSION CRITERIA:
 IVDP
 Spondylolisthesis
 Spondylosis
 Nerve root compression
 Spinal surgeries
 Spinal fractures
PROCEDURE:

30 subjects will be recruited based on inclusion and exclusion criteria. Subjects will be
explained about the Williams exercises that are to be performed. The following are the
exercises and written consent will be taken from the subject who will participate in the study.

EXERCISES

1. PELVIC TILT
 The patient will lie on their back with their hands at their side and their knees bent
 The patient will be then instructed to tighten the muscles of their abdomen as well as
buttocks by flattening their back against the floor
 Hold for 2 to 3 minutes, relax

2. SINGLE KNEE TO CHEST

 This will be usually done with the patients lying on a table or bed
 The patient will lie on their back and is then instructed to let the leg fall off the table or
bed, bend the other leg must wrap their hands around the bent knee and pull the bent leg
towards their chest
 Hold for 2 to 3 minutes, relax.

3. DOUBLE KNEE TO CHEST

 This will also be done with the patients lying on a table or bed
 The patient will lie on their back and is then instructed to bring both the knees one at a
time to their chest and curl their head forward while performing the motion, the is instructed
to keep their knees together and to have their shoulder lie flat on the floor. The patient must
then lower one leg at a time
 Hold for 2 to 3 minutes, relax.

4. HAMSTRING STRETCH
 The patient will lie on their back with hands on the side with one knee bent and the other
knee straight
 The patient will be then asked to pull their foot of their straight leg towards himself, and
then asked to raise their leg till they feel the stretch at their back of the thigh
 Hold for 2 to 3 minutes, relax.

5. SQUATTING
 The patient will stand with feet just wider than hip width apart toes pointed slightly out,
clasp hands at their chest for balance, send hip, back and bend at knees to lower down as far
as possible with their chest lifted
 They can swing their arms for momentum. Press through heels back up to explode up,
jumping vertically in the air
 Hold for 2 to 3 minutes, relax.
6. SEATED LUMBAR FLEXION
 The patient should sit in an upright chair
 The patient is urged to slowly bend forward until they feel tension in their back
 In contrast standing lumbar flexion starts exercise as follows
 The patient should slowly bend forward sliding their hand down to their legs until they
feel tension in their back
 Hold for 2 to 3 min, relax
The patient must do the above Exercises – 10 Repetitions for 10 to 20 min everyday and then advised
for follow up over a period of one week.

OUTCOME MEASURE
 Visual Analogue Scale (VAS)
 Lumbar Range of Motion
 Oswestry disability index

STASTISTICAL ANALYSIS
 The analysis is based on qualitative data descriptive statistics used to describe the data
 To see the effect of William’s exercises for the treatment of patients with low back pain in
elderly we can use non parametric Wilcoxon Signed Rank test which is equal to parametric
t –test.
8. REFERENCES:

1. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic

review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.
https://doi.org/10.1002/ art.34347 PMid:222314242.

2. Iizuka Y, Iizuka H, Mieda T, Tsunoda D, Sasaki T, Tajika T, et al. Prevalence of

chronic nonspecific low back pain and its associated factors among middle-aged and elderly
people: An analysis based on data from a musculoskeletal examination in Japan. Asian Spine
J. 2017;11(6):989–97. https://doi. org/10.4184/asj.2017.11.6.989
PMid:292797563.

3. Yiengprugsawan V, Hoy D, Buchbinder R, Bain C, Seubsman SA, Sleigh AC. Low

back pain and limitations of daily living in Asia: Longitudinal findings in the Thai cohort
study. BMC Musculoskelet Disord [Internet]. 2017;18(1):1–7.
https://doi.org/10.1186/s12891-016- 1380-5 PMid:281038644.
4. Sadeli HA, Sofiatin Y, Roesli RMA, Sukandar H, Novitasari DD, Soenggono A.
Prevalence and Characteristics of Low Back Pain among Productive Age Population in
Jatinangor. Althea Med J. 2017;3(3):469–76. https://doi.org/10.15850/amj.v3n3.8635.

5. Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al.

Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research [Internet].
2016;5:1530. https://doi. org/10.12688/f1000research.8105.1 PMid:274086986.

6. Persson G, Brorsson A, Hansson EE, Troein M, Strandberg EL. Physical activity on

prescription (PAP) from the general practitioner’s perspective – a qualitative study. BMC
Fam Pract [Internet]. 2013;14(1):1. https://doi.org/10.1186/1471-2296-14-128
PMid:239878047.

