Effects of tibiofemoral mobilization in patients of Patellofemoral pain syndrome.

OBJECTIVE: To determine the effects of tibiofemoral joint mobilisation on pain and range of motion in patients with patellofemoral pain syndrome. METHODS: The randomised control trial was conducted at the Lady Reading Hospital and Hayatabad Medical Complex, Peshawar, Pakistan, from July to December 2019, and comprised patellofemoral pain syndrome patients of either gender aged 25-35 years with anterior knee pain for at least one month. The subjects were randomly allocated control group A and experimental group B. Group A received 6 stretching and strengthening exercises of hip and knee muscles with hot pack, while group B additionally received tibiofemoral joint mobilisation. There were 3 sessions per week over 4 weeks for both the groups. Numeric pain rating scale, Kujala scale, algometer and goniometer were used to assess pain and range of motion at baseline and at the end of the last session. Data was analysed using SPSS 20. RESULTS: Of the 60 individuals initially assessed, 52(86.6%) were enrolled; 26(50%) in each of the two groups. The overall mean age of the sample was 29.63±3.25 years. The experimental group B showed significant improvement in pain, range of motion and pressure pain threshold (p<0.05) compared to the control group A. Group B also showed significant improvement in terms of functional activities (p<0.05). Except patellar instability and weight-bearing activities, the groups showed no significant difference (p>0.05). CONCLUSIONS: Tibiofemoral joint mobilisations with hip and knee stretching and strengthening exercises were found to be more effective in reducing pain, and increasing range of motion as well as pressure pain threshold. CLINICAL TRIAL NUMBER: Identifier: NCT04225000:https://clinicaltrials.gov/ct2/show/NCT04225000.

Structured Long Interview and Clinical Examination (SLICE) as Formative Assessment Tool in Clinical Clerkship: Medical Students Perspective.

OBJECTIVE: To evaluate medical students' views about undertaking structured long interview and clinical examination as a formative assessment. METHODS: The qualitative, exploratory study was conducted from February to July 2019 at the Islamic International Medical College, Riphah International University, Islamabad, Pakistan, and comprised final year medical students having undertaken formative assessment through structured long interview and clinical examination during their clerkship rotation in Paediatrics, General Medicine, General Surgery and Gynaecology and Obstetrics. Four sets of focus group discussions were conducted according to the relevant clerkship module. Each recorded FGD was transcribed verbatim. Thematic analysis was conducted manually. RESULTS: Of the 32 students, there were 8(25%) in each of the four groups. Five major themes and five-sub-themes emerged, with the main themes being: Purpose, Learning, Timing, Relevancy and Fairness of the structured long interview and clinical examination. CONCLUSIONS: The students generally thought that the structured long interview and clinical examination was effective in enhancing their clinical skills learning and should be conducted more frequently with minor adjustments.

McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain.

BACKGROUND AND OBJECTIVE: Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP). METHODS: This randomized control trial (RCT) was conducted at Riphah Physical Rehabilitation Centre, Pakistan Railways General Hospital Rawalpindi, from 1(st) July to 31(st) December 2014. The inclusion criteria was patients of both gender and age range 30-70 years with minimum 4 weeks history of CMLBP. A total of 37 patients were screened out as per inclusion criteria and randomly placed into two groups. Twenty patients in group A were treated with Mulligan SNAGs and 17 patients in group B with McKenzie EEP for four weeks at two session per week and single session per day. Visual Analogue Scale (VAS), Oswestry Disability Scale (ODI) and lumber Range of Motion (ROM) were used as an assessment tools and were measured at baseline and at the completion 4 weeks intervention. The data was analyzed with SPSS to draw the statistical and clinical significance of both interventions. RESULTS: At the completion of 4 weeks intervention the pre and post statistical analysis revealed that clinically the McKenzie EEP improved pain (mean 9.12 to 1.46) and disability (73.82 to 6.24) slightly more than Mulligan SNAGs (pain: from 8.85 to 2.55, disability 73.75 to 7.05), while the Mulligan SNAGs improved lumbar ROM more effectively than McKenzie EEP in all directions including flexion, extension, side bending and rotation. Statistically there was no significant difference between the effects of two interventions in managing pain and disability, and improving Lumber ROM. CONCLUSION: McKenzie EEP is clinically slightly more effective in the management of pain and disability as compared with Mulligan SNAGs, while Mulligan SNAGs are more effective in the improvement of lumbar ROM as compared with Mechanize EEP in the management of CMLBP.

Challenges Faced by Lady Surgeons during Professional Progress in Pakistan.

The purpose of this qualitative study was to investigate the professional challenges faced by lady surgeons in Pakistan. This qualitative exploratory phenomenological study was conducted from April 2019 to June 2019. Four lady surgeons participated in in-depth interviews, based on four questions: challenges during training; perceptions of gender-based professional treatment; perceptions of relationships with peers; and perception of gender on the quality of training. Four main themes with ten sub-themes were developed. Family support is identified as major facilitating factor. Participants experienced gender-based discrimination at workplace, long exhausting duty hours with lack of quality time for their families and social gatherings. With the passage of time, these problems diminished as the surgeons gained a work-life balance with their motivation. Key Words: Barriers, Career progression Challenges, Lady surgeons, Gender.