Vol 7 Issue 1 2018

Education in rehabilitation sciences have seen a boom in the last two decades in Pakistan and a variety of undergraduate and postgraduate courses have been introduced in the country. Up gradation of BS physical therapy into DPT program, BS Occupational Therapy into Doctor of Occupational Therapy, introduction of BS programs in Allied Health Sciences including Speech and Language pathology, Respiratory therapy, prosthetics and orthotics are glimpses of development of rehabilitation sciences in the country.

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Topical shifts in the dietary pattern with the intake of high caloric food along with the practices of Physical inactivities lead to the development of Obesity1. According to the statistics of Pakistan Demographic Health Survey (PDHS) 2013, the prevalence of Obesity among male and female population of Pakistan living in the rural setting is found to be 11% and 19% respectively whereas in urban setting the numbers are even higher where 23% of male population and 40% of female population are obese 2. A comprehensive global status report on non-communicable diseases, 2010 stated that every fourth adult individual in Pakistan is either overweight or obese making the population more vulnerable for the risk of developing non communicable diseases (NCDs) like obstructive sleep apnea, type II diabetes, cardiovascular disease, osteoarthritis, and cancers3. According to a study conducted in 2016, rapid urbanization along with the adaptation of western lifestyle conditions is the main contributing factors towards obesity. The paradigm shift toward the environment of ease and comfort along with the availability of the mechanized and modern infrastructure increased the likelihood of developing obesity among the urban population of Pakistan. Thereby, making obesity a soaring epidemic in Pakistan. Therefore, Identifying effective treatment strategies for overweight and obesity is of paramount importance. Life style modification is considered as the first option in comprehensive program of obesity management in order to achieve this goal that includes two primary components: diet and exercise. According to the epidemiological data physical activity levels are not met by majority of the adult population4 also the physiological adaptations of body to lose weight are related with a high risk of failure and transitional weight gain. Thus, the key challenge of obesity management is not weight loss, but long-term maintenance and to avoid weight regain. Hence, the purpose of writing this letter is to draw the attention of Health Care Professionals to identify the best possible exercise regime that significantly impacts the BMI of obese population with minimum dosage that will be both cost and time effective.

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ABSTRACT

BACKGROUND AND OBJECTIVES

Normally, aerobic exercises are considered as the therapeutic medium for improving cardiopulmonary parameters. The objective of this review is to evaluate the impact of aerobic resistance training on pulmonary parameters.

DATA SOURCES

Pubmed, Google Scholar, Science Direct, Biomed-Central (BMC), Pubmed-Europe, Medline, EMBASE and Pedro

ELIGIBILITY CRITERIA

Studies investigating role of resistive exercise training on pulmonary parameters including FVC, FEV1, VO2, TLCO etc, either alone or in combination with other exercise regimes, are included.

REVIEW METHODS

Data was extracted according to a standardized assessment form according to inclusion criteria. Risk of bias was evaluated according to the Cochrane risk of bias guidelines and qualitative analysis was performed.

RESULTS

Out of 13 selected studies, 4 studies supported the view that resistive exercises have significant role in improving the pulmonary parameters. There was a low risk of bias found among the studies that were selected and included in the review.

CONCLUSION

The review concludes that there is a low evidence for resistive exercises in improving the pulmonary parameters. However, more researches are needed to be conducted on the subject in future.

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ABSTRACT

Globally, cardiovascular disease is a leading cause of mortality and it is estimated that CVD is a cause of approximately 29.6% of all the deaths worldwide. According to a research published in 2015 in American journal of Cardiology it is a time to “rebrand and reinvigorate” the cardiac rehabilitation program as the existing program appears to be neither financially practicable nor maintainable mainly due to affordability barriers. A Quasi experimental study was conducted on 40 participants whom were diagnosed with cardiovascular disease with comorbidities (diabetes mellitus and dyslipidemia). Participants were asked to enroll in phase-II cardiac rehabilitation program on the recommendation of the cardiologist and were given intervention based on the guideline of American College of Sports medicine. Six weeks of supervised exercise protocol was conducted and its dosage was measured via Frequency, Intensity, Time and Type (FITT) protocol. While for determining the potency of phase-II Cardiac Rehabilitation program assessment of the outcome measures were made after every sessions and the results obtained from the assessment had revealed that for a CVD patients with diabetes 24 hours of exercise which would be performed for not less than four weeks provides a maximal result which carried on for further two weeks whereas for CVD patients with Dyslipidemia 20 hours of exercise had provided a desired result carried on for the remaining weeks. The study concluded that exercises based cardiac rehabilitation had a significant impact in improving the patient condition where a six week of training protocol improves the outcome measures included in the study.

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ABSTRACT

Myofascial trigger point is a hyperirritable nodule present in a palpable taut band of skeletal muscle, often results from muscle injury or repetitive strain that cause pain and tightness. Myofascial trigger points are one of the most common causes of chronic neck pain. This study aims to determine the efficacy of ischemic compression in comparison with myofascial stretching on trigger points of trapezius muscle for reduction of pain and spasm. Randomized Control Trial. The study was conducted in Ziauddin Hospital. 96 participants were enrolled in the study. Participants were divided into two groups equally and randomly, Group (A) an intervention group treated with hot pack, ultrasound therapy and ischemic compression, Group (B) a control group treated with hot pack, ultrasound therapy and myofascial stretching. This regime was followed thrice a week for three weeks. Statistically significant (P < 0.05) changes in the values were found in Group A and Group B for Visual Analog scale and Penn spasm frequency scale post treatment. The results showed that there is significant difference found after both interventions for the treatment of pain and spasm caused by myofascial trigger point. It cannot be said that ischemic compression is more effective than myofascial stretching for the treatment of myofascial trigger points of trapezius muscle.

