Effects of manual therapy in addition to stretching and strengthening exercises to improve scapular range of motion, functional capacity and pain in patients with shoulder impingement syndrome: a randomized controlled trial.

BACKGROUND: The current study aimed to measure the effectiveness of manual therapy in addition to stretching and strengthening exercises in patients with shoulder impingement syndrome to improve functional capacity, pain, and scapular range of motion. METHODS: This is a single-blinded randomized controlled trial. Thirty-two participants with chronic shoulder impingement syndrome were randomly allocated into two groups. Both groups received stretching and strengthening exercises while the treatment group was given manual therapy additionally. Treatment was started after the patients signed an informed consent form. The data were collected from the University of Lahore Teaching Hospital between March 2022 and December 2022. The study aimed to measure pain using a numeric pain rating scale, functional capacity was assessed by the disability of the arm and shoulder, and goniometry was used for scapular ranges, i.e., scapular protraction and upward rotation. Each treatment session lasted 45 min for the treatment group and 30 min for the control group. The treatment comprised five days a week for four weeks, after which post-intervention measurements were taken. RESULTS: Thirty-two participants were enrolled in the study, and 16 were divided into each group. The mean age of the participants in the treatment group was 38.19 ± 7.31 while the comparison group was 35.69 ± 7.98. An independent sample t-test was run on the data with a 95% confidence interval, statistically significant results were obtained, i.e., p-value < 0.05, post-intervention in the treatment group. Both groups have significantly improved functional capacity and scapular protraction (p < 0.005), however, pain and scapular upward rotation were not found statistically significant in the control group (p > 0.05). CONCLUSION: The addition of manual therapy along with exercise therapy showed clinical and statistical significant results for pain, functional capacity, and scapular range of motion. It demonstrated superior effects than exercise therapy alone for the chronic condition of SIS. TRIAL REGISTRATION: The trial was registered in the Iranian Registry of Clinical Trials ( https://www.irct.ir/ ) with the registration number: IRCT20230526058291N1, (Date: 12/08/2023).

Effect of physical therapy treatment in infants treated for congenital muscular torticollis - a narrative review.

Congenital muscular torticollis is a problem that arises at birth or immediately after birth in which the sternocleidomastoid muscle is shortened on the afflicted side, leading to an ipsilateral rotated of the head and a contralateral rotation of the face and jaw. To determine the effectiveness of physical therapy treatment in infants treated for congenital muscular torticollis, relevant articles published between 2011 and 2020 were located using electronic databases. A total of 9 studies out of 24 potentially relevant articles were reviewed. All studies were randomised controlled trials with 6-8 score on the Physiotherapy Evidence Database scale (Pedro scale) which showed high quality of methodology. The studies typically found significant statistical effects in the management of congenital muscular torticollis. Additionally, most of the studies reported increased adherence to exercise as another essential advantage. Conservative physical therapy management showed positive outcomes, and early physiotherapy referral showed significant reduction in treatment duration.

Reliability of modified-modified Schober's test for the assessment of lumbar range of motion.

OBJECTIVE: To determine the intra-rater reliability of modified-modified Schober's test for measuring lumbar flexion and extension in patients of lumbar radiculopathy. METHODS: The case-control reliability study was conducted at the University of Lahore Teaching Hospital, Lahore, Pakistan, from March to September 2020, and comprised lumbar radiculopathy patients of either gender aged 35-60 years in group A and healthy controls in group B. Lumbar flexion and extension were measured by the same examiner on three different occasions. A non-stretching measuring tape was used in which the first two measurements were taken using the modified-modified Schober's test on the same day with a difference of 5 minutes, and the third measurement was taken three days later to assess reliability. To assess the test-retest reliability, intraclass correlation coefficient was calculated through two-way random analysis of variance. Standard error of measurement and minimal detectable change were also calculated. Data was analysed using SPSS 25. RESULTS: Of the 40 subjects, 20(50%) were in group A with a mean age of 45.00±6.72 years, and 20(50%) were in group B with a mean age of 49.60±6.65 years. Overall, there were 16(40%) male and 24(60%) female subjects. Within-day lumbar flexion and extension measurements were highly reliable in controls (intraclass correlation coefficient 0.93 for flexion and 0.96 for extension) as well as in patients (intraclass correlation coefficient 0.94 for flexion and 0.95 for extension). The high values of intraclass correlation coefficient 0.91 for flexion and 0.94 for extension in the controls and 0.83 for flexion and 0.92 for extension in the patients showed high reliability also for between-days measurements. CONCLUSIONS: The modified-modified Schober's test appeared to be a highly reliable technique for the measurement of lumbar flexion and extension in patients of lumbar radiculopathy as well as in healthy controls.

Translation, cross-cultural adaptation and psychometric properties of Urdu version of upper limb functional index; a validity and reliability study.

BACKGROUND: The upper limb functional index is broadly used outcome measure for musculoskeletal disorders of the upper limb. The main objective of the study was to translate and validate the upper limb functional index (ULFI) outcome measure in the Urdu language. METHODS: Upper limb functional index was translated into Urdu language using Beaton et al. guidelines through forward and backward translation along with the expert committee reviews. Two fifty (n = 250) Urdu-speaking patients with sub-acute or chronic conditions of upper limb musculoskeletal disorders were included in the study. The mean age was 32.33 ± 4.67 years. The data were collected from the physical therapy department of The University of Lahore Teaching hospital. All participants completed the upper limb functional index-Urdu (ULFI-U), Numeric pain rating scale (NPRS), Quick Disability of arm, shoulder, and hand (QuickDash), and (health survey) SF-12 at baseline while only ULFI-U at day three. Reliability was assessed through internal consistency by Cronbach's alpha and test-retest reliability by intra-class correlation (ICC). Content validity was measured by Lynn and Lawshee method. Spearman's correlation has been used to measure criterion validity. The construct validity was measured through hypothesis testing. The structural validity has been explained through factor analysis by exploratory factor analysis (EFA) using Maximum likelihood extraction (MLE) with Promax rotation. RESULTS: The English version of ULFI was translated into the Urdu language with minor alterations. The Urdu version ULFI has demonstrated high levels of reliability with intra-class correlation (ICC2,1= 0.91) and Cronbach's alpha (α = 0.94). The content validity index found as 0.808, the criterion validity for ULFI-U correlating with quick Dash was found excellent (r = 0.845) and ULFI-U established strong correlation with 6 domains of SF-12(r = 0.697 to 0.767) and weak correlation with its 2 domains and NPRS(r = 0.520). A two-factor structure was obtained using EFA. CONCLUSIONS: The ULFI-U is a valid and reliable patient-reported outcome (PRO) that can be used to assess upper limb musculoskeletal disorders in Urdu-speaking patients. TRIAL REGISTRATION: This study was registered in the U. S National Library on clinicaltrial.gov under registration no. NCT05088096 . (Date: 21/10/2021).