Inayat Ullah

The six-minute walk test (6MWT) is a simple and low-tech assessment that has proven to be reproducible and well-tolerated since its introduction. However, the influence of non-anthropometric factors on functional capacity in healthy young adults remains unclear, as most do not exhibit age-related changes in the locomotor system or comorbidities. The aim of the study was to enhance our understanding of how these factors (e.g. physical activity level, dyspnoea severity, and pulmonary function) influence functional capacity (exercise performance), with implications for preventing clinical abnormalities and promoting overall health and well-being. This cross-sectional study involved 330 healthy young adults who completed the 6MWT to measure walking distance and dyspnoea using the Borg scale. Pulmonary function was assessed with spirometry, and physical activity level was categorized using the IPAQ Questionnaire, classifying participants irregularly active and active. The 6MWD was positively correlated with pulmonary function parameters (P ≤ 0.002 for all). There was marginally significant correlation between 6MWD and the change in Borg scale scores before and after the test. Additionally, there was a trend toward significant differences in 6MWD across IPAQ categories. Forced vital capacity was the only pulmonary function parameter significantly different between IPAQ categories (P = 0.02).This study demonstrates that in healthy young adults, better pulmonary function is associated with a longer 6-minute walk distance (6MWD). Physical activity levels, as categorized by the IPAQ, seem to influence pulmonary function, particularly forced vital capacity (FVC).However, there is a weak relationship between IPAQ categories, the degree of dyspnea, and the 6MWD in these individuals.

Background: With the rapid advancement of digital technology, smartphones have become indispensable handheld devices, integrating communication, education, and entertainment into a single tool. Their widespread use across all age groups, particularly among students, has raised concerns about physical and psychological health consequences. Prolonged smartphone use is associated with poor posture and repetitive strain, contributing to musculoskeletal discomfort. As this behavior becomes habitual, particularly in youth, identifying its health impact has become a growing public health priority. Objective: To determine the correlation between smartphone addiction and musculoskeletal discomfort among undergraduate university students. Methods: This cross-sectional correlational study was conducted on 150 undergraduate students from the Foundation University Institute of Rehabilitation Sciences, using a non-probability convenience sampling technique. Participants aged 18–25 years with daily smartphone usage of 4–5 hours were included. Data collection tools included a self-structured demographic form, the Smartphone Addiction Scale-Short Version (SAS-SV), and the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). Ethical approval and informed consent were obtained prior to data collection. IBM SPSS version 20 was used for statistical analysis. As the data were non-normally distributed (p < 0.05), Spearman’s rank correlation was applied. Results: Of the 150 participants, 93.5% (n=143) were female and 5.2% (n=8) male, with a mean age of 21.04 ± 1.89 years. Smartphone addiction was observed in 32.7% (n=50) of the participants. The most frequently reported musculoskeletal discomforts were in the neck (61.4%, n=94), lower back (53.6%, n=82), and upper back (47.1%, n=72). A moderate positive correlation was found between smartphone addiction and musculoskeletal discomfort, particularly in the neck (r = 0.267, p = 0.001), upper back (r = 0.352, p < 0.001), and upper limbs (p < 0.05). Conclusion: A significant positive correlation exists between smartphone addiction and musculoskeletal discomfort among undergraduate students, particularly in the neck, upper back, and upper limbs.

Background: Cardiovascular diseases are a leading cause of morbidity worldwide, necessitating effective tools for functional capacity assessment. The Duke Activity Status Index is widely used for this purpose; its adaptation and validation for Urdu speakers ensures accessibility and accuracy in clinical evaluations for native patients. Objective: To translate, cross-culturally adapt, and determine the validity & reliability of the Duke Activity Status Index Questionnaire in the Urdu version through psychometric properties. Methodology: It was a descriptive cross-sectional study conducted within 6 months at Allama Iqbal Hospital, Sialkot. A sample of 18 participants older than 22 years, having diagnosed coronary artery disease, valvular heart disease, arrhythmia, and who were able to recite and comprehend both Urdu and English, were included in the study. Two independent translators, both of whom had command of both English and Urdu and who were native speakers, worked on the forward translation from English to Urdu and formulated. A thorough review was done by the expert panel, which consisted of 10 experts having more than 10 years of clinical experience in cardiopulmonary physical therapy. The final Urdu version was forwarded to two expert translators, who were both native English speakers, for backwards translation, while maintaining the blinding. A small pilot study was done on 10 cardiovascular disease patients. The translated version was again re-evaluated by the bilingual experts for any inconsistencies that might have existed. The final phase II focused on cross-cultural adaptation and the establishment of the reliability and validity of this version. The participants were requested to fill Urdu version, and the test was repeated after 20 hours. Intra-class correlation coefficient was applied to analyse test-retest reliability. Results: The Duke Activity Status Index had good face and content validity. The test-retest reliability showed a strong relationship between the two measures (r=0.01) and an excellent correlation (intra-class correlation=0.89). Conclusion: The Duke Activity Status Index-Urdu version showed a very good agreement of the translated Urdu version with the original English version. The psychometric properties of this version were good, with strong reliability and validity.

