Rehabilitation Communications is a biannual, peer-reviewed, open-access journal published online and in print, that publishes scholarly input from the scientific and wider community related to the important themes in rehabilitation sciences. The journal emphasizes studies integrating the wider interdisciplinary fields of rehabilitation sciences with hardcore evidence-based. The aim of Rehabilitation Communications is to provide a discussion platform for the rehabilitation community where healthy debate on important topics in rehabilitation sciences is possible. The journal hopes to bring basic scientists, clinicians, administrators, policymakers, and other stakeholders to one platform for the efficient utilization of physical, behavioral, psychological, and pharmaceutical tools in providing comprehensive care for patients with physical and mental disabilities. Rehabilitation Communications primarily publishes original articles and reviews, however, case reports, short communications, special reports, and letters to the editor are also accepted.
The Role of Simulation-Assisted Teaching in Rehabilitation Sciences
Rehabilitation education is increasingly challenged by limitations in traditional apprenticeship-based clinical training, including concerns regarding patient safety, restricted opportunities for early procedural practice, shortages of clinical placements, and variability in clinical exposure among students. These constraints have prompted growing interest in simulation-assisted teaching as an innovative strategy to enhance clinical education in disciplines such as physiotherapy, occupational therapy, and speech-language pathology. This review synthesizes current evidence on the role of simulation-based education in rehabilitation sciences, with particular emphasis on its pedagogical foundations, major modalities, learning outcomes, and implementation challenges. Simulation-assisted teaching encompasses a broad spectrum of approaches ranging from low-fidelity task trainers to high-fidelity computerized mannequins, standardized patients, and emerging technologies including virtual and augmented reality. These methods provide structured, controlled environments that enable learners to practice psychomotor skills, clinical reasoning, and patient communication without risk to real patients. Evidence from systematic and scoping reviews indicates that simulation-based interventions are at least equivalent to traditional instructional approaches for technical skill acquisition and are frequently associated with improvements in learner confidence, engagement, and preparedness for clinical practice. However, barriers including high implementation costs, faculty training requirements, and limited longitudinal evidence regarding long-term transfer of skills to clinical practice remain significant considerations. Overall, simulation-assisted teaching represents an increasingly integral component of contemporary rehabilitation education, offering a safe and standardized framework for developing professional competencies while addressing systemic challenges in clinical training
Copyright (c) 2025 Eman Malik, Aneeza Zara https://creativecommons.org/licenses/by/4.0
Contemporary Cardiac Rehabilitation: Evolution of Approaches and Remaining Challenges
Cardiovascular diseases (CVDs) are the leading cause of death globally, with growing prevalence driven by modifiable risk factors including hypertension, dyslipidemia, poor diet, and sedentary lifestyles. A proven multidisciplinary strategy, cardiac rehabilitation (CR) enhances survival, functional capacity, and quality of life in patients with CVD. Phase 2, the traditional center-based program, delivers structured, supervised exercise and education immediately after cardiac events, significantly improving cardiovascular fitness. Phase 3 CR emphasizes long-term maintenance, fostering self-directed exercise and lifestyle modification; however, participation often declines without structured support. Exercise modalities, including aerobic, resistance, and high-intensity interval training (HIIT), produce multi-system physiological adaptations. Beyond exercise, behavioral counseling, psychosocial support, nutritional guidance, smoking cessation, and medication adherence are essential to comprehensive CR. Emerging delivery model such as home-based CR, hybrid, telehealth, and app-supported programmes, address barriers such as accessibility, travel constraints, and adherence while maintaining clinical efficacy. Despite these innovations, challenges persist, including low referral rates, socioeconomic disparities, digital literacy gaps, and limited long-term data on outcomes. Future CR strategies aim to integrate precision medicine, digital monitoring, wearable technologies, and artificial intelligence to personalize interventions. This review synthesizes contemporary evidence on CR evolution, highlights persistent barriers, and explores strategies for maximizing accessibility, equity, and long-term effectiveness, offering a roadmap toward the next generation of patient-centered, technology-enabled CR.
Copyright (c) 2025 Aimen Shahid, Maha Amin https://creativecommons.org/licenses/by/4.0
Manual Physical Therapies for Carpal Tunnel Syndrome: A Narrative Review of Mechanisms, Techniques, and Evidence
Carpal tunnel syndrome (CTS) is the conventional entrapment neuropathy, influencing millions worldwide and giving rise to pain, paresthesia, and functional impairment. Manual physical therapy has secured acknowledgement as an effective non-invasive approach. This scientific review provides a thorough review of key manual therapy (MT) techniques, counting soft- tissue mobilization (myofascial release, massage, IASTM), carpal bone and wrist joint mobilizations, median nerve neurodynamic gliding, and proximal cervical/thoracic outlet interventions, further with standard procedures (8–12 sessions over 4–8 weeks, often combined with splinting and home exercises). A combination of systematic reviews and network meta-analyses exhibits moderate-to-large short-term advancement in pain severity and Boston Carpal Tunnel Questionnaire scores, with progression in nerve conduction studies. MT frequently ranks highest among non-invasive therapies for pain relief and outperforms splinting or exercise alone, while obtaining outcomes equivalent to surgery in medium- and long-term follow-up with fewer complications and lower costs. Intended procedures include biomechanical relief of the carpal tunnel, enhanced nerve excursion, neurophysiological modulation via dropping inhibitory pathways, and contextual effects. MT is optimal as a frontline intervention for mild-to-moderate CTS. Despite these facts, limitations include clinical diversity and short follow-up in many trials; current evidence strongly supports its combination into clinical pathways. Future research should focus on standardized protocols, long-term consequences, subgroup analyses, and cost-effectiveness studies to process patient selection and optimize dosing.
