Deep transverse friction massage in the management of adhesive capsulitis: A systematic review.

Objectives: To review published clinical trials which assessed the effects of deep transverse friction massage on pain and range of motion in patients with adhesive capsulitis. Methods: A systematic review was conducted according to PRISMA guidelines. Literature search was performed in MEDLINE, AMED, EMBASE, HMIC, CINAHL, PEDRO, and SPORTDiscus. Two independent reviewers performed screening of the articles retrieved from different databases. Clinical trials published in English language from the earliest record to March 2022 that reported effects of deep transverse friction massage/Cyriax's friction massage on pain and/or range of motion in patients with diagnosis of adhesive capsulitis were included. The Critical Appraisal Skills Programme was used for quality assessment of the included studies. Results: A total of six studies reporting on 226 adhesive capsulitis patients were included in the systematic review. All the six studies were randomized controlled clinical trials. On the Critical Appraisal Skills Programme tool, four of the six studies had a score of 8/11, while the other two studies received a score of 7/11 and 6/11. Out of these six trials, four reported that pain was significantly (P<0.05) improved in the deep transverse friction massage group as compared to the control group. Regarding range of motion outcome, five studies showed that range of motion was significantly (P<0.05) improved in the deep transverse friction massage group while only one study showed non-significant results. Conclusion: It can be concluded that deep transverse friction massage significantly relieves pain and improves the range of motion in individuals with adhesive capsulitis.

Clinical tests accuracy in diagnosing subacromial impingement syndrome: A systematic review.

OBJECTIVE: To determine the sensitivity and specificity of the clinical diagnostic tests of subacromial impingement syndrome. METHODS: The systematic review comprised search on PubMed, PEDro, Cochrane Library and Google Scholar databases. For prospective cohort studies published in peer-reviewed English-language journals without any time limit, at least fully describing one clinical test. Only studies with free full text available were included. Data extracted included sensitivity and specificity for each clinical test, and variations were sorted out by the 3 reviewers by discussion. RESULTS: Of the 4137 studies identified, 2951(71.3%) were on PubMed, 119(2.9%) PEDro, 5(0.1%) Cochrane Library and 1062(25.7%) Google Scholar. After screening out all the studies that did not match the detailed inclusion criterion, 3(0.07%) studies were selected for review; 1(33.3%) each done in Spain, Turkey and France. Overall, there were 181 aged 15-82 years; 85(47%) males and 96(53%) females. Supraspinatus palpation test had a sensitivity of 92%, while the modified Neer test had specificity of 95.56% in terms of ruling out subacromial impingement syndrome. CONCLUSIONS: Supraspinatus palpation and modified Neer tests were found to be the most effective in the diagnosis of subacromial impingement syndrome.

Effectiveness and implementation of psychological interventions for depression in people with non-communicable diseases in South Asia: Systematic review and meta-analysis.

We evaluate the effectiveness of psychological interventions for depression in people with NCDs in South Asia and explore the individual, organizational, and policy-level barriers and facilitators for the implementation and scaling up of these interventions. Eight databases (and local web pages) were searched in May 2022. We conducted random effects models to evaluate the pooled effect of psychological interventions on depression in people with NCDs. We extracted the individual, organizational, and policy level barriers and facilitators. We found five randomized control trials, nine qualitative studies, and 35 policy documents that fitted the inclusion criteria. The pooled standardized mean difference in depression comparing psychological interventions with usual care was -2.31 (95% CI, -4.16 to -0.45; p = .015, I2 = 96.0%). We found barriers and facilitators to intervention delivery, mental health appears in the policy agenda in Bangladesh and Pakistan. However, there is a lack of policies relating to training in mental health for NCD health providers and a lack of integration of mental health care with NCD care. All of the psychological interventions reported to be effective in treating depression in this population. There are important delivery and policy barriers to the implementation and scaling up of psychological interventions for people with NCDs.