Background: In Pakistan, physiotherapy is often underutilized as a primary treatment modality due to limited public awareness and delayed patient engagement. Typically, patients seek physiotherapy only after medical referral and often exhibit uncertainty or mistrust toward their physiotherapists. Given the growing recognition of therapeutic alliance (TA) as a determinant of treatment success, this study aimed to explore the nature and strength of the therapeutic relationship within physiotherapy departments in hospitals based in Islamabad. Objectives: To assess the perceived level of helping alliance among patients using the Helping Alliance Questionnaire-II (HAQ-II); to evaluate the correlation between patient and therapist responses on the HAQ-II; to determine the therapeutic working alliance using the Working Alliance Inventory–Short Revised (WAI-SR); and to explore the relationship between HAQ-II and WAI-SR scores. Methods: This was a descriptive cross-sectional study involving 200 participants, including 150 patients and 50 physiotherapists, recruited through convenience sampling from hospitals in Islamabad. Inclusion criteria involved adults aged 18 years and above currently receiving physiotherapy care. Data were collected using two validated tools: the HAQ-II and WAI-SR. Descriptive statistics, Pearson and Spearman correlations, chi-square tests, and confidence interval analyses were used for statistical evaluation. Results: The mean HAQ-II score for patients was 5.24 (SD = 0.564) and for therapists was 4.84 (SD = 0.548). Pearson correlation between versions was 0.090 (p = 0.535) and Spearman's rho was 0.128 (p = 0.374), both indicating weak, non-significant relationships. Chi-square values were significant for both patient (χ² = 71.040, df = 2, p < 0.001) and therapist versions (χ² = 81.520, df = 3, p < 0.001), showing differing perceptions. No significant distributional relationship was found between HAQ-II and WAI-SR (p = 0.981). Conclusion: The study highlights the perceptual differences between patients and therapists regarding the therapeutic alliance, emphasizing the importance of integrating both perspectives to foster trust and improve physiotherapy outcomes.

Background: Stroke is one of the leading causes of morbidity and mortality worldwide, often associated with modifiable risk factors. Passive smoking, also known as secondhand smoke exposure, has emerged as a significant contributor to cardiovascular diseases, including stroke. Despite global efforts to reduce tobacco-related harm, passive smoke exposure remains prevalent, especially in low- and middle-income countries. Understanding its impact on stroke patients is crucial to inform targeted prevention strategies. Objective: To determine the frequency of passive smoking among patients diagnosed with stroke. Methods: This cross-sectional study was conducted at the Neurology Department of Pak Emirates Military Hospital, Rawalpindi, over a six-month period from September 2024 to February 2025. A total of 139 patients aged 18 to 80 years, diagnosed with acute stroke and confirmed via non-contrast computed tomography (CT) of the brain, were included after obtaining informed consent. Patients with a history of active smoking or previous stroke were excluded. Demographic data, clinical characteristics, and history of passive smoking were collected through structured interviews. Stroke types were categorized as ischemic or hemorrhagic. Data were analyzed using SPSS version 25.0, with quantitative variables expressed as medians and interquartile ranges (IQR), and qualitative variables as frequencies and percentages. Results: Among the 139 patients, the median age was 51 years (IQR: 22), median symptom duration was 36 hours (IQR: 13), and median BMI was 23.8 kg/m² (IQR: 2.1). Of the total, 78 (56.1%) were male and 61 (43.9%) were female. Ischemic stroke was diagnosed in 112 (80.6%) patients and hemorrhagic stroke in 27 (19.4%). Passive smoking was reported by 21 (15.1%) patients. Conclusion: A significant proportion of stroke patients were found to be exposed to passive smoking, highlighting the need for public health measures to reduce secondhand smoke exposure in the community.

Background: Migraine is a chronic, disabling neurological disorder marked by recurring episodes of headache and associated symptoms, significantly affecting patients' quality of life and functional capacity. Despite its global burden, prophylactic treatment remains underutilized, particularly in chronic cases unresponsive to medication. Recent evidence supports peripheral nerve blocks, especially greater occipital nerve (GON) block, as a promising intervention for migraine prevention. Objective: To determine the effectiveness of greater occipital nerve (GON) block in terms of mean reduction in headache frequency, severity, and analgesic consumption as a prophylactic treatment for patients with migraine. Methods: A quasi-experimental study was conducted at the Neurology Department of Pak Emirates Military Hospital, Rawalpindi, over a six-month period from July to December 2023. A total of 138 patients diagnosed with migraine were enrolled after informed consent using consecutive sampling. Baseline data on headache frequency, duration, severity (measured via Visual Analog Scale), and monthly analgesic consumption were recorded. GON block was administered bilaterally with 2 mL of 0.25% bupivacaine under sterile ultrasound-guided technique. The intervention was repeated weekly during the first month and once monthly for the subsequent two months. Follow-ups were conducted at 1-, 2-, and 3-months post-intervention. Data were analyzed using SPSS version 25.0; p≤0.05 was considered statistically significant. Results: The median age of patients was 38 (IQR: 8.25) years. Headache frequency significantly reduced from 8 (IQR: 2) to 4 (IQR: 2) attacks per month (p=0.000). Median headache duration declined from 10 (IQR: 7) to 5 (IQR: 4) hours (p=0.000). The VAS pain score decreased from 7 (IQR: 2) to 4 (IQR: 2) (p=0.000), and analgesic use reduced from 11 (IQR: 5) to 6 (IQR: 3.25) per month (p=0.000). Conclusion: GON block showed significant clinical benefit as a prophylactic treatment for migraine, reducing headache frequency, intensity, duration, and analgesic dependency. It offers a viable alternative in patients with chronic migraine not adequately managed by pharmacologic therapy.

Background: Low-dose intravenous thrombolysis using tissue plasminogen activator (tPA) at 0.6 mg/kg has emerged as a potential alternative to the standard regimen in acute ischemic stroke (AIS), particularly in populations at higher risk for bleeding complications. This strategy may offer comparable efficacy with a lower incidence of symptomatic intracranial hemorrhage (sICH), although evidence on its functional outcomes and safety remains limited in real-world settings. Objective: To evaluate 3-month functional outcomes and safety profiles following low-dose intravenous tPA in AIS patients and to identify predictors of functional independence and sICH. Methods: This cross-sectional study was conducted on 160 patients with AIS treated with intravenous alteplase (0.6 mg/kg) within 4.5 hours of symptom onset at a tertiary care center between July and December 2024. Clinical variables, stroke severity using the NIH Stroke Scale (NIHSS), time-to-treatment, and stroke subtype were recorded. Functional independence was defined as a modified Rankin Scale (mRS) score of 0–2 at 3 months. Primary safety outcomes included sICH, defined by SITS-MOST criteria, and all-cause mortality. Results: At 3-month follow-up, 113 patients (71%) achieved functional independence (mRS 0–2), with 73 (46%) attaining favorable outcome (mRS 0–1) and 43 (27%) experiencing complete recovery (mRS 0). sICH occurred in 6 patients (4%), while all-cause mortality was reported in 9 patients (6%). Independent predictors of poor functional outcome included increased age (OR 0.96, p = 0.003), higher baseline NIHSS (OR 0.79, p < 0.001), delayed treatment time (OR 0.98, p = 0.038), and hypertension (OR 0.53, p = 0.041). Predictors of sICH included higher NIHSS (OR 1.19, p = 0.009), elevated blood glucose (OR 1.02, p = 0.027), and advanced age (OR 1.06, p = 0.013). Conclusion: Low-dose intravenous tPA (0.6 mg/kg) is a safe and effective therapeutic option for AIS in carefully selected patients. Age, stroke severity, blood glucose, and treatment delays significantly influence both recovery and risk of sICH. Emphasis on early intervention and individualized risk stratification is key to optimizing outcomes.

