The Rehabilitation Journal <p>The Rehabilitation Journal (TRJ) is an international multidisciplinary peer-review journal published biannually 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 Rauf) Thu, 30 Dec 2021 20:36:56 +0000 OJS 60 WOMEN’S HEALTH ISSUES: THE CONTINUING APPEAL FOR WOMEN HEALTH PHYSICAL THERAPY PRACTICE IN PAKISTAN <p>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.<a href=""><sup>1</sup></a> 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.<a href=""><sup>2</sup></a><sup>,</sup><a href=""><sup>3</sup></a> 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.<a href=""><sup>4</sup></a> Regrettably, the burden of disease is increased manifolds due to unavailability of expert women’s health physical therapist.<a href=""><sup>5</sup></a> 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.</p> <p>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.<a href=""><sup>6</sup></a> 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.<a href=""><sup>7</sup></a> 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.<a href=""><sup>8</sup></a></p> <p>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.</p> Sidra Qureshi, Furqan Ahmed Siddiqi, Waqar Ahmed Awan Copyright (c) 2021 Sidra Qureshi, Furqan Ahmed Siddiqi, Waqar Ahmed Awan Thu, 30 Dec 2021 00:00:00 +0000 INSPIRATORY MUSCLES TRAINING: AN EFFECTIVE WAY TO IMPROVE POST-OPERATIVE OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING <p>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.<a href=""><sup>1</sup></a> 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.<a href=""><sup>2</sup></a></p> <p>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.<a href=""><sup>3</sup></a></p> <p>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.<a href=""><sup>4</sup></a></p> <p>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.<a href=""><sup>5</sup></a> 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.<a href=""><sup>6</sup></a> 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.<a href=""><sup>7</sup></a></p> <p>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.</p> <p>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.</p> Malik Muhammad Ali Awan, Kiran Khushnood, Nasir Sultan Copyright (c) 2021 Malik Muhammad Ali Awan, Kiran Khushnood, Nasir Sultan Thu, 30 Dec 2021 00:00:00 +0000 FREQUENCY OF THORACOLUMBAR JUNCTION DYSFUNCTION AMONG EQUESTRIAN POLO ATHLETES <p><strong>Background: </strong>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. <strong>Objective: </strong>To determine the frequency of Thoracolumbar Junction Dysfunction (TLJD) among Equestrian Polo Athletes <strong>Methods: </strong>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. <strong>Results: </strong>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. <strong>Conclusion: </strong>Thoracolumbar Junction Dysfunction among Equestrian Polo Athletes was an immensely prevailing condition</p> <p><strong>Keywords: </strong>Athletes, athletic injuries, dysfunction, overuse injuries.</p> Mahina Aleem, Muhammad Faheem Afzal, Adeela Arif, Hafiz Muhammad Manan Haider, Lal Gul Khan Copyright (c) 2021 Mahina Aleem Fri, 31 Dec 2021 00:00:00 +0000 EFFECTS OF KETTLEBELL HIGH-INTENSITY INTERVAL TRAINING (HIIT) PROTOCOL ON UPPER-BODY POWER <p><em><strong>Background: </strong></em><em>Upper body powers are the major fitness component of majorities of games which is necessary to improve. Kettle bell swing stimulus for upper body performance is little unique, that is sufficient to increase both maximum strengths with explosive execution.<strong> Objective</strong></em>: To evaluate the effects of kettlebell high-intensity interval training protocol on upper body power. <em><strong>Method</strong></em>: The randomized control trials (RCT) on amateur athletes were conducted at I-8 Active Gym at I-8 Markaz Islamabad Pakistan after approval from CEO. Data was collected through non probability convenience sampling technique. A total of n=40 volunteer amateur athletes were recruited without neuromuscular injury in the last 6 months and randomly divided experimental and control groups. The experimental group received Kettelbell Exercises and the participants in the control group, on the other hand, went about their regular lives without engaging in any fitness training. Subjects were assessed before and after 12 weeks using Medicine ball throw tests, measured by distance covered in centimetre (cm) for upper body explosive power. The medicine ball throw test was used to upper body strength. All statistical analyses were calculated by the SPSS statistical package. <strong>Result:</strong> The mean age of the study participants was 21.66 ±1.71. The mean weight and height were 62.55±4.04 kg and 5.78±0.14 feet respectively. All participants were in the normal BMI range (20.11±0.62). Both groups were comparable at the baseline (p≥0.05) in upper body strength. While after 8<sup>th</sup> week experimental group showed more significant improvement with large effect size (95.94±9.52 ver. 83.60±11.20, MD=12.34, p=0.001, d=1.07) in upper body power as compare to control group. <strong>Conclusion:</strong> The Kettle Bell High Intensity Interval Training (KB-HIIT) program is beneficial for enhancing upper body explosive strength.