THE THERAPIST (Journal of Therapies & Rehabilitation Sciences)

Physical Therapy Strategies for Osteogenesis Imperfecta

Ghulam Saqulain — 2024-03-31

Osteogenesis Imperfecta (OI) is known to affect about 1/15,000–20,000 individuals in the world [1]. OI is rare congenital disorder characterised by bone fragility. Mutation in collagen related genes results in deficiency of collagen, which forms the bone matrix. This can result in fractures, deformities of the spine, and effects on other organs. A child's perception of pain can be influenced by a variety of circumstances, including repetitive fractures, bone deformities, muscle atrophy, mobility issues, and psychological concerns. Based on clinical characteristics and the course of the disease, OI subtypes are categorised; types I, II, III, and IV. OI Type I is considered the mildest form of the condition, with normal growth patterns and a low incidence of fractures during the perinatal period. Type II OI is more severe and causes death during the prenatal period. In contrast, OI Type III is a more serious presentation of the disorder. People with type III OI have significant bone deformities, and have fractures often even after birth. The most clinically heterogeneous type of OI is Type IV, with members displaying mild to severe symptoms. OI is diagnosed by using ultrasonography, radiography, bone densitometry, and serum electrolytes(calcium and phosphorous). Bone and skin biopsy also helps in diagnosis by studying collagen tissue. Individual differences in treatment response and outcome are due to genetic complexity in each kind of OI. Medicinal treatment(bisphosphonates) is the most common approach used to manage pain but these treatments' primary drawbacks include their comparatively low efficacy, their lack of benefits, the emergence of treatment resistance in certain individuals, or their cytotoxic adverse effects. The multidisciplinary approach to manage OI involves occupational therapy, physical therapy, orthotics and by other health care professionals including orthopaedic surgeon, dieticians, and speech therapists. Ongoing studies have provide new avenues for the management of OI, including medical, rehabilitation, and surgical treatments. Physical therapy maximise mobility and independence while lowering the risk of fracture and bone loss. The physiotherapists play a crucial role by providing counselling to the parents of OI infants based on disease severity and help the children with OI reach adult independence and maintain optimal musculoskeletal health. Parents are advised to handle and position the baby safely, with the ultimate goal of enabling the child to gain mobility on their own, whether that means utilising a wheelchair in the future or walking aids. Observational studies have shown evidence that supervised exercise regimes can enhance physical capacity and muscle strength.

Determining the Frequency of Non-Obstructive Coronary Artery Disease in Elective Angiography Cases

Hafiz Muhammad Rashid Javaid — 2024-03-31

Cardiovascular disease particularly ischemic heart disease has emerged as a leading cause of death. Atherosclerosis in epicardium results in CAD without the restriction of coronary circulation but the other processes that may disrupt the myocardial supply and demand in patients exhibiting angina symptoms or indications may be suspected of having non-obstructive CAD. Objective: To find out the prevalence of non-obstructive CAD in patients enrolled for elective angiography. Methods: A cross-sectional descriptive analysis was done in the Cardiology department in King Edward Medical University and Mayo Hospital, Lahore. The duration of study was for six months from 01-08-2022 to 01-02-2023. After approval from hospital ethical committee, 150 patients were enrolled in the study with informed written consent. Demographics including Name, age, BMI, confounding factors like (diabetes, hypertension, smoking and family history) and address were noted. All selected patients underwent coronary angiography via right femoral artery approach by a consultant cardiologist. Non-obstructive coronary artery disease was assessed as per operational definition. All the information was noted on pre-designed proforma (attached). Results: A total of 150 patients were selected for the study. It showed that out of 150 patients, 2.7% (n=4) fall in age group of 18-40 years and 97.3 % (n=146) were in age group of 41-60 years, average age was 51.94±5.26 years and the BMI was 27.96±6.44 kg/m2. There were 62.7 % (n=94) male and 37.3 % (n=56) females. Frequency of diabetes mellitus was 34.7 % (n=52), hypertension was 24.7 % (n=37), smokers 16.7 % (n=25), family history was 12.7 % (n=19) and frequency of non-obstructive CAD was 27.3 % (n=41). Conclusions: It is to be concluded that a considerable percentage of patients enrolled for elective coronary angiography had non-obstructive CAD.

Comparing the Effectiveness of Specific Lumbar Mobilization and Core Stability Exercises in Mechanical Low Back Pain in Decreasing Pain and Disability: A Randomized Control Trial

Rehana Hayat — 2024-03-31

Low back pain (LBP) is a global neuro - muscular problem developing significant disability of thoracic, lumbar or sacroiliac joint at any age. Objective: To analysis comparative effectiveness of specific lumbar mobilizations and core stability exercises in mechanical low back pain in reducing pain, ROM and disability. Methods: A patient blinded randomized trial was executed in the department of Physical therapy of Mayo Hospital, Lahore including 45 LBP patients randomly distributed into three groups. Each group received Conventional physical therapy in which Group A was control group, Group B received specific lumbar mobilizations while Group C received core stability exercises. NPRS, RMDQ and MODI were used for assessing pain and disability. SPSS version 24.0 was used for analyzing within and between group analysis through Paired T-test and Independent T- test with p-value <0.05. Results: The results showed conventional therapy, specific lumbar mobilization and core stability exercises are effective in improving pain, ROM and functional status. However; Core stability exercises was more effective with p-values for NPRS (p=0.049), MODI (p=0.038), RMDQ (p=0.003) and for Ranges (R-side flexion; 0.008, L-side flexion; 0.033, R-side rotation; 0.00, L-side rotation; 0.00) as compared to lumbar mobilization. Additionally; there was no substantial difference was found between three groups for flexion and extension. Conclusions: Core stability exercises are statistically and clinically more effective than conventional therapy and specific lumbar mobilizations in improving ROM, decreasing pain and functional status.

Awareness About Glaucoma and Associated Factors Among Glaucoma Patients Visiting Munawar Memorial Hospital Chakwal

Hamza Aziz — 2024-03-31

Glaucoma is a significant public health problem worldwide blindness after cataract is attributed to this ophthalmic disease. The resultant blindness is mostly irreversible. Its earlier detection is imperative to prevent blindness. Objective: To ascertain the awareness about glaucoma and associated factors among glaucoma patients in association with family history. Methods: A cross-sectional descriptive hospital base study was done among 21 glaucoma patients at Munawar Memorial Hospital Chakwal from October – December 2021. The patients were enrolled through consecutive sampling. Data were gathered from the patients through self-structured questionnaire pertaining to demographics, family history, association of glaucoma with blindness, reversibility of resultant blindness, treatment in addition to prevention and cure of blindness. Data were analysed by SPSS version 25.0. Apart from descriptive statistics, Fisher’s exact test was also applied to measure the association of family history of glaucoma with other factors. p<0.05 was taken as significant. Results: Of the 21glaucoma patients, most (63%) were males and 11 patients had positive family history. Overall, 25% patients knew about the disease. Mean age of the respondents was 50.52 ± 22.5 years. Almost 72.2% of the patients with positive family history were aware about the prevention of blindness resulting from glaucoma (p<0.05). on the other hand, 81.8% of the patients with negative family knew about cure. 81.8% of the patients knew the purpose of treatment (p<0.05). Conclusions: There was scarcity of knowledge about glaucoma among patients. Despite the positive family history, knowledge of glaucoma patients about their disease was deficient.

Attributes of Menstruation among Young Physical Therapy Female Students of Karachi

Shafaq Afreen Hasnain — 2024-03-31

The average age of menarche is between 9 to 14 years of age. Menarche is considered a normal milestone of every female's life. This period is supposed like a special period of every girl's life because in this stage girl is converted to the woman's age. Menarche is the indicator sign of a female that is ready to take part in reproduction activity. Objective:To determine the attributes of menstruation among young physical therapy female students of Karachi. Methods: This cross-sectional study was done among 385 young physical therapy female students in Karachi-Pakistan to reveal the age, duration, symptoms, and length of the menstruation cycle. The duration of the study was between June to November 2023. A non-probability purposive sampling technique was used. The validated questionnaire was used from a previous study done in 2016. Data were analyzed through SPSS version 23.0 software. Results: A total number of 385 young females was included in this study. The mean age of menarche revealed 187 (48.57%) found between 11 to 13 years. The regularity of menses was found in 299 (77.66%)participants. The average days of menstruation flow were about 6 to 8 days in 218 (56.62%) of research participants. The average length of the menstrual cycle was 21 to 35 days in 221 (57.40%) while the most common symptom found in research participants was lower abdominal pain in 187 (48.57%). Conclusions:There were significant differences between the characteristics of every young female related to the pattern, duration, age, regularity, and cycle length of the menstrual cycle.

Assessment of Fall Risk and its Association with Frailty among Elderly

Adeena Nisar — 2024-03-31

Falls are a major public health concern about 10% of falls result in serious injuries like traumatic brain injury. Falls can cause poor quality of life and financial costs for both individuals and society. Early detection of who are at high risk of falling makes it easier to provide rehabilitation therapy in the future. Objectives: To assess functional mobility, fall risk and its association with frailty among elderly. Methods: This cross-sectional study design comprised 90 male / female elderly patients ages 65 to 75. Subjects with limb amputation history, cognitive impairment and ICU status were excluded. Data were gathered from DHQ Kasur andAriz Memorial Hospital. Non-probability convenience sampling was applied. Ethical approval was obtained from institute before conducting research study ran July 2022 to December 2022.Evaluation tools included Berg Balance Scale, Elderly Mobility Scale, Functional Reach Test, and FRAIL Scale. SPSS version 25.0 used to analyze data. Frequencies, percentages, cross tabulations, bar charts, and pie charts were used to display the categorical variables. Results: Frailty and fall risk are significantly correlated, with a p-value of less than < 0.001. Mobility and Frailty had significant relationship (p< 0.001). There was significant association between Frailty and balance dysfunction with (p<0.001). There was significant association between Frailty and fall risk with (p<0.001). Conclusions: Results suggested that frail elderly were at higher risk of fall and their functional mobility is more compromised as compared to non-frail.

Vital Signs Monitoring in Outpatients Physical Therapy in Various Cities of Pakistan

Faria Bibi — 2024-03-31

Every time a new patient or client visits, their vital signs should be taken, according to the American Physical Therapy Association (APTA). Taking vital indicators such as blood pressure, heart rate, breathing rate, and body temperature is part of a physical therapist's professional decision-making process. Objective: To determine the frequency of vital signs monitoring in outpatients physical therapy practice. Methods: A descriptive cross-sectional study was conducted in physical therapy departments of different clinical settings. Data were collected through 12 items survey questionnaire from physical therapist, which was then analyzed by SPSS version 2022.The frequency of monitoring of vital signs by physical therapist was measured by using frequency tables. Association was seen with the help of chi-square test. Results: In this survey study, 12 items and 300 respondents were included to find out the frequency of physical therapist who monitor vital signs in their daily practice. The results suggested that 56.7% respondents monitor vital signs, 27.3% respondents monitor vitals only when there is an indicted or diagnosed cardiovascular condition and 16.0% respondent do not monitor vital signs. There is a significant relation that vital signs are neglected due to time constraints in daily practice with p-value less than 0.05. Conclusions: This study demonstrated that vital signs are being monitored by most of the physical therapist. Further studies need to conducted and better stratify risk factors for different conditions to better determine when exercise and activity may be at risk.

Occupational Risk Factor for Carpel Tunnel Syndrome Related to Computer Usage: A Descriptive Cross-Sectional Study

Tallat Anwar Faridi — 2024-03-31

Carpal tunnel syndrome (CTS) is triggered by compression of the median nerve as it travels through the wrist's carpal tunnel. CTS is also more likely to occur if you work in certain occupations such as Related with clerical and administrative work on Computer. Objective: To identify the frequency and pattern of CTS among clerical and administrative workers using computer. Methods: A descriptive cross-sectional study was started from October 2021 to January 2022 between 20-50 years of age at five Private colleges in Lahore city. The participants fulfilling the inclusion criterion were using computer for more than 6 hours a day, having co-operative attitude, weren’t taking any analgesics and had no associated co-morbidities. After informed consent 200 participants were enrolled using convenient sampling method. Sample size was calculated by taking average from previous research publications. A designed questionnaire was given among the participants to obtain information about demographics and Phalen’s test for CTS. Data were entered and analyzed in SPSS version 21.0. Results: The Results shows that 5 participants have Positive CTS in 20-30, 10 in 31-40, 14 in 41-50 age group. Positive CTS was considered positive via Phalen’s Test. Males have higher frequency of CTS as 21 Males and 8 Females with Positive Phalen’s test. Conclusions: CTS is related with an occupational factor in terms of computer usage. It is common in males because of excess workload and job duties

Comparative Effects of Core Neuromuscular Training versus Conservative Physical Therapy to Reduce Pain and Improve Functional Performance in Patients with Patellofemoral Pain Syndrome

Amna Khalid — 2024-03-31

Running, stair climbing, jumping and squatting represent a few of the activities that can cause patellofemoral pain syndrome. Patellofemoral pain syndrome (PFPS) is one of the most typical causes of anterior knee discomfort in teenagers and persons below Sixty. Objective: To contrast the results of conservative physical treatment plus core neuromuscular training and conservative physical therapy alone. Methods: It was a quasi-experimental study in which patients suffering from patellofemoral pain syndrome were selected on the basis of convenience sampling from Government hospitals of Faisalabad after meeting the inclusion and exclusion criteria. Twenty patients with patellofemoral pain syndrome were divided into Group A and Group B at random. Participants of Group A performed neuromuscular core training plus conservative physical therapy exercise program for 4 weeks while participants of group B performed conservative physical therapy exercise alone for 4 weeks. Data were analyzed by SPSS version 27.0. Results: Following therapy, the pain level was substantially reduced in both of the groups (P < 0.05) with Intervention group showing better results. Similarly, there was improvement in scores of Kujala questionnaire in both groups after treatment (P< 0.05) but the results of Intervention group were comparatively better. Conclusions: There is significant effect of core neuromuscular training plus conservative physical therapy as compared to conservative physical therapy alone.

Effectiveness of PNF Pattern in Regular Physical Therapy Sessions on Functional Mobility in Frozen Shoulder

Sidra Ghias — 2024-03-31

Frozen shoulder, or adhesive capsulitis, is a musculoskeletal condition that presents with symptoms such as discomfort, nocturnal pain, and limited range of motion. Abduction and external rotation are significantly reduced. Objective: To investigate the effectiveness of combining proprioceptive neuromuscular facilitation (PNF) patterns into routine physical therapy sessions for patients with frozen shoulder. Methods: A six-week quasi-experimental study was conducted on a total of 30 participants, divided into group A (n=15) and group B (n = 15), selected from the outpatient department (OPD). Pain, disability, and range of motion were evaluated as outcome measures. The group A received proprioceptive neuromuscular facilitation (PNF) patterns in addition to their usual physical therapy sessions, and group B only received conventional physical therapy sessions. Disabilities of the Arm, Shoulder and Hand (DASH), VAS (Visual Analog Scale) and goniometer were used to assess pain, disability and range of motion (ROM). Data were analyzed using SPSS version 23.0. Results: Both groups showed a significant reduction in DASH and VAS scores and an increase in ROMs, as group A showed a better result in terms of DASH score and abduction range (p<0.05). Conclusions: Both the experimental and control groups had statistically significant outcomes. The PNF pattern and Codman exercises both have a positive impact on rehabilitation. However, PNF is more advanced because it involves a combination of movements that are also useful in daily activities. Additionally, PNF helps develop memory for correct patterned movements. On the other hand, Codman exercises are only effective for retaining and improving shoulder ranges.

Comparative Effectiveness of Muscle Energy Technique (MET) With or Without Proprioceptive Neuromuscular Facilitation (PNF) Pattern in Lumbosacral Dysfunction

Ramiza Khalid — 2024-03-31

Lumbosacral dysfunction is a condition affecting the lumbar and sacral regions of the spine, causing back pain, limited range of motion, sensory deficits, and motor impairments. It can be caused by degenerative changes, traumatic injuries, congenital anomalies, or abnormal biomechanics. Objective: The objective of this study was to compare the effects Muscle Energy Technique (MET) alone and with combination of PNF in treating lumbosacral syndrome. Methods: The study was a quasi-experimental design over the duration of 8 weeks. Purposive sampling was employed with a sample size of 40 patients, divided equally into Group A (N= 20) who received MET combined with PNF and Group B (N= 20) that only received MET. We used Oswestry Disability Index (ODI), Numeric Pain Rate Scale (NPRS) and goniometer to assess disability, pain, and range of motion (ROM). We analyzed the data using IBM SPSS version 23.0. Results: Outcome measures including pain intensity, functional disability, and range of motion, were assessed at baseline and post-intervention (8 weeks). The group A showed significant improvements in all outcome measures compared to the group B at post-intervention assessments (p < 0.05), pain intensity decreased by 60-80%. Functional disability scores were reduced by 60-75% in the group A, while the group B showed only 40% significant change. Moreover, the group A exhibited a substantial increase in lumbosacral range of motion compared to the group B. Conclusions: The study reveals that both MET alone and MET combined with PNF effectively improve pain, functional disability, and lumbar range of motion in lumbosacral dysfunction patients.

Consequences of Stress on the Workability of Physical Therapists

Muhammad Haris — 2024-03-31

Assertive stressors are legitimate within all occupations. Elements similar to varying employee slots, underprivileged administration, increasing payables, lack of scheduled employee development, insufficient figures of workers, moreover disputes in the office might be frequent job-related irritants. Work efficiency is based on the equilibrium between job requirements and individual resources. Objective: To evaluate the consequences of stress on the ability of physical therapists to work. Methods: A cross-sectional study was conducted in which data were collected from 100 Physical therapists by using a non-probability convenient sampling technique from multiple hospitals in Karachi. The duration of the study was 6 months from January 2023 to June 2023. Data were evaluated by two validated questionnaires: The Work Ability Index Questionnaire (WAI) and the Perceived Stress Scale (PSS). Statistical analysis was done through SPSS version 23.0. Results: Our study results show there is a weak relationship between stress with the different systems of the body in most of the research participants but it physically affects the performance of work in 27 % of participants with symptoms while 4% were unable to complete their task due to stress. Among the participants, 42% were taking leave due to sickness and work burden. Conclusions: There is a significant effect of stress on the workability of a physical therapist.

Prevalence of Hamstring Tightness Among Healthcare Workers

Komal Jamil — 2024-03-31

Hamstring tightness is the incapability of the muscle to move more than 160 degrees of extension of the knee while 90 degrees is flexion of the hip is called tightness of the hamstring. Mostly seen that the higher ratio of hamstring tightness occurs in the right lower limb. Objective: To determine the prevalence of hamstring tightness among healthcare workers. Methods: It was a cross-sectional study conducted on hamstring tightness among healthcare workers in Karachi from July 2023 to Jan 2024. The sample size of the study was 643 healthcare workers. The convenient sampling techniques was used. For the evaluation: SLR(Straight leg raise) and AKE(Active knee extension) were used. The data were analyzed through the SPSS version 23.0. Results: A total number of 643 healthcare professionals of both genders were recruited from hospitals in Karachi. There were 197 (30.63%) physical therapists who were found to be the tightness of the hamstring muscle. The ranges of body mass index among healthcare workers are higher in the underweight BMI category. The severity of hamstring muscle tightness in males was observed higher between 31 to 45 degrees in the right lower limb as compared to the left. The severity of hamstring muscle tightness in females was observed higher between 31 to 45 degrees in the right lower limb as compared to the left. Conclusions: The prevalence of hamstring was found in all healthcare workers of research but the highest percentage was found in physical therapists as compared to other professions.

Occurrence of Coccydynia in Healthcare Professionals of Karachi; Pain and Straight Leg Raise Test Perspective

Komal Jamil — 2024-03-31

Coccydynia is a condition in which pain is experienced around the tailbone or coccyx region. The sitting position triggers the pain in the coccyx region especially when while patient comes from sitting to a standing position. The prevalence of coccydynia is unknown in the general population but it is more common in females than males. Objective: To determine the occurrence of coccydynia in healthcare professionals of Karachi. Methods: A cross-sectional study was conducted among healthcare professionals in Karachi from August 2023 to Feb 2024. The sample size of the study was 543 healthcare professionals. The sampling techniques which was used in this study were convenient. For the collection of data, a self-administered questionnaire was used while for the evaluation of data, two tests Visual Analog Score (VAS) and Straight Leg Raise( SLR) were used. The data were analyzed through the SPSS version 23.0 software in which we calculated the frequencies and percentages. Results: The study was done on 543 healthcare professionals between the ages of 20 to more than 59 years old who were recruited from different hospitals in Karachi. Pain intensity which was evaluated by the visual analog scale observed 223 (41.06 %) of participants found to lie in the moderate pain category while confirmation of coccydynia was done by the application of SLR and was found to be positive in 426 (78.85%) of healthcare professional's. Conclusions: The occurrence of coccydynia was found in the majority of the healthcare professionals of Karachi while the complaints of pain were found in the moderate category.

Assessment of Facial Function in Patients with Facial Palsy Using Patient-Based and Clinician-Based Tools

Ammara Latif — 2024-03-31

Facial palsy is a serious disorder that impairs both function and appearance resulting from facial muscle weakness. It impairs the quality of life of affected patients. There are questionnaires for general health and disease-specific assessments of quality of life accessible. Objective: To assess the facial function in patients with facial palsy using patient-based and clinician-based tools. Methods: A cross-sectional study was conducted among patient diagnosed with facial palsy. The study sample size 79 of both genders calculated via Epitools software and using convenient sampling technique. A pre-tested structured valid and reliable tool was used for the assessment of disability and facial function via Facial Clinimetric Evaluation used as patient-based tool and House-Brackmann Scoring Scale used as clinical based tool. SPSS version 25.0 was used to analyze data. Results: The mean age of the participants was 27.53 years. 59.5% were males whereas, 40.5% were females. So, a higher prevalence of males was seen. 58.2% were recorded at grade IV (moderately severe), 31.6% were at grade III (moderate level) and 10.1% were at grade V (severe) level. There was statistically significant association between House-Brackmann scores and facial clinimetric evaluation scores (p<0.001) that was indicating that there was an association between disability and patient’s perception towards facial palsy. Conclusions: Facial Clinimetric Evaluation scale used as patient-based tool provide subjective experience and functional limitation experienced by facial palsy patient while House-Brackmann Scoring Scale used as clinical based tool provides objective evaluation of facial function of facial palsy patient.