Assessing Gait & Balance in Adults with Mild Balance Impairment: G&B App Reliability and Validity.

Smartphone applications (apps) that utilize embedded inertial sensors have the potential to provide valid and reliable estimations of different balance and gait parameters in older adults with mild balance impairment. This study aimed to assess the reliability, validity, and sensitivity of the Gait&Balance smartphone application (G&B App) for measuring gait and balance in a sample of middle- to older-aged adults with mild balance impairment in Pakistan. Community-dwelling adults over 50 years of age (N = 83, 50 female, range 50-75 years) with a Berg Balance Scale (BBS) score between 46/56 and 54/56 were included in the study. Data collection involved securing a smartphone to the participant's lumbosacral spine. Participants performed six standardized balance tasks, including four quiet stance tasks and two gait tasks (walking looking straight ahead and walking with head turns). The G&B App collected accelerometry data during these tasks, and the tasks were repeated twice to assess test-retest reliability. The tasks in quiet stance were also recorded with a force plate, a gold-standard technology for measuring postural sway. Additionally, participants completed three clinical measures, the BBS, the Functional Reach Test (FRT), and the Timed Up and Go Test (TUG). Test-retest reliability within the same session was determined using intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Validity was evaluated by correlating the G&B App outcomes against both the force plate data and the clinical measures using Pearson's product-moment correlation coefficients. To assess the G&B App's sensitivity to differences in balance across tasks and repetitions, one-way repeated measures analyses of variance (ANOVAs) were conducted. During quiet stance, the app demonstrated moderate reliability for steadiness on firm (ICC = 0.72) and compliant surfaces (ICC = 0.75) with eyes closed. For gait tasks, the G&B App indicated moderate to excellent reliability when walking looking straight ahead for gait symmetry (ICC = 0.65), walking speed (ICC = 0.93), step length (ICC = 0.94), and step time (ICC = 0.84). The TUG correlated with app measures under both gait conditions for walking speed (r -0.70 and 0.67), step length (r -0.56 and -0.58), and step time (r 0.58 and 0.50). The BBS correlated with app measures of walking speed under both gait conditions (r 0.55 and 0.51) and step length when walking with head turns (r = 0.53). Force plate measures of total distance wandered showed adequate to excellent correlations with G&B App measures of steadiness. Notably, G&B App measures of walking speed, gait symmetry, step length, and step time, were sensitive to detecting differences in performance between standard walking and the more difficult task of walking with head turns. This study demonstrates the G&B App's potential as a reliable and valid tool for assessing some gait and balance parameters in middle-to-older age adults, with promise for application in low-income countries like Pakistan. The app's accessibility and accuracy could enhance healthcare services and support preventive measures related to fall risk.

Body composition profiling and obesity analysis of healthy adults: A cross-sectional study.

Obesity as depicted by changes in the body composition is considered a global epidemic of the 21st century, predisposing to cardiometabolic diseases. This analytical cross-sectional study evaluated body composition parameters in both genders and conducted an obesity analysis of healthy adult Pakistani population. Using non-probability purposive sampling technique, data was collected from 205 healthy adults (aged 18-45 years), who had not been participating in any structured exercise or dietary regime over the last six months. Body composition was assessed using bioelectrical impedance analyser. For data analysis, descriptive statistics, Mann-Whitney U-test and one-sample T-test were applied. The mean body mass index was 24.3±4.93 kg/m2. Body composition components which were significantly higher in males included soft lean mass, fat-free mass index, skeletal muscle mass index and bone mineral content, whereas females had significantly higher percentage of body fat (PBF), visceral fat area and fat mass index (p<0.05). For obesity analysis, the mean PBF (34.61±9.68%) of our sample was higher than White, Hispanics and European adults. Majority of healthy adults had greater body fat mass and lower skeletal muscle mass. The primary obesity index was significantly higher in Pakistani population compared to other ethnicities, with females exhibiting a higher trend towards obesity.

Effects of glucosamine and chondroitin sulfate supplementation in addition to resistance exercise training and manual therapy in patients with knee osteoarthritis: A randomized controlled trial.

