- LETTER TO THE EDITOR
- META ANALYSIS
- RESEARCH REPORTS
- CASE STUDY
- The articles for the PJR Issue 2018 are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.
TAILORED EXERCISES PROGRAM – CONCEPT OF EXERCISES AS MEDICINE
Exercises programs that are customized and tailored according to the need of the individual is the focus of various international organizations. Today the concept of long and continuous form of exercises has seen a paradigm shift towards the concept of exercises as medicine where health care professional are focusing towards designing and prescribing exercises that fits the need of individual and that could be discontinued once the desired goals are achieved. Evidences in favor of tailored exercises programs have further strengthen this concept where various literatures have suggested that customized and tailored exercise programs does not only provides short term benefits but certainly found to be helpful in improving agility, cardiovascular fitness, lung compliance, weight management and improving social life in long run as well.
- Ali Farhad
- Assistant Professor
- Ziauddin College of Rehabilitation Sciences Ziauddin University
AQUATIC PHYSICAL THERAPY FOR THE MANAGEMENT OF GESTATIONAL DIABETES- A NEED FOR LOW INCOME REGIONS OF PAKISTAN
Gestational diabetes is increasing globally with the rise in obesity and type II diabetes 1. Gestational diabetes is also intensifying among the Pakistani population. Although no significant data regarding the prevalence of GDM is available in Pakistan, one of the reports suggested approximately 6.5% GDM incidence 2. This imposed a huge economic burden as the treatment approaches are costly and jeopardizing maternal and fetal health.
- Mubarra Rao
- Student MPhil in Physical Therapy
- Ziauddin College of Rehabilitation Sciences Ziauddin University
YOGA IN CHRONIC NECK PAIN: AN EFFECTIVE COMPLEMENTARY THERAPEUTIC OPTION – A META – ANALYSIS
Neck pain is recognized as the fourth leading cause of disability worldwide. The severity of neck pain may lead to adverse outcomes related to individual’s health and well-being that augment the risk of disability and may severely interfere in activities of daily living (ADL’s) and participation in the society.
The aim of the quantitative analysis is to determine the effectiveness of yoga in relieving chronic neck pain and disability.
Databases such as Google scholar, MEDLINE, PEDro, the Cochrane Library and Pub Med were explored from October-November for randomized controlled trials which assessed neck pain and related disability among chronic neck pain individuals.
Total six studies consisted of 298 participants with chronic neck pain. In risk of bias assessment, all six studies reported low risk of allocation and reporting bias, while one or two study disclosed high or unknown risk of bias in several domains. Moderate to large effect of -0.857 SMD at 95% CI suggest evidence in favor of the effectiveness of yoga; (Q 30.32, df 5, I2 83.51%) on a significant P-value of <0.0001.
The analysis of studies provided robust evidence with pool effect of -0.857 SMD at 95% CI (p<0.0001) concluded that yoga is an effectual and complementary method for the management of chronic or non-specific neck pain.
IMPACT OF AQUATIC THERAPY ON SENSORY MODULATION OF AUTISTIC CHILDREN TO IMPROVE ACTIVITIES OF DAILY LIVING
A Quasi experimental study was performed to evaluate the impact of aquatic therapy on sensory modulation in order to improve the ADL’s in children with autistic spectrum disorder.
A Quasi Experimental study.
Convenience sampling technique was used.
STUDY SETTINGS & PARTICIPANTS
This study was conducted in Liaquat National Hospital-Occupational Therapy Peads Unit. The participants were the children with autistic spectrum disorder having sensory modulation disorder.
56 autistic children were enrolled in this study. Each autistic child was first assessed on the basis of sensory profile for sensory deprivation and on WeeFIM pediatric functional independence measure for activities of daily living. The entire protocol was divided into six months of aquatic therapy with a frequency of 3 days a week.
A significant difference was observed in pre and post measurement of sensory profile and WeeFIM score measured by paired t-test. The p-value is found to be 0.03 on sensory profile and a p-value of 0.02 on FIM.
The findings indicated that the aquatic therapy has good impact on sensory modulation for activities of daily living.
PREVALENCE OF MUSCULOSKELETAL DISORDERS AMONG THE CARE GIVERS OF PHYSICALLY DISABLED CHILDREN
BACKGROUND AND AIMS
It has been estimated that 14-17% of the cases referred to primary care consultations are related to musculoskeletal disorders. The study was aimed to determine prevalence of Work Related Musculoskeletal disorder among care givers of physically handicapped children.
The study includes a sample size of 187 caregivers of physically handicapped children. Two differently self-designed questionnaires were used to gather information from the clinician and the parents separately. The data was collected only once from the participants. It was assured that the data would be used only for research purpose, prior consent was taken before administering the questionnaire.
The result showed that n=187 participants that were involved in the process of care giving to the physically handicapped children. Prevalence of musculoskeletal disorder was found equally high among clinicians and parents. However, no association p>0.05 between the age and the type of WMSDs was observed.
The study concluded that Work Related Musculoskeletal disorders were prevalent among the care givers of physical handicapped children and was found to be equally affecting the parents and the clinicians.
EFFECTS OF 8-WEEK STABILIZATION EXERCISES ON PELVIC GIRDLE AND LOW BACK PAIN AMONG PREGNANT FEMALES
BACKGROUND AND AIM
90% of pregnant female suffer with low back and pelvic girdle pain during the course of pregnancy. This study is aimed to determine the efficacy of stabilization exercises in the pregnant female in order to improve their compliance in activities of daily living (ADL’s), with the reduction in the pain intensity.