Copyright (c) 2025 Fatima Saleem, Hasnain Sabir https://creativecommons.org/licenses/by/4.0
Comparative Effects of Vojta, Bobath, and Combined Therapy on Gait and Balance in Children with Spastic Diplegic Cerebral Palsy: A Randomized Controlled Trial
Spastic Diplegic Cerebral Palsy (SDCP), a subtype of Cerebral Palsy (CP) characterized by increased muscle tone predominantly affecting the lower limbs, leads to impairments in balance, gait, and functional mobility in children. This Randomized Controlled Trial was conducted at Al-Farabi Institute, Islamabad, Pakistan, to compare the effects of Vojta therapy (a reflex locomotion approach that stimulates automatic motor patterns), Bobath therapy (a Neuro-Developmental Treatment (NDT) focusing on postural control and functional movement), and their combined application on muscle tone, balance, and gait parameters. A total of 68 children (mean age 4.79 ± 1.74 years) with SDCP were randomly allocated into three groups: Vojta group (received reflex locomotion therapy), Bobath group (received NDT), and combined group (received both therapies in an integrated manner). Interventions were conducted for eight weeks (two sessions per week) along with daily parent-guided exercises. Outcome measures included the Modified Ashworth Scale (a clinical measure of spasticity), Gross Motor Function Classification System (a five-level scale classifying motor abilities), Pediatric Berg Balance Scale (a functional balance assessment tool), and spatiotemporal gait parameters measured using an electronic walkway system. All groups demonstrated significant improvements over time (p < 0.05); however, the combined group showed the greatest gains, with marked reductions in spasticity and improvements in balance and gait characteristics such as step length and stride length. These findings suggest that integrating Vojta and Bobath therapies may provide superior functional outcomes compared to either approach alone. Early implementation of combined therapy may enhance rehabilitation effectiveness in children with SDCP
Copyright (c) 2025 Asad Khan, Unsa Zahoor, Fuldisia Dilawar, Hamza Ahmed, Dr. Bilal Arshed, Aitezaz Khaliq https://creativecommons.org/licenses/by/4.0
Diastasis Recti in Postpartum Women: Association with Delivery Method and Health-Related Quality of Life
Diastasis recti (DR), defined as the separation of the rectus abdominis muscles along the linea alba, is a common postpartum condition resulting from pregnancy-related musculoskeletal changes. Despite its high prevalence, the association between mode of delivery (MOD), DR severity, and postpartum quality of life (QoL) remains insufficiently explored. This cross-sectional study aimed to determine the frequency and characteristics of DR among postpartum women, compare its occurrence between normal vaginal delivery and cesarean section (C-section), and evaluate associated QoL outcomes. A total of 344 primigravida postpartum women aged 20–40 years were recruited from PNS Shifa Hospital and Jinnah Postgraduate Medical Centre, Karachi. Participants were assessed at least six weeks postpartum and diagnosed with DR using the inch-tape method. Demographic and obstetric data were collected through a structured proforma, while health-related QoL was evaluated using the SF-36 questionnaire. Data were analyzed using SPSS version 23. Most participants were aged 26–30 years (46.8%), and 43.0% were overweight. DR was most commonly observed both above and below the umbilicus (68%). A highly significant association was found between MOD and DR location, with C-section participants demonstrating more extensive separation (p < 0.001). Body mass index showed a near-significant association with MOD (p = 0.054). Women who underwent C-sections reported significantly poorer QoL, including greater physical and emotional limitations, higher pain levels, and worse perceived health compared to the previous year. These findings suggest that C-section may be associated with more severe DR and reduced postpartum QoL, highlighting the importance of early screening and targeted physiotherapy interventions.
Copyright (c) 2025 Prem Lata, syeda sana waheed, syed kazim raza, samiya, summaiya sahar, syeda taneem rizvi https://creativecommons.org/licenses/by/4.0
Barriers to Care: Patient Inflow Challenges in Physical Therapy Services
Physical therapy is central to recovery, disability prevention, and quality of life enhancement. However, patient inflow into physical therapy services is restricted by multiple barriers that undermine access, adherence, and continuity of care. This narrative review aimed to synthesize evidence on barriers to patient inflow in physical therapy services, identify emerging challenges, and explore strategies to improve equitable access. A narrative review was conducted using five databases (PubMed, Scopus, Web of Science, CINAHL, Google Scholar) and grey literature from professional and policy organizations. Sources published between 2015 and 2025 were screened, with relevant articles and reports included and synthesized narratively across structural, financial, geographical, cultural, organizational, and pandemic-related factors. Six major categories of barriers were identified. Workforce shortages and infrastructure deficits were most acute in low- and middle-income countries, while financial inequities—such as high out-of-pocket costs and inadequate insurance—were dominant in high-income regions. Geographical disparities, limited rural access, cultural misconceptions, low health literacy, and stigma reduced patient engagement. Organizational inefficiencies, including fragmented referral systems, further constrained inflow. The COVID-19 pandemic magnified these barriers but also accelerated adaptive strategies such as tele-rehabilitation, community-based programs, and direct access models. We concluded that these issues are crucial enough to be put in policy recommendations emphasizing the provision of financial protection, improved referrals, patient education, and incorporation of tele-rehabilitation as an intervention to build a timely resource to mitigate the global burden of disability.
Copyright (c) 2025 Fateh Muhammad, Rab Nawaz Khan, Majid Abbas, Usama Ali, Nouman Khan, Benish Shahzadi https://creativecommons.org/licenses/by/4.0
Prevalence and Risk Factors of low Back Pain; A Case from the Higher Education Institutions in Pakistan
Low Back Pain (LBP) is among the major causes of disability in the world, and it poses serious occupational health challenges to the working class, especially among less active workers like as faculty researchers in universities. The purpose of this study was to find the prevalence of LBP and identify the occupational, psychosocial, and lifestyle risk factors of LBP in faculty members in higher educational institutions. The cross-sectional analytic design was used including 300 faculty researchers of five universities (60 researchers in each Higher Educational Institutions). A standardized questionnaire that included all the items of Nordic Musculoskeletal Questionnaire (NMQ) as well as information about the demographics, work characteristics, physical activity, and psychosocial stress was gathered. Associations were analyzed using descriptive statistics, chi-square tests and multivariate logistic regression. LBP prevalence in the past 12 months was 57.3% (n= 172). Significant risk factors in the multivariate analysis included prolonged sitting (>6 hours/day) (OR = 2.34, 95% CI 1.45–3.78, p < .001), lack of regular physical activity (OR = 1.92, 95% CI 1.18–3.13, p = .009), high perceived work stress (OR = 1.76, 95% CI 1.08–2.88, p = .023), and poor ergonomic workstation setup (OR = 2.01, 95% CI 1.24–3.25, p = .004). We concluded that LBP is prevalent amongst the faculty members of higher education institutions and is correlated with the adaptable work and lifestyle situations. Factors including ergonomics, physical activity promotion, and stress prevention interventions are likely to avoid this burden.
Copyright (c) 2025 Sadia Batool, Kiran Ishaq, Syed Mehran Gillani, Muhammad Kashif Khan, Syed Nazir Abbas https://creativecommons.org/licenses/by/4.0
Rehabilitation of Primary Healthcare Through Family Medicine: Challenges and Opportunities in Public Sector Hospitals in Pakistan
Pakistan’s healthcare system faces persistent challenges of overcrowded tertiary hospitals, weak referral mechanisms, and underutilized primary care services. This study explores the potential of Family Medicine as a strategic intervention for rehabilitating primary healthcare within the public sector. Using a mixed-methods approach combining policy review, case analysis, and stakeholder perspectives, the study identifies key barriers, including a limited trained workforce, inadequate infrastructure, and insufficient policy alignment. Findings demonstrate that Family Medicine, with its holistic and preventive focus, can enhance continuity of care, strengthen referral systems, and reduce unnecessary tertiary-level burden. Integrating digital health tools, continuous professional training, and community engagement emerged as critical enablers for reform. The discussion situates Pakistan’s context within global best practices, highlighting the alignment of Family Medicine-led primary healthcare with Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). The study concludes that effective policy reforms, investment in capacity building, and structured implementation of Family Medicine are essential to establish a resilient, equitable, and efficient healthcare system in Pakistan.
Copyright (c) 2025 Sheeba Zafar, Rehana Ali Shah, Zia Ul Haq https://creativecommons.org/licenses/by/4.0
The Impact of Rehabilitation and Family Medicine Training on Referral Reduction in District Hospitals
Pakistan District hospitals are struggling with repetitive issues of overcrowding, unintegrated referral routes, and inadequate capacity to handle patient volumes. In this narrative review, the authors investigate how the incorporation of rehabilitation service and family medicine training in the reduction of referral rate in district hospitals can be achieved. To identify patterns, advantages and challenges, a systematic review of all peer-reviewed articles, policy reports, and global case studies published between 2015-2025 was reviewed. Results indicate that early rehabilitation intervention helps in patient recovery, improves readmission, and minimizes tertiary care referrals whereas family medicine training improves primary care by increasing diagnostic accuracy, continuity of care and patient satisfaction. All these interventions are combined to form a more effective model of healthcare delivery that will be relevant to the Sustainable Development Goals (SDGs) and, in particular, to health system strengthening and universal health coverage. Finally, the review concludes that burden on tertiary hospitals can be decreased with the implementation of family medicine residency programs, rehabilitation units and formal referral protocols. These improvements are only possible with policy reforms and investment in workforce training in Pakistan.
Copyright (c) 2025 Rehana Ali Shah, Sheeba Zafar, Zia Ul Haq https://creativecommons.org/licenses/by/4.0
Decompression Therapy Helps to Reduce Pain & Improve Function in Patients with Lumbar Disc Protrusion
Traction or Decompression is an effective method used to rehabilitate patients with spinal disc protrusion. Decompression reduces the intra-disc pressure and provides space to allow the disc to remake itself. The objective of this investigation was to measure the effects of lumbar spine decompression therapy in patients with lumbar radiculopathy due to disc protrusion. A single-blind randomized controlled trial of 120 patients was conducted at Max Rehab & Physical Therapy Centre, Islamabad, Pakistan. All the patients were randomly allocated to a decompression group or a control group. Both groups received manual physical therapy treatment, including moist hot packs, soft tissue mobilization, manual spinal traction, lumbar spine mobilization, stretching and strengthening exercises, and a home plan. The only difference was that the decompression group received additional decompression therapy. The collected data included demographics and the numeric pain rating scale (NPRS) scores for the back pain, and the patient's functional levels through the modified Oswestry disability index. The data was collected before 1st visit and after 8th visit. We found that after the end of the 8th session of treatment, there was a significant difference in the baseline (pre) NPRS median interquartile range (IQR) value of the control group 3(1), and the decompression group 2(1), compared to their baseline (pre) values, with a p-value less than 0.001. The pre- (Modified Oswestry disability index (MODI) median (IQR) value of the control group was 43.5(7), and the decompression group was 28(9) with a p-value less than 0.001. We concluded that additional decompression therapy showed better results in managing patients’ back pain and improving their functional level.
Copyright (c) 2025 Abdul Ghafoor Sajjad, Muhammad Shahid Javed, Aiman Alam, Sameen Fatima, Iqra Hamid https://creativecommons.org/licenses/by/4.0
The Effect of Home-Based Intensive Lower Extremity Training on Gross Motor Function in Children with Cerebral Palsy: A Randomized Controlled Trial
Cerebral palsy (CP) commonly causes motor disturbances affecting balance impairment and local movement. While Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) shows promise, its comparative benefits compared to conventional therapy require critical assessment. Therefore, the objective of this study was to compare the effects of HABIT-ILE with conventional therapy and conventional therapy alone on lower limb performance in children with CP. A randomized controlled trial having 44 children with CP aged between 5-12 years was randomized to either: (1) 6-week HABIT-ILE (60 hours) plus conventional therapy (n=22), or (2) conventional therapy alone (n=22). Gross Motor Function Measure-66 (GMFM-66) was taken as the primary outcome. The secondary outcomes consisted of the 6-Minute Walk Test (6MWT), and the Pediatric Balance Scale (PBS). Measures were done at Baseline, end of the intervention, and 3 months follow-up. The results showed that both groups significantly improved the GMFM-66 (HABIT-ILE p<0.001; and control p<0.001), and the difference between the groups was not significant (p=0.34). HABIT-ILE showed more gains than PBS within the context of minimal clinically important difference on a 1-4 cm scale (+4.3 vs +3.1 points; p=0.04). A between-group difference was not found in 6MWT (p=0.72). Subgroup analysis indicated that children with GMFCS Level II obtained the highest gains in HABIT-ILE balance. We concluded that although both the interventions enhanced gross motor function, HABIT-ILE gave certain benefits in the balance, especially in the children who belong to Gross Motor Function Classification System (GMFCS) II. Such results are helpful to justify the rehabilitation strategies focusing on a certain functional profile.
Copyright (c) 2025 Abdul Ghafoor Sajjad, Kiran Ishaq, Aiman Alam, Sameen Fatima, Rakshan Rahim https://creativecommons.org/licenses/by/4.0
Enhancing Rehabilitation Communication in Pakistan: Bridging Gaps Through Culturally Inclusive Approaches and Technological Innovation
The study investigates enhancing rehabilitation communication in Pakistan by bridging the gaps through culturally inclusive approaches and technological innovation. The study’s main objectives are to explore the role of culturally inclusive communication in rehabilitation and to assess the impact of technological innovations in overcoming communication barriers. Another objective is to identify the challenges faced by healthcare providers and patients in adopting these approaches. The population of the study was patients and healthcare professionals taken in equal numbers (250 patients and 250 healthcare professionals). The surveys were used to collect data from the study participants. The study's findings reveal that cultural sensitivity significantly enhances patient trust, engagement, and adherence to rehabilitation protocols. Family involvement plays a critical role in improving rehabilitation outcomes, with 85% of patients identifying it as essential to success. Technological integration, particularly through telemedicine and mobile health applications, positively impacts patient satisfaction. We concluded that technology integration, family support, quality of internet connection, and digital literacy impact rehabilitation communication.
Rehabilitation Communication, Cultural Sensitivity, Technological Innovation, Telemedicine, Pakistan, Disability Inclusion, Mental Health, Healthcare Accessibility.
Copyright (c) 2025 Muhammad Asif Chuadhry, Jahanara Ayaz, Hamail Ayaz, Rakhshan Raheem https://creativecommons.org/licenses/by/4.0
Beyond the Pill: Exercise as a Potential Treatment for Menstrual Migraines
Menstrual migraine (MM) is a prevalent type of headache in women, caused by decreased estrogen levels during the menstruation cycle. It typically occurs two days before menstruation and lasts until the third day of menstrual bleeding. This literature review aims to enhance awareness and understanding of the potential relationship between exercise and menstrual migraines. A literature search was conducted using databases such as PubMed, Scopus, and Google Scholar, focusing on studies that investigate the correlation between exercise and menstrual migraines. Our investigation shows that several treatment regimens are available, including medications and preventive measures. Studies suggest that yoga and high-intensity interval training can be beneficial. We concluded that regular physical activity can help regulate hormone levels and reduce stress, potentially managing menstrual migraines.
Copyright (c) 2024 Avi Choudhary, Himani Kaushik https://creativecommons.org/licenses/by/4.0
Ergonomic Risk Assessment and Upper Limb Musculoskeletal Disorders Among Physiotherapists
Ergonomic risk in a workplace environment can result in musculoskeletal disorders in physiotherapists because of their demanding work. It is a major contributor to musculoskeletal upper limb disorders (WRULDs) and work-related upper limb disorders. This study examines the ergonomics hazards and their connection with WRULDs among physiotherapists. Cross-sectional research was done to investigate ergonomic risk and work-related upper limb problems. 204 physiotherapists, ages 24 to 40, from clinical settings in Islamabad and Rawalpindi, who had at least a year's experience and most of them worked five hours a day, made up the sample. A standardized Nordic musculoskeletal questionnaire was used to assess WRULDs, together with demographic information. Using a Rapid Upper Limb Assessment (RULA) sheet and the pen and paper observational method, the posture was evaluated. The mean age of the research participants was 28.21±3.04, with a mean BMI of 22.94±3.75. In the study, 62% of physiotherapists had reported upper limb disorders. The order of pain was shoulder > wrist > elbow. Postural assessment on the RULA scale showed a mean of 4.26 ±1.18. The result showed that 112 (65.8%) participants were at a low level of risk, 49 (28.8%) of participants were at medium risk, and 9 (5.2%) were at a high level of risk. WRULDs were substantially correlated with ergonomic risk (9.488) (p-value<0.05), according to the chi-square test analysis. The elbow was not shown to be substantially related to ergonomic hazards (p-value>0.05), however, the shoulder and wrist were (p-value<0.05). The study concluded that ergonomic risk is common among physiotherapists, and there is a need to change working posture by adjusting workstation heights, encouraging regular breaks for stretching exercises, and promoting the use of ergonomic tools. It is further concluded that there is an association between ergonomic risk and musculoskeletal problems of the upper limb. The findings emphasize the need for workplace interventions to improve postures and mitigate upper limb musculoskeletal risks among physiotherapists.
Copyright (c) 2024 Saima Saima https://creativecommons.org/licenses/by/4.0
Prevalence of Upper Cross Syndrome and Associated Neck Pain in Lecturers of Private Sector Universities in Peshawar, Pakistan
Upper cross syndrome (UCS) is significantly increased in today's population, especially in lecturers. The condition presents as a posture difficulty caused by hyperactive pectoralis and upper trapezius muscles. The purpose of this study is to determine the prevalence and related risk factors of upper cross syndrome, as well as its relationship with neck discomfort in the lecturers of private sector universities of Peshawar, Pakistan. A cross-sectional descriptive study was conducted on lecturers of private universities in Peshawar, Pakistan. Lecturers having experience of one year or more, both male and female, willing to give informed consent, and lecturers having ages ranging from 25-to 60 years were included. Lecturers having a history of upper body trauma, a history of postural structure deformity, and occupational computer users were excluded. A total of 131 participants were included in the study, 90 participants (68%) were male and 41 (31%) were female. In 56 (42.7%) participants had UCS and the remaining 75 (57.3%) were normal. On the basis of discomfort or pain 57 (43.5%) participants reported having minor neck pain, 53 (40.5%) reported having mild neck pain and 21 (16%) reported severe pain. In conclusion, this study highlights the significant prevalence of UCS among university lecturers in Peshawar's private sector universities, approximately half of the participants were affected by the UCS. P-Value 0.817 shows that there is a weak correlation between UCS and neck discomfort, as evidenced by 43.5% of participants reporting minor neck discomfort and 40.5% experiencing mild neck pain. These results show that postural issues related to UCS are a considerable concern within this population.
Postural Disorder, Neck disability Index, Upper crossed syndrome
Copyright (c) 2024 Baz Meer Afridi https://creativecommons.org/licenses/by/4.0
Frequency of Nomophobia Among Medical Students of Hayatabad, Peshawar, Pakistan: A Cross-Sectional Survey
Nomophobia is a new medical term coined in 2008 by a UK-based health organization. It is an acronym for the term “No mobile phone phobia” and refers to people's anxiety and fear of being unable to use their smartphones due to their battery running out or being out of coverage area. In some cases, it can become a serious mental problem for those affected. This study was conducted to determine the frequency of nomophobia in medical students of Hayatabad, Peshawar, Pakistan. A cross-sectional study was conducted for a period of 6 months from Feb 2021-July 2021 on medical students of Hayatabad and included all 5-year MBBS students in the survey. Participants who did not own their smartphones were excluded from the study. The total sample size was 325 participants. The convenient sampling method was used for data collection. Demographic data was obtained initially, and nomophobia was assessed using the Nomophobia Questionnaire which is a 7-point Likert scale, and performed scoring and minimum score was 20, whereas the maximum possible score was 140. Data was analyzed using SPSS version 21. A total of 130 (40%) males and 195 (60%) females participated in the study. The mean age of the participants was 21.72±3.043 (years). Out of the total 325 participants, a majority (168; 51.7%) reported having moderate levels of nomophobia followed by severe levels. Only 42 (12.9%) participants reported to have mild levels of nomophobia. The current study findings showed that nomophobia is quite common in medical students. Nomophobia is a serious mental health issue and raising awareness is essential to help reduce its impact.
Anxiety, fear, mental health, phobia, smart phone
Copyright (c) 2024 Naveed Ahmad, Iqra Imtiaz, Rehana Safia, Kanwal Ali, Hira Gul, Asma https://creativecommons.org/licenses/by/4.0
Prevalence of Low Back Pain Among Bank Workers in Peshawar, Pakistan
Low back pain (LBP) is estimated to affect 90% of the global population and is considered the most common reason for functional disability worldwide. The objective of the present study was to measure the severity of back pain according to the visual analog scale (VAS), to identify the prevalence of LBP among bank workers, and to determine the primary risk factors of low back pain among bank workers. This study was submitted to and approved by the Institutional Research Committee (IRC) - NCS University System, Islamabad, Pakistan. A quantitative, cross-sectional research design was employed in this study. Data were only collected from those participants, who were willing and met our inclusion criteria after approval from the graduate committee of the NCS- University system. Before the collection of data, permission was taken from the respective participants. Conveniently 405 participants among the bank workers were collected from various banks in Peshawar, Pakistan. The instruments used include a direct interview, a body discomfort assessment tool that consists of a VAS) and a questionnaire. Data was collected by mixed type questionnaire and confidentiality of information and voluntary participation were ensured by the researcher. Data were numerically coded and captured in Excel, using an SPSS 25 version program. The study's findings provide a baseline of information about the prevalence of back pain among bank workers. It was found that 65.6% of the workers had experienced LBP, with males (80.7%) being more vulnerable than females (19.3%). The most affected age range was 25-38 years, which constitutes the largest proportion of the workforce. This high prevalence in such a significant age group could negatively impact a company's productivity. The study also revealed that the prevalence of back pain was highest among those with job experience of more than three years (69.9%), followed by those with 1-2 years of experience (23.3%), and the least among those with less than one year of experience (6.8%).
Copyright (c) 2024 Dr. Ataur Rahman, Iftikhar Ahmad, Muhammad Nauman, Muhammad Ayaz, Muhammad Naeem https://creativecommons.org/licenses/by/4.0
Accessibility Issues Faced by Wheelchair Users: A Cross-Sectional Study
A cross-sectional survey was conducted in Islamabad to determine the accessibility issues faced by wheelchair users in commercial areas. Participants with various disabilities, ranging from spinal cord injuries to partial or full-body amputations, were enrolled using a convenient sampling technique. Exclusions included mentally handicapped individuals and those temporarily using wheelchairs post-surgery but otherwise healthy. The study was conducted from September 2021 to March 2022. Data was collected from 277 participants using a self-structured questionnaire to determine the accessibility issues they face and analysis was done using SPSS version 21. Out of the total of 277 participants, 202 (72.9%) were males and 75 (27.1%) were females. Results indicated that 147 (53.1%) participants reported difficulty finding special parking places for wheelchair users. Additionally, 118 (42.6%) faced issues using sidewalks and walkways due to the absence of handrails, and 95 (34.3%) cited the lack of accessible routes as a major problem. The study concluded that most commercial areas in Islamabad are not wheelchair-friendly, lacking adequate infrastructure to facilitate hassle-free commuting for wheelchair users. The findings highlight the critical need for improvements in urban planning to enhance accessibility in these zones. This study's unique focus on Islamabad provides context-specific insights that differ from broader studies conducted globally. It emphasizes the importance of tailored solutions to address local accessibility issues. The results underscore the necessity of addressing these barriers to ensure inclusivity for all citizens.