7. Lin CWC, Haas M, Maher CG, MacHado LAC, Van Tulder MW. Cost-
effectiveness of general practice care for low back pain: A systematic review. Eur Spine J.
2011;20(7):1012–23. https:// doi.org/10.1007/s00586-010-1675-4 PMid:212038908.

8. Mohan G. Effectiveness of William’s Flexion Exercise in the Management of

LowBack Pain. Int J Physiother Occup Ther. 2015;1:33-40.
9. Sukmajaya W, Alkaff FF, Oen A, Sukmajaya AC. Williams Flexion Exercise for Low
Back Pain: A Possible Implementation in Rural Areas. Open Access Maced J Med Sci
[Internet]. 2020 Feb. 5 [cited 2024 Jun.16];8(B):1-5. Available from:
https://oamjms.eu/index.php/mjms/article/view/3988
10. Amila Amila, Henny Syapitri, Evarina Sembiring. The Effect of William Flexion
Exercise on Reducing Pain Intensity For Elderly with Low Back Pain Departement of
Medical Surgical Nursing, Sari Mutiara Indonesia University, Medan, Indonesia
Departement of Public Health, Sari Mutiara Indonesia University, Medan, Indonesia Volume
Issue February 20 , 2020,, pp 28-36 - ISSN 2654-6310 http://ijnhs.net/index.php/ijnhs/home.

11. Zita Lachika Anung Poltekkes Kemenkes Surakarta1, Mei Kusumaningtyas

Poltekkes Kemenkes Surakarta2, Yoga Handita Windiastoni Poltekkes Kemenkes Surakarta3,
Effect of additional William’s Flexion Exercise on Functional ability in Myogenic Low Back
Pain patients, Vol 7 No 2 (2023): Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal
Public Health) / https://doi.org/10.35910/jbkm.v7i2.609
12. Stefani A. Nelvin1*, Anderias Umbu Roga2 , Jacob Ratu2 , Noorce Ch. Berek2 , Imelda F.
E. Manurung2 The Effect of William Flexion Exercise on Low Back Pain in Farmers in
Lembor District, West Manggarai Regency Public Health Sciences Faculty Students, Post-
Graduate Program,Nusa Cendana University, Kupang-85001, East Nusa Tenggara, Indonesia
Published:06.01.2021 https://www.easpublisher.com
13. A.A Istri Dalem Hana Yundari, Putu Puspita Wulandari Mas, effectiveness of william
flexion exercise to reduce pain intensity on low back pain (lbp) of woodcarvers in bali,
indonesia. proceedings of the icash [Internet]. 2018 Aug. 2 [cited 2024 Jun. 16];(3):305-11.
Available from: http://publications.inschool.id/index.php/icash/article/view/788

14. Akbar A, Zainuddin R. Application of William’s Flexion Exercise in Patients with

Low Back Pain Problems: A Literature Review. JLMH [Internet]. 2020Aug.10 [cited
2024Jun.16];1(3):9-
Available from: https://newinera.com/index.php/JournalLaMedihealtico/article/view/122
15. Hasmar W, Junaidi AS. Educational Exercise William’s Flexion Exercise To Reduce
Lower Back Pain. AJCS [Internet]. 2022 Jul. 23 [cited 2024 Jun. 16];1(1):33-6. Available
from: https://journal.formosapublisher.org/index.php/ajcs/article/view/776