A Quasi-experimental study was conducted at the out-patient physical therapy department of tertiary care hospital. 89 pregnant female participated and evaluated twice, both before and after treatment. Stabilization exercises were performed including a 10 minute warm up session followed by 40 minutes of circuit training. Circuit training consisted of two phases, phase 1 comprised of muscular exercises while phase 2 consists of cardiovascular exercises followed by a cool down session of 10 minutes
Results showed significant reduction (p<0.05) in pain scores on VAS where the median scores of the pain was reduced to 3 post treatment from 6 pretreatment and functional mobility of women on pregnancy mobility index with mean of 15.12±3.88 was improved to 8.54±3.13
Stabilization exercise helped in reducing pregnancy related Low back pain and showed great improvement in physical activities in the participant which improved the quality of life.
THE EFFECTS OF MUSCLE ENERGY TECHNIQUE AND STATIC STRETCHING OF GASTROCNEMIUS ON PAIN AND DISABILITY IN KNEE OSTEOARTHRITIS
BACKGROUND AND AIMS
Knee Osteoarthritis (OA) is a degenerative disorder and a leading cause of disability associated with pain, restricted ROM and difficulty in performing Activities of Daily Living (ADLs). The aim of this study was to compare the effectiveness of Muscle Energy Technique (MET) and static stretching on gastrocnemius muscles among the patients suffering with knee OA.
A 2-arm Randomized Control Trial was conducted at Ziauddin Hospital among 120 patients suffering with grade-II OA. Initial screening was conducted on the basis of Knee OOS. Group A received the MET whereas Group B received Static Stretching Technique both group received the treatment for three days/week for 4 weeks.
In initial evaluation, our results revealed that group A shows the KOOS score 0.43±0.10 that improved significantly after four weeks of treatment to 0.49±0.14. Our results revealed that at 95% CI, the KOOS score of patients significantly improved in both the groups p<0.05
Our study concluded that Muscle Energy Technique is found to be more effective technique in reducing pain and functional disability in knee OA patients.
EFFECTIVENESS OF MANUAL LYMPHATIC DRAINAGE IN IMPROVING QUALITY OF LIFE AMONG WOMEN WITH BREAST CANCER RELATED LYMPHEDEMA
BACKGROUND & AIM
The body of evidence related to higher incidence of breast cancer related lymphedema after breast surgeries concluded compromise Quality of Life (QoL) among women over the past decade. The aim of this study is to evaluate the effectiveness of Manual Lymphatic Drainage (MLD) in improving QoL among women with Breast cancer related Lymphedema.
STUDY DESIGN & PARTICIPANTS
A Quasi Experimental study was conducted on women of the age 36-60 years with stage I and II breast cancer related lymphedema at Rehabilitation Department of a tertiary care Hospital.
Total 70 women recruited with lymphedema were assessed at baseline and after treatment on Lymphedema Life Impact Scale. Manual lymphatic drainage technique was applied for 3 days in a week for 6 weeks with a compression bandage for first 4 weeks.
The findings showed that Manual Lymphatic Drainage (MLD) technique significantly improves the Lymphedema Life Impact Scale score after intervention p <0.05 notably in psychological domain of the scale p=0.0001 furthermore, the percentage of impairment was also reduced significantly from 75.98% to 44.18%.
MLD is found to be more effective treatment for improving the overall Quality of Life among women with Breast cancer related lymphedema
EFFECTIVENESS OF VIRTUAL REALITY IN RECOVERY OF MOTOR FUNCTION IN POST-STROKE HEMIPARESIS: A QUASI-EXPERIMENTAL STUDY
Virtual Reality(VR) is a novel treatment approach for stroke rehabilitation as it enables individuals to reproduce standard controlled movements to accomplish functional task. In contrast to conventional rehabilitation that is monotonous, long-term and challenging, VR increases patient interest in rehabilitation thereby reduces the boredom and adaptation therefore enhances the visuo-spatial feedback. It has been observed that approximately 65% of the stroke survivors suffer hemiparesis that predominantly leads difficulty in performing daily living activities. Therefore, this study aims to assess the sensorimotor and functional performance in post-stroke hemiparetic patients using VR based gaming system. A total of 81 participants who had first-ever ischemic or hemorrhagic stroke with onset of >6 months, enrolled in post-acute rehabilitation program at Tertiary Care Hospital were included. The VR gaming software named Wonder Tree (WT) © was used for the intervention. All participants were required to play two different games i.e. bucket ball and bubble pop for 15-20 minutes, 3 days/week for the duration of 8th weeks. Participants were assessed on baseline and post-intervention on Fugyl-Meyer Assessment for Upper Extremity (FMA-UE) and Wolf Motor Function Test (W.MFT) to assess sensorimotor function and functional skills. Participants showed significant improvement in sensorimotor function and functional abilities (p<0.05) after 8th weeks of intervention. It was concluded that VR gaming is effective in improving motor recovery in post-stroke hemiparesis. Besides, future clinical trials are needed to be conduct to establish VR gaming system as an alternative to conventional stroke rehabilitation.
MULTIPLE APPROACHES IN MANAGEMENT OF BELL’S PALSY- A CASE STUDY
Bell’s palsy is a prevalent type of Facial nerve Palsy, estimated up to 75% of the cases. A 58 year old male patient presented with right sided Bell’s palsy. Thorough examination revealed the weakness of facial musculature and synkinesis associated with drooping and asymmetry. Reportedly, he had difficulty in eye closure, chewing and drinking. Assessment was conducted using Sunny Brook Facial Grading Scale. After assessment a comprehensive strategy combining of different modalities including electrical stimulation with Russian Current, gentle soft tissue mobilization, resistance exercises and taping. Symptomatically, after 3 weeks there was a significant improvement in the facial symmetry, strength and function of facial musculature as well as score of Sunny Brook Facial Grading Scale. Experimentally, this indicates effectiveness of this treatment regime, however; further randomized control trials should be conducted to further investigate efficacy and validity of this combination approach.