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ABSTRACT

BACKGROUND AND OBJECTIVES

Scoliosis is the deviation in the lateral curvature of spine. This study aimed to estimate the prevalence of idiopathic scoliosis among the school going female population of Sikanderabad, Karachi, Pakistan between the ages of 11 to 20 years.

STUDY DESIGN

Cross-sectional study.

STUDY SETTINGS AND PARTICIPANTS

Study was conducted at Sikanderabad, Karachi, Pakistan. Adolescent female population of primary and secondary schools between the ages of 11-20 years were the targeted population.

METHOD

Data was collected by observation of the posture, palpation of spine and questionnaire. Examination was carried out by dividing the thoracic spine into three segments i-e; upper, middle and lower thoracic spine. Adam’s forward bending test was used to assess the three segments of spine and the results were confirmed by using a scoliometer. Data was analyzed by using SPSS version 20. RESULTS The total sample consisted of 226 students. The mean age estimated was 13.61 with ±2.10 and the overall prevalance of idiopathic scoliosis was 21.16%. Lower thoracic region was founded the most affected.

CONCLUSION

Study confirmed that scoliosis is prevalent in females especially in the lower thoracic region of spine and the mean age group affected is 13.6 1 years.

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ABSTRACT

OBJECTIVE

To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder

STUDY DESIGN

Randomized Control Trial

SAMPLE SELECTION

30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique.

PROCEDURE

Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant.

RESULTS

60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

CONCLUSION

Joint mobilization is more effective than self-exercises in reducing pain and increasing ROM of patients of adhesive capsulitis of shoulder.

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ABSTRACT

BACKGROUND AND AIM

Early mobilization practices in critical care settings are safe, efficacious and evidently proven treatment to reduce morbidity as well as mortality. Inactivity adversely affects pulmonary and cardiovascular systems. Despite of widely available evidences, barriers to early mobilization still exist in critical care settings. Hence the present study aims to identify the barriers related to early mobilization perceived by physiotherapist in critical care settings.

METHOD

A cross-sectional survey among 99 physiotherapists working in a critical care setting of different tertiary care hospitals of Karachi, Pakistan was conducted in which a self-administered questionnaire related to perceived barriers for early mobilization was introduced.

RESULTS

The descriptive statistics revealed that 87% of physician requisition is required for mobilization, 74% response rate was received by PT for unawareness to identify the suitable patient for early mobilization, and 68% showed lack of staffing resources. 56% response rate was received regarding requirement of adequate training to facilitate early mobilization. Moreover, lack of decision making and safety concerns were 68% respectively.

CONCLUSION

Perceptions received by physical therapist reveals that the barriers identified should be considered important in the tertiary care hospitals as mobilization is found to be potentially beneficial in improving patients’ functional outcomes. It is recommended to conduct further studies in future that can evaluate the role of knowledge transformation in modifying these barriers.

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ABSTRACT

Child sexual abuse (CSA) is a significant health problem with potential long-term consequences for victims, therefore knowledge regarding sexual abuse is essential for children. Educating children about body parts, good and bad touch develops positive body image and self-confidence. Informed and confident children are more likely to prevent themselves from abuse and reach out for the help. This quantitative descriptive survey based study evaluates and compares the knowledge and alertness against CSA among children of both genders. 100 participants of age bracket 6 to 12 years old both genders from different areas of Karachi were selected through simple random sampling technique. Informed consent was taken from the parents of the participants. The survey of 20-25 minutes was done in a course of 2 weeks in a semi structures setting. Each question was explained to children taken in group of 5, in simple and comprehensible Urdu language. Assessment was done using The Child Knowledge of Abuse Questionnaire – Rev II (CKAQ-REV II). Result indicates negligible difference of knowledge and skills about CSA between girls and boys. More than average of the children in the study have marked ‘False’ and ‘I don’t know’ on the application based questions that depict poor practical skills. Mean score of girls and boys on CKAQ-REV II is 16 and 17 respectively that shows children of Pakistani society are at high risk of CSA. Similar study can be performed to find the correlation of knowledge and awareness of CSA between children and their parents.

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ABSTRACT

The growing incidence of stroke is one of the major causes of disability in Pakistan leading to restriction in participation and functional occupation of every day task, return to previous role of life and meeting social economical challenges. Many of the studies have revealed that early intervention of rehabilitative approach may assist the early comeback of the patient to work. In Pakistan occupational therapist plays dynamic role that engrosses combination of roles of Occupational Therapist for reintegration of patient in the society.
The aim of this study is to promote the understanding of role adaptation by therapist based on patient’s occupational need in context of functional restoration, from counselor to advocator, social worker and vocational rehabilitator. Therapist switched roles for the reintegration of 24 year- old man with post stroke functional independence measurement ( FIM) score 2, ( completely dependent ) Initially intervention plan was proposed for six months based on COOP (cognitive orientation to daily occupational performance) along with compensatory and rehabilitative approach, due to relapse it extended for one and a half year.
The FIM scores was monitored independence measurement in occupational performance that was gained from 2 to 5 (mild assistance level) and the role support was provided accordingly.
In conclusion, the FIM scores improvement needs the interchangeable role of the therapist for promotion and improvement of occupational performance to restore role of client for back to work.

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