ABSTRACT
Background and Objective: Hyperlipidemia and dyslipidemia are very common conditions among patients with Type-2 diabetes mellitus [T2DM] and associated with increased risk of coronary heart diseases. Physical activity and exercises along with medical management and dietary plan are common strategies to use for the management of deranged lipid profile in patients with T2DM. We aimed to determine the effects of supervised structured aerobic exercise training [SSAET] program on high and low density lipoprotein in patients with T2DM
Methods: This randomized control trial study was conducted at Riphah Rehabilitation Research Centre [RRRC], Pakistan Railway General Hospital [PRGH] Rawalpindi from 1[st] January 2015 to 30[th] March 2016. The inclusion criteria was Type-2 diabetes patients of both gender aged between 40 to 70 years. Patients with severe complications like coronary artery diseases [CAD], and other serious complications like diabetic foot, and severe knee and hip osteoarthritis [OA] were excluded from the study. A total of 195 patients diagnosed with T2DM were screened out and 102 were selected for the study as per the inclusion criteria. All participants were randomly assigned into two groups, experimental 'A' [n=51] and control 'B' [n=51]. Patients in group A were treated with SSAET program of 25 weeks at 3 days a week in addition to routine medical management, while patients in Group-B were on their routine medications and dietary plan. Serum LDL, and HDL were tested at baseline and after 25 weeks. The data was analysed through SPSS 20
Results: Mean and standard deviation of LDL in group A [n=51] was 118.56 +/- 19.17 [pre] and 102.64 +/- 13.33 [post], while the mean and standard deviation for Group-B [n=51] was 116.50 +/- 18.45 [Pre] and 109.88 +/- 17.13 [post]. Both groups showed improvement but, Group-A treated with SSAET along with RMM showed significantly higher [P Value
Conclusion: SSAET program along with RMM is more effective strategy for the management of deranged lipid profile in patients with T2DM
ABSTRACT
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 [premean=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
ABSTRACT
Objective: To determine the effects of supervised structured aerobic exercise training [SSAET] program on interleukin-6 [IL-6], nitric oxide synthase 1 [NOS-1], and cyclooxygenase-2 [COX-2] in type 2 diabetes mellitus [T2DM]
Study Design: Randomized controlled trial
Place and Duration of Study: Riphah Rehabilitation and Research Centre, Railways General Hospital, Rawalpindi, from January 2015 to June 2016
Methodology: Patients of either gender of minimum one year history of T2DM ranging from 40-70 years of age were included. Those with chronic systemic diseases, history of regular exercise, smoking, and those on dietary plan were excluded. A total of 195 patients were screened; 120 were selected and 102 agreed to participate in the study
They were randomly placed into experimental and control groups. SSAET program, routine medication, and dietary plan were applied in experimental group; whereas, control group was managed with routine medication and dietary plan for 25 weeks. IL-6, NOS-1, and COX-2 were assessed at baseline and 25 weeks
Results: SSAET program, routine medication and dietary plan showed significantly improved IL-6 [pre-mean=0.25 +/-0.11ng/ml, post-mean=0.19 +/-0.04 ng/ml], NOS-1 [pre-median=4.65 ng/ml, IQ range=1.04 ng/ml], [post-median=2.72 ng/ml, IQ range=1.60 ng/ml], and COX-2 [pre-mean=18.72 +/-4.42 ng/ml, post-mean=15.18 +/-2.63 ng/ml] in experimental group, as compared with control group managed by routine medication and dietary plan, where deterioration was noted in IL-6 [pre-mean=0.23 +/-0.08 ng/ml, post-mean=0.27 +/-0.08 ng/ml] and COX-2 [pre-mean=18.49 +/-4.56 ng/ml, post-mean=19.10 +/-4.76 ng/ml], while NOS-1 slight improvement [pre-mean=4.99 ng/ml, IQ range=2.67 ng/ml], [post-mean=4.56 ng/ml, IQ range=3.85 ng/ml]. Statistically at the baseline the p-values were not significant [p>0.05] in both experimental and control groups for IL-6, COX-2 and NOS-1; while after 25 weeks of intervention, the experimental group showed significant improvement [p<0.05] in comparison with the control group
Conclusion: SSAET program, routine medication, and dietary plan had positive effect on IL-6, NOS-1, and COX-2 in T2DM patients
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Aged , Exercise , Interleukin-6 , Nitric Oxide Synthase , Cyclooxygenase 2 , Randomized Controlled Trials as TopicABSTRACT
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 exercises program [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
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To determine the outcome of strength training programme; with and without hamstring stretching in Patients with Knee Osteoarthritis. A Comparative experimental study. This research study was conducted in department of physical therapy at National Institute of Rehabilitation Medicine [NIRM] Islamabad from 1st January to 31st July 2014. A total of 40 patients were randomly selected and placed into two groups. The inclusion criteria were radiologically diagnosed patients of both genders for knee Osteoarthritis of age ranges from 40 to 75 years. The isometric quadriceps strengthening exercise, hamstring stretching exercises and NSAIDS were applied in group A, while group B was treated with isometric quadriceps strengthening exercise and NSAIDS. Both the groups were treated for 6 weeks at 3 days per week and Visual Analog Scale [VAS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and knee range of motion were used as assessment tools to assess pain, function, and mobility. The measurements were made at the baseline and at the completion of 6 weeks treatment program to obtain numbered data. The data was analyzed through SPSS-20 and paired t test was applied to assess the statistical significance outcomes at 95% level of significance. The results showed that the patients treated with isometric quadriceps strengthening exercises and hamstring stretching exercises combined with NSAIDS managed pain, function and mobility clinically and statistically more [p=0.011, p=0.021, p=0.001], as compared with group B treated with isometric quadriceps strengthening exercise and NSAIDs [p=0.931, p=0.814, p=0.742], in patients with knee Osteoarthritis, as assessed by visual analog scale [VAS], WOMAC index andgoniometry. It is concluded that isometric quadriceps strengthening exercise, hamstring stretching exercises and NSAIDS will managed pain, function, and mobility more effectively as compared with isometric quadriceps strengthening exercise and NSAIDS in patients with Osteoarthritis
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To determine the effectiveness of Spinal Mobilization with manual traction on pain and disability in patients with cervical Radiculopathy. Randomized control trial [RCT]. The study was conducted at Helping Hand for Relief Rehabilitation Centre Mingore Swat from IstJanuary to 30th June 2014. A total of 40 patients [23 males and 17 females] with mean age 35+8 were randomly selected and placed into two groups A and B. The inclusion criteria was patients with diagnosed cervical radiculopathy on physical examination were included. The Group A was treated with spinal mobilization with manual traction, while group B was treated with spinal mobilization alone for 6 weeks at 3 days per week. The Neck Disability Index [NDI] and Numeric Pain rating Scale [NPRS] were used to measure disability and radiating pain. SPSS version 21 was used for the analysis of data and paired t-test was applied at 95% level of significance to determine the statistical outcomes. The results of both groups were significant but group of patients treated with the spinal mobilization and traction managed pain [from NPRS mean score 6.2 to 2.5] and disability [from NDI mean score 29.18 to 13.45] more than the group of patients treated with the spinal mobilization alone [Pain from NPRS mean score 6.1 to 3.15 and disability from NDI mean score 30.5 to 18.21]. Statistically the group A showed more significant results [p= 0.001] than group B [p= 0.054]. It is concluded that Spinal mobilization combined with manual traction is more effective than spinal mobilization alone for the management of radicular pain and disability in patients with cervical radiculopathy
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To determine the efficacy of Sustained Natural Apophyseal Glides [SNAGs] with and without Isometric Exercise Training Program [IETP] in Non-specific Neck Pain [NSNP]. This randomized control trial of one year duration was conducted at out-patient department of Physiotherapy and Rehabilitation, Khyber Teaching Hospital [KTH] Peshawar, Pakistan from July 2012 to June 2013. The sample of 102 patients of NSNP were randomly selected through simple random sampling technique, and placed into two groups. The SNAGs manual physical therapy technique with IETP was applied on 51 patients in group A and SNAGs manual physical therapy techniques was applied alone on 51 patients in group B. The duration of intervention was 6 weeks, at 4 times per week. The Neck Disability Index [NDI] and Visual Analog Scale [VAS] for neck pain were assessment tools used for all patients before and after 6 weeks of physical therapy intervention. All the patients were assessed through NDI and VAS before intervention and at the completion of 6 weeks program. The data of all 102 was analyzed by SPSS-20 and statistical test was applied at 95% level of significance determine the efficacy of both the treatments interventions and compare with each other. The patients in group A, treated with SNAGs and followed by IETP for 6 weeks, demonstrated more improvement in pain and physical activity as assessed by VAS [p=0.013] and NDI [p=0.003], as compared to the patients treated with SNAGS alone, as pain and function assessed by VAS [p=0.047] and NDI [p=0.164]. In group A the NDI score improved from 40 to 15 and VAS from 7 to 4, while in group B the NDI score improved from 42 to 30 and VAS from 7 to 4. Patients with non-specific neck pain treated with SNAGs manual physical therapy techniques and followed by IETP was more effective in reduction of pain and enhancement of function, as compared to those patients treated with SNAGs manual physical therapy techniques alone
