Cervical joint positioning error and its association with cervical spine mechanics among undergraduate students.

A cross sectional analytical study was conducted from September 26 to December 28 2018 at Shifa Tameer-e-Millat University Islamabad with 111 undergraduate students aged 17-26 years as participants. The aim of the study was to establish the normative values of cervical joint positioning error (CJPE) and its association with cervical spine mechanics. Neck discomfort was measured using the neck portion of the "student specific Cornell Musculoskeletal Discomfort Questionnaire" (ssCMDQ) and CJPE was measured via cervico-cephalic relocation test using a goniometer. Non-parametric tests of significance were used because the data was not normally distributed in terms of normality testing. Normative values of CJPE were noted to be highest in flexion (9o±9o), rotation towards left (9o±6o) and right (8o±7o), extension (6o±8o), and lastly lateral flexion towards left (5o±7o) and right (5o±5o). Higher CJPE in all movements was observed among females; however, no significant statistical differences were observed (p>0.05). In terms of correlation, important trends included significantly positive correlation of neck discomfort with CJPE in extension, and of CJPE in lateral flexion towards the left with CJPE in lateral flexion towards the right and flexion (p<0.05).

Effect of muscle energy techniques and facet joint mobilization on spinal curvature in patients with mechanical neck pain: A pilot study.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p<0.05); demonstrating an effective combination therapy in terms of improved spinal curvature, pain, disability, ROM and isometric muscle strength.

Salat (Muslim prayer) as a therapeutic exercise.

'Salat' is a Muslim prayer mandatory for all Muslims five times a day. It is comparable to performing a mildintensity exercise, because most of the joints and musclesundergo exercise during different positions and movements adopted in Salat. Though Salat is practised by all Muslims, evidence is very limited regarding the biomechanics and therapeutic effects of Salat as an exercise. However, literature shows activation of biceps brachii, triceps brachii, pectoralis major, scapular musculature, rectus femoris, biceps femoris, tibialis anterior and gastrocnemius during different postures of Salat. Moreover, Salat is also found to improve balance in healthy individuals as well as stroke patients, decreases the chances of development of knee osteoarthritis, and provide cardiovascular and compositional benefits. The current literature review was planned to look into the current evidence and discuss what is known regarding the effects of Salat and how it can be used as an exercise.

Posture related musculoskeletal discomfort and its association with computer use among university students.

The objective of this study was to assess the association of postural musculoskeletal discomfort with computer use and to determine its contributing factors among undergraduate university students. A comparative cross sectional study with a sample of 136 students was conducted at Shifa Tameer-e-Millat University. Musculoskeletal discomfort was calculated using ssCMDQ. A positive association of musculoskeletal discomfort was found with duration of computer use (P<0.05). Significant differences were observed in musculoskeletal discomfort scores based on the type of posture adopted (P<0.05), however no significant differences were observed in terms of discomfort based on gender, ergonomic awareness and type of computer used (P>0.05). The findings of this study reveal that risk factors for postural discomfort include posture, duration and type of computer used however ergonomic awareness and gender is not associated with the buildup of musculoskeletal discomfort. Ideal posture to be adopted during computer use is supported sitting on chair with computer on desk.

Clinical Trial Registry: An essential requirement for physical therapy and health researchers in Pakistan.

Clinical trial registry is a free, open access platform which registers clinical trials, often done prospectively, minimizing the risk of selective reporting, publication bias and replication of trials, as well as allowing individuals to participate in the study. A prospective clinical trial registration has been made mandatory by International Committee of Medical Journals Editors (ICMJE), FDA US, World Medical Association (WMA) and International Society of Physical Therapy Journal Editors (ISPJE), followed by a steep increase in the number of registered trials, emphasizing the need and importance of clinical trial registration. Unfortunately, 100% lack of registration of physical therapy articles published recently in Pakistan is due to the unavailability of local registry and laws requiring trial registration. Meanwhile, Pakistani researchers can register their trials at "clinicaltrials.gov" which is a service provided by the U.S. National Institute of Health. Nonetheless, it is very important to create a publicly accessible clinical trial registry and increase awareness regarding clinical trial registration in Pakistan.

FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation-a retrospective cohort study.

Background: Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods: We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results: The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion: A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway.

The effects of surface inclination on gastrocnemius, soleus and tibialis anterior muscle activation during gait.

BACKGROUND: Inclined walking is associated with multiple musculoskeletal benefits and is considered a therapeutic exercise. Various patterns of increased and decreased muscle activation with inclined surfaces have been observed in normal muscles, with more focus on the proximal lower limb musculature. OBJECTIVE: The aim of this study was to assess the differences in electromyographic activation of gastrocnemius, soleus, and tibialis anterior at various inclined surfaces during gait. METHODS: Fourteen healthy male participants aged between 17-30 years walked at a self-selected speed at motor driven treadmill on 0, 2 and 4 degrees of inclination. EMG activity of the muscles was recorded using the Delsys Trigno surface EMG system. RESULTS: Results showed that muscular activation of tibialis anterior significantly decreased with increase in the level of inclination (p< 0.05). However, soleus, gastrocnemius medialis and gastrocnemius lateralis showed no significant differences (p> 0.05) in their muscular activation, and no noticeable trends were found. Furthermore, no significant difference was found between all the muscles at ground level and inclined level 2 and 4. CONCLUSION: These differences in activation patterns found in distal extremity can be useful for designing rehabilitation protocols in sports training and for patients with neurological and musculoskeletal pathologies.