Copyright (c) 2024 Iqra Imtiaz, Naveed Ahmad, Asees-ul-Hassan, Liaqat Ali, Muhammad Mustafa, Zoya Mehmood https://creativecommons.org/licenses/by/4.0
Association of Sleep Quality with Musculoskeletal Discomfort in Young Adults
The purpose of the study was to determine the prevalence of sleep quality and musculoskeletal discomfort and to investigate the association of sleep quality with musculoskeletal discomfort in young adults. This was a cross-sectional study, conducted online on young adults in twin cities of Rawalpindi and Islamabad, Pakistan. 354 participants were selected through a convenient sampling technique on the basis of inclusion criteria of healthy adults of both genders with an age range of 18-24 years. Participants with diagnosed neurological/cognitive impairment and musculoskeletal injuries were excluded from the study. A self-structured questionnaire was used to obtain demographic data. Pittsburg sleep quality index and Nordic scale were used to assess sleep quality and musculoskeletal discomfort. Results showed that the mean age of the participants was 21.57± 1.74. Among 354 individuals, only 46 participants (13 %) exhibited sound sleep duration with no sleep disturbance whereas 251 participants (71%) reported mild sleep disturbance. Neck (46.6%) and lower back (36.2) regions have been mostly affected due to sleep disturbances. A significant association (p-value <0.05) between sleep quality and musculoskeletal discomfort has been observed for all body regions except for the neck (p-value 0.94). It is concluded that the prevalence of musculoskeletal discomfort is not common in all body regions however, neck, shoulder, upper, and lower back pain showed the most frequent discomfort. Sleep quality of the majority of young adults was also poor and disturbed and a significant association between the two factors has been observed.
Copyright (c) 2024 Zoya Mehmood, Iqra Imtiaz, Syeda Ruqayyah Fatima, Fatima Hadi, Naveed Ahmad https://creativecommons.org/licenses/by/4.0
Physiotherapy Practice Patterns in the Management of Patients with Knee Osteoarthritis in Khyber Pakhtunkhwa, Pakistan: A Cross-Sectional Survey
Knee osteoarthritis (OA) is one of the leading disabilities throughout the world. With a prevalence of 365 million, the knee is the most frequently affected joint, followed by the hip and the hand. It is characterized by functional restriction and reduced quality of life. Physiotherapists play an important role in preventing them. This study aimed to find out the management preferences used by the Physical Therapists in Khyber Pakhtunkhwa for knee OA treatment. The study was ethically approved by the Khyber Medical University, Institute of Physical Medical and Rehabilitation, Peshawar. This descriptive cross-sectional study surveyed clinical physiotherapists in Khyber Pakhtunkhwa to explore their management preferences for knee OA treatment. Physiotherapists were sampled using purposive sampling. A questionnaire adapted from (Ayanniyi, Egwu, and Adeniyi 2017) was utilized. Frequencies and percentages were calculated for responses. A total of 300 physiotherapists were included in the study. Based on clinical investigation, a majority of physiotherapists (88.8%) demanded an x-ray as a part of the diagnostic process for knee OA, while (11.2%) depended on physical/clinical examination. Therapeutic exercise was the most common protocol approach used by 86.2% of Physical Therapists for knee OA management. The second most common protocol was education on weight reduction (80%). Manual therapy was the choice of treatment for 75.8% of Physical Therapists followed by Transcutaneous Electrical Nerve Stimulation (TENS) (57%), ice/heat (50%), and bed rest advice (39.3). We concluded from this investigation that most Physical Therapists used therapeutic exercise and weight loss as their priorities.
Copyright (c) 2024 Manzoor, Ali Rahman, Arif Shah, Ijaz Ul Haq https://creativecommons.org/licenses/by/4.0
Occupational Stress and Its Association with Musculoskeletal Disorders in University Teachers during COVID-19 Pandemic
The Coronavirus disease (COVID-19) was first observed near the end of 2019, and soon after it became a turning point for the world. Almost all the academic institutes remained closed. This led to the adoption of a ‘hybrid teaching style’ and work from home became the modus operandi for the teachers during the pandemic. The COVID-19 pandemic compounded occupational stress, which is why teachers’ mental and physical health suffered tremendously, giving rise to anxiousness, pressure, headaches, musculoskeletal complications, and bodily exhaustion. The objective of this study was to determine the frequency of occupational stress and its association with musculoskeletal disorders (MSDs) in university teachers during the COVID-19 pandemic. This cross-sectional study was conducted from August 2021 to February 2022, within 6 months duration, after the approval of IRB & EC of Riphah International University, Islamabad. Data was taken from three cities in Pakistan (Rawalpindi, Islamabad, and Bahawalpur). It included 347 full-time teachers aged 25 to 59 from 7 government and private universities. The study utilized the Teachers Stress Inventory (TSI) and Nordic Musculoskeletal Questionnaire (NMQ) to assess stress frequency and musculoskeletal pain, respectively. The mean age of participants was 33 ± 6 years. Out of 347, 49.5% of teachers were from government universities and 50.4% were from private universities. The results revealed that the frequency of stress levels was 119 ± 27.2 in government teachers and 109 ± 18.3 in private teachers. Among government university teachers, 60.4% reported musculoskeletal discomfort, while only 32.8% of the participants from private universities reported discomfort. This study described the weak association (r = 0.08) and non-significant relationship (p>0.05) between occupational stress and musculoskeletal discomfort. The study concludes that mild stress levels were found in university teachers during the COVID-19 pandemic. There was a weak correlation between stress and musculoskeletal disorders.
Copyright (c) 2024 Aasiya Pashtana, Amina Saeed, Asma Naseer, Laraib Anum, Misbah Ghous https://creativecommons.org/licenses/by/4.0
Prevalence of Carpal Tunnel Syndrome Symptoms in Excavator Machine Drivers in District Swat, Pakistan
The objective of this study was to investigate the prevalence of carpel tunnel syndrome (CTS) symptoms among excavator machine drivers in the district of Swat, Pakistan. The duration of the research study was six months and the data was collected within two months. Data was collected by a CTS diagnostic questionnaire. The sample size calculated for the research study was 292. A convenience sampling technique was used in this study. There were 3 categories of diagnostic CTS questionnaire in which 10(3.4%) fell in unlikely CTS (1-2 score category-1), 134(45%) fell in the suggested possibility of CTS (3-4 score category-2) and 148(50.7%) fell in strongly suggestive of CTS (5 or more score category-3). The mean and standard deviation of CTS symptoms among excavator driver participants was 2.4726±0.56465. We observed an association between CTS symptoms and excavator machine drivers through the Chi-square test. The results of this study demonstrate a high prevalence of CTS symptoms among excavator machine drivers in the district of Swat, Pakistan.
Copyright (c) 2023 Rehabilitation Communications https://creativecommons.org/licenses/by/4.0
Effectiveness of Abdominal Hollowing Exercises Versus Conventional Physical Therapy for Low Back Pain in Caregivers of Spinal Cord Injury Patients
This study aimed to compare the effectiveness of abdominal hollowing exercise vs. conventional physical therapy for low back pain (LBP) among caregivers of spinal cord injury (SCI) patients. In this quasi-experimental study via consecutive sampling, 60 subjects with LBP were arbitrarily allocated into two groups: Group A (n=30), who received abdominal hollowing exercise (AHE), group B (n=30), conventional physical therapy for 4 weeks at the Paraplegic Centre, Peshawar. The primary outcome measures were functional disability score through the modified Oswestry Disability Index (mODI) and pain intensity using the visual analog scale (VAS) questionnaire. In terms of the mODI score and the VAS of caregivers with low back pain, a comparison was made between the two groups at baseline and the end of a four-week treatment period. At baseline, comparable results were observed. However, after the treatment, a statistically significant difference was found in both VAS and ODI scores (p<0.05). The VAS scores within group A were significantly lower (3.23±1.61) compared to the baseline scores (4.93±0.78). Similarly, the ODI scores showed a significant improvement (p=0.001) in group A in the fourth week, as compared to group B (p=0.719). AHE demonstrated effectiveness in managing LBP among caregivers of patients with SCI, surpassing the outcomes observed in those who underwent conventional physiotherapy for LBP. Considering the context of chronic LBP in caregivers, it is recommended to integrate AHE into the treatment approach, as it can lead to substantial pain reduction and diminished disability among individuals caring for SCI patients.
Cross-Cultural Adaptation and Psychometric Testing of the Lower Extremity Functional Scale to Urdu Language
The standardization of outcome measurements across studies, conducted in various contexts, is facilitated by the cross-cultural adaptation of questionnaires. It is advised that the procedure should adhere to the standardized methods. In addition to addressing cultural and linguistic issues, the psychometric features of the modified version should be investigated. The purpose of this study was to translate and culturally adapt the Lower Extremity Functional Scale (LEFS) into Urdu and evaluate the reliability, validity, and responsiveness of the Urdu version of the Lower Extremity Functional Scale (LEFS-U. The original version of LEFS was translated and cross-culturally adapted using established worldwide standards. All the participants underwent baseline administration of LEFS-U, 36-item Short Form Health Survey (SF-36), Visual Analogue Scale for Pain (VAS-pain), and Visual Analogue Scale for Disability (VAS-disability), followed by a second administration to the patients’ group after receiving 3 weeks of the intervention. The Global Rate of Change Scale (GROC) was also administered at that time. Furthermore, factor analysis, reliability, validity, and responsiveness of LEFS-U, all were assessed. The LEFS was found internally consistent with Cronbach’s alpha of 0.99 and excellent test re-test reliability, evaluated by Intraclass correlation coefficient (ICC) was 0.98 (95% CI: 0.96-0.99). The LEFS-U has a one-factorial structure, which constitutes 67.85% of the total variance. A significant difference in LEFS-U total score was found between patients and healthy controls (p<0.001). Moreover, Pearson’s correlation coefficient showed a moderate correlation between LEFS-U and SF-36 Physical Function (0.54), Role Physical (0.58), Body Pain (0.61), VAS-pain (-0.50), and VAS-disability (-0.45). The results show that LEFS-U is a reliable, valid, and responsive questionnaire to measure disability in patients with lower extremity disorders.
Prevalence of Burnout in Physical Therapy Students in the Twin Cities of Rawalpindi and Islamabad, Pakistan
Burnout, a condition of physical, emotional, and mental tiredness brought on by sustained involvement in challenging work settings, is widespread among medical students. International studies were conducted on burnout among healthcare students, particularly medical and nursing students, and the levels of burnout reported are concerning. The objective of this study is to find out the prevalence of burnout among physical therapy students. It was a cross-sectional survey conducted in the colleges/universities of Islamabad and Rawalpindi. The data was collected by using a self-structured questionnaire for demographic data and the Copenhagen Burnout Inventory (CBI) scale which assesses burnout in the dimensions of Personal burnout, Work burnout, and student-related burnout, with a cut-off score of 50 for each dimension. A total of 299 DPT students enrolled in this study. The Mean age of participants in this study was 21.05±1.75. The prevalence of personal burnout was 46.2%, work-related burnout was 35.5% and student-related burnout was 39.1%. It was concluded that burnout is common among physical therapy students, with personal burnout being reported as the highest level of burnout.
Frontiers in Neuromuscular Physical Therapy
Neuromuscular physical therapy, also known as neurological physical therapy, focuses on assessing and treating individuals with conditions affecting the nervous system and muscles. It is crucial in promoting recovery, improving function, and enhancing the quality of life for individuals with neurological disorders. As the field continues to evolve, several new frontiers and advancements have emerged in neuromuscular physical therapy. Some of the recent trends in neuromuscular physical trends include the following. Technology-assisted rehabilitation: The integration of technology has revolutionized neuromuscular physical therapy. Various devices, such as robotic exoskeletons, virtual reality systems, and wearable sensors, are being utilized to enhance treatment outcomes. These technologies provide interactive and engaging platforms for therapy, facilitate repetitive practice, and offer real-time feedback on movement performance. They can be particularly beneficial in promoting motor recovery and functional improvements in individuals with stroke, spinal cord injury, and traumatic brain injury. Motor learning principles: There is an increased focus on incorporating motor learning principles into neuromuscular physical therapy interventions. Motor learning involves acquiring and retaining new motor skills through practice and feedback. By tailoring therapy sessions to optimize motor learning, therapists can facilitate more effective skill acquisition and long-term retention. This may involve techniques such as task-specific training, variable practice, and contextual interference. Brain-computer interfaces (BCIs): BCIs are systems that establish direct communication pathways between the brain and external devices. In the context of neuromuscular physical therapy, BCIs hold promise in neurorehabilitation. They enable individuals with severe motor impairments to control external devices or robotic exoskeletons using brain signals. BCIs can provide opportunities for functional restoration, promote neuroplasticity, and enhance the rehabilitation process for individuals with conditions like spinal cord injury or amyotrophic lateral sclerosis (ALS). Telerehabilitation: With the advancement of telehealth technology, telerehabilitation has gained momentum in neuromuscular physical therapy. Telerehabilitation allows therapists to deliver assessment and treatment remotely, overcoming barriers of geographical distance and accessibility. It enables real-time video consultations, remote exercise monitoring, education, and support. Telerehabilitation has the potential to increase access to care, improve convenience for patients, and enhance the continuity of therapy. Personalized and precision rehabilitation: The concept of personalized and precision medicine is increasingly applied to neuromuscular physical therapy. By considering individual characteristics, such as genetics, biomechanics, and neurophysiology, therapists can tailor interventions to meet specific needs and optimize outcomes. Advanced assessment tools like motion analysis systems and genetic testing can provide valuable insights for personalized treatment planning and targeted interventions. These new frontiers in neuromuscular physical therapy hold great promise in advancing the field and improving outcomes for individuals with neurological conditions. Integrating technology, motor learning principles, brain-computer interfaces, telerehabilitation, and personalized approaches can enhance the effectiveness, accessibility, and individualization of neuromuscular rehabilitation programs.
