Multimodal approach to address the multifaceted nature of Chronic Musculoskeletal Disorders: Bridging the gap between research and clinical practice.

Musculoskeletal (MSK) disorders encompass various conditions impacting bones, muscles, tendons, ligaments, and nerves. An estimated 1.71 billion individuals globally have MSK disorders, causing disability and reduced quality of life. Literature contradicts the notion that musculoskeletal pain and disability solely arise from physical impairments; psychological, behavioural, and social factors contribute significantly. These facets influence pain perception and chronic impairment development. Common interventions-medication, exercise, manual and hydrotherapy, electro-thermal modalities, behavioural and alternative therapies-address pain individually, yet lack the comprehensive response required. In contrast, a multimodal approach combines diverse therapies tailored to individual needs. It ensures lasting symptom relief, prevents recurrence, and improves function. Although proven effective, clinical implementation of this approach remains limited. This mini-review discusses the reasons behind this gap, underscores multimodal approach importance, and enlightens rehabilitation professionals on its potential for managing chronic musculoskeletal issues.

Preserving cognitive vitality: Value of cognitive rehabilitation in addressing cognitive deficits in the elderly.

The recent advancements in medical sciences has resulted in not only increasing life expectancy of the elderly but has also improved survival rate in elderly with neurological disorders including those with head trauma . This has resulted in an increasing number of persons with cognitive deficits. Cognitive functions such as executive functioning and memory play an important role in success of a rehabilitation programme and therefore can positively contribute to public health goals. Considering cognitive decline at present has no cure and pharmacological therapies have a limited role, efforts are usually made to delay the onset and progression of cognitive decline and improve quality of life. Literature suggests that active life style, regular exercise, actively performing activities of daily living can have a significant impact on cognitive skills. In addition different models of cognitive rehabilitation and approaches can be integrated into practice to improve cognitive reserve and cause neuroplastic changes to facilitate cognitive function by providing cognitive stimulus and training. Moreover with technological advancements, the computerized cognitive intervention field is growing. This usually integrates conventional cognitive intervention with digital smart devices to provide an engaging and cost effective alternate approach. This review aims to highlight the importance of cognitive rehabilitation and suggest a few evidence based approaches that may be considered by rehabilitation professionals to promote and improve cognitive rehabilitation in Pakistan.

Exploring the Differential Effects of Transcranial Direct Current Stimulation: A Comparative Analysis of Motor Cortex and Cerebellar Stimulation.

Background: Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique. Constant electric current is passed through the patient's scalp with the aim of modulating cortical excitability. Stroke is a cerebrovascular disease characterized by hemorrhage or cerebral ischemia. This systematic review and meta-analysis are aimed at comparing the efficacy of motor cortex stimulation with that of cerebellar stimulation by using transcranial direct current stimulation. Method: Google Scholar, PubMed, EMBASE, Cochrane CENTRAL, and Physiotherapy Evidence Database (Pedro) databases were searched for studies. The extracted qualitative data was synthesized systematically. Cochrane RevMan software was used to conduct a meta-analysis of quantitative data. The fixed effects mean difference of the collected data was calculated at a 95% confidence interval (CI) for the changes in balance and side effects. Results: This research included 10 articles with seven studies assessing changes in balance (outcome measured in CoP and FMA scores) and side effects (tingling and itching were the most prevalent). There was no significant difference between the efficacy levels of m1-tDCS versus ctDCS (P = 0.18), m1-tDCS versus sham (P = 0.92), and ctDCS versus sham (P = 0.19). Itching and tingling sensation were the most common and were significantly prevalent in sham interventions (P < 0.00001). Conclusion: We found that motor cortex and cerebellar stimulations are both effective in improving motor function in stroke patients. There are no adverse effects to using the interventions besides mild itching and tingling experienced during the stimulation.

Correlation Of Kinesiophobia And Upper Extremity Parameters In Post Mastectomy Patients.

Breast cancer, if diagnosed at advanced stages, often leads to surgical intervention, i.e. mastectomy, which later presents complications that add to morbidity. A cross-sectional analytical study was conducted to determine pain, upper limb ROM, grip strength, lymphoedema, and their co-relation with kinesiophobia in post mastectomy patients. A sample of 55 female patients was selected via non-probability purposive sampling. Kinesiophobia was assessed using Tampa Scale of kinesiophobia (TSK-11) and pain via Numeric Pain Rating Scale. Upper extremity ROM was measured using a plastic goniometer, grip strength by Jamar Hydraulic dynamometer, and limb volumes were calculated by summed truncated cone volume via circumferential tape measurements. Wilcoxon signed rank test and Spearman co-relation test was used for analysis. Significant difference between the limb volumes was noted (p=0.02) and a reduction in overall upper extremity ranges was seen (p<0.05). A positive significant co-relation between pain and TSK score (r= 0.300, p=0.026) was observed.