Pulmonary physical therapy techniques for the management of COVID-19 patients: A systematic review.

OBJECTIVE: To review studies reporting pulmonary physical therapy techniques for the management of coronavirus disease-2019 patients. METHODS: The systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines Comprised search of MEDLINE via PubMed, Physiotherapy Evidence Database (PEDro), Excerpta Medica Database (EMBASE), Allied and Complementary Medicine Database (AMED) and Cumulated Index to Nursing and Allied Health Literature (CINHAL) for Observational and interventional studies published in English language between December 2019 and January 2022 describing pulmonary physical therapy techniques for the management of coronavirus disease-2019 patients. Google Scholar and reference lists of relevant studies were also searched to identify additional articles. Methodological quality of the included studies was assessed using either the Physiotherapy Evidence Database (PEDro) scale for interventional studies or the National Institutes of Health quality assessment tool for observational studies. RESULTS: Of the 3767 studies found, 17(0.45%) were analysed; 13(76.5%) observational and 4(23.5%) interventional. The most common pulmonary physical therapy techniques used were active cycle of breathing techniques, positive expiratory pressure device, breathing exercises, percussions, and chest abdomen muscle exercises. However, majority of the studies applied prone positioning and suctioning as priority treatment. During mechanical ventilation, mucus clearance and alveolar recruitment manoeuvres were commonly applied. CONCLUSIONS: There was scarcity of high-quality studies regarding the use of different pulmonary physical therapy techniques in coronavirus disease-2019 patients. Based on available literature, different techniques can be used, depending on stage and severity of the disease.

Effectiveness of bent leg raise technique and neurodynamics in patients with radiating low back pain.

OBJECTIVE: To compare the effectiveness of bent leg raise technique and neurodynamics in patients with low back pain that radiates up to the knee. METHODS: The pre-test post-test control group study was conducted at Department of Physical therapy, Maqsood Medical Complex and General Hospital Peshawar from February to July 2019. Patients with radiating low back pain of both genders aged 18-60 years were included in the study. Patients were divided into Group-A and Group-B. Group-A patients received Mulligan bent leg raise technique while Group-B patients received neurodynamics. Both groups received five sessions per week, for four weeks. Numeric pain rating scale, Oswestry disability index and goniometer was used to assess pain, functional disability and straight leg raise range before and after the interventions. Data was analyzed using SPSS version 20. RESULTS: Thirty-two participants with mean age of 38.81±9.94 years, participated in the study. There were no significant differences (P-value>0.05) between the two groups at baseline. Post-treatment, within Group-Analysis showed that all three variables (pain, functional disability and straight leg raise range) significantly (P<0.05) improved in both groups. However, post treatment between Group-Analysis showed that there were no significant differences (P>0.05) between the two groups. CONCLUSION: Both neurodynamics and bent leg raise technique significantly improved pain, functional disability and straight leg raise range in patients with low back pain that radiates up to the knee. However, there were no significant differences between the groups who received either neurodynamics or bent leg raise technique.

Frequency of neuropathic pain and its effects on rehabilitation outcomes, balance function and quality of life among people with traumatic spinal cord injury.