OBJECTIVE: To determine the added benefits of short-term glucosamine and chondroitin sulfate supplementation in combination with manual therapy and resistance exercise training in the management of knee osteoarthritis. METHODS: A parallel-design, double-blind randomised controlled trial was conducted from January to September 2020 at the Foundation University Institute of Rehabilitation Sciences and Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised of knee osteoarthritis patients of either gender having radiological evidence of grade III or less on Kellgren classification. The subjects were randomly allocated to active comparator group A and experimental group B. Both the groups received manual therapy and resistance exercise training, while group B additionally received glucosamine and chondroitin sulfate supplementation for 4 weeks. Study outcomes included pain, function, quality of life, range of motion, strength, fall risk, skeletal muscle mass, visceral fat area, body fat, intracellular water ratio, and segmental lean and fat mass. Data was analysed using SPSS 21. RESULTS: Of the 24 subjects, there were 12(50%) in each of the two groups. Each groups had 9(75%) males and 3(25%) females. In terms knee osteoarthritis grade, there was no significant difference between the groups (p=1.00). No significant differences were observed in any of the outcome measures neither at 2 weeks, nor at 4 weeks post-intervention between the groups (p>0.05) except for percentage change in segmental lean mass of the right leg at 2nd week and of the left leg at 4th week (p<0.05). CONCLUSIONS: Manual therapy and resistance exercise training are effective in the management of knee osteoarthritis, however, glucosamine and chondroitin sulfate supplementation for 4 weeks showed no additional benefits. Clinical Trial Number: NCT04654871. https://www.clinicaltrials.gov/ct2/show/NCT04654871.

Occurrence of paralytic scoliosis in patients with poliomyelitis reporting at Fauji Foundation Hospital, Rawalpindi.

Pakistan is one of the only three countries in the world with an enduring poliovirus transmission, making poliomyelitis an important health concern for Pakistan. Paralytic scoliosis is a common musculoskeletal dysfunction associated with poliomyelitis. To determine the occurrence of paralytic scoliosis a cross-sectional study was conducted at Fauji Foundation Hospital, Rawalpindi from 2015 to 2018. All patients with poliomyelitis reporting to the hospital were included, whereas patients with scoliosis but no poliomyelitis were excluded. Cobb's angle was used to determine the severity of scoliotic curves. Pearson correlation was used to determine the correlation of Cobb's angle with age and Independent T-test was used to determine the difference in terms of gender. Confidence interval was kept at 95%. A total of 51 patients with poliomyelitis were included in the study with a mean age of 28.58±15.07 years. The overall occurrence of scoliosis was found to be 60.8% with mean Cobb's angle of 23.35o±7.40o, and risk of developing paralytic scoliosis in males was 0.90 times the risk in females. No significant correlation (p=0.833) was observed between age and Cobb's angle. No significant difference (p=0.72) was observed among males and females in relation to Cobb's angle.

Six-minute walk distance, ECOG Performance Status, and Modified Borg Scale scores in a cohort of Pakistani patients with noncancerous end-stage liver disease selected for liver transplant.

OBJECTIVE: To evaluate the functional status of Pakistani patients with non-cancerous end-stage liver disease selected for liver transplant and to compare results acquired through various assessment tools. METHODS: The study was conducted at the Rehabilitation Medicine Department, Shifa International Hospital Islamabad, Pakistan, from August 2017 to November 2019 and comprised end-stage liver disease patients of either gender who had been selected for liver transplant. Assessment tools included the Six-Minute Walk Distance, Eastern Cooperative Oncology Group Performance Status and Modified Borg Dyspnoea Scale across age, gender, ethnicity, primary aetiology, and Model for end-stage liver disease score. Data were analysed using SPSS 20. RESULTS: Of 172 patients, 143(83%) were males; 99(58%) hailed from the Punjab province; and 118(71%) had hepatitis C as the most common aetiology. The overall mean age was 46.1±10.5 years (range: 14-70 years). The mean Six-Minute Walk Distance was 291.9±67.2m. Model for end-stage liver disease score had a significant inverse correlation with Six-Minute Walk Distance (p<0.01) and a significant positive correlation with Modified Borg Dyspnoea Scale (p=0.02) and Eastern Cooperative Oncology Group Performance Status scores (p<0.01). Age and ethnicity had no correlation with the variables (p>0.05). CONCLUSIONS: The Six-Minute Walk Distance was significantly low. The Model for end-stage liver disease score was inversely correlated with Six-Minute Walk Distance score, and positively correlated with Eastern Cooperative Oncology Group Performance Status and Modified Borg Dyspnoea Scale scores.

Effect of muscle energy techniques and facet joint mobilization on spinal curvature in patients with mechanical neck pain: A pilot study.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p<0.05); demonstrating an effective combination therapy in terms of improved spinal curvature, pain, disability, ROM and isometric muscle strength.

Effects of McConnell taping combined with strengthening exercises of vastus medialis oblique in females with patellofemoral pain syndrome.

Objective of the study was to determine the effects of McConnell taping combined with strengthening exercises of vastus medialis oblique muscle in females with Patellofemoral Pain Syndrom. Females with Patellofemoral Pain Syndrome with an age group of 25-45 years having a less than 30/80 score on a Lower Extremity Functional Index (LEFI), anterior knee pain and painful/limited range of motion (ROM) at knee, were included in the study. A total of 51 subjects were randomly assigned into two groups. They were assigned a 30-40 minute per session for 5 days per week over a length of 2 weeks. Numeric Pain Rating Scale, Lower Extremity Functional Index and Goniometry tools were used to assess the measure of interest. These samples only comprised of females with a mean age of 36.04+7.35 years. After 2 weeks, significant improvement was recorded in the Numeric Pain Rating Scale (NPRS) (p<0.001) and Lower Extremity Functional Index (LEFI) (p<0.001). Flexion range of motion of the knee also improved significantly. No statistically significant difference in extension range of the knee was noted in either groups as it was normal at base line.

Association of breast feeding positioning with musculoskeletal pain in post partum mothers of Rawalpindi and Islamabad.

During breastfeeding, lactating mothers adopt different positions that can cause musculoskeletal problems. The purpose of this study was to determine common breastfeeding positions and musculoskeletal problems in our population and the association between them. A descriptive cross-sectional survey was conducted on 400 breast feeding mothers from hospitals, universities and community of Rawalpindi and Islamabad using a self structured questionnaire. It was found that 283(70.8%) reported cross cradle hold (opposite arm) breastfeeding position, while 86(21.5%) reported breastfeeding in side lying position. Also 31(7.9%) were those mothers who adopted other different BF positions. Mechanical neck pain was seen in 147(36.8%) women and mechanical low back pain was seen in 88(22.0%) women. When chi square test was applied to find out association between breastfeeding position and musculoskeletal problems p value was 0.989 that there was no significant difference between them.

ExoMechHand prototype development and testing with EMG signals for hand rehabilitation.

Rehabilitation is a major requirement to improve the quality of life and mobility of patients with disabilities. The use of rehabilitative devices without continuous supervision of medical experts is increasing manifold, mainly due to prolonged therapy costs and advancements in robotics. Due to ExoMechHand's inexpensive cost, high robustness, and efficacy for participants with median and ulnar neuropathies, we have recommended it as a rehabilitation tool in this study. ExoMechHand is coupled with three different resistive plates for hand impairment. For efficacy, ten unhealthy subjects with median or ulnar nerve neuropathies are considered. After twenty days of continuous exercise, three subjects showed improvement in their hand grip, range of motion of the wrist, or range of motion of metacarpophalangeal joints. The condition of the hand is assessed by features of surface-electromyography signals. A Machine-learning model based on these features of fifteen subjects is used for staging the condition of the hand. Machine-learning algorithms are trained to indicate the type of resistive plate to be used by the subject without the need for examination by the therapist. The extra-trees classifier came out to be the most effective algorithm with 98% accuracy on test data for indicating the type of resistive plate, followed by random-forest and gradient-boosting with accuracies of 95% and 93%, respectively. Results showed that the staging of hand condition could be analyzed by sEMG signal obtained from the flexor-carpi-ulnaris and flexor-carpi-radialis muscles in subjects with median and ulnar neuropathies.

Effectiveness of Deep Breathing Exercises and Incentive Spirometry on Arterial Blood Gases in Second Degree Inhalation Burn Patients.

OBJECTIVE: To find out the effectiveness of the deep breathing exercises and incentive spirometryon arterial blood gases in second degree inhalation burn patients. STUDY DESIGN: Randomised control trial. PLACE AND DURATION OF STUDY: The study was conducted in the Burns Unit of PIMS Hospital, Islamabad from September 2017 to March 2018. METHODOLOGY: The data was collected on structured questionnaire using respiratory distress scoring and objective tools including arterial blood gases (ABGs) and vital signs with signed consent. There was random allocation of patients in the control and experimental groups. Baseline data was collected on day 00 and after completion of 14 sessions, it was recollected on day 07, and was assessed by using independent t-test and paired t-test. Both groups were given standard medical and nursing care. The experimental group was given single treatment regimen i.e. deep breathing exercises (given twice daily with 5-10 repetitions of each DBE possible onto patient for a period of 15-30 minutes). ISM was being performed on control group patients with 10-15 cycles along with steam inhalation and nebulization with beta 2 agonist for a period of 15-20 minutes for 35-45 minutes twice daily for a period of 07 days. RESULTS: The male to female ratio was 7:8 in control group and 8:7 in the experimental group. The mean age was 29.6 ±6.66 years in the control group, and 38.4 ±4.91 years in the experimental group. The pH in arterial blood gas analysis of the experimental group was 7.33 (p=0.002) > pO2 was was 90.53 (p<0.001) and pCO2 was 41.61 (p=0.626). For control group, the pH in ABGs was 7.36 (p=0.268), pO2 was 88.06 (p=0.739) and pCO2 was 38.86 (p<0.001). CONCLUSION: Deep breathing exercises are significant in improving pulmonary complications in patients of second degree inhalation burns.