</p> <p><strong>Keywords: </strong>High Intensity Interval Training, kettle bell exercises, power, strength.</p> Ismat Ullah, Mohibullah Khan Marwat, Muhammad Shah, Fozia Jamshaid, Iqra Rizwan, Manzar Shabab Yousuf Copyright (c) 2021 Ismat Ullah, Mohibullah Khan Marwat, Muammad Shah, Fozia Jamshaid, Iqra Rizwan, Manzar Shabab Yousuf Thu, 30 Dec 2021 00:00:00 +0000 EFFECTS OF MOTOR IMAGERY TECHNIQUE ON LOWER LIMB FUNCTION AMONG STROKE PATIENTS <p><strong>Background: </strong>Stroke is one of the leading causes of disability and most of the stroke survivors have limit their upper extremity functions. Motor imaginary technique is the innovative technique for engaging the brain areas either prior to or simultaneously with movement. <strong>Objective:</strong> To determine the effects of motor imagery technique on lower limb function. <strong>Methods:</strong> Randomized control trial was conducted, 20 post stroke patients included through non probability purposive sampling technique in Bibi Zahida Memorial Teaching Hospital, Peshawar, randomly allocated through sealed envelope method into control and experimental group. Conventional therapy for Control group while motor imagery plus conventional for experimental group performed 20 minutes motor imagery plus conventional therapy 3 times/week for 6 weeks, evaluation done at baseline, 2<sup>nd,</sup> 4<sup>th</sup> and 6<sup>th</sup>week.Lower Extremity Function scale (LEFS), Modified Ashworth scale (MAS), Dynamic Gait Index (DGI) and Time Up and Go test (TUG) and Stroke Specific Quality of Life Scale (SS-QOL) utilized for assessment and analysed through SPSS 22 version. <strong>Results: </strong>This study showed that significant improvement after 6 weeks of intervention in LEFS in experimental group was p&lt;0.007 while in control group was p&lt;0.494. DGI in experimental group was p&lt;0.001 while in control group was p=0.015. TUG in experimental group was p&lt;0.001 while in control group was p=0.007. MAS in experimental group was p=0.002 while in control group was p=0.019. SSQOL in experimental group was p=0.027 while in control group was p=0.194. <strong>Conclusion: </strong>Motor imagery plus conventional therapy significant improvement in lower extremity function, gait, spasticity and quality of life in stroke patient’s compared conventional therapy in 6 weeks.</p> <p><strong>Keywords</strong>: Gait, Lower extremity function, Motor imagery, Quality of life, stroke.</p> Izhar Uddin, Mirza Obaid Baig, Aruba Iram Copyright (c) 2021 Izhar Uddin, Mirza Obaid Baig, Aruba Iram Thu, 30 Dec 2021 00:00:00 +0000 ASSOCIATION BETWEEN FORWARD HEAD POSTURE, PAIN SEVERITY AND DISABILITY IN UNDER-GRADUATE PHYSICAL THERAPY STUDENTS WITH NECK PAIN <p><strong>Background: </strong>Excessive neck flexion may lead to a forward head posture in which Craino-vertebral angle (CV angle) is decreased. Prolonged forward head posture may lead to postural impairment. Pain and disability of neck is increased with forward head posture. <strong>Objective</strong>: To find out the association of forward head posture with pain and disability in under-graduate physical therapy (PT) students. <strong>Methodology</strong>: A correlational study was conducted on n=34 male and female undergraduate PT students, with forward head posture. The n=34 participants were divided into group A having crainovertebral angle &lt;50 with neck pain and without neck pain were assigned to group B. The Craniovertebral angle, Northwick Park Neck Pain Questionnaire and Numeric Pain Rating Scale were used to measure head posture, pain and disability. The Pearson moment correlation was used find association among the variables. <strong>Results</strong>: The mean age of study participants was 21.1±1.87. The results showed that there is no significant association (p&lt;0.05) in both groups, between forward head posture (CV angle) with pain and self-perceived disability due to neck pain. <strong>Conclusion</strong>: Neck pain and disability showed no association with craniovertebral angle in both groups.</p> <p><strong>Keywords:</strong> Disability, neck pain, posture</p> Irfana Shahid, Mehwish Ikram, Syed Shakil ur Rehman Copyright (c) 2021 Irfana Shahid, Mehwish Ikram, Syed Shakil ur Rehman Fri, 31 Dec 2021 00:00:00 +0000 COMPARISON OF INJURY PREVENTION PROGRAM ON PHYSICAL FITNESS AMONG CRICKETERS IN WARM-UP AND COOL-DOWN PHASES <p><strong>Background:</strong> Cricket is considered 2nd most famous sports while the chances of injuries are very high. Proper warm-up, cool down exercises play important role in reduction of injuries and cricket injury prevention program may be effective in warm-up or cool-down phases of training. <strong>Objective:</strong> To compare the effects of injury prevention program on physical fitness among cricketers in warm-up and cool-down phases. <strong>Methods:</strong> A Randomized Clinical Trial (<strong>NCT04017715)</strong> was conducted at Rawalpindi cricket club. Subjects were recruited through purposive sampling. The inclusion criteria were athletes registered with Pakistan Cricket Board, age 16-30 years and attending minimum 3 sessions were week. The n=55 subjects were recruited and randomly divided into three groups by sealed and envelop method. Cricket Injury Prevention Program introduced in warm-up and cool-down phases in Group A (n=18) and B (n=20) respectively and group C (n=17) is considered as control group for 6 weeks. Assessment were taken through 100m sprint, Burpee test, Illinois Agility Run test, plank test and star excursion balance test at baseline and after 6 weeks of intervention. Data analysis was done through SPSS 25. <strong>Results:</strong> The mean age of the subjects was 19.31±2.79, mean Body Mass Index was 18.77±1.58. There is a significant difference among all groups in 100m sprint, T agility, plank test, 3 minutes burpee test and start excursion test (p value˂0.05).<strong>Conclusion:</strong> Cricket injury prevention program (CIPP) is effective in preventing injuries in cricketers in both warm up and cool down.</p> <p><strong>Keywords:</strong> Athletics performance, Cricket sport, Cool-down exercises, Warm-up exercises.</p> Muhammad Faheem Afzal, Amna Imran, Adeela Arif, Aamir Gul Memon, Khurrum Sarfraz, Hafiz Muhammad Waseem Javaid Copyright (c) 2021 Muhammad Faheem Afzal, Amna Imran, Adeela Arif, Aamir Gul Memon, Khurrum Sarfraz, Hafiz Muhammad Waseem Javaid Fri, 31 Dec 2021 00:00:00 +0000 PSYCHOMETRIC ANALYSIS OF URDU VERSION OF SHOULDER PAIN AND DISABILITY INDEX: A RELIABILITY AND VALIDITY STUDY <p><strong>Background: </strong>Shoulder-related pain leads to disability due to the impairment of functional movements of the shoulder and affects the quality of life. Realizing the importance of cultural adaptation and validation, Shoulder Pain and Disability Index (SPADI) is need to be translated and validated in the Urdu language<strong>. Objective:</strong> to determine the validity and evaluate the reliability of the Urdu version of the Shoulder pain and disability index (SPADI-U) in the Urdu-speaking population with shoulder pathologies in Pakistan.<strong> Methodology: </strong>The SPADI-U was administered to 135 respondents; of which 105 were subjects with shoulder pathology and the remaining 30 were healthy individuals for determination of its discriminant (Construct) validity. Visual analogue scale (VAS) and active range of motion were used to evaluate its convergent (construct) and criterion validity, respectively. It’s internal and intra-rater reliability was also evaluated and a retest was conducted after 2-3 days of first administration and was completed by 50 patients. The data were analysed in SPSS version 21.<strong> Results: </strong>Cronbach’s alpha value for SPADI-U was 0.920, and intraclass coefficient (ICC, 95% CI)) value ranged between 0.700 and 0.938 for individual items. High values of 0.935 (0.887-0.963) for a total SPADI score were observed. The Pearson’s correlation coefficient showed moderately negative correlation (range r= -0.457 to -0.683) with SPADI-U indicating its acceptable criterion validity. Whereas, the high positive correlation of VAS with SPADI; for pain (r=0.871, 0.910, 0.891) and disability (r= 0.877, 0.915 and 0.813), showing good convergent validity. Mann-Whitney U-test was used for discriminant validity with significant difference (<em>p&lt;0.05</em>) between the groups. No floor and ceiling effect was found. <strong>Conclusion:</strong> SPADI-U is valid and reliable tool for use in Urdu speaking individuals.