16. Mohan Kumar .G, Revathi R,Ramachandran S, Effectiveness of William’s Flexion

Exercise in the Management of Low Back Pain Faculty of Physiotherapy, Dr. MGR
Educational & Research Institute University, Velappanchavadi, Chennai, Tamil Nadu, India
June 2015 1(1):33-40 Available from:www.tjprc.org
17. Septiyanti* , Milda Putri Dinanty, Hermansyah, The Effect of William’s Flexion
Exercise (WFE) on Low Back pain among Nursing in DR. M. YUNUS HOSPITAL,
BENGKULU CITY, Department of Nursing, Poltekkes Kemenkes Bengkulu, Indonesia
Presented at The 2nd Bengkulu International Conference on Health (B-ICON), Bengkulu-
Indonesia, 15-17 November, 2022 Published: January 11, 2023 Publisher: Polkeslu Press
Copyright © 2022 ISSN : 2986-027X, available from *septiyanti@poltekkesbengkulu.ac.id
18. S Abinaya, M Manikandan, V Dhivyadharshini, S Barathkumar, A Study on the
Effectiveness of William's Flexion Exercises on Non-Specific Low Back Pain, (2023). 15. 9-
12.10.5281/zenodo.7969858.
19. Anjali Atmaram More, Sanket Nagarale and Sucheta Golhar, P.E.S Modern College of
Physiotherapy, Shivajinagar, Pune, Maharashtra, India (2020), 6(7): 24-30. Multidisciplinary
Journal | International Journal of Applied Research (allresearchjournal.com)
20. Dwi Wardianti1, W Wahyuni2,PHYSIOTHERAPY MANAGEMENT OF WILLIAM
FLEXION EXERCISE FOR PAIN REDUCTION IN LOW BACK PAIN MYOGENIC
(2020), Physiotherapy Department Faculty of Health Sciences, “Innovation of Physiotherapy
Community on Increasing Physical Activity during Pandemic Covid-19”
21. Lee CP, Fu TS, Liu CY, Hung CI. Psychometric evaluation of the Oswestry Disability Index in
patients with chronic low back pain: factor and Mokken analyses. Health Qual Life Outcomes.
2017 Oct 3;15(1):192. doi: 10.1186/s12955-017-0768-8. PMID: 28974227; PMCID: PMC5627480

22. Brogan Samuel Williams1, David Johnson2, Low Back Pain Oswestry Disability Index
changes Following 8-week movement proficiency exercise program-A retrospective study,
1Department of Sports Science, The Strength Science Clinic, Auckland,New Zealand,
Department of NeurosurgeryCity to Coast Neurosurgery,Brisbane,Australia,Published-30th
May 2023,Available from brogan.s.williams@gmail.com, DOI
Oswestry disability index
0.32892/JMRI.290.
 ANNEXURE
INFORMED CONSENT FORM FOR SUBJECTS

Title

“EFFECTIVENESS OF WILLIAM”S EXERCISES FOR THE TREATMENT OF

PATIENTS WITH LOWBACK PAIN IN ELDERLY “

Subjects consent;
I Mr / Miss / Mrs....................................................................agree to participate in the study.
I have understood the procedure of the study and explained to me by the investigator of the
study. This study will help the health care professional to know about the extent of difficulty
faced by the patients.

Purpose of the research

I have been informed by Mr. AN Rajat Bhushan that he is going to do an experimental study
to find out the “EFFECTIVENESS OF WILLIAM’S EXERCISES FOR THE
TREATMENT OF PATIENTSWITH LOW BACK PAIN IN ELDERLY”
Procedure:
I have been explained that this study is conducted by some intervention. This study involves
40 participants.
Risk and discomfort
I know there is no risk involved in participating in the study. If I feel any discomfort during
intervention period Mr. Rajat will take appropriate care to safeguard welfare and best
interests of the subjects.
Benefits:
This study will help to evaluate the effectiveness of William’s exercises for the treatment of
patients with low back pain in elderly. The information so obtained shall provide insight in
to further research for establishment of data in context to Indian population.
Confidentiality:
I understand that the medical information produced by this study will be confidential. Apart
from the investigator no one will be ever access to the data without my consent. If the data
are used for the publication in the medical literature or for teaching purpose no name will be
used.
Photography consent documents:

I............................................................................have been explained by Mr. Rajat, that

phototography are required in order to illustrate various aspect of the study for the thesis and
other article, and at presentation and conference. Thesis image may also be converted to
electronic format for the use in multimedia presentation and documents accessible to other by
computer for the purpose of the study and promoting this research. By giving my consent I
authorise him to use any of the format. If the photograph are used, the face will be taped to
prevent the identification.
Request for more information:
I understand that I am encouraged to discuss any concerns regarding this study at any time
Mr. Rajat, is available to answer my question to the best of his knowledge. A copy of this
consent form will be given to my careful reading.
Refusal or withdrawal of participation:
I understand that my participating is voluntary and I may withdraw consent and discontinue
participation and time without fear of prejudice. My decision whether or not to participate
will not affect relationship with any agency, health care provider, etc. I also understand that
he may terminate my participation in this study after he has explained the reason for doing
so. The data collected will not be distributed for monetary benefit.

Investigator: Date:

I confirm that Mr. Rajat has explained me the purpose of this research, the study procedure
and the possible risks and benefits associated that I may experience. I have read and
understood the consent form let myself participate as a subject in this research project and I
am giving the consent wilfully.

Subject: Date:

Signature of witness:

I have been made aware of the purpose for this study. I understand that I have to co-operate
with the researcher for this study and a copy of the consent form has been given to me for
my reference.

Date: Permission of the subject:

Place: