The Rehabilitation Journal <p>The Rehabilitation Journal (TRJ) is an international multidisciplinary peer-review journal published biannually <strong>(Quarterly after December 2021)</strong> in English. TRJ is the official publication of the Health Education Research Foundation (HERF), which is non profit organizaton registered with government of Pakistan under society registration act 1860.</p> <p>The aim of TRJ is to publish articles about all aspects Rehabilitation Sciences and to promote excellence in education, scientific research, clinical practice, health policy, and administration.TRJ publishes two issues in a year and welcomes manuscripts from all over the world in the field of Medical Rehabilitation but not limited to;</p> <ul> <li>Musculoskeletal Rehabilitation</li> <li>Neurological Rehabilitation</li> <li>Cardiopulmonary Rehabilitation</li> <li>Sports Rehabilitation</li> <li>PsychosocialRehabilitation</li> <li>Speech and Language Rehabilitation</li> <li>Community Based Rehabilitation</li> </ul> <p>The overall goal of TRJ <em>is</em> to enhance the interrelationship of practice, research, and education to advance the field of Rehabilitation Sciences for the ultimate benefit of the patient and the field.</p> en-US <p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="">Creative Commons Attribution (CC-BY) 4.0 License</a> that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.</p> (Huraim Ahmed Awan) (Dr Danish Raouf) Fri, 30 Sep 2022 18:06:57 +0000 OJS 60 GYNECOLOGICAL AND PSYCHOSOCIAL RISK FACTORS ASSOCIATED WITH OBESITY IN ADOLESCENT GIRLS <p><strong>Background:</strong> There has been an increase in childhood and adolescent obesity worldwide, which affects the girls resulting low self-esteem and depression and diminishes health- related quality of life. The overweight and obese teenage girls are more likely to have gynaecologic and obstetric complications during adolescence and later in life. <strong>Objective:</strong> To determine gynaecological and psychosocial risk factors associated with obesity in adolescent girls. <strong>Methods:</strong> A cross sectional study conducted at schools and colleges of Islamabad and Rawalpindi with a sample size of n=99. The participants were divided into two groups of which n=25 were obese adolescents (cases) and n=74 were non-obese adolescents (controls). The Data collection was done based on self-structured questionnaire from adolescent females aged 10 to 19 years in cases with BMI &gt;27.5kg/m2 in controls 18.5 to 23kg/m2. The study duration was 6 months from (October- 2020 to March- 2021). Study was conducted in various school and colleges of Islamabad and Rawalpindi. To determine the association odds ratio (OR) was calculated. <strong>Results:</strong> The mean age of the cases was 16.2±2.10 years and 14.78±1.82 years for controls. The BMI of cases was 29.38±1.97 kg/m<sup>2</sup> and a control was 18.06±2.88 kg/m<sup>2</sup>. In gynaecological risk factors cases are more at risk to have excessive acne/pimple on face (Odds ratio: 3.484, p= 0.008), more likely to experience amenorrhea (OR: 4.504, p= 0.007) and more likely to have excessive facial/abdominal hair growth (OR: 3.600, p=0.014). For psychosocial risk factors the cases presented with a greater need/referral of a psychological evaluation (OR: 4.063, p=0.008) and feel social limitation or emotional disturbance (OR: 2.561, p=0.044). <strong>Conclusion: </strong>It was concluded that certain gynaecological and psychosocial determinants could be influenced by adolescent obesity leading to many complications and negative consequences on present and future health outcomes.</p> <p><strong>Key words:</strong> adolescents, females, gynaecologic, obesity, overweight, quality of life</p> Ammara Rauf, Huma Riaz, Hadia Nadeem Copyright (c) 2022 Ammara Rauf, Huma Riaz, Hadia Nadeem Fri, 30 Sep 2022 00:00:00 +0000 COMPARE THE EFFECTS OF STRENGTHENING EXERCISES WITH AND WITHOUT SOFT TISSUE MOBILIZATION FOR THE MANAGEMENT OF TENSION NECK SYNDROME IN FEMALES: A RANDOMIZED CONTROLLED TRIAL <p><strong>Background:</strong> Tension neck syndrome (TNS) is a prevalent condition worldwide. Soft tissue mobilization and strengthening exercises are used in physiotherapeutic rehabilitation of the musculoskeletal disorders. <strong>Objective: </strong>To compare the effects of strengthening exercises with and without soft tissue mobilization (STM) for pain and disability reduction in females with TNS. <strong>Methods: </strong>A single-blinded, parallel-group randomized controlled trial was conducted at the National Institute of Rehabilitation Medicine, Pakistan, from April to July 2016. A total of n=30 females, aged 30-70 years, were recruited through non-probability convenient sampling technique and randomly allocated to the experimental and control group. The experimental group received STM and neck isometric strengthening exercises, whereas the control group received neck isometric strengthening exercises only. The Numeric Pain Rating Scale (NPRS) was used to assess the pain intensity, while Neck Disability Index (NDI) was used for the neck-related disability. The data was collected at the baseline, after the 4<sup>th</sup> session and after the 8<sup>th </sup>session. The repeated measure analysis of variance (RM ANOVA) was used to analyse within the group changes, while the independent t-test was used to analyse the differences between the groups. The data was analysed by using SPSS version 21.<strong>Results: </strong>The mean age of the study participants was 47.9 ± 8.95 years. Within groups’ changes showed that pain intensity, individual items of NDI and its total score showed significant improvement in both the groups from the baseline to the 8<sup>th</sup> session (p £ 0.05). After the 8<sup>th</sup> session, the experimental group showed more significant reduction (p £ 0.05) in pain intensity and neck disability as compared to the control group. <strong>Conclusions: </strong>Soft tissue mobilization when combined with neck isometric strengthening exercises was more effective than exercises alone for reducing the pain intensity and disability in females with tension neck syndrome.</p> <p><strong>Keywords: </strong>Management, neck pain, physical therapy, soft tissue mobilization, strength training</p> Javairia Javaid, Wardah Hussain Malick, Abdul Ahad, Danish Rauf Copyright (c) 2022 Javairia Javaid, Wardah Hussain Malick Fri, 30 Sep 2022 00:00:00 +0000 COMPARISON OF PERCEIVED BENEFITS AND BARRIERS TO EXERCISE AMONG MEDICAL AND NON-MEDICAL STUDENTS <p><strong>Background:</strong> Perceptions of exercise benefits and barriers in medical and non- medical students needs to be explored as it is expected that medical students have more awareness regarding physical activities. <strong>Objective: </strong>To compare the perception of exercise benefits and barriers among medical and non-medical students. <strong>Methodology: </strong>This comparative cross-sectional study was conducted in 6 months from November 2020 to April 2020, on sample of n=289 regular male and female students in the age range of 19-27 years. The data of final year medical students was collected from Azra Naheed Medical College and nonmedical students from Superior University, Lahore Through on probability convenient sampling technique. The perception of exercise benefits and barriers was assessed using the exercise benefit/barrier scale (EBBS). The data was carried out by an online Google form due to the pandemic situation. The independent sample t-test was used to estimate of difference among both groups. <strong>Results: </strong>The mean age of the participants was 23.75±2.11 years. A total of n=164(56.74%) were males and n=125 (43.25%) were females. The result of independent t-test showed no significant difference between medical and non-medical students regarding exercise benefit (91.2±11.66 ver. 91.09±12.83, p=0.93) and barriers (34.97±7.22 ver. 35.27±7.62, p=0.72) as well in total score of EBBS (126.23±14.450 ver. 125.81±16.390, p=0.810).<strong>Conclusion: </strong>It is concluded that medical and non-medical final year students are equally aware about exercise benefits and barriers.