Background & Objectives: Traumatic Spinal cord injury (SCI) is a devastating condition that results in life long disability. Impairments associated with traumatic SCI such as sensory, motor, and autonomic dysfunctions lead to an array of secondary SCI-specific complications. Neuropathic pain is one of the most common medical complications of traumatic SCI which significantly affects motor function and activities of daily living (ADL) in people with traumatic SCI. Neuropathic pain is one of the main factors for dependency, decreased quality of life (QOL), poor rehabilitation outcomes, and depression in traumatic SCI individuals. The main aim of the current study was to determine the frequency of neuropathic pain and its effects on rehabilitation outcomes, balance function, and QOL in people with traumatic SCI. Methods: A cross-sectional survey was carried out at PCP from March to August 2020. Overall, 123 participants were added to the study using a non-probability convenience sampling technique. Information was collected using an adapted, validated questionnaire. Both male and female traumatic SCI patients with age between 18-60 years who received at least two weeks of rehabilitation, 42 days after diagnosis of traumatic SCI were included in current study while patients with Acute SCI, SCI patients with any other condition which can affect neuropathic pain such as traumatic brain injury, diabetic neuropathy, amputation, etc. and progressive neurological diseases such as multiple sclerosis and Guillain barre syndromes were excluded. Patients who have received at least two weeks of rehabilitation, 42 days after diagnosis of traumatic SCI. Patients with traumatic SCI. Results: Overall, 123 traumatic SCI patients were included in the study. The majority of the (n=101, 82%) participants were male and 83 (67.5%) were from urban areas. Eighty-Seven (70.73%) participants had neuropathic pain. Neuropathic pain was significantly associated (P-value <0.005) with rehabilitation outcomes, balance function, and quality of life. Conclusion: It can be concluded that more than two-third of SCI patients suffer from neuropathic pain. Moreover, neuropathic pain is significantly associated with rehabilitation outcomes, balance function, and quality of life.

Comparing the effectiveness of Mulligan mobilization versus Cyriax approach in the management of patients with subacute lateral epicondylitis.

OBJECTIVES: To determine the effectiveness of Mulligan mobilisation versus Cyriax approach in the management of patients with subacute lateral epicondylitis. METHODS: The clinical trial was conducted at the District Headquarter Hospital, Bahawalnagar, Pakistan, from September to December 2018, and comprised lateral epicondylitis patients having symptoms for >2 weeks. The diagnosis was confirmed on the basis of physical tests and musculoskeletal ultrasound. The subjects were randomly allocated to two equal groups A and B. Group A received deep transverse friction and Mill's manipulation according to Cyriax approach, while group B received Mulligan mobilisation with movement techniques. Patient-related tennis elbow evaluation index was used to collect data which was analysed using SPSS 20. RESULTS: Of the 60 patients, there were 30(50%) in each of the two groups. The overall mean age was 35.27±7.30 years, and 38(63.3%) participants were male. After 4 weeks of treatment sessions, both groups showed significant improvements (p<0.05) in pain and functional disability scores. Group A showed significantly more improvement (p<0.05) in pain subscale scores compared to group B, while group B showed significant improvement (p<0.05) in functional disability subscale scores compared to group A. There was no significant difference (p>0.05) between the groups on total the patient-related tennis elbow evaluation index score. CONCLUSIONS: Both Mulligan mobilisation with movement and Cyriax approach decreased pain and improved functional status in lateral epicondylitis patients.

Reliability of modified functional reach test in the assessment of balance function in people with spinal cord injury: A systematic review.

OBJECTIVE: To systematically review studies reporting reliability of modified functional reach test for the assessment of sitting balance function in people with spinal cord injury. METHODS: The systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and comprised research studies published in English language from the earliest record till October 2019 on the subject of reliability of modified functional reach test in assessing balance function in adult spinal cord injury patients.. Prominent databases were searched with relevant key words to shortlist the targeted studies. RESULTS: Of the 108 studies retrieved initially, 6(5.55%) were included in the current systematic review. All the 6(100%) studies reported only test-retest reliability of modified functional reach test. Of them, 4(66.6%) studies measured only forward reach, while 2(33.3%) measured reach in different directions. All 6(100%) studies reported good to excellent reliability of modified functional reach test with interclass coefficient values ranging from 0.78 to 0.99. CONCLUSIONS: Modified functional reach test was found to be a reliable tool for assessing sitting balance function in individuals with spinal cord injury.

Effectiveness of proprioceptive training and conventional physical therapy in treating adhesive capsulitis.

OBJECTIVE: To determine effectiveness of proprioceptive training and conventional physical therapy in managing patients with adhesive capsulitis. METHODS: A pre-test post-test control group study was conducted at Rehman Medical Institute from June to December 2019. Thirty-eight patients, aged 30 to 60 years, with diagnosis of adhesive capsulitis for more than four months were divided into two groups. Subjects in Group-I (conventional group; n=19) received conventional physical therapy protocols for one month while subjects in Group-II (proprioceptive group; n=19) received proprioceptive training along with conventional physical therapy for one month. Disability of Arm Shoulder & Hand questionnaire, Shoulder Pain & Disability Index and goniometer were used at baseline and post-treatment to assess functional activity level, pain & disability and range of motion respectively. Data was analyzed using SPSS version 20. RESULTS: The mean age of the participants was 53.13 ± 9.12 years. Baseline characteristics were balanced between the two groups. After the treatment, all measures (functional activity level, pain, disability, ROM) improved in both groups. Post treatment, between group analysis showed that functional activity (DASH) and pain (SPADI pain) significantly (P-value <0.05) improved in proprioceptive group as compared to conventional group. However, there were no significant differences (P-value≥ 0.05) in post treatment SPADI disability, SPADI total and ROM (flexion, abduction, external rotation) scores of both groups. CONCLUSION: Proprioceptive exercises along with conventional physical therapy are more effective in managing pain and improving functional activities in adhesive capsulitis patients as compared to conventional physical therapy alone.

Assessment of DNA damage and oxidative stress among traffic conductors and coal miners.

OBJECTIVE: To assess the DNA damage and oxidative stress among traffic conductors and coal miners. METHODS: An analytical cross-sectional survey was conducted in Karak, Pakistan from March to October 2019. A total of 240 individuals participated in the study with an age range between 17 to 55 years. Among the total sample, 60 participants had exposure to traffic pollution while 60 were mine workers. Two control groups, consisting of 60 individuals each, were also recruited for comparison with the two exposure groups. Comet assay protocols were performed for assessing DNA damage and oxidative stress (length of DNA tail, levels of Superoxide Dismutase (SOD), Malondialdehyde (MDA) and Glutathione (GSH)). Data was analyzed using T-test on statistix 9.0 software. RESULTS: The DNA tail length in traffic conductors ranged from 26.83-30.55µm (Mean=28.69 µm while their control group had DNA tail length of 7.98-9.26µm (Mean= 8.62). There was significant difference (P <0.001) between exposure and control group. The DNA length recorded in coal mine workers and their control group was ranged from 29.06-31.26µm (Mean=30.16µm) and 9.42-10.22µm (Mean=9.82), respectively. There was significant difference (P <0.001) between the two groups. As compared to control groups, both exposure groups have high levels of Superoxide Dismutase and Malondialdehyde and low levels of Glutathione. The finding was statistically significant (P <0.001). CONCLUSION: Increased inhalational exposure to air pollutants via working in traffic or coal mines can impose higher oxidative stress and DNA damage among workers as compared to the general population.

Effect of balance training with Biodex Balance System to improve balance in patients with diabetic neuropathy: A quasi experimental study.

OBJECTIVE: To determine the effect of balance training with Biodex Balance System in improving balance function in patients with diabetic neuropathy. METHODS: A quasi experimental study was conducted at physiotherapy department of Rehman Medical Institute Peshawar from January to June 2018. Thirty-eight Diabetes Mellitus Type-II patients with diagnosis of diabetic neuropathy participated in the study. Those patients were included who were able to stand independently and who scored moderate or severe neuropathy on Toronto Scale. Participants received 12 sessions (two sessions per week) of balance training on Biodex stability system in six weeks. Berg Balance Scale and Time Up and Go test were used to collect pre and post treatment data. Paired sample T-test was used to compare pre and post treatment data because data was normally distributed. RESULTS: The mean age of the participants was 63.08 ± 3.3 years. Pretreatment Berg Balance Scale score was 42.68 ± 3.7 which improved to 48.89 ±3.7 after the treatment (P<0.001). Similarly, pretreatment Time Up and Go test score was 17.47 ± 2.0 while post treatment score was 13.57 ±1.5 (P<0.001). CONCLUSION: Balance training with Biodex Balance System can significantly improve balance function in Diabetes Mellitus Type-II patients with diabetic neuropathy.

