FREQUENCY OF THORACOLUMBAR JUNCTION DYSFUNCTION AMONG EQUESTRIAN POLO ATHLETES

Background: Low back pain among equestrian sports is because of the significant connection between thoracolumbar junction dysfunction (TLJD) and its commencement in equestrian sports; appearing as low back ache spreading out to the adjoining sites and structures. Objective: To determine the frequency of Thoracolumbar Junction Dysfunction (TLJD) among Equestrian Polo Athletes Methods: A descriptive cross-sectional study with a sample size of n=108 was conducted at different polo clubs of Lahore and Islamabad Pakistan for the duration of 6 months from July 2020 to December 2020. Participants were selected via non-probability convenient sampling technique. Male athletes between 18 to 50 years of age, non-competitive with mechanical low back pain were included in the study. Athletes who fulfill the inclusion criteria were assessed using Robert Maigne’s Gold standard examination protocol. SPSS version 21 was used for data entrance and Descriptive analysis was done to present the results of study. Results: The mean age of the subjects was 36.86±6.65 years, duration in sports was 13.58±4.81 in years and frequency of participation in sports was 3.648±0.75 days per week. Total n=108 athletes were examined for TLJD, 66.7% (n=72) were found to be positive with the thoracolumbar junction dysfunction. Conclusion: Thoracolumbar Junction Dysfunction among Equestrian Polo Athletes was an immensely prevailing condition Keywords: Athletes, athletic injuries, dysfunction, overuse injuries.

WOMEN’S HEALTH ISSUES: THE CONTINUING APPEAL FOR WOMEN HEALTH PHYSICAL THERAPY PRACTICE IN PAKISTAN

Women’s health in its widest definition includes study of whole body particularly examining biological characteristics unique to women, with a focus on reproductive organs, body structure, hormones, childhood development and genetics.1 In 2017, maternal mortality ratio was determined to be 211 deaths per 100,000 live birth globally and in Pakistan, the ratio was 186 deaths per 100,000 live births in 2021.2,3 Besides obstetrical health issues, Pakistani female are also facing gynecological maladies on a large scale as compared to other countries such as grade I and II pelvic organ prolapse that is likely to be managed through pelvic physical therapy as per National Institute for Health and Care Excellence (NICE) guidelines.4 Regrettably, the burden of disease is increased manifolds due to unavailability of expert women’s health physical therapist.5 Like many countries, Pakistan is signatory to several international commitments till now to empower the women. To overcome the lacking, women’s health issues should be fostered by a woman’s health physical therapist. A women health physical therapist evaluates, treats, and educates a woman throughout the stages of life starting form active child-bearing years, pregnancy, postpartum, perimenopause and post menopause.6 The area of practice has now spread to encompass all health concerns of a woman namely infertility, osteoporosis, fibromyalgia, rehabilitation following gynecological surgery, breast cancer rehabilitation, incontinence, dyspareunia, vulvodynia, pregnancy related musculoskeletal pain, lymphedema, wellness and exercise. A woman throughout the life span whether a childbearing woman, a menopausal and a young athlete or an elderly woman can obtain benefit from women’s health physical therapy (WHPT). The American College of Obstetricians and Gynecologists (ACOG) claims that conjoint care provided by physician and physical therapist can enormously improve treatment prognosis.7 An optimal quality of life for a woman can be ensured through clinical evaluation and assessment to plan physical therapy interventions incorporated with various modalities that are cautiously prescribed according to an individual’s scenario.8 It is about time to emphasize WHPT practice throughout the country. There is a prolonged schedule to fulfil all fundamental components of women’s health issues which demands the joint collaboration of health-care providers, governments, policy makers, and the overall population. This article shout-out to novice physical therapy professionals to get themselves enrolled in WHPT specialty degree for the betterment of women. It is the need of hour to incorporate the services of qualified and expert WHPT professional in large tertiary care hospitals whether public or private, so that the premium quality of medical services pertaining to women health is available to the masses of all walks of life.

INSPIRATORY MUSCLES TRAINING: AN EFFECTIVE WAY TO IMPROVE POST-OPERATIVE OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING

Cardiovascular diseases (CVD) are the leading cause of death worldwide. It is a multifactorial disease and has many risk factors including hypertension, diabetes mellitus, physical inactivity and smoking. Coronary artery disease (CAD) is one of the consequences of CVD.1 If we talk about CAD, it is a really common heart disease in our country, also known as ischemic heart disease and develops when coronary arteries or its sub-branches which are the blood supply of the heart become narrowed or blocked due to accumulation of plaque leading to an impaired supply of oxygen rich blood to the heart and thus cause retrosternal chest pain typically known as angina that is accompanied by dyspnea.2 Coronary artery bypass grafting (CABG) is generally the ideal treatment option for the individuals suffering from CAD. In this procedure, an auto-graft of vessel is taken and the commonly used vessels are left internal thoracic artery and great saphenous vein. The graft is sutured in such a way that the blocked coronary artery is bypassed and the blood supply to the heart is restored.3 Although medical sciences have advanced a lot, yet the prevalence of post-operative complications, specifically the respiratory ones pose an immediate threat to the survival and are the aiding factors to mortality and morbidity.4 Physical therapy after any surgery plays a pivotal role in improving the post-operative outcomes and helps the patient fight the effects of surgery. It makes a patient return to his or her normal life and helps in the early discharge of patients from hospitals thus preventing the chances of hospital acquired infections and reducing the financial load on masses.5 Respiratory rehabilitation, which is the specialty of physical therapy, have tremendous positive effects on the pulmonary compliance and function by preventing the post-operative pulmonary atelectasis.6 Moving further towards the components of respiratory rehabilitation, a group of breathing maneuvers conjointly known as inspiratory muscles training (IMT), if applied pre-operatively to the patients who are scheduled to undergo the coronary artery by-pass grafting displayed healthy post-operative outcomes.7 To conclude, it is the dire need of today to raise awareness among the health care professionals especially cardiologists and cardio-thoracic surgeons; and the general public regarding the pre-operative respiratory physical therapy for the patients planned to go through CABG. So, in the light of supported evidence, it is proved that respiratory physical therapy, particularly pre-operative IMT has positive outcomes in post-operative state. Moreover, the authors would also like to shed light on the facts about the healthcare policies and physical therapy services in Pakistan. Contrary to public sector hospitals, the rehabilitation departments in private sector hospitals are properly managed, substantially equipped and well established, leading to enhanced quality of physical therapy practices that result in better prognosis of the patients. The health department of our country should also emphasize on the public sector hospitals to make necessary arrangements for logistics of sufficient equipment and the hiring of physical therapists that are qualified and specialized in the field of cardiopulmonary physical therapy.

EFFECTS OF FRAGILITY FRACTURE INTEGRATED REHABILITATION MANAGEMENT HIP FRACTURE IN PAKISTANI OLDER ADULTS

Objective: to evaluate the effectiveness of fragility Fracture Integrated Rehabilitation Management (FIRM) on older adults of Pakistan after hip fracture surgery. Methodology: A one-group pretest–posttest designwas conducted at the National Institute of Rehabilitation Medicine (NIRM), Islamabad from March 2020 to May 2021.. A n=11 participants with age above 55 years, both male and female, with confirming diagnosed cases of hip fracture were included. Every participats receveied 10 sesssions of Fragility Fracture integrated Rehabilitation Management (FIRM) program in two weeks. Data was collected at baseline at 2nd day and after 10th session on 15th day, through the KOVAL scale to assess the walking ability, the Functional Ambulatory Category (FAC) to assess the level of independence, the modified Barthel index (MBI) for activities of daily living (ADLs), and quality of life (QoL) was assessed by EQ-5D. Data were analyzed by using SPSS Version 21. Result: the mean age 76.45±9.32, of which n=6 (54.6%) were males and n=5(45.4%) were females. after 10th sessions the QoL on EQ-5D, ambulation on FAC and KOVAL scale and the ADL on MBI were significantly improved (p<0.05) with large effect size, except for the anxiety domain of EQ5D and subdomains of MBI; Personal hygiene, feeding, Bowel control, bladder control, Wheelchair, and Chair & bed transfer showed no significant change (p>0.05). Conclusion: FIRM care is found to be effective in improving the walking ability, functional status, ADLs and quality of life in geraiatric population following a hip fracture surgery

EFFECTS OF LATISSIMUS DORSI STRETCHING ON FUNCTIONAL DISABILITY RELATED TO CHRONIC LOW BACK PAIN

Objective: To determine effects of latissimus dorsi stretching on functional disability related to chronic low back pain. Methodology: A single group pretest-posttest design trial was conducted in NOSIS clinics Mansehra Pakistan. Patients with the age between 20-60 years had chronic mechanical low back pain lasting for 7-12 weeks were included in the study. A total of n=64 randomly divided into experimental and control group, those received stabilization exercises (SE) plus latissimus dorsi stretching (LDS) and stabilization exercises alone respectively. Oswestry Disability Index (ODI) was used to determine functional disability. The level of significance was set at 95% CI (p≤0.05). Results: A total of n=61 participants participated in the study. The mean age of the study participants was 39.60 ± 10.02 and sitting time was 6.54± 1.23. It was observed that both the experimental group {p<0.001, ɳp2=0.934} and control group {p<0.001, ɳp2=0.875} significantly improved the ODI score with large effect size after 4 weeks of intervention. However, between the comparison showed significant improvement with large effect size in experimental group as compared to control group, after first week (p<0.001), and 2nd week (p<0.001) of intervention. Conclusion: the combination of spinal stabilization exercises and stretching of latissimus dorsi effective in improving functional disability related to chronic low back pain.

EFFECTS OF STRETCHING EXERCISES WITH OR WITHOUT BACLOFEN ON SPASTICITY, FLUID INTAKE AND CALORIES INTAKE IN CEREBRAL PALSY CHILDREN

Objectives: to find out the effectiveness of stretching exercises and baclofen alone and combined in spastic cerebral palsy children on spasticity, fluid and calorie intake. Material & Methods: A single-blinded, randomized control trial was conducted at Allama Iqbal Hospital, and Idrees Teaching Hospital. The participants between 5-15 years, having spasticity score of 2 or more on Modified Ashworth Scale (MAS). The participants were randomly divided into three treatment groups i.e. group A received baclofen, group B received stretching and group C received both baclofen and sustained stretching. Data were collected by Performa / Questionnaire, which calculated basic demographics, BMI, fluid and calorie intake, and Modified Ashworth Scale (MAS). Results: The result showed significant difference (p<0.05) among group with large effect size while comparing mean differences of Fluid intake {F(df)=2,57(988.603), η2 =0.972, p<0.001} and Calories intake {F(df)= 2,57(166.877), η2 =0.854, p<0.001}. While there was no significant difference in mean difference of spasticity {F(df)= 2,57(2.119), p=0.130}. Conclusion: baclofen along with stretching exercises significantly improved fluid, calorie intake and spasticity.

EFFECTS OF PILATE TRAINING ON PHYSICAL PERFORMANCE OF CRICKETERS

Objective: to determine the effectiveness of Pilate training on physical performance of cricket players. Methodology: A two-arm, single-centered, randomized control trial was conducted at LFR I8Active Gym I8, Islamabad for time duration of six months from June 2020 to March 2021. The active male cricketers aged between 19-30, who had practiced for at least 2 years and had normal BMI (ranging in between 18.5 to 24.9) were included in the study. The n=20 participants fulfilled the inclusion criteria and recruited through non-probability convenient sampling technique and divided in two groups. The experimental group received Pilate training (PT) with conventional training (CT) exercise plan. However, control group received only CT exercise plan. The 30 feet agility shuttle run test, core strength test, endurance test, underarm throw accuracy test, throw-length test and ground fielding test was performed before and after the intervention. The MANCOVA was applied to see the differences in group while controlling the confounding variables. The level of significance was set at 95% CI (p≤0.05). Results: The mean age of study participants was 23.95±2.7 years, while average BMI was 22.4± 3.79. After running MANCOVA test on combine dependent variables, while controlling BMI and pretest score, statistically significant difference {F (6, 12) = 12.95, p<0.001, ηp2= .866} between groups was observed. All variables except endurance fitness (p=0.217), showed significant improvement in cricketer receiving combined conventional training and Pilates training (p<0.05). Conclusion: It was concluded that Pilates with conventional training significantly improved physical performance of cricketers.

CENTER BASED VERSES TELE-REHABILITATION FOR DIABETES MELLITUS

Globally, new trends of practices are incorporating in health care sector, academics as well as in our daily lives to cope with the current population need. It is much needed to develop and implement new sophisticated practice models in rehabilitation to treat the different clinical conditions. Diabetes mellitus is one among the top 10 causes of death, with significant increase of 80% since year 20001. As estimated by International Diabetes Federation worldwide, 425 million people are suffering with diabetes mellitus.2 Diabetic neuropathy is one of highly prevalent condition which substantially affects patients by increasing frequency of falls, neuropathic pain and low quality of life (QOL).Diabetic patients suffer with following complaints i.e. Foot ulcers that develops due to peripheral vascular ischemia and poor pressure distribution on plantar surface of foot which increases the risk of fall due to loss of balance and disturbance in gait patterns.3 Total 20% of foot ulcers need an amputation wherein patients further suffer with secondary complications which in turn builds massive economic burden on health care system.4 The rehabilitation combined with diet and medications has proven as an effective method to treat diabetes and its neuropathy symptoms. Supervised conventional center based physical activity training programs are generally in practice to treat this metabolic condition. Though clinical effectiveness of these programs is established on clinical outcomes, with reduction in mortality rate, despite all the benefits of rehabilitation programs, very low patient attendance is observed in hospital based supervised rehabilitation programs. The regularity in exercise along with dietary intervention and fixed medication monitoring is the key component to manage diabetes. But high drop-out levels negatively affects the proven effectiveness of rehabilitation. There are different aspects for this low level of participation i.e. lack of time, approachability of a program, home bound work or obligations and psychological barriers etc. Therefore, new practice models are essential to improve the rate of participation on regular basis in these exercise program.5 Computer based technological incorporation in the field of health is evolving dramatically as a promising tool in improving quality of life cost effectively. It can also help us to achieve WHO goal “to improve access to health care services and professionals”. Tele-rehabilitation may prove effective as part of the rehabilitation program, especially for diabetic patients who fail to participate in conventional rehabilitation center-based programs due to domestic issues. The factors associated with suboptimal participation in rehabilitation at home are less prevalent. In tele-rehabilitation, patients are not bound to visit rehabilitation center or hospital; hence they have the freedom to perform exercise at home. But the limitations in utilization of this approach are: patient assessment and evaluation in a structured manner, monitoring the effect of program on regular basis, suitability of approach for all type of morbidities & severity levels of diabetes and suitable equipment having required features for patients as well as practitioners.6 Tele-rehabilitation is a prospective opportunity to treat the diabetic patients through regular monitoring with less drop outs rather than center based approach. However, there is a need to identify the types and severity of diabetic patients for whom this approach is safe and effective. Secondly, it is required to define clinical assessment outcomes which can be monitored and assessed. Incorporation of advanced equipment and relevant operational training is indispensable. Development of Standardized documentation for patient evaluation, intervention and outcomes monitoring is imperative to long term sustainability and improvement of practice. It is equally important to ensure the security and confidentiality of Patient’s personal data and privacy.7

EFFECTS OF PHYSICAL ACTIVITY ON QUALITY OF LIFE AMONG FEMALE UNDERGRADUATE STUDENTS

Objective: to determine the effects of physical activity on quality of life among female undergraduate students. Material & Methods: A randomized clinical trial was conducted on n=52 female students, after taking approval from higher authorities of the Bilquis Postgraduate College for Women PAF Nur Khan Base Rawalpindi, The inactive female students >1monthbetween 18-25 years were included in the study. The participants were randomly divided into three groups, such as Light Physical Activity (LPA), Moderate Physical Activity (MPA) and Vigorous Physical activity (VPA) group. The short form (SF-36) was used to observe Quality of Life (QOL), among participant at baseline and after six weeks of intervention. The One Way ANOVA with Tukey HSD post hoc was applied on mean differences for comparison. The clinical significance eta squared (η2) was used. Results: The result showed that Role limitation (mental) was significantly improved in vigorous activity group than the light (MD=21.20, d=0.85, 95% CI=0.97 to 43.37) and moderate (MD=23.94, d=0.96 95% CI=4.05 to 43.83) activity group. While social function showed significant improvement in moderate activity group as compared to light (MD=15.30, d=1.01, 95% CI=3.83 to 26.76) activity and vigorous (MD=9.60, d=0.63, 95% CI=1.68 to 20.88) activity group. The pain also showed significant improvement in moderate activity as compared to light (MD=20.32, d=1.09, 95% CI=5.48 to 35.16) and vigorous (MD=21.97, d=1.18, 95% CI=9.67 to 34.26) activity group. Conclusion: PA significantly improved QOL of female undergraduate students. It was also found that VPA improves role limitation (emotional) while MPA improves social function and body pain.

QUALITY OF LIFE IN PATIENTS WITH NEUROGENIC COMMUNICATION DISORDER

Background: neurogenic communication disorders e.g. Dysarthria, aphasia and Voice disorders impacts the quality of life of individuals. A comprehensive picture for an intense understanding of different dimensions, that affecting QOL in neurogenic communication disorder is needed. Objectives: to determine the Quality of life in patients with neurogenic communication disorders Method: The Study design was comparative Cross-sectional survey. A total of n=100 participants were included through Conventional sampling technique. The data was collected from speech therapy department of Pakistan Railway Hospital (PRH) and NESCOM hospital Islamabad. The male and females both were included in the study. The older adults with age range 50-75 years with neurogenic conditions like dysarthria, aphasia and voice disorders related to stroke, Bell’s palsy Parkinson’s disease and triatic brain injury were included in the study The quality of life was assessed through Stroke Aphasia Quality of Life questionnaire. One Way ANOVA was used for comparison between the different conditions regarding quality of life (QOL). Results: the Mean±SD of age was 61.4 + 7.9 years. A total of n=63 participant were male and remaining n-37 were female. The result of One Way ANOVA can be seen in Table 1, which shows that there no significant difference (p≥0.05) in neurogenic communication disorders regarding QOL. Conclusion: It was concluded that quality of life was compromised equally in +neurogenic communication disorders like dysarthria, aphasia and voice disorders