Association of demographics, lumbar active range of motion and disability in chronic low back: a baseline data analysis of a randomized controlled trial from Pakistan.

BACKGROUND: The disability and significant economic costs accredited to Low back pain (LBP) are likely to rise which is an essential problem in low and middle-income countries like Pakistan. The associated factors of LBP are age, sex, and race including physical activity, high spinal load, lifting, bending, and twisting occupations. The literature highlighted there is substantial differences in associated factors of LBP within available studies in developing countries. The objective is to investigate the association of demographic factors and lumbar range of motion with disability in patients with chronic low back. METHODS: A baseline data analysis was performed as an analytical cross-sectional study among 150 patients with chronic low back in a randomized controlled trial with a duration from March 2020 and January 2021. After recording demographics, Modified-Modified Schober's test was used to measure lumbar flexion and extension and Oswestry disability index for disability. After the descriptive analysis the continuous variables, age and pain were analyzed with Spearman's correlation. Variables that were significant in bivariate analysis were then fitted in a multivariable linear regression. The Kruskal-Wallis test was used to analyze variations of disability in gender, marital status, work status, education level, and duration of pain. The p-value of 0.05 was significant. RESULTS: The results showed a significant correlation between age and pain in sitting (rh=-0.189, p = 0.021 and rh = 0.788, p < 0.001) with the disability but no significant effects of age and pain in sitting (B=-0.124, p = 0.212 and B = 1.128, p = 0.082) on disability were found. The decrease in lumbar flexion and extension was found to increase disability (B=-6.018 and - 4.032 respectively with p < 0.001). Female gender (x2(1) = 15.477, p = < 0.001) and unmarried marital status (x2(1) = 4.539, p = 0.033) had more disability than male gender and married marital status, respectively. There was a significance between groups of the duration of pain regarding disability (x2 (2) = 70.905, p < 0.001). Age, education level, and work status showed no significance (p > 0.05). CONCLUSIONS: The female gender and unmarried marital status are associated with functional disability. Decreased lumbar range of motion accompanies more disability, while age, education level, and work status do not effect on disability.

Bilateral Asymmetrical Limb Proprioceptive Neuromuscular Facilitation Effects on Pain, Multifidus Activity, Range of Motion, and Disability in Low Back Pain: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to determine the effects of bilateral asymmetrical limb proprioceptive neuromuscular facilitation (PNF) pattern exercises on lumbar multifidus (LM) activity, pain, disability, and lumbar range of motions (ROMs) compared to Swiss ball exercises in patients with chronic low back pain (CLBP). METHODS: A randomized controlled trial was conducted at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan, between March 2020 and January 2021. A sample size of 150 patients with CLBP was randomized into 2 groups. Participants in the intervention group (n = 75) received bilateral asymmetrical limb PNF, while the comparison group (n = 75) received Swiss ball exercises. The scores of the visual analog scale, Oswestry Disability Index, Modified-Modified Schober's test, and percentage of the maximum voluntary contractions of LM (%MVC LM) through surface electromyography were recorded before and after 15 sessions of exercises. The Wilcoxon signed rank and Mann-Whitney U tests were employed for within-group and between-group comparisons of all outcomes, respectively. The considered level of significance was 0.05. The trial was registered with ClinicalTrials.gov (NCT04206137). RESULTS: Pain (in sitting, standing, and walking), disability on the Oswestry Disability Index, and left side %MVC LM were significantly improved (P < .001) in the PNF group compared to the comparison group except for right side %MVC LM and ROMs on the Modified-Modified Schober's test (P > .05). CONCLUSION: Bilateral asymmetrical limb PNF exercises showed improvement in pain, disability, and LM activity of patients with CLBP more than those who used Swiss ball exercises.

Effect of exercise training program in post-CRET post-CABG patients with normal and subnormal ejection fraction (EF > 50% or < 50%) after coronary artery bypass grafting surgery.