</p> <p><strong>Keywords: </strong>Benefits, BarriersExercise, Medical students, non-medical students, hysical activity, Perception</p> Muhammad Usman Zia, Rubab naqvi, Aroosha Abrar, Wajeeha Mahmood, Tahir Mahmood Copyright (c) 2022 Muhammad Usman Zia, Rubab naqvi, Aroosha Abrar, Wajeeha Mahmood, Tahir Mahmood Fri, 30 Sep 2022 00:00:00 +0000 ASSOCIATION OF COMMON TYPES OF HEADACHES WITH VESTIBULAR IMPAIRMENT AND NECK PAIN IN ELDERLY <p>Headache(TTH). The headache is associated with vestibular impairment (VI) and neck pain, but this association has not been studied in elder population. <strong>Objective: </strong>To determine the association of common types of headaches with vestibular impairment and neck pain in elderly. <strong>Methods</strong>: A cross sectional study was conducted from February 2021 to June 2021 at District Headquarters Hospital Narowal using a non-probability convenience sampling technique on n=140 participants. The inclusion criteria include age above 50 years, able to ambulate independently, complaint history of common type of headache. Headache was assessed clinically based on diagnostic criteria. The head impulse test was used to assess the vestibular function. The neck pain presence was asked through close ended question with binary response. The chi-square (x<sup>2</sup>) test used for association between the variables. <strong>Results: </strong>The mean age of the participants was 58.17 ± 7.14 years. The tension type headache was seen in n=76 (54.2%), migraine in n=33 (23.5%) and cervicogenic headache in n=31 (22.1%) patients. Vertigo was seen in n=52 (37%) patients and neck pain in n=82 (58%) patients. A significant association of vestibular impairment with migraine (Chi square value= 7.79, p=0.02) and cervicogenic headache (Chi square value= 6.12, p=0.04). While no significant association with tension type headache (Chi square value= 0.97, p=0.04). All type of headache were significantly associated (p&lt;0.05) with neck pain. <strong>Conclusion</strong>: The vestibular impairment and neck pain are associated with all type of headache, except tension type headache where vestibular impairments are not associated. There was an association between types of headaches and neck pain.</p> <p><strong>Keywords</strong>: Cervicogenic headache, Migraine, Neck pain, Tension type headache, Vestibular impairment (VI).</p> Samia Khaliq, Arshad Nawaz Malik, Saira Jahan, Mahnoor Zia Copyright (c) 2022 Samia Khaliq, Arshad Nawaz Malik, Saira Jahan, Mahnoor Zia Fri, 30 Sep 2022 00:00:00 +0000 EFFECTS OF DOSE-RESPONSE OF NORDIC HAMSTRING EXERCISE ON MUSCLE PERFORMANCE IN ATHLETES, A RANDOMIZED CONTROLLED TRIAL <p><strong>Background:</strong> The Nordic Hamstring muscle training is effective for eccentric strengthening of the hamstring in a sports population. Due to its high volume, its compliance is low and researchers are working to find out its lowest effective dose. <strong>Objectives:</strong> To determine the effects of dose-response of Nordic hamstring exercise on hamstring muscle performance. <strong>Methods: </strong>A randomized controlled trial was conducted from August to November 2020 and comprised of athletes of both genders who were randomized into high (3 times/week, 4 weeks) and low volume (1 time/week, 4weeks) Nordic hamstring exercise groups. The Outcome measures were taken using the single leg hamstring bridge test for hamstring strength, 30-m speed test, agility T-test, anthropometric measurement at 5cm, 10cm, 15cm above the patella. The assessments were taken at baseline, 2nd and 4th weeks. The data were analysed using SPSS 23. <strong>Results:</strong> There were 30(88.2%) males and 4(11.8%) females with a mean age of 23.41±3.67years and a mean BMI of 18.6±3.16. A significant difference (p&lt;0.001) was observed between both groups for all outcome variables post-exercise protocol at 2<sup>nd</sup> and 4<sup>th</sup> week. <strong>Conclusion:</strong> The Nordic hamstring exercise was effective in improving hamstring muscle performance. The higher dose of Nordic Hamstring Exercise was more effective than the lower dose in improvement in muscle size, strength, speed and agility of the participants after 4 weeks of training.</p> <p><strong>Keywords</strong><strong>: </strong>Agility, athletes, hamstring injuries, muscle strength, nordic hamstring exercises, speed</p> Saeed ullah, Aisha Razzaq, Huma Riaz, Suman Sheraz Copyright (c) 2022 Saeed ullah, Aisha Razzaq, Huma Riaz, Suman Sheraz Fri, 30 Sep 2022 00:00:00 +0000 VIRTUAL REALITY VERSUS TRADITIONAL STROKE MANAGEMENT IN IMPROVING ACTIVITY OF DAILY LIVING BALANCE: A RANDOMIZED CONTROL TRIAL <p><strong>Background: </strong>Loss of balance and Activity of daily living commonly compromised in stroke patients. Conventional physical therapy CPT) showed promising result in the rehabilitation of stroke, but these effects are very slow. Virtual reality (VR) technology is an adjunctive therapy that could be applied in neurorehabilitation in conjunction with conventional physical therapy. <strong>Objective: </strong>The aim of the study was to determine the effectiveness of virtual reality and conventional physical therapy (CPT) for stroke management in improving activities of daily living and balance. <strong>Methodology: </strong>A total of n=30 participants with sub-acute ischemic stroke, aged between 45-65 years, were divided into group A and group B. The group A received virtual reality training (VRT) with conventional physical therapy (CPT) for stroke management, while Group B received conventional physical therapy (CPT). The activities of daily living (ADLs) were assessed through Barthel index and balance was assessed through Balance Berg Scale (BBS). The data was collected at baseline, 2<sup>nd</sup> week, 4<sup>th</sup> week and after 6<sup>th</sup> week of intervention. The mixed ANOVA and One way MANCOVA was applied to see the interaction and main effects. The data was analyzed using SPSS 21. <strong>Results: </strong>The mean age of study participants of Group A was 51.533±4.82 years and Group B was 52.53±5.01 years. There is significant interaction effect between interventions and level of assessment in Balance score {F=11.705(1.683, 47.134), p&lt;.001, ηp<sup>2</sup>=.295} as well as activity of daily living {F=4.782(2.209, 61.841), p=.010, ηp<sup>2</sup>=.146} after 6 week intervention. <strong>Conclusion:</strong> Both groups were effective in improving ADLs and balance but VR was more effective as compared to traditional balance exercises.</p> <p><strong>Keywords</strong>: activities of daily living, acute stroke, balance, physical therapy, virtual reality</p> Anam Aftab, Sarah Kafeel, Sonia Munir, Habiba Aslam, Rizwana Butt, Syeda Kaukab Copyright (c) 2022 Anam Aftab, Sarah Kafeel, Sonia Munir, Habiba Aslam, Rizwana Butt, Syeda Kaukab Fri, 30 Sep 2022 00:00:00 +0000 EFFECTS OF ELDOA TECHNIQUE VERSUS MCKENZIE EXTENSION EXERCISES ON NON-SPECIFIC LOW BACK PAIN PATIENTS.: A RANDOMIZED CLINICAL TRIAL <p><strong>Background</strong>: Low back pain may lead cause disability in the patients. There are several physical therapy protocols used to manage the low back pain including McKenzie exercises. The Elongation Longitudinaux Avec Decoaption Osteo Articulaire (ELDOVA) is novel techniques could help to reduce the pain and disability related to lower back problems. <strong>Objective: </strong>to determine the effects and compare the McKenzie extension exercise and ELDOA stretch in non-specific low back pain patients.<strong> Methodology: </strong>A randomized clinical trial was conducted at Railway General Hospital, Rawalpindi and Irada Rehabilitation Center, Buchal Kalan from October 2021 - December 2021<strong>. </strong>The female participants with the age range of 40-69 years and had chronic non-specific low back pain for more than 3 months were included in the study. The participants were randomly divided into group A which received McKenzie extension exercises while group B received ELDOA stretch. The patient’s outcome measures were assessed through Numeric Pain Rating Scale (NPRS), inclinometer for, flexi curve ruler for lordships angle, and Oswestry Disability Index (ODI) for disability. MANCOVA test was used for controlling the covariates at baseline. Friedman with post hoc Wilcoxon test (non-parametric-within group analysis) for ODI variables RMANOVA was applied to observe pairwise changes with-in the groups for ODI total score, lordosis angle at baseline, and end of second, and fourth week of the treatment. NPRS and range of motion (extension, flexion) at pre and post treatment session.