Effects of balance training with and without gaze stabilization exercises on clinical outcomes in elderly patients with chronic dizziness: A randomized controlled trial.

OBJECTIVE: To compare the effects of balance training with and without Gaze Stabilization exercises on clinical outcomes in elderly patient with chronic dizziness. METHOD: Total 64 participants after referral from neurologist at Lahore General Hospital were recruited in this study. These participants were randomly assigned into two groups i.e. Group A (Gaze group) and Group B (control group) with 32 participants in each group by sealed envelope method. Gaze group performed balance exercises with gaze stability exercise whereas, group B performed balance exercises with saccade eye exercises. Berg Balance Scale, Disability Handicapped Inventory, and Activity Specific Balance Confidence Scale were used to measure outcome variables. RESULTS: Demographic variables were represented by mean, standard deviation and frequency distribution. Results showed that there was no baseline difference between gaze and control group (p > 0.05). Both groups showed improved results with the gaze group showing significantly more improvement as compare to the control group on balance (p < 0.05, Mean Group A = 44.1, Mean group B = 40.91), perceived disability (p < 0.05, Mean Group A = 52.84, Group B = 56.09), and risk of fall (p < 0.05, Mean Group A = 53.84, Mean Group B = 50.72) respectively. CONCLUSION: This study concluded that gaze stability exercises with balance training are effective in improving balance, level of perceived disability, and risk of fall prevention among elderly patients with chronic dizziness.

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).

Effects of low-intensity pulsed ultrasound on pain and functional disability in patients with early-stage lumbar spondylolysis: A randomized controlled trial.

BACKGROUND: Low Intensity Pulsed Ultrasound (LIPUS) is beneficial in accelerating fracture recovery, enhancing their capacity to execute tasks of daily life and, as a result, their autonomy. OBJECTIVE: To compare the outcomes of routine physical therapy and routine physical therapy along with LIPUS in patients with early-stage lumbar spondylolysis. METHODS: Thirty-four (29 males and 5 females) patients exhibiting symptomatic low back pain for at least four weeks were recruited and randomly divided into control group (CG) and intervention group (IG) group. Randomization was done by using goldfish bowl method and allocation was done by using sealed envelope method. Parallel assignment was done. Numeric Pain Rating Scale (NPRS) was utilized for the measurement of pain and Oswestry Disability Index (ODI) for functional disability. Patients were assessed at baseline, at the end of 12th and 20th week. Interventions were applied by two physical therapists (one male and one female) having more than eight years of clinical experience for 10 weeks on alternate days. RESULTS: Intervention group reported significant percentage change of 47% at 12th week and 65% at 20th week for pain and 42% at 12th week and 81% at 20th week for functional disability compared with 40% at 12th week and 37% at 20th week for pain and 3% at 12th week and 25% at 20th week follow-up for functional disability from baseline in control group. CONCLUSION: Low-intensity pulsed ultrasound has significantly reduced pain and functional disability in patients with early-stage lumbar spondylolysis by using following parameters; 1.1-MHz oscillation frequency, 1-kHz pulsed frequency, 100-mW/cm2 spatial intensity, 2 ms pulse duration, 100Hz pulse repetition rate, 20% pulse duty cycle, and 20-min duration on alternate days.

Comparison of Mulligan technique versus muscle energy technique in patients with adhesive capsulitis.

Objectives: To compare the effects of Mulligan technique and muscle energy technique in patients with adhesive capsulitis. METHODS: The randomised controlled trial was conducted at the Department of Physiotherapy, Government Mian Munshi Hospital, Lahore, Pakistan, from September 1, 2019, to March 31, 2020, and comprised patients with adhesive capsulitis who were randomised into Mulligan mobilisation Group A and muscle energy technique Group B. The outcome assessor was kept blinded to the treatment plan. Pain, range of motion and functional disability were measured using Visual Analogue Scale, universal goniometer and Shoulder Pain and Disability Indexat baseline, and subsequently at the end of third and sixth weeks. Data was analysed using SPSS 24. RESULTS: Of the 78 subjects, 39(50%) were in each of the two groups. Group A had 11(28%) male and 28(72%) female patients, while Group B had 20(51%) male and 19(49%) female patients. Both groups showed significant improvement (p<0.001), and inter-group comparison showed the difference to be non-significant at baseline and third week (p>0.05). However, post-intervention difference showed significantly better results in Group A compared to Group B (p<0.05). CONCLUSIONS: Mulligan technique was found to be more effective than muscle energy technique in improving range of motion, and in reducing pain and functional disability. Clinical Trial Number: IRCT 20200605047660.