Fall risk screening and balance rehabilitation in elderly: a missing healthcare intervention in Pakistani healthcare system.

Elderly are one of the fastest-growing population globally and require significant healthcare services due to age-related deterioration in physiological systems. Poor postural control due to aging results in impaired balance leading to increase in frequency of falls, poor quality of life, and rise in disability and mortality rates. In Pakistan, due to lack of awareness, and resources, fall prevention and screening programmes for the elderly are lacking. Regular fall risk screening utilizing balance assessment tools, integration of fall prevention programmes and balance rehabilitation approach as part of elderly healthcare services can serve as tools to lower the incidence of falls in the elderly population of Pakistan. Moreover, integration of latest technology as part of balance rehabilitation can also be considered. The review aims to highlight appropriate strategies for fall risk screening and balance rehabilitation in an effort to promote an important healthcare intervention for elderly in Pakistan.

Neurorehabilitation in time of COVID 19: A perspective from Pakistan.

A global public health emergency, the coronovirus disease-2019 pandemic has impacted every way of life, including neuro-rehabilitation, worldwide. Issues related to increased service demand in primary care, exhausted or insufficient healthcare facilities were significantly high in low and middle-income countries, like Pakistan, with already a struggling health infrastructure. This required major change in health service delivery and impacted rehabilitation care of vulnerable patients with neurological conditions and impairments. For the current review, relevant key words and their combinations were used for literature search, including 'COVID 19', 'SARS-CoV-2', 'Corona Virus', 'rehabilitation', 'physical rehabilitation', 'pandemic', 'NCOC', 'lockdown', 'health services', 'physical therapy', 'disability', 'access', 'tele-rehabilitation', 'research', 'human resource', 'healthcare', etc. The platforms searched were Google search, Google Scholar and PubMed. The idea was to highlight how the pandemic impacted neuro-rehabilitation care in countries like Pakistan throughout the pandemic duration and during the lockdowns.

The UN Incheon strategy Implementation and the Pakistani quagmire; ground realities.

The Economic and Social Commission for Asia and the Pacific is the regional developmental arm of the United Nations. There are over 650 million persons with disabilities living in the region. In 2012, member countries, including Pakistan, launched the new decade of persons with disabilities from 2013 to 2022, adopting the Incheon Strategy to 'Make the Right Real', based on the Put Convention on the rights of Persons with Disabilities" and aimed at accelerating the disability inclusive development with 10 measurable goals and targets. The year 2017 marked the mid-point of that decade at which point member countries were to submit the Government Members Report on the Implementation of Incheon Strategy. The ambiguity in usage of terms, variable definition of disability, and use of impairment screens in population census of Pakistan has resulted in flawed data and underreporting of persons with disabilities. Pakistan provided data on only 13 of the 30 core indicators as part of its midpoint review. There is lack of awareness among ministries regarding the Incheon Strategy implementation.

Perceptions regarding team-based learning among undergraduate physical therapy students.

Team-based learning (TBL) is a strategy where teams work together to develop concepts and apply them towards problem-solving. This latest learning approach has not been tried in the educational environment of Rehabilitation Sciences. Hence, this study aimed to assess the knowledge and practices regarding TBL among undergraduate physical therapy students. A descriptive cross sectional survey was conducted involving 222 undergraduate physical therapy students who were selected via non-probability convenience sampling from Foundation University Institute of Rehabilitation Sciences over a period of three months (May 2018 - July 2018). Data was collected using questionnaire in the light of literature review, developed by Wright States University's Department of Communication based on the Minnesota satisfaction questionnaire. It contained questions regarding knowledge, practices and satisfaction with team-based learning, assessed via 19 statements on 5-point Likert scale. The sample consisted of 208 (93.7%) females and 14 (6.3%) males with mean age of 20.07±1.18 years. Regarding familiarity with TBL, 189 (85.1 %) students had understanding of TBL. 182 (82%) participants had practiced team-based learning whereas 40 (18%) had never practiced TBL in their lives. Majority of the students agreed on the positive effects of TBL on quality of learning, clinical reasoning abilities and professional development (median=4.00). TBL could be a highly useful, active learning strategy inculcating multiple skills among undergraduate students and should be introduced as supplementary to traditional lecture-based teaching.