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To observe the effects of Active Self Propelled Wheel Chairs versus Regular [Standard] Wheel Chairs on Quality of Life in Paraplegic Population. This observational study was conducted in three union councils of district Swat from the period of January to December 2012. The total of 50 paraplegic patients were selected and placed into two groups. After taking a written consent Active Wheel Chair Self Propelled was provided to the patients in group A, and Regular Wheel Chair Standard to the patients in group B. Initially all the patients were trained for the proper use of wheel chair. The baseline characteristics were same in all patients. The individual prioritize problem assessment instrument [IPPA] was used an assessment toll, and it measures the effects of assistive technology. IPPA score was calculated for all patients at baseline and after 3 months use of wheel chairs. The quality of life was significantly more enhanced in group A with Active Self Propelled Wheel Chairs [P=O.OOl], as compared to group B with Regular Standard Wheel Chairs [P=0.541], in paraplegic population, as assessed by the individual prioritize problem assessment instrument [IPPA]. The Active Self Propelled Wheel Chairs are more effective for the enhancement in quality of life, as Compare to Regular Standard Wheel Chairs in Paraplegic Population
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To Compare the Specific Lumber Mobilization [SLM] techniques and Core-Stability [CS] Exercises with Core-Stability Exercises Alone in Mechanical low back pain [MLP] A 6 month pretest-posttest design, quasi experimental study was conducted at department of physiotherapy Khyber Teaching Hospital [KTH] Peshawar, Pakistan. We conveniently selected a sample 40 patients and placed into two groups. The SLM techniques with CS exercises was applied in group A and CS exercises alone in group B for 6 weeks. The Oswestry Disability Index [ODI] and Visual analog scale [VAS] for mechanical low back pain were assessment tools assessed for all patients before and after 6 weeks of physical therapy intervention. Data was analyzed by SPSS and statistical test were applied at 95% level of significance determine the efficacy of both the treatments regimes and compared with each other. After comparison between two groups, the group A treated with specific lumber mobilization techniques shows better results in improving pain [p=0.008] and reducing physical disability [p=0.004] as compared to the group B treated with specific lumber mobilization techniques alone [pain intensity: p= 0.172 and physical disability: p=0.201]. It is concluded that patients with mechanical low back pain will show more improvement in pain and function while treated by specific lumber mobilization and core stability exercises as compared to those patients who will be treated by specific joint mobilization techniques
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To determine the role of early passive range of motion exercises in the reduction in scar formation and prevention of Contracture in sub-acute Burn Patients. Study Design: Randomized Control Trail [RCT]. Burn Centre Pakistan Institute of Medical Sciences Islamabad, from January to December, 2010. Thirty patients were selected from the burn center at Pakistan Institute of Medical sciences [PIMS] Islamabad, age ranging from 12-60 years, and were randomly placed into two groups, 15 patients in each group. The anti-contracture positioning program was applied on group A with early passive range of motion [PROM] exercises of the involved areas and in group B only anticontracture positioning program was applied. The Vancouver Scar Scale [VSS] was used as an assessment tool and 4 variables were assessed including vascularity, height/thickness, pliability, and pigmentation. Data was analyzed on SPSS version-20 and independent t-test was applied at 90% level of significance to calculate the p-value for group A and B. The results show that the anti-contracture positioning with early passive range of motion [PROM] exercises reduced scar formation and prevent contractures more significantly in group A [P-value =0.002] with average VSS score 6, as compare to the anticontracture positioning alone in group B [P-value=0.435] with VSS score 10, as assessed at the completion of physical therapy management program in all the 30 patients of subacute stage of burn. It was concluded that the early passive range of motion exercises with anti-contractures positing can reduce the amount of scar formation, prevent contractures and increase the quality of physical therapy management in sub-acute stage of burn patients
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To evaluate the overall faculty performance by comparison of Self-assessment with peer and student assessment. A comparative cross sectional survey. Study was conducted from January to June 2012 in Riphah College of Rehabilitation Sciences, Riphah International University Islamabad. This research study was conducted among students of Doctor of physical therapy [DPT], post-professional Doctor of physical Therapy [PPDPT], and Master of Science in speech language pathology [MS-SLP], and faculty members at Riphah College of Rehabilitation Science [RCRS], Riphah International University Islamabad. The total sample size was 730, including 700 students and 30 faculty members. A questionnaire was developed according to likert scale, and after a pilot study on 20 student and 10 faculty member to determine the reliability. The questionnaire was circulated among all the 30 faculty members and 700 students, including 500 undergraduate and 200 post graduate students of all the 3 programs. The data was analyzed and Wilcoxon [Kruskal-Wallis] was applied at 95% level of significance for all the 3 groups. The group [A] included assessment of the performance of the faculty members done by the students, group [B] done by other faculty members, and group [C] included self assessment done by faculty members. The averages were calculated to determine the overall performance of the faculty members as assessed by themselves, other faculty members, and the by students as well, afterwards the averages of 3 groups were compared. the overall performance of the faculty members was graded as 71% [P=0.015] as evaluated by the students, 77% [P=0.009] as evaluated by other faculty members, and 73% [P=0.011] as evaluated by the faculty members through self assessment. It is concluded that there was no significant difference in the performance of the faculty members, as assessed themselves, by the students and the other faculty members
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To determine the efficacy of rib cage mobilization on lung function in COPD patients. This randomized control trial was carried out at Department of Physical Therapy and Rehabilitation, Fauji Foundation Hospital, Rawalpindi and Railway General Hospital Rawalpindi, Pakistan from sep. 2010 to sep. 2011. Sixty two patients were randomly placed into two groups, 35 in group A and 27 in group B. The inclusion criteria was at least one year history of COPD, altered Dyspnea index, and decrease FEV1/FVC ratio and the exclusion criteria was less than one year history of COPD, normal Dyspnea index and no change in FEV1/FVC ratio. All the patients were treated for three weeks and rib cage mobilization was applied in group A and deep breathing exercise in group B. The rib cage mobilization was applied in sitting and side lying position for 10[th] to 2[nd] ribs and in supine position for 1[st] rib. The Dyspnea index and FEV1/FVC ratio were used as assessment tools, and were calculated before and after the therapy intervention. The data was analyzed by SPSS v 20 and paired t- test was applied to calculate the probability at 95% level of significance. The rib cage mobilization increased FEV1/FVC ratio and Dyspnea index significantly [P=0.004, P=0.006] in group A, as compared to the deep breathing exercise in group B [P= 0.073, and P=0.083]. We conclude that rib cage mobilization had very effective role in increasing rib cage mobility and improve lung function in COPD patients
Subject(s)
Humans , Respiratory Function Tests , Ribs , Random AllocationABSTRACT
To determine effects of early mobilization in reducing post operative wound infection after lower extremity orthopedic surgeries. Quasi Experimental Study. This study was carried out at department of orthopedics Pakistan Railway General Hospital Rawalpindi, from August 2010 to July 2012. Eighty nine patients who had undergone lower extremity surgery were conveniently placed into early mobilization group A and delayed mobilization group B. All the patients mobilized within first week after surgery were included in group A, and those mobilized after one week of surgery were included in group B. Patients' wound infection was defined as local redness, pain, and pus discharge within three weeks after surgery. Results were analyzed using Chi-square test with SPSS-16.0. Minimum age of patients in this study was 10 and maximum 90 years with a mean of 45 in group A and 44 in group B. The total number of the cases of wound infections was 6 [6.74%]; 2 [4.4%] in the early mobilized group and 4 [9%] in the delayed mobilized group. Statistical analysis showed significant difference in the number of wound infections in both groups and the result for group A was statistically more significant [p value=0.03] as compared to result] for group B [p value =0.06]. We conclude that after lower extremity orthopedic surgeries, early mobilization is needed, as it significantly reduces the postoperative wound infection rates, and early mobility is achieved