Role of low-intensity pulsed ultrasound on lumbar spondylolysis: A systematic review.

OBJECTIVE: To systematically review the role of low-intensity pulsed ultrasound on lumbar spondylolysis. METHODS: Literature search was conducted on PubMed, Embase, CINAHL, Web of Science, PEDro and Scopus databases to identify relevant studies published between 2010 and 2020 by using medical subject headings and applying Booleans, such as low-intensity pulsed ultrasound OR interventional ultrasound AND lumbar spine OR lumbar region AND spondylolysis OR stress fracture. Unpublished studies were hand-searched in the journals, abstracts of conferences were reviewed, and citation index was used for searching experts in the field and then contacting them for information. Studies included were the ones that had at least one of the following outcomes: bone union rate, treatment period to bone union and time to return to previous activities. RESULTS: Of the 243 studies identified, 228(94%) were full text articles and only 2(0.8%) studies were critically appraised for qualitative synthesis based on bone union rate, treatment period to bone union, and time to return to previous activities. CONCLUSIONS: Low-intensity pulsed ultrasound was found to be effective for bone union and a useful therapy for quick return to playing sports in patients with lumbar spondylolysis.

Reliability of Hand-Held Dynamometer for assessing Isometric Lumbar Muscles Strength in Asymptomatic Healthy Population.

OBJECTIVE: To determine intra-rater and inter-rater reliability of hand-held dynamometer for assessing isometric lumbar muscle strength in asymptomatic healthy population. METHODS: It was a cross-sectional study conducted at the department of physiotherapy, University of Lahore Teaching Hospital, Lahore, Pakistan, from July 2020 to August 2020 through non probability-purposive sampling technique. Thirty healthy subjects were tested at thirty-degree lumbar flexion and zero-degree lumbar extension positions. Two raters assessed isometric strength of lumbar flexor and extensor muscles, by a hand-held dynamometer. Strength was measured and recorded by each of the two raters and re-assessed after a week. Correlation and pairwise comparison were done between readings. ICC values were calculated for the assessment of isometric lumbar muscle strength using handheld dynamometer. RESULTS: A total of 30 healthy subjects had participated with mean age of 22.84±1.21 years, height 174.33±6.83 cm, weight 68.58±5.08 kg and BMI 22.52±0.35. Findings showed an excellent intra-rater (ICC 2, k = 0.95 to 0.97) and inter-rater (ICC 2, k = 0.94 to 0.95) reliability. CONCLUSIONS: Hand held dynamometer demonstrated an excellent intra- and inter-rater reliability for assessment of isometric lumbar muscles strength of healthy subject at clinical setting as it is simple to use, portable and cost-effective for the precise measurement of lumbar muscles strength.

Reliability of musculoskeletal ultrasound imaging to measure supraspinatus tendon thickness in healthy subjects.

[Purpose] The purpose of this study was to assess intra-rater and inter-rater reliability of musculoskeletal ultrasound (MSKUS) as a tool to measure supraspinatus tendon thickness in healthy subjects. [Subjects and Methods] Twenty healthy subjects were assessed in similar sitting position. Two experienced musculoskeletal ultrasound specialists measured supraspinatus tendon thickness. Tendon was measured twice in one day by each of two raters with an interval of one hour for within day reliability and was re-measured following one week for between days reliability. Data analysis was performed using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM). [Results] Results reflected excellent within day intra-rater and inter-rater reliability with Mean ± standard deviation (SD)=5.14 ± 0.83 and 5.17 ± 0.78, ICC (2,1)=0.89-0.93 and ICC (2,2)=0.98 (0.95-0.99) and SEM=0.18-0.18 and 0.17 while between days intra-rater rater and inter-rater reliability with Mean ± SD=5.14 ± 0.83 and 5.17 ± 0.78, ICC(2,1)=0.88-0.90 and ICC(2,2)=0.95 (0.88-0.98), SEM=0.17-0.38 and 0.17 [Conclusion] The results of the current study indicate that MSKUS is a reliable tool for measuring supraspinatus tendon thickness in healthy subjects.