Gamified Exercise with Kinect: Can Kinect-Based Virtual Reality Training Improve Physical Performance and Quality of Life in Postmenopausal Women with Osteopenia? A Randomized Controlled Trial.

BACKGROUND: Osteopenia, caused by estrogen deficiency in postmenopausal women (PMW), lowers Bone Mineral Density (BMD) and increases bone fragility. It affects about half of older women's social and physical health. PMW experience pain and disability, impacting their health-related Quality of Life (QoL) and function. This study aimed to determine the effects of Kinect-based Virtual Reality Training (VRT) on physical performance and QoL in PMW with osteopenia. METHODOLOGY: The study was a prospective, two-arm, parallel-design, randomized controlled trial. Fifty-two participants were recruited in the trial, with 26 randomly assigned to each group. The experimental group received Kinect-based VRT thrice a week for 24 weeks, each lasting 45 min. Both groups were directed to participate in a 30-min walk outside every day. Physical performance was measured by the Time Up and Go Test (TUG), Functional Reach Test (FRT), Five Times Sit to Stand Test (FTSST), Modified Sit and Reach Test (MSRT), Dynamic Hand Grip Strength (DHGS), Non-Dynamic Hand Grip Strength (NDHGS), BORG Score and Dyspnea Index. Escala de Calidad de vida Osteoporosis (ECOS-16) questionnaire measured QoL. Both physical performance and QoL measures were assessed at baseline, after 12 weeks, and after 24 weeks. Data were analyzed on SPSS 25. RESULTS: The mean age of the PMW participants was 58.00 ± 5.52 years. In within-group comparison, all outcome variables (TUG, FRT, FTSST, MSRT, DHGS, NDHGS, BORG Score, Dyspnea, and ECOS-16) showed significant improvements (p < 0.001) from baseline at both the 12th and 24th weeks and between baseline and the 24th week in the experimental group. In the control group, all outcome variables except FRT (12th week to 24th week) showed statistically significant improvements (p < 0.001) from baseline at both the 12th and 24th weeks and between baseline and the 24th week. In between-group comparison, the experimental group demonstrated more significant improvements in most outcome variables at all points than the control group (p < 0.001), indicating the positive additional effects of Kinect-based VRT. CONCLUSION: The study concludes that physical performance and QoL measures were improved in both the experimental and control groups. However, in the group comparison, these variables showed better results in the experimental group. Thus, Kinect-based VRT is an alternative and feasible intervention to improve physical performance and QoL in PMW with osteopenia. This novel approach may be widely applicable in upcoming studies, considering the increasing interest in virtual reality-based therapy for rehabilitation.

Effects of kinect-based virtual reality training on bone mineral density and fracture risk in postmenopausal women with osteopenia: a randomized controlled trial.

Osteopenia is a condition characterized by low bone mineral density (BMD) that increases fracture risk, particularly among postmenopausal women (PMW). This study aimed to determine the effects of Kinect-based VRT on BMD and fracture risk in PMW with osteopenia. The study was a prospective, two-arm, parallel-design, randomized controlled trial. The study enrolled 52 participants, 26 randomly assigned to each group. In the experimental group, Kinect-based VRT was provided thrice weekly for 24 weeks for 45 min/session. Both groups were instructed to engage in a daily 30-min walk outdoors. The fracture risk assessment tool (FRAX) was used to calculate fracture risk, and dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. Both variables were assessed at baseline and 24 weeks afterwards. After 24 weeks of Kinect-based VRT, the experimental group showed significant BMD increases in the right and left femoral necks and lumbar spine (p value < 0.001). In the control group, the BMD at the right and left femoral necks showed fewer significant changes (p value < 0.022 and 0.004, respectively). In the control group, lumbar spine BMD did not change (p = 0.57). The experimental group showed significantly lower FRAX scores for hip fracture prediction (HFP) and hip prediction of major osteoporotic (HPMO) at both femoral necks (p value < 0.001) than the control group (p = 0.05 and p = 0.01, respectively), but no significant change at the left femoral neck for HFP (p = 0.66) or HPMO (p = 0.26). These findings indicate that a Kinect-based VRT intervention resulted in significantly increased BMD and a reduced fracture risk, as predicted by HFP and HPMO measurements. These improvements were more pronounced in the experimental group than in the control group. Thus, Kinect-based VRT may be utilized as an effective intervention to improve BMD and reduce fracture risk in postmenopausal women with osteopenia.