Psychological Stress and Satisfaction with Life among Physical Therapy Students of Rawalpindi / Islamabad, Pakistan.

OBJECTIVE: To determine the occurrence of perceived stress and satisfaction with life as well as the association between the two among under graduate physical therapy students. METHODS: The cross-sectional study was conducted from January to July 2015 at Riphah International University, Isra University and Foundation University, Islamabad, Pakistan, and comprised Doctor of Physical Therapy students aged 17-23 years. Perceived Stress Scale and Satisfaction with Life Scale were used as tools to measure the outcomes. Data was analysed using S P SS 2 0.. RESULTS: Of the 306 students approached, 279(91%) responded. There were 39(14%) males and 240(86%) females with an overall mean age of 19.18±0.92 years. Mean stress and satisfaction with life scores were 21.35±5.76 and 24.49±5.77. Significant negative co-relation between the two scores was observed (p=0.001). There was no significant association of age with satisfaction with life (p=0.591) and perceived stress (p=0.283). A significant gender-based difference was observed in terms of perceived stress (p=0.037) and satisfaction with life ( (p=0.008), with females scoring higher. CONCLUSIONS: Male students were more satisfied with life compared to female students, and satisfaction with life decreased with an increase in stress.

Open Researcher and Contributor Identifier and other author identifiers: Perspective from Pakistan.

The Open Researcher and Contributor ID (ORCID) is a globally trending initiative for author name disambiguation and serves as a 'digital curriculum vitae' for displaying an individual's research output. Although there are several other tools similar to ORCID, the collaborative efforts by ORCID make it the most attractive option. Most of the organizations and publishers are increasingly adopting ORCID in their systems, and authors from West and other parts of the world have attempted to create awareness about ORCID initiative. However, researchers from Pakistan and other developing countries should be introduced to this concept and be encouraged to adopt to such initiatives. Therefore, this paper aims to present a brief introduction to author identifiers, with special focus on the ORCID.

Common balance measures and fall risk scores among older adults in Pakistan: Normative values and correlation.

The objective of this study was to assess the balance and fall risk among the community dwelling healthy older adults in Pakistan and to determine the correlation between balance measures and fall risk, for which a crosssectional correlation study was conducted at Foundation University Islamabad and Fauji Foundation Hospital from March 2016 to February 2017. A total of 77 individuals over 50 years were included via convenience sampling. I n di vi d u al s w i t h he a r i ng /v is ua l an d c o gn it ive impairments, infections, and orthopaedic and severe comorbid conditions were excluded. Data collection tools included Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Functional Reach Test (FRT) and Fall Risk Score (FRS). Independent t-test and Bivariate Pearson Correlation (CI=95%, P<0.05) were used for analysis. Mean value of the BBS, FRS, TUG and FRT was 41.36±2.96, 3.40±1.47, 15.90±2.68 and 13.34±3.45 respectively. Age had a significant (p<0.05) positive correlation with FRS and negative correlation with BBS. A significant correlation (P<0.05) was found only between FRT & TUG and TUG & BBS.

Predatory conferences: Addressing researchers from developing countries.

Publishing a manuscript or presenting at a conference are considered valuable accomplishments in one's professional career. However, it is necessary that the outlet be a legitimate rather than a fraudulent or predatory one. Predatory journals have been explored previously to a greater extent but the conference version of predatory entities is the newest iteration. To date, very few studies have endeavored to address the nuisance of predatory conferences and to explain the full magnitude of their significance. Our study addresses the issue of predatory conferences as an educational article for the readership of the Journal of Pakistan Medical Association, and highlights their features, available literature on predatory conferences, and puts forward several new suggestions to avoid falling prey to these illegal entities.

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.

Physical therapy as a profession and its educational development in Pakistan.

Physical therapists work in different medical and related settings and serve to maintain and restore functional capability. Pakistan has a disability rate of 2.65% with a total of around 5.035 million disabled people. Physical therapy as a profession started in 1956 at the Jinnah Postgraduate Medical Centre with a 2-year diploma, later on 4 years bachelors programme was also started. In 2008, doctor of physical therapy programme was initiated. The representative body "Pakistan Physical Therapy Association" was also established in 2008 which then joined the World Confederation for Physical Therapy in 2011. There is plenty of work being done in the field and it has seen a rapid growth in the past decade compared to the last 50 years. Currently, there are 69 institutions in Pakistan offering various physical therapy courses. The profession currently requires an autonomous regulatory body to control its educational curriculum and development as well as safeguard its interests.