Prevalence of Ankle Sprain in Recreational Football Players of Peshawar Sports Complex, Peshawar, Pakistan
Ankle sprains are a common injury that can occur during recreational sports activities. They account for 22% of all reported sports injuries in emergency departments. Football players are particularly at risk of ankle ligament injuries, which can result in biomechanical, functional, and financial risks. Severe injuries can lead to ligament sprains, reduced ankle mobility, and permanent limitations in athletic activities. The study used a cross-sectional design and collected data from recreational football players at Qayyum Stadium Peshawar. The sample size was 218, while the margin of error was 5% with a confidence level of 95%, and convenient sampling techniques, i.e., statistical tools were used to analyze the data. Data collection was performed using the foot and ankle outcome score (FAOS) questionnaire. A total of 119 players sprained their ankle out of 218 players. A Chi-square test was applied to determine the comparison of ankle sprain and quality of life (P = 0.000). The findings of this study show that football players frequently experience ankle sprain injuries, which negatively impact their confidence and have a significant association with their quality of life.
Foot Health & Its Association with the Quality of Life in Individuals with Foot Dysfunctions
Foot health plays a critical role in maintaining overall health and functions. Foot fitness is dependent upon many factors. Various problems limit the foot's functionality and affect the quality of life. Posture, gait, mobility, and balance are directly related to podiatric health. The study aimed to determine foot health and quality of life in individuals with foot dysfunctions and establish its relationship with quality of life. A cross-sectional survey was conducted among the general population of the twin cities of Pakistan (Islamabad & Rawalpindi). A self-structured online questionnaire was distributed among 323 individuals aged 25-60 years suffering from different foot problems. The study showed that 259 (80.19%) of the participants were females, and 64 (19.81%) were males. Teachers, nurses, beauticians, and housewives reported moderate pain levels on numeric pain rating scales, likely associated with long standing hours and the use of flat and tight shoes. This impacted their ability to perform daily tasks, moderate to vigorous activities, and limited ability to walk. This study concluded that the most commonly reported issues were heel pain, ankle pain, and metatarsalgia. Moreover, the commonly affected foot regions were the hind foot and toes. Diet and social life remained mostly unaffected in individuals with heel pain and edema as these conditions were very common among the selected population, and they adapted their lifestyles accordingly. In conclusion, health and quality of life were negatively impacted in individuals with metatarsalgia, flat foot, and ankle sprain.
The Attitude of Physical Therapy Students Towards Online Education During COVID-19
This study aimed to determine the attitude of physical therapy students toward online education during the coronavirus disease (COVID-19). An analytical cross-sectional survey was conducted on 406 physical therapy students after the approval of the institutional review board & ethics committee (IRB&EC) of Shifa Tameer-e-Millat University. Using a non-probability convenient sampling technique, participants were selected from different universities in Pakistan. Physical therapy students of both genders, aged between 18 to 24, were included. The sample size was calculated by Rao software, and responses were collected through a self-structured online survey. Cronbach's alpha was also applied to check the internal consistency of our self-structured questionnaire, which reached acceptable reliability of α = 0.77. The total valid responses were 387. The results show that 65 (16.8 %) were males, and 322 (83.2%) were females. Student satisfaction showed a moderate positive correlation (r= 0.039, p= 0.442) with the student's attitude toward online education. The study concludes that physical therapy students in Pakistan are not satisfied with the online education system introduced due to the current situation of lockdown. It further concluded that the online education system for physical therapy students in Pakistan is not effective.
Frequency of Musculoskeletal Pain Among Rickshaw Drivers of Rawalpindi, Pakistan
Although rickshaw, a mode of public transport, has existed in Rawalpindi for decades, little is known about its impacts on its drivers' health. Several factors lead to postural stress in rickshaw drivers that are likely to affect the musculoskeletal system and, consequently, musculoskeletal pain. Since rickshaw is an important way of public transit in Rawalpindi, Pakistan, a survey was conducted to investigate the frequency of musculoskeletal pain in rickshaw drivers. This was a cross-sectional study in which 284 rickshaw drivers were recruited from rickshaw stands and surrounding areas within Rawalpindi, Pakistan. Participants ranged in age from 18 to 65 years and were required to be working as full or part-time rickshaw drivers at the time of data collection. Three characteristics, i.e., age, work experience, and driving hours per week, were obtained from these participants. A self-structured questionnaire was used to record the frequency of musculoskeletal pain. Of the 284 subjects of the study, 162 subjects reported musculoskeletal pain. The most commonly reported site of pain was back (64.81%), 32.71% reported knee pain,30.68% reported shoulder pain, 18.51% reported ankle pain, 14.19% reported neck pain, and the least reported anatomical site of pain was elbow (3.70%). The results showed that drivers who had been driving for more than ten years reported more musculoskeletal pain. Also, those who drove a rickshaw for more than 8 hours daily had similar complaints. We concluded that musculoskeletal pain is common among rickshaw drivers. Work experience and working hours also seem to be associated with musculoskeletal pain.