<strong> Results: </strong>The mean age of study participant was 44.29±3.08. Within group analysis showed that significant improvement (p&lt;0.05) was observed in both groups regarding ODI total score, NPRS, Lordosis angle and range of motion (flexion, extension) from baseline to the end of 4<sup>th</sup> week and at each level of assessment. The group A (McKenzie extension exercises) was a significantly improved on the combined dependent variables as compared to group B (ELDOA stretch) after controlling for baseline values of BMI, NPRS, lordosis angle and ROMs, F (7, 34) = 55.12, p&lt;0.001, Wilks' Λ=0.018, ηp<sup>2</sup>=0.49.<strong>Conclusion: </strong>McKenzie extension exercise showed better result in improving pain, range of motion, angle of lordosis and disability than ELDOA technique.</p> <p><strong>Keywords: </strong>disability, low back pain, physical therapy, stretching exercises. ROM</p> Muniba Shamshad, Raheela Kanwal, Rizwana Butt, Hafiz Muhammad Manan Haider Copyright (c) 2022 Muniba Shamshad, Raheela Kanwal, Rizwana Butt, Hafiz Muhammad Manan Haider Fri, 30 Sep 2022 00:00:00 +0000 EFFECTS OF PROLONGATION OF SPEECH AND SYLLABLE TIME SPEECH ON REDUCTION OF SEVERITY OF STUTTERING IN STUTTERING PATIENTS <p><strong>Background: </strong>Stuttering is an organic process utterance condition. This utterance condition is broken by prolongation of sounds and repetitions of part words and phrases. Speech constitution strategies facilitate the client to use a new way of oral communication in stutters. <strong>Objective:</strong> to determine the effects of prolongation of speech and syllable time speech on reduction of severity of stuttering in stuttering patients. <strong>Methods </strong>This Randomized clinical trial study design was conducted in National Institute of Rehabilitation Medicine Islamabad. A total of n=30 participants of both gender having developmental stuttering with age between 20-30 years were included in the study through purposive sampling. The n=30 participants were randomly divided in to Group A received prolonged speech protocol (PSP) and Group B received syllable time speech protocol. The data was collected using the Scale of rating severity of stuttering (SRSS) at baseline, after 6th weeks and after 12<sup>th</sup> weeks of training. The data was analyzed through SPSS-21. <strong>Results </strong>The mean age of the study participants was 22±2.05 years. The median number of sibling was 4(2), birth order 2.5(2) and age of onset was 4(1) years. With-in group analysis showed that the group received prolong speech protocol {F=25.24(2), p&lt;0.001} and syllable time speech protocol {F=29.52(2), p&lt;0.001}, both were significantly improved from the baseline to the end of 12<sup>th</sup> week of intervention as well as at each level of assessment. While comparing the groups, there was significantly large mean difference (MD) of SRSS in group received syllable time speech protocol (2.53±.83 ver 1.73±.59, p=0.005, Cohen’s d=0.72) as compared to group received prolong speech protocol. <strong>Conclusion </strong>It is concluded that Syllable time speech was effective in reducing severity of stuttering and improving fluency in stutterers. .</p> <p><strong>Key words: </strong>Stuttering, stammering, fluency shaping therapy, speech therapy.</p> Nasir Khan, Muhammad Imran, Kashif Ali Shah, Aarsa Saeed, Ramsha Haroon, Humaira Shamim Kiani Copyright (c) 2022 Nasir Khan, Muhammad Imran, Kashif Ali Shah, Aarsa Saeed, Ramsha Haroon Fri, 30 Sep 2022 00:00:00 +0000