Effectiveness of Physical Therapy for Improving Constipation In Spastic Cerebral Palsy.

BACKGROUND: Bowel and bladder problems in children with cerebral palsy (CP) negatively affect both the children and their families. Routine physical therapy (PT) may contribute to relieving constipation in children with CP by reducing spasticity. OBJECTIVE: To determine the effectiveness of PT in relieving constipation in children with spastic CP. DESIGN: This was a single-blinded randomized crossover trial (Clinical Trail # NCT03379038) that included 35 children with spastic CP. The children who fulfilled the inclusion criteria were randomly assigned to one of two groups: the progressive physical therapy (PPT) or the maintenance physical therapy (MPT) group. METHODS: Data was collected via general demographic questionnaire, defecation frequency (DF) questionnaire, Constipation Assessment Scale (CAS) and the Modified Ashworth Scale (MAS) at baseline and at the 2nd, 4th, and 6th week before and after crossover. The Mann Whitney U-test was used for between-group comparisons and the Friedman and Wilcoxon signed-rank test for post hoc analysis tests were used for within-group changes. To determine the relationship between spasticity and constipation, simple linear regression was used. SETTING: National Institute of Rehabilitation Medicine, Islamabad, Pakistan. RESULTS: Neither group showed a significant difference in spasticity level or DF at baseline or at the end of the 2nd week. However, at the end of the 4th week (PPT = 4[1] vs MPT = 2[1]; U = 192; P < .001) and 6th week (PPT = 4[1] vs 3(1); U = 158; P < .001) DF was significantly better in the PPT group than in the MPT group. Regarding constipation severity, the PPT group showed significantly better results on all items of the Constipation Assessment Scale (CAS) compared with the MPT group after intervention (P < .001). The results showed that spasticity was significantly correlated with DF (r = -0.81; P < .001) and constipation severity (r = 0.45; P < .001). CONCLUSION: Physical therapy significantly improves DF and reduces constipation severity in children with spastic CP.

Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial.

OBJECTIVE: To compare the effects of eccentric muscle energy technique versus static stretching exercises combined with cervical segmental mobilisation in the management of upper cross syndrome in patients having neck pain. METHODS: The randomised controlled trial was conducted at the Khan Kinetic Treatment Canada Orthopaedic and Rehabilitation Centre, Rawalpindi, Pakistan, from August 2017 to January 2018, and comprised patients of upper cross syndrome who were randomized into two equal groups using lottery method. Patients in Group-A were treated with eccentric muscle energy technique with cervical segmental mobilisation, while those in Group-B received static stretching exercises with cervical segmental mobilisation. Two sessions per week for 3 weeks were given to each patient who were analysed by measuring tragus-to-wall distance, visual analogue scale and neck disability index. Cervical passive range of motion was measured using inclinometer. Data was recorded at baseline and after 3 weeks of treatment. Data was analysed using SPSS 21. RESULTS: Of the 40 subjects, 20(50%) each were in the two groups. In Group-A mean age was 42.75±11.13 years. In Group-B, it was 40.50±9.14 years. Eccentric muscle energy technique and static stretching technique both showed significant results (p<0.05) for within group analysis, but comparison across groups showed non-significant results (p>0.05 each) on all parameters. CONCLUSIONS: Both the techniques used were found to be equally effective in decreasing pain, improving cervical range of motion and reducing neck disability.

Comparison between Manual Traction, Manual Opening technique and Combination in Patients with cervical radiculopathy: Randomized Control Trial.