The aim of the present study is to compare the effect of exercise training program in post-Cardiac Rehabilitation Exercise Training (CRET), post-CABG patients with normal & subnormal ejection fraction (EF >50% or <50%) who have undergoing coronary artery bypass grafting (CABG) surgery. The study was conducted on 100 cardiac patients of both sexes (age: 57-65 years) who after CABG surgery, were referred to the department of Physiotherapy and Rehabilitation between 2008 and 2010 at Liaquat National Hospital & Medical College, Karachi. The patients undertook exercise training program (using treadmill, Recumbent Bike), keeping in view the Borg's scale of perceived exertion, for 6 weeks. Heart Rate (HR) and Blood Pressure (BP) were measured & compared in post CABG Patients with EF (>50% or <50%) at the start and end of the exercise training program. Statistical formulae were applied to analyze the improvement in cardiac functional indicators. Exercise significantly restores the values of HR and BP (systolic) in post CABGT Patients with EF (>50% or <50%) from the baseline to the last session of the training program. There appeared significant improvement in cardiac function four to six weeks of treadmill exercise training program. After CABG all patients showed similar improvement in cardiac function with exercise training program. The exercise training program is beneficial for improving exercise capacity linked with recovery cardiac function in Pakistani CABG patients.

The relationship between sleep and cognitive functioning in adult people.

The purpose of the current study is to find out if subjective sleep complaints will have less cognitive functioning in older people (50 years and above). Sleep was assessed with the subscale Sleep Problems of the Symptoms Checklist-90 (Arrendell & Ettema 1986). Cognitive performance was measured with the Mini Mental Status Examination (Folstein, et al 1975) which is used as a dependent variable. Subjective complaints would be negatively associated with cognitive performance, since in elder people biological sleep is likely to be related with cognitive changes. A group of 12 people were given the task of collecting data through purposeful sampling techniques. Sample size of 120 participants was assessed. Each member of the group collected data from 10 subjects. Pearson Correlation Moment was applied for data analysis. In older persons the coefficient of falling asleep difficulty was -0.05 (p=0.33) and for waking up too early the coefficient was -0.13 (p=0.012) while for restless sleep coefficient was calculated as -0.09 (p=0.094). The assumption was verified that sleep problems negatively associated with cognitive functioning.

Intrarater and interrater reliability of digital calipers in assessing Achilles tendon thickness in patients with knee osteoarthritis.

OBJECTIVE: This study aimed to evaluate the intrarater and interrater reliability of measuring Achilles tendon (AT) thickness using a digital caliper in patients with knee osteoarthritis. METHODS: A cross-sectional survey was conducted at the Physiotherapy Department of Rabia Moon Hospital, involving the recruitment of 61 patients with knee osteoarthritis. Measurements were taken in millimeters at a 90-degree angle, approximately 5 cm from the attachment to the calcaneus, precisely where the ankle joint joins the medial malleolus. Two physical therapists conducted two testing sessions, separated by 7 days, to assess both the intrarater and interrater reliability of the digital caliper. During the second session, two raters simultaneously assessed the patients' responses on the digital caliper. The study analyzed reliability indices, including the Intraclass Correlation Coefficient (ICC) and Bland-Altman plot. RESULTS: The study found high intrarater reliability for the digital caliper, with an ICC of 0.96 (95% confidence interval: 0.22, 0.99). For interrater reliability, the ICC was 0.98 (95% CI: 0.96, 0.98) in patients with knee OA. Additionally, both interrater and intrarater agreement for measuring AT thickness with the digital caliper fell within acceptable limits on 95% of occasions, as indicated by the Limits of Agreement values: 0.32 to -0.53 mm for interrater agreement and -0.35 to -0.04 mm for intrarater agreement. CONCLUSIONS: Digital Calipers have been found to provide excellent intrarater and interrater reliability when used to measure AT thickness in patients with knee osteoarthritis (OA).

Effects of Physical Activity on Thyroid Stimulating Hormone Levels in Obese Metabolic Syndrome Patients: A Meta-Analysis.

Metabolic syndrome is a combination of multiple disorders that predispose an individual to risk of diabetes, obesity, cardiovascular diseases (CVDs), cerebrovascular accidents (CVAs), and insulin-resistance. Hypothyroidism is the most prevalent metabolic disorder causing obesity, followed by hypercortisolism and hypogonadism. Hence, this study aimed to determine the effects of various exercises on thyroid stimulating hormone (TSH) levels in obese patients with metabolic syndrome. The study conformed to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) standards. The PubMed, Cochrane, Google Scholar, Medline, and Biomed Central databases were searched using the keywords exercise, aerobic, rehabilitation, etabolic syndrome, and thyroid stimulating hormone. Studies in English language published between 2010 and 2021 and that examined the efficacy of physical therapy management with sham treatment on TSH levels in patients with obesity were included. The meta-analysis comprised of 526 patients with metabolic obesity from 10 randomised controlled trials. The analysis revealed that when compared with the control group, exercise had a moderate pooled effect on lowering TSH levels, with an effect size standardised mean difference (SMD) of -0.56 (95% Confidence Interval (CI), -1.09-0.02) estimated using a random effects model, with an I2 of 86.61% (95% CI, 77.31-92.10) in the interventional group. It was concluded that although a pooled moderate effect of training on TSH levels was observed when all the studies were analysed using a continuous measure analysis SMD model, an individual analysis of the studies revealed a mild effect, with many studies also revealing the negative impact of training on TSH levels. Nonetheless, exercise-based intervention strategies are safe and effective as a management strategy for hypothyroidism and obesity due to hypothyroidism. Key Words: Thyroid hormone, Exercise, Metabolic syndrome, Obesity, TSH level.

Effect of nature-based physical activity on post-traumatic growth among healthcare providers with post-traumatic stress.

The purpose of this randomized control trial was to observe the effect of nature-based physical activity in achieving post traumatic growth and to estimate the combined effect of nature and physical activity on the psychophysiological outcomes. A 3-month therapy was provided to participants meeting eligibility criteria to receive the walk-in nature (experimental group) or sit-in nature (control group) in the 1:1 ratio. At baseline and 3-month follow-up, participants were assessed with Trauma Symptom Checklist 40, Traumatic Stress Scale, Post-Traumatic Growth Inventory (PTGI), Cortisol, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Brain-Derived Neurotropic Factor (BDNF) and heart rate variability. There was a significant effect of nature-based physical activity on traumatic stress and post-traumatic growth in comparison with the sit-in control. A significant post-interventional difference was observed in the mean PTGI score [F = 5.412, p = 0.022] between the experimental and control groups after 3 months of intervention. All the biochemical estimates, including CRP, BDNF, IL-6, and cortisol levels, were significantly altered in both post-intervention study groups (p < 0.01). Taken together, these results show that nature-based physical activity significantly improves psychophysiological outcomes induced as a result of post-traumatic growth and also reduces traumatic stress.

Importance of Multifidus Muscle Activity as a Treatment Outcome Measure in Chronic Low Back Pain.

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Physiological biomarkers of chronic stress: A systematic review.