Comparison of dual task specific training and conventional physical therapy in ambulation of hemiplegic stroke patients: A randomized controlled trial.

OBJECTIVE: To compare the effectiveness of dual task specific training and conventional physical therapy in ambulation of patients with chronic stroke. METHODS: The randomised controlled trial was conducted at the Habib Physiotherapy Complex, Peshawar, Pakistan, from January to August 2017, and comprised patients with chronic stroke. The patients were randomly assigned to two treatment groups. Group A received dual task training, while Group B received conventional physiotherapy. Dual task training included activities such as slowlywalking backward, sideways, and forward on a smooth surface while holding a 100gm sandbag. The conventional physiotherapy included mat activities, stretching and strengthening exercises and gait training. Pre-test and post-test data was taken for both spatial and temporal variables for both groups using Time Up and Go Test and 10-meter walk test. Step length, stride length, cycle time and cadence were also calculated before and after treatment. SPSS 23 was used to analyse the data. RESULTS: Of the 64 patients, there were 32(50%) in each of the two groups that both had 17(53%) males and 15(47%) females. Mean age in Group A was 58.28 ± 7.13 years, while in Group B it was 58.87 ± 6.13 years. Baseline parameters had no significant differences between the groups (p>0.05). Post-treatments scores revealed significant improvement of spatial and temporal variable of gait, 10-meter walk, cadence, step length, stride and cycle time in Group A compared to Group B (p<0.05 each). CONCLUSIONS: Conventional physical therapy and dual task training effectively improved gait ability of chronic stroke patients, and the latter showed significant improvement in all spatial and temporal gait variables compared to former.

Effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain; a randomized controlled trial.

OBJECTIVES: To compare the effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain. METHODS: The randomized controlled trial was conducted at 3 different hospitals in Peshawar, Pakistan, from October 2016 to January 2017, and comprised patients suffering from non-specific neck pain aged 25-60 years. The control group received cervical manual therapy alone while the experimental group received cervical along with thoracic manual therapy for 2 weeks. Data was analysed using SPSS 20. RESULTS: Of the 37 subjects, 20(54%) were cases and 17(46%) were controls.The overall mean age was 35.9±9.6 years. There was no significant difference between the groups at baseline in terms of the levels of pain (p=0.125) and disability (p=0.392). The experimental group showed greater reduction in pain (p=0.02) and disability (p=0.03) compared to the control group. CONCLUSIONS: Cervical along with thoracic manual therapy reduced neck pain and associated neck disability more effectively than cervical manual therapy alone.

Motor relearning program along with electrical stimulation for improving upper limb function in stroke patients: A quasi experimental study.

OBJECTIVE: To determine the effectiveness of motor relearning program along with electrical stimulation for improving upper limb function in patients with sub-acute stroke. METHODS: A quasi experimental study was conducted at Physiotherapy Department of SAIDU Group of Teaching Hospitals Swat Khyber Pakhtunkhwa from January to June 2019. Forty four subjects with post stroke duration of 3-9 months (sub-acute) participated in the study. Subjects received electrical stimulations for the effected arm for 15 minutes along with motor relearning programme for an hour five days a week for six weeks. The upper limb sub scales of motor assessment scale were used to collect pre and post treatment data. SPSS version 20 was used to analyze the data. RESULTS: The mean age of the participants was 54.95±13.2 years. Out of 44 participants 31(70.5%) were male and 13 (29.5%) were female. Pretreatment upper arm function, hand movement and advance hand activities scores were 1.36 ± 0.49, 1.18 ± 0.39 and 1.04 ± 0.21 respectively while their post treatment scores were 5.18 ± 0.96, 4.77 ± 1.02 and 3.95 ± 1.21 respectively. There was significant differences (P<0.05) between pre and post treatment scores of upper arm function, hand movement and advance hand activities. CONCLUSION: Motor relearning program along with electrical stimulation significantly improves upper limb function in patients with sub-acute stroke.

Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study.

OBJECTIVE: To determine the effectiveness of Occupational therapy (OT) in improving activities of daily living performance in complete cervical tetraplegic patients. METHODS: A quasi experimental study was conducted at Paraplegic Center Peshawar from May 2018 to March 2019. Seventy two spinal cord injury patients with complete cervical tetraplegia having age 18-60 years were included in the study using non probability convenience sampling technique. A trained Occupational therapist conducted two occupational therapy sessions per day, three times a week on alternative days for a period of six weeks. Self-care portion of Spinal cord injury independence measure (SCIM) was used to collect pre and post data. Data was analyzed using SPSS version 20. RESULTS: Mean age of the participants was 30.21±13.52.Majority of the participants were (n= 61, 84.7%) male while remaining 11 (15.3%) participants were female. Pre self-care total score was 0.39±0.987 and post self-care total score was 7.17±5.536. There was significant differences (P value <0.05) between pre and post scores of feeding, upper & lower body bathing, upper & lower body dressing, grooming and total self-care scores. CONCLUSION: Occupational therapy significantly improves activities of daily living performance in complete cervical tetraplegic spinal cord injury patients.

Comparing the effectiveness of kaltenborn mobilization with thermotherapy versus kaltenborn mobilization alone in patients with frozen shoulder [adhesive capsulitis]: A randomized control trial.

OBJECTIVE: To compare the effectiveness of Kaltenborn mobilization combined with thermotherapy versus Kaltenborn mobilization alone in patients with adhesive capsulitis. METHODS: The randomised controlled trial was conducted at the Hayatabad Medical Complex and Habib Physiotherapy Complex, Peshawar, Pakistan, from January to June 2017, and comprised patients with adhesive capsulitis. The subjects were randomised into two groups. Group A received Kaltenborn mobilisation with thermotherapy, while group B received Kaltenborn mobilisation alone. Shoulder pain and disability index was used to assess the effectiveness of the intervention. SPSS 20 was used for data analysis. RESULTS: Of the 30 patients, 15(50%) were in each of the two groups. Baseline characteristics were not significantly different between the groups (p>0.05). Pre- and post-treatment Shoulder pain and disability index score of group A was 75.27}5.738 and 12.33}1.988 respectively (p<0.05). Corresponding scores in group B were 73.67}6.137 and 64.13}5 (p<0.05). Group A showed greater reduction in disability compared to group B (p<0.05). CONCLUSIONS: Kaltenborn mobilisation combined with thermotherapy was found to be more effective than Kaltenborn mobilisation alone in patients with adhesive capsulitis.

A randomized control trial comparing the effects of motor relearning programme and mirror therapy for improving upper limb motor functions in stroke patients.

OBJECTIVE: To compare the effectiveness of motor relearning programme with mirror therapy in upper limb motor functions of stroke patients. METHODS: The randomised control trial was conducted in Rafsan Neuro Rehabilitation Centre, Peshawar, Pakistan, from June to December 2017, and comprised stroke patients who had Mini Mental State Examination score over 24. Participants were randomly allocated into treatment and control groups. The treatment group underwent a Motor Relearning Programme, while the control group received Mirror therapy. Upper limb sub-scales of the motor assessment scale were used as data collection tool. SPSS 20 was used for data analysis. RESULTS: Of the 66 subjects, 46(69.7%) were males and 20(30.3%) were females. The overall mean age was 55.44±9.21 years. Left hemiplegia was found in 31(47%) subjects, while 35(53%) had right hemiplegia. Each of the two groups had 33(50%) subjects. There were significant differences between pre-treatment and post-treatment mean scores of upper arm functions, hand function and advance hand activities of the two groups (p<0.05 each). All the three variables significantly improved in the treatment group compared to the control group (p<0.001). CONCLUSIONS: Motor Relearning Programme and Mirror therapy were found to be effective in improving upper limb motor functions of stroke patients, but the former was found to be more effective than the latter.