</p> <p><strong>Key words:</strong> Psychometrics, reliability and validity, shoulder, SPADI-U, Urdu version</p> Keramat Ullah, Nimra Ilyas Bhutta, Abdul Haseeb Bhutta Copyright (c) 2021 Keramat Ullah, Abdul Haseeb Bhutta, Nimra Ilyas Bhutta Thu, 30 Dec 2021 00:00:00 +0000 EFFECTIVENESS OF STABILITY BALL EXERCISES COMBINES WITH ERGONOMIC SETTING IN PREGNANCY RELATED LOW BACK PAIN. A RANDOMIZED CONTROL TRIAL <p><strong>Background: </strong>Pregnancy related low back pain (PR-LBP) is very common, which affects activities of daily life including work, sleep, physical activity and compromise the quality of life. The prevention PR-LBP through physical therapy is uncommon in Pakistani population. <strong>Objective:</strong> to determine the effectiveness of stability ball exercises (SBE) in combination with ergonomic training (ET) in pregnancy related low back pain (PR-LBP). <strong>Methodology:</strong> A single blinded, randomized clinical trial was conducted at physical therapy department of Haleema Siraj Hospital Rawalpindi Pakistan. A total of n=90, who were coming to the clinic for follow-up, fulfilled the inclusion criteria and were thus recruited through non-probability convenient sampling technique. The study participants were randomly divided in to two groups i.e. SBE (n=45) and combination of SBE with ES (n=45), through lottery method. Quebec disability scale (QDS) was used to determine the functional disability. <strong>Results:</strong> The mean age of study participants was 26.5±4.56723 years. Significant improvement was observed in both groups with larger effect size throughout the treatment duration (p&lt;0.05).<strong>Conclusion:</strong> SBE and combination of SBE with ES significantly reduced low back pain and functional disability</p> <p><strong>Keywords: </strong>activities of daily living, disability, ergonomic, posture, pregnancy, pregnancy related low back pain, stability ball exercises.</p> Anam Aftab, Amjad Rashed Hamdan Alyahyawi, Sara Kafeel, Nabeela Kanwal, Javeria shehzadi, Hadia Nadeem, Rizwana Butt Copyright (c) 2021 Anam Aftab, Amjad Rashed Hamdan Alyahawi; Sara Kafeel; Nabeela Kanwal; Javeria shehzadi, Hadia Nadeem, Rizwana Butt Thu, 30 Dec 2021 00:00:00 +0000 IMPACT OF SUPERVISOR SUPPORT AND HEPATITIS C STIGMA ON EMPLOYEE PERFORMANCE WITH MEDIATING EFFECT OF SELF EFFICACY AND PREJUDICE: EVIDENCE FROM PAKISTAN <p><strong>Background: </strong>Stigmatization also excessively upsetting the people who are suffering from Hepatitis C. In employees perspective they suffers more when those patients stigmatizes in the working environment at this point they are at risk and any exploitation from their supervisors effect worsen then in normal condition. Lack of resources, damage health and negative behaviour can directly impact the efficacy of employee. <strong>Objective: </strong>to determine the impact of supervisor support and hepatitis C stigma on employee performance with mediating effect of self-efficacy and prejudice.<strong> Methodology: </strong>A cross-sectional correlational study was conducted at different private and government hospitals of the Rawalpindi and Islamabad. The sample of n=242 hepatitis C (HCV) patients with age between 25-50 years, having 5-year experience and positive with HCV were included in the study were taken during June 2020 to March 2021. The HCV stigma scale, Supervisory support scale, prejudice scale, self-Efficacy scale and employee performance scale was used for data collection. . This data was analysed by SPSS version 20. <strong>Results:</strong> The mean age of participants was 33.3 ±10.5 years. A total of n=242 (85.10%) were males and n=36 (14.90%) were females. HCV stigma has negative correlation (with r=.45 p<em>=.05</em>) performance of employees through increased prejudice (r=.45, <em>p=.04</em>) and lower self-efficacy whereas (r=.45,<em> p=.05</em>) supervisory support can moderate this relationship to enhance the performance at the workplace (r=.45, p=.05). <em><strong>Conclusion:</strong></em> The positive effect of Supervisor Support is clear from the results. Hence, if the Supervisor Support invades the relationship of HCV Stigma and Self Efficacy and Prejudice and their ultimate impact on Employee Performance, it alters their impact.</p> <p><strong>Keywords: </strong>Hepatitis C-Stigma, Supervisory Support, Self-Efficacy &amp; Prejudice, Employee Performance.</p> Ali Raza Nemati, Sarah Ali Nemati, Wasmiya Javed, Taimoor Javed Copyright (c) 2021 Dr Ali Raza Nemati, Sarah Ali Nemati, Wasmiya Javed, Taimoor javed Thu, 30 Dec 2021 00:00:00 +0000