Development of Urdu version of Chronic Respiratory Disease Questionnaire Self-Administered Standardized (CRQ-SAS); validity and reliability analysis in COPD patients.

PURPOSE: Chronic Respiratory Disease Questionnaire Self-Administered Standardized (CRQ-SAS) is a valid and reliable tool that evaluates the health-related quality of life among the adult population affected with chronic respiratory disorders (CRDs) and has been translated into many languages as per need. The main objective of this study was to translate the CRQ-SAS into the Urdu language and evaluate its psychometric properties. METHODOLOGY: It was a two-staged study that consisted of translating the original version into Urdu language and then psychometric testing of the translated version. The reliability of the translated questionnaire was assessed by measuring its internal consistency, test-retest reliability, standard error of mean (SEM) & minimal detectable change (MDC). Validity was determined by evaluating its content for content validity, construct (convergent and discriminative) validity, and exploratory factor analysis. Data was analyzed using SPSS v 28 with an alpha level < 0.05 considered to be significant. RESULTS: CRQ-SAS U had an excellent internal consistency (Cronbach's Alpha α = 0.89), test-retest reliability (ICC2,1) = 0.91 of all items, and low SEM = 0.11 and MDC = 0.65. S-CVI was 0.9, with statistically significant difference across the response of COPD patients and healthy subjects, and a high degree of correlation with St Georges Respiratory Questionnaire (r = 0.7-0.9) proving CRQ-SAS U content, discriminant and convergent valid respectively. Exploratory factor analysis identified two factors responsible for 80% of the variance. CONCLUSION: CRQ-SAS U demonstrated optimal psychometric properties which renders it to be used in Urdu speaking populations with COPD.

Effects of cervical stabilisation exercises on respiratory strength in chronic neck pain patients with forward head posture.

The objective of this study was to determine the effects of cervical stabilisation exercises on respiratory strength in chronic neck pain patients with forward head posture. The study was conducted from August 2020 to February 2021, at the Jinnah Hospital, Lahore; 44 patients who fulfilled the eligibility criteria were randomly assigned to two groups-experimental group and control group-. Baseline measurement was taken for numeric pain rating scale, neck disability index, craniovertebral angle, single breath count, and spirometry and all the measurements were retaken at the completion of the fourth week. Results were not significant (p>0.05) before the treatment in both groups but post-intervention results revealed significant differences in both the groups (p<0.05), with the experimental group showing more improvement. Four weeks of cervical stabilisation with isometric exercises is more effective in the management of pain, forward head posture, neck disability and respiratory strength as compared with the four weeks of isometric exercises programme alone.

Effects of decompression on pain, range of motion and function in patients with acute vs chronic lumbar radiculopathy.

The purpose of this study was to determine the effects of manual lumbar decompression on pain, range of motion, and function in patients with acute vs chronic lumbar radiculopathy. Thirty patients fulfilling the eligibility criteria at Tehsil Headquarter Civil Hospital Daska were randomly placed into three groups: acute group (n=10), chronic group (n=10), and control group (n=10). Mean age of the participants was 33.3±8.5 years and the mean body mass index was 25.0±4.4. There were 12 males and 21 female participants. Group A and Group B were 18 treated with decompression, lumbar mobilisation, hot packs, TENS and exercise therapy, while the patients in Group C were treated with lumbar mobilisation, hot packs and exercise therapy. Total duration of the treatment was four weeks at three sessions per week and the outcomes were measured at baseline and at the completion of four-week treatment with Visual Analogue Scale, Modified Oswestry Disability index, Straight Leg Raise, and Inclinometer. Data was analysed by using SPSS version 25. One Way ANOVA and Kruskal-Wallis Test were used to compare the means across the groups. It was concluded that manual lumbar decompression decreases pain, and increases range of motion and function in Group A (acute) as compared to Group B (chronic) and Group C (control).

Teaching strategies for rehabilitation curriculum: Coping with the Covid-19 situation.

The novel corona virus pandemic culminated in a global emergency shutting down educational institutions with recommendations of distant learning. Developing countries like Pakistan faced challenges in terms of keeping the education stream running. The current narrative review was planned to discuss the teaching strategies adopted by various institutes for coping with the situation created by the coronavirus disease-2019. Literature search was done using search engines and databases with key words 'Academics', 'Coping strategies', 'Covid-19', 'Online learning', 'Rehabilitation curriculum' and their combinations. As a result, 37 articles were analysed for education involving conformation of curricula to social distancing protocol, and use of video-conferencing software, practical rehabilitation curriculum delivery, and evaluation methods. Developing countries, like Pakistan, should upgrade and revise their rehabilitation curriculum at theoretical and practical levels and try to convert the adversity of the pandemic into an opportunity to develop standardised e-learning programmes and compatible software.

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.

The effects of an exercise programme for core muscle strengthening in patients with low back pain after Caesarian-section: A single blind randomized controlled trial.

OBJECTIVE: To determine the effects of an exercise programme for core muscle strengthening in patients with low back pain after caesarean section. METHODS: The single-blind randomised controlled trail was conducted from August 2018 to January 2019 at the Helping Hand for Relief and Development Comprehensive Rehabilitation Centre, Chakwal, Pakistan, and comprised post-caesarean section women aged 25-40 years with low back pain. Patients were randomised into supervised group I and unsupervised group II using the sealed envelope method. Group I received supervised core stability exercise programme, while group II received unsupervised, home-based core stability exercise programme. Baseline and post-intervention values were compared for numeric pain rating scale, Oswestry disability index, inclinometer and core stability assessment. Data was analysed using SPSS 21. RESULTS: Of the 30 subjects, there were 15(50%) in each of the two groups. There was no significant difference at baseline between the groups (p>0.05). Post-intervention results showed significant intra-group and inter-group differences (p<0.05) with respect to all parameters. No improvement was observed for right and left side bending (p>0.05). CONCLUSIONS: Supervised core stability exercise programme was more effective in reducing pain and disability, and improved core muscle activation than unsupervised, home-based core exercise programme.

The effects of a static exercise programme versus Swiss ball training for core muscles of the lower back and pelvic region in patients with low back pain after child delivery. A single blind randomized control trial.

OBJECTIVE: To determine the effects of static exercise programme compared to Swiss ball training for core muscles of the lower back and pelvic region in patients with low back pain after child delivery. METHODS: The prospective single-blind randomised controlled trial was conducted at Rehabilitation department of Pakistan Railway General Hospital Rawalpindi from March to December 2018, and comprised patients with low back pain after delivery who were randomised into 2 equal groups. The subjects in Group A received static core exercises, while those in Group B got Swiss ball training. Outcome was measured using numeric pain rating scale, Oswestry disability index, goniometry and core stability assessment scale. Data was analysed using SPSS 21. RESULTS: Of the 30 patients, 15(50%) were in Group A with mean age of 28.38±4.8 years, and 15(50%) were in Group B with a mean age of 29.57±3.3 years. Intra-group difference was significant (p<0.05), while inter-group difference was non-significant (p>0.05). CONCLUSIONS: Both exercise protocols used in the study were equally effective in the rehabilitation of postpartum low back pain.

Effects of core muscle stability on low back pain and quality of life in post- menopausal women: A comparative study.

OBJECTIVE: To determine the effects of core stability exercises on backache and quality of life of postmenopausal women. METHODS: he comparative study was conducted at the Department of Physical Therapy, Margalla General Hospital, Rawalpindi, Pakistan, from February to June 2018, and comprised post-menopausal woman aged 40-60 years having backache who were randomly divided into experimental group A and control group B. Group A underwent core stability exercises along with traditional therapy, while group B had traditional low backache physical therapy. Each participant was treated three days a week for 12 weeks. The outcome was assessed using the manual muscle testing numerical pain rating scale, Oswestry disability index and Utian quality of life scale at baseline, week 6 and week 12. Data was analysed using SPSS 21. RESULTS: Of the 35 subjects initially enrolled, 24(68.5%) completed the study. Of them, 14(58.3%) cases were in group A and 10(41.6%) controls in group B. The overall mean age was 54.54±5.13 years, mean menopause duration was 99.79±50.02 months, and mean duration of backache complaint was 23.95±14.85 months. Differences in outcome were significant between the groups for flexion and extension manual muscle testing and Utian quality of life scale (p<0.05) and non-significant for numerical pain rating scaleand Oswestry disability index (p>0.05). CONCLUSIONS: Core stability exercises were found to have the ability to reduce pain, disability and to improve strength and quality of life.

Diagnostic tests to assess balance in patients with spinal cord injury: a systematic review of their validity and reliability.

Background: Sophisticated biomechanical instruments can assess balance in patients with spinal cord injury (SCI) with accuracy and precision; however, they are costly and time consuming to use. Clinical diagnostic tests to assess balance in patients with SCI are less costly and easier to use, but there is limited literature available regarding their reliability and validity. Objectives: To review systematically articles reporting the validity and reliability of diagnostic tests used to assess balance function in patients with SCI. Methods: We searched for articles in the English language from the earliest record to December 15, 2020, which reported validity or reliability of any clinical instrument or diagnostic test used to assess balance in patients with SCI. Articles assessing balance in paraplegic patients with causes other than SCI were excluded. Databases included MEDLINE, AMED, EMBASE, HMIC, PsycINFO, CINAHL, Scopus, and Google Scholar. The COSMIN Risk of Bias checklist was used to assess the studies included and PRISMA-DTA guidelines were applied. Results: We included 16 articles that assessed the validity or reliability of 10 diagnostic tests. The Functional Reach Test (FRT), Berg Balance Scale (BBS), and Mini-Balance Evaluation Systems Test (Mini-BESTest) were assessed by more than 1 study, while the remaining 7 diagnostic tests including the Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure were assessed by 1 study each. The FRT has good-to-excellent test-retest reliability, excellent inter-rater reliability, and good construct, concurrent, and convergent validity. The BBS has excellent inter-rater and intra-rater reliability, high internal consistency, and good concurrent and construct validity. The Mini-BESTest has excellent test-retest reliability, excellent inter-rater reliability, high internal consistency, and good concurrent, convergent, and construct validity. Conclusions: The FRT, BBS, and Mini-BESTest appear to be valid and reliable clinical instruments to assess balance function in patients with SCI.

Effects of post-isometric relaxation, myofascial trigger point release and routine physical therapy in management of acute mechanical neck pain: a randomized controlled trial.

OBJECTIVES: To compare the effects of post-isometric relaxation, myofascial trigger point release and routine physical therapy on pain, disability and cervical range of motion in patients with acute mechanical neck pain. METHODS: The randomised control trial was conducted at the District Headquarter Hospital in Nowshehra, Pakistan, from July to December 2017 and comprised subjects of either gender aged 16-49 years with acute neck pain. They were randomised into three groups; post-isometric relaxation group 1, myofascial trigger point release group 2 and routine physical therapy group 3. Neck disability index, numeric pain rating scale and cervical goniometry were documented before intervention, after the first session and after 6 sessions in two weeks. Data was analysed using SPSS 21. RESULTS: Of the 60 patients, there were 20(33.3%) in each of the three groups. Mean age in group 1 was 32.25±9.56 years, group 2 2.35±9.05 years and in group 3 it was 32.75±7.82 years. Scores for neck disability index and numeric pain rating scale as well as rotation to right and left showed significant difference among the groups post-treatment (p<0.05). Within group analysis showed significant improvements in all parameters post-treatment in all the groups (p<0.0001). CONCLUSIONS: Acute mechanical neck pain treated with post-isometric relaxation technique had more and faster effect in decreasing pain and disability and in improving mobility.

Effects of ELDOA and post-facilitation stretching technique on pain and functional performance in patients with piriformis syndrome: A randomized controlled trial.

BACKGROUND: Piriformis syndrome (PS) is a neuro-muscular condition, which is often underdiagnosed in clinical settings. This study will determine the effects of myofascial stretching Elongation Longitudinaux Avec Decoaption Osteo Articulaire (ELDOA) and post-facilitation stretching of the piriformis muscle in patients with PS. OBJECTIVE: We aimed to compare the effects of ELDOA and post-facilitation stretching of the piriformis muscle on pain, muscle length and functional performance in patients with PS. METHODS: A randomized clinical trial was conducted with 40 PS patients including both males and females, between the ages of 30-70. Patients were randomly assigned to the ELDOA or post-facilitation group after assessments with the Numeric Pain Rating Scale (NPRS), Lower Extremity Functional Scale (LEFS), Piriformis Length Test and Straight Leg Raise (SLR). The assessments were done at baseline and at the end of the sixth week of treatment. RESULTS: The patients treated with ELDOA demonstrated significant improvement in pain (pre = 7.00 ± 2.75, post = 3.00 ± 1.75), piriformis length (pre = 27.6 ± 5.54, post = 36.8 ± 3.13), SLR (pre = 36.40 ± 7.24, post = 67.5 ± 8.36) and LEFS (pre = 26.90 ± 12.24, post = 58.10 ± 8.62), as compared with the group treated with post-facilitation stretching: pain: pre = 6.00 ± 1.00, post = 2.00 ± 1.50; piriformis length: pre = 28.55 ± 4.03, post = 38.8 ± 2.70; SLR: pre = 40.60 ± 7.48, post = 74.25 ± 5.19, and LEFS: pre = 25.20 ± 7.66, post = 66.30 ± 7.27). CONCLUSION: It can be concluded that the post-facilitation stretching technique shows more improvement in pain, muscle length, SLR, and LEFS in patients with PS as compared to ELDOA.

Effects of static stretching as compared to autogenic inhibition and reciprocal inhibition muscle energy techniques in the management of mechanical neck pain: a randomized controlled trial.

OBJECTIVE: To compare the effects of static stretching with autogenic inhibition and reciprocal inhibition muscle energy techniques on pain, disability and range of motion in patients with mechanical neck pain. METHODS: A parallel design randomised controlled trial was conducted at Fauji Foundation Hospital and Railway-General Hospital, Rawalpindi, Pakistan, from April to November, 2017, and comprised of patients aged 18-70 years with neck pain of moderate intensity scoring 4-8 on numeric pain rating scale with limited or painful range of motion. The patients were randomly allocated via lottery method into static stretching group, autogenic inhibition muscle energy technique group and reciprocal inhibition muscle energy technique group. All the subjects received five consecutive treatments sessions. Outcome measurements included numeric pain rating scale score, neck disability index score and goniometry for cervical range of motion. Data was collected at baseline and after first and fifth sessions, and was analysed using SPSS 21. RESULTS: Of the 78 subjects, there were 26(33.3%) in each of the three groups. Of them 7 were lost to follow-up and the study was completed by 71(91%) subjects. The overall mean age was 41.55±11.89 years (p>0.05). There was no significant difference between the groups at baseline (p>0.05). However, at first and second follow-up, there was a significant difference (p<0.05) between the groups in terms of immediate and short-term relief, except for immediate effects related to range of motion (p=0.056). CONCLUSIONS: Significant difference existed among static stretching, autogenic inhibition and reciprocal inhibition groups in terms of pain, disability and range of motion in patients with mechanical neck pain.

Effects of Sustained Natural Apophyseal Glides with and without thoracic posture correction techniques on mechanical back pain: a randomized control trial.

OBJECTIVE: To determine effectiveness of sustained natural apophyseal glides with and without thoracic postural correction techniques on patients of chronic mechanical low back pain . METHODS: The randomized control trial was conducted at the National Institute of Rehabilitation Medicine, Islamabad, Pakistan, from November 1, 2015, to January 31, 2016, and comprised females aged 20-60 years experiencing mechanical low back pain for more than 03 months. They were randomly assigned to two equal groups. Group 1 was given Mulligan sustained natural apophyseal glides mobilization, while group2 was given the same along with thoracic postural correction techniques for 4 weeks, 3 sessions per week and one session per day. Outcome measures included Numeric Pain Rating Scale, Oswestry Disability Index and Goniometry of Lumbar Range of Motion. Data was analysed using SPSS 20. RESULTS: Of the 40 patients, there were 20(50%) in each of the groups. Mean age of patients in group 1 was 41.30±10.45years, while in group 2 it was 35.12±9.04 years. Compared to the baseline readings, pain, functional independence and range of motion showed significant improvement (p<0.0001) postintervention in both groups. Mean scores in group 2 showed more improvement than group 1 (p<0.0001) in all variables. CONCLUSIONS: The effectiveness of thoracic postural correction exercises along with sustained natural apophyseal glides was noted in patients with mechanical low back pain.

Effect of Mulligan spinal mobilization with arm movement along with neurodynamics and manual traction in cervical radiculopathy patients: A randomized controlled trial.

OBJECTIVE: To determine the effect of Mulligan Spinal Mobilisation with Arm Movement along with neurodynamics and manual traction on pain, disablity and cervical range of motion in cervical radiculopathy patients. METHODS: The randomised controlled trial (RCT) was conducted from August to December 2017 at the Railway General Hospital, Rawalpindi, Pakistan, and comprised cervical radiculopathy patients of either gender aged 20-60 years. They were randomised into two groups, with the experimental Group A getting treated with Spinal Mobilisation with Arm Movement along with neurodynamics and manual traction, while the control group B only getting treated with neurodynamics and manual traction. The pain, disability and cervical range of motion were assessed before and after treatment of 3 weeks using Numeric Pain Rating Scale, Neck Disability Index and Goniometry. Data was analyzed using SPSS 21. RESULTS: Of the 31 patients, 19(61.3%) were females and 12(38.7%) were males. The overall mean age was 41.65±9.714 years. There were 15(48.4%) patients in Group A, and 16(51.6%) in Group B. Group A showed significantly better results in terms of pain, disability and cervical range of motion (p<0.05 each). CONCLUSIONS: Patients treated with Spinal Mobilisation with Arm Movement along with neurodynamics and manual traction had better outcome compared to those who only got neurodynamics and manual traction.

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.

Study of curriculum of Doctor of Physical therapy programme based on World Federation of Medical Education standards.

OBJECTIVE: To evaluate the curriculum for Doctor of Physical Therapy (DPT) programme based on World Federation of Medical Education (WFME) standards. METHODS: A questionnaire was constructed based on WFME 'Should' and 'Must' standards. It was validated by five experts in two rounds. It is comprised of Items/ questions with Yes/No options. The questionnaire was filled by the DPT Faculty and final year students at Riphah International University, Islamabad from March 01, to April 30, 2017. RESULTS: The key weakness identified were students participation in program management, evaluation, mission statement, program designing, curriculum committee, students activities and organization, and other matters relevant to students, followed by the use of external examiners, reliability and validity of assessment tools, scrutiny of assessments by external examiners and feedback to the students on assessment. The integration of behavioral and social sciences, readiness of graduates for postgraduate studies, institutional autonomy and academic freedom for curriculum development and designing, and opportunity for the participation of other stakeholders were identified as strengths. CONCLUSIONS: As per WFME standards the curriculum for DPT program needs improvements in student's assessments and their participation in program management, evaluation, mission statement and designing, along with facilitation in student's activities, organizations. Strengths of the curriculum were integration of behavioral and social sciences, readiness for postgraduate studies, institutional autonomy and academic freedom for the development and designing of curriculum, and the participation of other stakeholders.

Response to a Supervised Structured Aerobic Exercise Training Program in Patients with Type 2 Diabetes Mellitus - Does Gender Make a Difference? A Randomized Controlled Clinical Trial.

OBJECTIVE: Because of the globally increasing occurrence of diabetes mellitus (DM) in the population, exercise is becoming vitally important for prevention and disease management, along with medical and dietary interventions. This study was designed to test the hypothesis that women with DM would respond similarly to men with DM following supervised structured aerobic exercise training (SSAET) program. METHODS: This randomized, single blind, controlled clinical trial was conducted on 102 patients with T2DM with ranging in age from 40 to 70 years. All the participants were randomly allocated to either an experimental or a control group. The experimental group participated in an SSAET program, routine medication, and dietary plan, while the control group was treated with routine medication and dietary plan, for 25 weeks. Assessments of physical and biochemical variables were carried out at baseline and after 25 weeks' intervention and gender-based response to the SSAET program was analyzed. RESULTS: Both the male and female patients responded to 25 weeks of SSAET, routine medication, and dietary plan equally in the experimental group, whereas in the control group IL-6 and NOS-1 showed slight differences. All male and female patients in the experimental group treated with SSAET, routine medication, and dietary plan showed significant improvement in all variables (P < 0.05), while in the control group, deterioration or no change was noted except in HDL and LDL. CONCLUSION: SSAET is equally effective in both male and female patients with T2DM when compared with a non-exercise control group, but no gender-based difference was found. (Trial ID ISRCTN16466697/ http://orcid.org/0000-0002-6682-9896).

Effects of supervised structured aerobic exercise training program on fasting blood glucose level, plasma insulin level, glycemic control, and insulin resistance in type 2 diabetes mellitus.

OBJECTIVE: To determine the effects of supervised structured aerobic exercise training (SSAET) program on fasting blood glucose level (FBGL), plasma insulin level (PIL), glycemic control (GC), and insulin resistance (IR) in type 2 diabetes mellitus (T2DM). METHODS: Riphah Rehabilitation and Research Centre (RRRC) was the clinical setting for this randomized controlled trial, located at Pakistan Railways General Hospital (PRGH), Rawalpindi, Pakistan. Study duration was 18 months from January 1, 2015 to June 30, 2016. Patients of both genders ranging 40-70 years of age with at least one year of history of T2DM were considered eligible according to WHO criteria, while patients with other chronic diseases, history of smoking, regular exercise and diet plan were excluded. Cohorts of 195 patients were screened out of whom 120 fulfilled the inclusion criteria. Amongst them 102 agreed to participate and were assigned to experimental (n=51) and control (n=51) groups. Experimental group underwent SSAET program, routine medication and dietary plan, whereas the control group received routine medication and dietary plan, while both group received treatment for 25 weeks. The blood samples were taken at baseline and on the completion of 25 weeks. The investigation of fasting blood glucose level, plasma insulin level, and glycemic control was conducted to calculate IR. RESULTS: Patients with T2DM in experimental group (n=51) treated with SSAET program, routine medication and dietary plan significantly improved FBGL (pre-mean= 276.41±25.31, post-mean=250.07±28.23), PIL (pre-mean=13.66±5.31, post-mean=8.91±3.83), GC (pre-mean=8.31±1.79, post-mean 7.28±1.43), and IR (pre-mean=64.95±27.26, post-mean 37.97±15.58), as compared with patients in control group treated with routine medication and dietary plan in whom deteriorations were noted in FBGL (pre-mean=268.19±22.48, post-mean=281.41±31.30), PIL(pre-mean=14.14±5.48, post-mean=14.85±5.27) GC (pre-mean=8.15±1.74, post-mean=8.20±1.44, and IR (pre-mean=64.49±23.63. post-mean=70.79 ±23.30). Statistically at the baseline the results were not significant (p>0.05), but at the completion of 25 weeks intervention all the variable showed significant results (p<0.05. CONCLUSION: It is concluded that a 25 weeks SSAET program along with routine medical management is more effective treatment in the management of fasting blood glucose level, glycemic control, plasma insulin level and insulin resistance as compared with routine medical management and dietary plan in the management of T2DM.