Spinal cord injury due to fall from electricity poles after electrocution.

OBJECTIVE: The objective of this study was to report epidemiology, complications and rehabilitation outcomes of patients who sustained spinal cord injury (SCI) due to fall from electricity poles after electrocution. METHODS: A prospective observational study was conducted in which patients admitted to Paraplegic Centre Peshawar from July 2016 to July 2018 who sustained SCI due to fall from electricity poles after electrocution were included. Of total 852 patients, 39 (4.58%) sustained SCI due to fall from electricity poles after electrocution. Two patients were excluded and data of 37 patients was analyzed. RESULTS: The mean age of the participants was 35.03±13.47 years. Twenty-two (59.4%) patients had associated burns on different parts of body. Twenty-seven (72.9%) had pressure ulcers, 31 (83.8%) had spasticity, 18 (48.6%) had neuropathic pain and 2 (5.4%) had limb amputations due to injury. Mean Spinal cord injury independence measure score at the time of discharge was 53.4±5.7. CONCLUSION: SCI due to fall from electricity poles after electrocution is rare however combined effect of injury by electricity along with fall from electricity poles are associated with severe complications. Rehabilitation outcomes in these patients are also minimal.

Employment status of person with disability in Government Departments in Khyber Pakhtunkhwa Pakistan.

OBJECTIVE: The objective of the study was to determine whether anticipated number of person with disabilities was employed in different government departments of Khyber Pakhtunkhwa (KPK), Pakistan. METHODS: Using across sectional survey, data from 16 different departments of provincial government of KPK was collected by volunteers of 'Friends of Paraplegics. RESULTS: Out of total 1, 71,137 Govt. employees, only 1151 (0.67%) were person with disabilities. None of the included departments fulfilled 2% allocated job quota for person with disabilities. Majority of the employees included in study were from Elementary & Secondary Education Department (n=140345) and Agriculture, Livestock & Cooperation Department (n=14315). The number of person with disabilities in these departments were 960 (0.68%) and 68 (0.48%) respectively. The highest percentage of person with disabilities were working in Higher Education Archives & Libraries Department (1.65%)followed by Law, Parliamentary Affairs & Human Rights Department (1.42%), Planning & Development Department (1.39%) and Administration & Establishment Department (1.16%). CONCLUSION: It is concluded that a small number of person with disabilities are employed in different Govt. Departments. Moreover, these departments has not ensured providing 2% job quota for person with disabilities.

Effectiveness of transcutaneous electrical nerve stimulation in management of neuropathic pain in patients with post traumatic incomplete spinal cord injuries.

OBJECTIVE: To determine the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) in management of neuropathic pain in post-traumatic incomplete spinal cord injury patients. METHODS: A quasi-experimental study was conducted at from January 2017 to June 2017 at Paraplegic Center Hayatabad, Peshawar. Total 60 incomplete spinal cord injured patients with diagnosis of neuropathic pain were subjected to high frequency TENS of 80 HZ. One session was of 45 minutes while there were two sessions per day. TENS was applied for four days in a week and all patients were followed for eight week duration. Pain intensity was measured by using VAS (Visual analogue scale). RESULTS: Mean pain intensity on VAS at baseline was 6.45 which was decreased to 4.77 post intervention at day-1 while it was decreased to 3.48 at day-4 of week one. After application of TENS for 8 weeks, mean pain intensity was decreased to 2.80 ± 1.74. During the consecutive sessions of the TENS application, the pain intensity decreases in a linear fashion and there were significant difference (p<0.05) between pre and post treatment sessions. CONCLUSION: TENS is useful and safe adjuvant in spinal cord injury patients for the management of neuropathic pain.