Background: Bell’s palsy is an acute unilateral facial nerve disorder resulting in partial to complete facial muscle paralysis, significantly affecting communication and social interactions. The condition is associated with viral infections, immune responses, and vascular ischemia. Its prevalence increases with age and is observed more frequently in rural populations. Recovery depends on the severity of the condition and timely intervention. Recent cases have been linked to COVID-19 and its vaccines. Physiotherapy plays a crucial role in improving functional outcomes at all stages of the disease. Objective: To evaluate the effects of Bell’s palsy on the psychosocial health of patients in tertiary care hospitals in Peshawar. Methods: A cross-sectional study was conducted in three tertiary care hospitals in Peshawar. A total of 121 patients diagnosed with Bell’s palsy were included using non-probability convenience sampling. The sample size was calculated using the OpenEpi sample size calculator. Data were collected using the House-Brackmann Grading Scale (HBGS) to assess disease severity and the Psychosocial Scale of Facial Appearance (PSFA) to evaluate psychosocial distress. Statistical analysis was performed using SPSS version 22. Descriptive statistics, including frequencies and percentages, were calculated, and the chi-square test was applied to determine associations between Bell’s palsy severity and psychosocial distress. Results: Among the 121 patients, 58.7% experienced moderate psychosocial distress, while 41.3% reported severe psychosocial issues. A statistically significant association was found between Bell’s palsy severity and psychosocial health (p<0.001). Patients with severe facial paralysis had higher rates of emotional distress, social withdrawal, and self-esteem issues. The psychosocial impact was more pronounced among young, unmarried females, who expressed concerns about societal acceptance and future relationships. Conclusion: Bell’s palsy has a profound impact on psychosocial health, leading to moderate to severe psychological and social distress due to facial disfigurement, loss of facial expressions, and societal reactions. These findings highlight the need for comprehensive patient education and psychological support alongside medical treatment.

Background: Flat feet, medically referred to as pes planus, are a common structural deformity characterized by the collapse or underdevelopment of the medial longitudinal arch, resulting in the navicular bone coming into contact with the ground. This condition is generally asymptomatic during early life but may become symptomatic later, leading to foot pain and functional limitations. In some cases, it can cause significant disability by altering gait mechanics and postural stability. Objective: To compare static and dynamic balance between patients with flat feet and those with neutral arched feet attending tertiary care teaching hospitals in Dera Ismail Khan. Methods: A comparative cross-sectional study was conducted on 92 participants using a non-probability convenience sampling technique at public tertiary care hospitals in Dera Ismail Khan. Participants were divided equally into two groups, with 46 individuals each having flat feet or neutral arches. The unipedal stance test, performed with eyes open and closed, was used to assess static balance, while the Y-Balance Test measured dynamic balance using right and left leg composite score percentages. Data were analyzed using SPSS version 22, employing descriptive statistics and non-parametric tests to assess differences between groups. Results: The sample included 50 males (54.3%) and 42 females (45.7%). The mean score for static balance with eyes open was 43.84 ± 10.86 seconds, while with eyes closed, it was 13.93 ± 25.41 seconds. Dynamic balance tests showed mean right leg composite scores of 75.45 ± 15.81% and left leg scores of 75.28 ± 17.31%. Significant differences were observed in static balance between groups (p = 0.001), whereas dynamic balance scores did not show statistically significant differences between the flat feet and neutral arch groups (p = 0.093 for the right leg; p = 0.144 for the left leg). Conclusion: The findings of this study suggest that static balance is significantly affected by foot structure, with individuals having flat feet showing impaired balance compared to those with neutral arches. In contrast, dynamic balance appears to be independent of foot structure type. These results underscore the importance of targeted interventions for improving postural stability in individuals with flat feet.

Background: This study examined the prevalence of Work-Related Musculoskeletal Disorders (WRMSDs) among hairdressers and beauticians in Peshawar, specifically targeting the areas of Hayatabad, University Town, and Peshawar Saddar. Objective: The objective of this study is to determine the prevalence of work-related musculoskeletal disorders (WRMSDs) among hairdressers and beauticians in Peshawar, focusing on associated risk factors and impacts on occupational health. Methods: A descriptive cross-sectional design was employed, surveying a total of 340 participants, including 179 males and 161 females. Results: The findings revealed a high prevalence of WRMSDs, with 73.8% of respondents reporting various musculoskeletal conditions. The most reported areas of pain were the ankles (62.1%), followed by the lower back (56.5%), hands/wrists (35.0%), and shoulders (34.4%). Other frequently affected areas included the neck, upper back, hips/thighs, knees, and elbows. Musculoskeletal symptoms had varying impacts on work performance, with 8.5% of respondents reporting no impact, 40.0% reporting a slight impact, 31.8% reporting a moderate impact, 13.2% reporting a high impact, and 6.5% reporting a severe impact. Conclusion: The study found a significant association between repetitive tasks involving awkward postures and work-related stress contributing to musculoskeletal symptoms. Among the 340 participants, 283 reported both work-related stress and repetitive awkward postures as contributors to musculoskeletal symptoms, while only 7 participants reported neither. These findings suggest that repetitive tasks involving awkward postures are significantly associated with stress-related musculoskeletal symptoms among hairdressers and beauticians.