OBJECTIVE: The basic objective of this systematic review was to identify potential biomarkers for chronic stress. METHODS: A systematic review of studies linking biomarkers in people with chronic stress was conducted using PRISMA guidelines. The last 40 years' studies were included in the systematic review with no age restrictions; animal studies were excluded from the study. Electronic databases including PubMed, Embase, and Google Scholar were searched for the study purpose. The studies were searched using the combinations of search terms that comprised chronic stress together with the keywords hypothalamic-pituitary-adrenal axis (HPA axis), autonomic nervous system (ANS), immune system, metabolic biomarkers, cortisol, hair cortisol, salivary cortisol, urinary cortisol, epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), brain-derived neurotropic factor (BDNF), metabolic biomarkers, antioxidants, glucose, hemoglobin, C-reactive protein (CRP), cytokines, pro-inflammatory cytokines, anti-inflammatory cytokines, and tumor necrosis factor (TNF). RESULTS: A total of 37 studies out of 671 studies met the eligibility criteria and were included in this review. Potential diagnostic biomarkers of chronic stress included cortisol, ACTH, BDNF, catecholamines, glucose, HbA1c, triglycerides, cholesterol, prolactin, oxytocin, dehydroepiandrosterone sulfate (DHEA-S), CRP, and interleukin - 6 and 8. While the others including antioxidants and natural killer (NK) cells require further validation. Taken together, addition, these stress biomarkers have critical prognostic capacities for stress-associated diseases and therapeutic guidance. CONCLUSION: This systematic review provides an update to the literature by highlighting the role of physiological biomarkers in chronic stress and describing their prognostic and therapeutic values.

Effects of osteoanabolic exercises on bone mineral density of osteoporotic females: A randomized controlled trial.

OBJECTIVES: With the increase in the life expectancy of older adults, the scoring diagnosis of osteoporosis has been highly reported hence rising the incidence of fragility fractures due to decrease in bone mineral density (BMD), thereby significantly impacting the quality of life and health status of elderly population. The aim of this study is to identify the impact of different exercise regimes in improving the BMD among osteoporotic females. METHODOLOGY: A trial was conducted on 93 diagnosed postmenopausal osteoporotic females aged 50-75 years screened on the basis of physical activity readiness-questionnaire and YOU form randomly divided equally into three groups', that is, aerobic, anaerobic, and osteoanabolic exercises using an envelope method. The intervention was given on the basis of American College of Sports Medicine (ACSM), frequency, intensity, time, and type protocol for the period of 12 weeks. The pre- and post-BMD was determined to find out the improvements on the t-value of the participants. The outcome measure was calculated using a peripheral dual X-ray absorptiometry scan (bone densitometer). RESULTS: At 95% of confidence interval, the pre- and post-median difference observed within the osteoanabolic group was 0.4 followed by 0.3 and 0.1 in the aerobic and anaerobic groups, respectively. The level of significance was determined by applying the Friedman test revealing a statistically significant difference P < 0.001 between the groups. Further, post hoc analysis shows that osteoanabolic exercises were more significant in comparison with aerobic and anaerobic exercises. CONCLUSION: Structured physical exercises based on ACSM protocol show improvement among the osteoporotic females; however, the impact of osteoanabolic exercises significantly increased the BMD, thus reducing the t-value. However, larger scale studies in different clinical settings are recommended for more accurate results.

Effects of spinal mobilization techniques in the management of adolescent idiopathic scoliosis - A meta-analysis.

OBJECTIVES: The aim of this study is to examine the effectiveness of diverse exercise regimes used in multiple Randomized Control Trials as the only conservative management strategy for increased Cobb angle among Adolescent Idiopathic Scoliosis. METHODS: Database such as Google Scholar, Medline, and BioMed Central was reconnoitered for the purpose of research articles of interest. Studies in which the effects of conservative management of scoliosis on the magnitude of Cobb angle were calculated were scrutinized procedurally, studies fulfilling the inclusion criteria were retrieved and encompassed in the present study. RESULT: A total of 698 cases of AIS that were included in 17 controlled trials are part of this meta-analysis. The pool effects were measured using a standardized mean difference between the experimental and control group at 95% of confidence interval using Hedges'g statistics. Outcomes analyzed, reveals favorable for exercises based experimental group in term of standardized mean difference with an impact of 0.42° on random effect model, according to a Cohen's rule of thumb that depicts a near to moderate effects of exercises based interventions on Cobb angle. CONCLUSION: The present study concludes that therapeutic exercise regimes alone have a pivotal role in both decelerating the progression of the curve and reducing the already increased magnitude of the curve.