OBJECTIVE: To compare the effects of manual traction, manual intervertebral foramen opening technique and combination of the two techniques in patients with cervical radiculopathy. METHODS: The single-blind randomised control trial was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 2017 to January 2018, and comprised patients of either gender having unilateral upper extremity pain, paresthesia or numbness. The subjects were placed into groups I, II and III using sealed envelope method. Group I was treated with the opening of intervertebral foramen technique, while group II received manual traction of cervical spine, and group III received both techniques. Three sessions were conducted per week for 3 weeks. The outcome measures were neck disability index, Numeric pain rating scale, patient-specific functional scale, and range of motions of cervical spine. SPSS 21 was used for data analysis. RESULTS: Of the 40 patients, 17(30%) were males and 23(70%) were females. There were 13(32.5%)patients each in groups I and II, while group III had 14(35%). Mean age in group I was 42.41±6.86 years, in group II 40.95±7 .32 years and in group III 42.50±5.77 years. There was no statisticallysignificant difference among the three groups with respect to any parameter (p>0.05). Individual group analysis showed significant improvement (p<0.05) in all parameters . CONCLUSIONS: Manual intervertebral foramen opening technique, manual traction, and combination of both techniques were equally effective in decreasing pain, level of disability and improved cervical mobility in patients with cervical radiculopathy.

A randomized controlled trial of intermittent Cervical Traction in sitting Vs. Supine position for the management of Cervical Radiculopathy.

OBJECTIVE: To compare the effectiveness of intermittent cervical Traction in sitting vs. supine position for the management of cervical radiculopathy. METHODS: A randomized clinical trial was done to compare pain and disability modification of cervical radiculopathy patients by using cervical traction in sitting and supine positions. Forty patients (males and females aged between 18-60 years with chronic cervical radiculopathy) were recruited for the trial. Participants were randomized into two homogeneous groups by dice method. The Group-A (n=20) received 3-weeks of intermittent cervical traction in sitting position along with Transcutaneous Electric Nerve Stimulation (TENS) and hot pack. The Group-B (n=20) received the same treatment except the intermittent cervical traction that was applied in supine position. Participants were assessed two times: at baseline (week 0) and at the termination of rehabilitation (week 3). Neck disability index was used to collect the data before and after the treatment. RESULTS: The mean age of the patients was 43.15±8.99 vs. 48.80±6.89 years in Group-A vs. Group-B respectively. Mean (±S.D.) weight of the patients was 74.75±12.11 vs. 74.60±11.24 kg in Group-A vs. Group-B respectively. Mean Neck Disability Index score at start of treatment was 30.30±7.46 vs. 30.75±7.85 in Group-A and Group-B respectively. There was a significant difference in Group-A and Group-B regarding aggregate NDI score at the end of treatment (19.45±7.12 vs. 11.05±4.40; p<0.0001). CONCLUSION: Supine position is better choice for applying cervical traction as compared to sitting position for the management of cervical radiculopathy comparing post interventional NDI score.

Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: a randomised equivalency trial.

BACKGROUND: WHO case management guidelines for severe pneumonia involve referral to hospital for treatment with parenteral antibiotics. If equally as effective as parenteral treatment, home-based oral antibiotic treatment could reduce referral, admission, and treatment costs. Our aim was to determine whether home treatment with high-dose oral amoxicillin and inpatient treatment with parenteral ampicillin were equivalent for the treatment of severe pneumonia in children. METHODS: This randomised, open-label equivalency trial was done at seven study sites in Pakistan. 2037 children aged 3-59 months with severe pneumonia were randomly allocated to either initial hospitalisation and parenteral ampicillin (100 mg/kg per day in four doses) for 48 h, followed by 3 days of oral amoxicillin (80-90 mg/kg per day; n=1012) or to home-based treatment for 5 days with oral amoxicillin (80-90 mg/kg per day in two doses; n=1025). Follow-up assessments were done at 1, 3, 6, and 14 days after enrollment. The primary outcome was treatment failure (clinical deterioration) by day 6. Analyses were done per protocol and by intention to treat. This trial is registered, ISRCTN95821329. FINDINGS: In the per-protocol population, 36 individuals were excluded from the hospitalised group and 37 from the ambulatory group, mainly because of protocol violations or loss to follow-up. There were 87 (8.6%) treatment failures in the hospitalised group and 77 (7.5%) in the ambulatory group (risk difference 1.1%; 95% CI -1.3 to 3.5) by day 6. Five (0.2%) children died within 14 days of enrollment, one in the ambulatory group and four in the hospitalised group. In each case, treatment failure was declared before death and the antibiotic had been changed. None of the deaths were considered to be associated with treatment allocation; there were no serious adverse events reported in the trial. INTERPRETATION: Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalisation and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised.