Ergonomic risk factors among computer office workers for complaints of arm, neck and shoulder and workstation evaluation.

BACKGROUND: Studies have suggested an association between computer work and the development of musculoskeletal disorders. However, studies examining the workplace ergonomics assessment of computer offices are scarce in the Pakistani population. OBJECTIVE: To determine the presence of ergonomic risk factors in the office using the Rapid Assessment Office Strain (ROSA) method for complaints of arm, neck and shoulder (CANS) among office computer workers. METHODS: From January to August 2019, a cross-sectional study was carried out among office workers who worked at least three hours on computers in their daily work. The prevalence of CANS was measured by using the Maastricht Upper Extremity Questionnaire (MUEQ) and work station evaluation was done by using Rapid Office Strain Assessment (ROSA). Data were collected from 773 computer workers, of whom 443 (56%) worked in the information technology sector, 215 (28%) in industry and 124 (16%) in universities. SPSS version 20 was used for data entry and analysis. RESULTS: Out of 773 computer workers, 448 (58%) reported musculoskeletal pain and the most prevalent were shoulder pain (327, 42%) and neck pain (270, 35%). The mean scores of ROSA sections A, B, C and D were 4.00±0.82, 2.98±0.72, 3.49±0.67 and 3.61±0.72 respectively. The mean ROSA total score in 773 office computer workers was 4.19±0.78, which indicates a low risk of musculoskeletal complaints. There was significant association was found between ROSA section A and shoulder pain (P = 0.043), ROSA section C with complaints of lower arm (P = 0.013), wrist (P = 0.016), and hand pain (P = 0.005), ROSA section D with lower arm (P = 0.002), wrist (P = 0.004) and hand complaints (P = 0.002). A significant association was found between ROSA total score and complaints of shoulder and hand, with p values of 0.012 and 0.006, respectively. CONCLUSION: CANS are prevalent among computer office workers, and there is a significant relationship between CANS and workstation ergonomics.

Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson's disease.

BACKGROUND: Virtual reality (VR) is an advanced technique used in physical rehabilitation of neurological disorders, however the effects of VR on balance, gait, and motor function in people with Parkinson's (PD) are still debated. Therefore, the systematic review aimed to determine the role of VR on motor function, balance and gait in PD patients. METHODS: A comprehensive search to identify similar randomised controlled trials was conducted targeting 5 databases including Web of Science, PubMed, CINHAL, Cochrane Library, and Physiotherapy Evidence Database. A total of 25 studies were found eligible for this systematic review, and the methodological assessment of the quality rating of the studies was accomplished using the physiotherapy evidence database scale by 2 authors. RESULTS: Out of the 25 included studies, 14 studies reported on balance as the primary outcome, 9 studies were conducted to assess motor function, and 12 assessed gait as the primary outcome. Most studies used the Unified Parkinson disease rating scale UPDRS (part-III) for evaluating motor function and the Berg Balance Scale as primary outcome measure for assessing balance. A total of 24 trials were conducted in clinical settings, and only 1 study was home-based VR trainings. Out of 9 studies on motor function, 6 reported equal improvement of motor function as compared to other groups. In addition, VR groups also revealed superior results in improving static balance among patient with PD. CONCLUSION: This systemic review found that the use of VR resulted in substantial improvements in balance, gait, and motor skills in patients with PD when compared to traditional physical therapy exercises or in combination with treatments other than physical therapy. Moreover, VR can be used as a supportive method for physical rehabilitation in patients of PD. However, the majority of published studies were of fair and good quality, suggesting a demand for high quality research in this area.

Combined effects of virtual reality techniques and motor imagery on balance, motor function and activities of daily living in patients with Parkinson's disease: a randomized controlled trial.

BACKGROUND: Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder, impairing balance and motor function. Virtual reality (VR) and motor imagery (MI) are emerging techniques for rehabilitating people with PD. VR and MI combination have not been studied in PD patients. This study was conducted to investigate the combined effects of VR and MI techniques on the balance, motor function, and activities of daily living (ADLs) of patients with PD. METHODS: This study was a single-centered, two-armed, parallel-designed randomized controlled trial. A total of 44 patients of either gender who had idiopathic PD were randomly allocated into two groups using lottery methods. Both groups received Physical therapy (PT) treatment, while the experimental group (N: 20) received VR and MI in addition to PT. Both groups received assigned treatment for three days a week on alternate days for 12 weeks. The Unified Parkinson's Disease Rating Scale (UPDRS) (parts II and III), Berg Balance Scale (BBS), and Activities-specific Balance Confidence (ABC) Scale were used as outcome measures for motor function, balance, and ADLs. The baseline, 6th, and 12th weeks of treatment were assessed, with a 16th week follow-up to measure retention. The data was analysed using SPSS 24. RESULTS: The experimental group showed significant improvement in motor function than the control group on the UPDRS part III, with 32.45±3.98 vs. 31.86±4.62 before and 15.05±7.16 vs. 25.52±7.36 at 12-weeks, and a p-value < 0.001. At 12 weeks, the experimental group's BBS scores improved from 38.95±3.23 to 51.36±2.83, with p-value < 0.001. At 12 weeks, the experimental group's balance confidence improved considerably, from 59.26±5.87to 81.01±6.14, with a p-value of < 0.001. The experimental group's ADL scores improved as well, going from 22.00±4.64 to 13.07±4.005 after 12 weeks, with a p-value of < 0.001. CONCLUSION: VR with MI techniques in addition to routine PT significantly improved motor function, balance, and ADLs in PD patients compared to PT alone. TRIAL REGISTRATION: IRCT20200221046567N1 . Date of registration: 01/04/2020.

Psychometric Properties of the Urdu Translation of Berg Balance Scale in People with Parkinson's Disease.

BACKGROUND: The most common assessment tool used in clinical settings to detect changes in balance performance is the Berg Balance Scale (BBS). Thus, the purpose of this study was to translate the BBS into Urdu and investigate the psychometric properties (acceptability, internal consistency reliability, interrater reliability, construct validity) for individuals with Parkinson's disease (PD). METHODS: Eighty patients of either gender with idiopathic Parkinson's disease, stages I-III on the modified Hoehn-Yahr (H&Y) scale, with intact cognition according to the Mini Mental Score Examination (MMSE) score (greater than or equal to 24) and independent of transfers, were included in this study. The BBS was translated according to international guidelines based on forward and backward translation processes. The test-retest reliability as well as intra- and inter-observer reliability was assessed by calculating the intra-class correlation coefficient (ICC). The internal consistency of the entire BBS score was assessed by calculating Cronbach's α. The convergent validity was assessed by correlating the scale with the Unified Parkinson Disease Rating Scale (UPDRS) parts II and III and the Activity-specific Balance Confidence Scale (ABCS). The construct validity was assessed using a factor analysis. RESULTS: The mean age of the subjects was 62.35 ± 5.74 in years (range: 60-87 years). The ICC for intra- and inter-observer reliability was 0.95 (p < 0.0001) and 0.99 (p < 0.001), respectively. Cronbach's α was calculated as 0.81, which showed acceptable internal consistency of the Urdu version of the BBS. The test-retest reliability (ICC) of the Urdu version of the BBS was determined as 0.97 for the total score, and ranged from 0.66-0.95 for individual items. In terms of validity, the Urdu version of the BBS was correlated with the ABCS (in the positive direction) and UPDRS-II and III (in the negative direction) (r = 0.53, p < 0.001; r = -0.68, p < 0.001, r = -0.78, p < 0.0001), respectively. CONCLUSION: The Urdu version of the BBS is a reliable and valid scale to be used in balance assessment of population diagnosed with PD with excellent psychometric properties.

Effects of proprioception training programme on balance among patients with diabetic neuropathy: A quasi-experimental trial.

OBJECTIVE: To determine the effects of proprioception training in improving balance in patients with diabetic neuropathy. METHODS: The quasi-experimental study was conducted at Safi Hospital, Faisalabad, Pakistan, from August to December 2019, and comprised diabetic neuropathy patients of both genders aged 60-83 years. They were divided into two groups of cases and controls, with the former getting. proprioception training twice a week for eight weeks along with diabetes awareness lectures once a week, while the former group only received awareness lectures. Static and dynamic balance were assessed using one leg standing test with eyes open and closed, Berg balance scale and timed-up and go test. Data was collected at baseline and post-intervention. Data was analysed using SPSS 23. RESULTS: Of the 38 patients, there were 19(50%) in the exercise group with a mean age of 64±7.7 years; 10(52.6%) males and 9(47.3%) females. The control group had 19(50%) patients with a mean age of 63±8.2 years; 12(63.1%) males and 7(36.8%) females. The one leg standing score with eyes open improved significantly (p<0.05), but the difference was non-significant with eyes closed (p=0.073). Berg balance scale and timed-up and go scores revealed significant improvement in the exercise group (p<0.05). CONCLUSIONS: Proprioception training exercises were found to be effective in improving balance among patients with diabetic neuropathy.

Comparison of subtalar mobilisation with conventional physiotherapy treatment for the management of plantar fasciitis.

OBJECTIVES: To compare the effectiveness of subtalar mobilisation technique on pain and functional disability compared to conventional physiotherapy in patients with plantar fasciitis. METHODS: The randomised controlled trial was conducted at the Prime Care Hospital, Faisalabad, Pakistan, from January to August 2017, and comprised patients of either gender aged 30-60 years presenting with complaints of heel and foot pain, a limited range of motion at the ankle joint due to heel pain, and pain in the morning when taking the first steps or after prolonged rest. The participants were randomly assigned to intervention group A, that received subtalar mobilisation, and control group B treated with therapeutic ultrasound. The groups received two treatment sessions per week over 3 weeks. Patients in both the groups received stretching and rigid tapping as standard treatment. Visual analogue scale and the foot and ankle disability inventory were used to measure pain and functional disability. Data was analysed using SPSS 20. RESULTS: Of the 60 patients enrolled, 8(13.3%) were lost to follow-up, while 52(86.6%) completed the study. Of the 52 subjects, there were 25(48%) in group A with a mean age of 32.40±8.02 years, while in group B there were 27(52%) subjects with a mean age of 32.59±7.00 years. Group A had 11(44%) males and 14(56%) females, while group B had 16(59.3%) males and 11(40.7%) females. Mean body mass index for group A was 25.35±3.8 compared to 25.67±3.25 for group B. There were significant differences in terms of pain between the two groups (p<0.05). Group A showed more reduction in functional disability than group B (p<0.05). CONCLUSIONS: Subtalar mobilisation with movement was found to be effective in reducing pain and functional disability than conventional treatment in patients with plantar fasciitis. RANDOMIZED CONTROLLED TRIAL NO: 20200221046567N2 dated April 18, 2020. URL:https://www.irct.ir/trial/46988.with the World Health Organisation (WHO)-recognised Iranian Registry of Clinical Trials.

Effects of Virtual Reality with Motor Imagery Techniques in Patients with Parkinson's Disease: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Parkinson's disease (PD) is one of the most common neurological disorders, of insidious onset, with major motor symptomatology including bradykinesia, rest tremor, rigidity, and postural disturbances. Virtual reality (VR) and motor imagery (MI) are among the more innovative techniques for the rehabilitation of patients with PD which promote motor learning both through explicit and implicit processes. This study is unique in that it will examine the combined effects of VR and MI on motor function, balance and activities of daily living (ADLs) in patients with PD. OBJECTIVE: The aim of this work is to investigate the effects of VR with MI techniques in addition to routine physical therapy on motor function, balance, and ADLs in patients with PD. METHODS: This is a two-armed parallel design, single-blinded (assessor blinded), single-centered, randomized controlled trial, and the study protocol is based on SPIRIT guidelines. Thirty-four patients with PD (Modified Hoehn and Yahr stages I-III) will be randomly allocated with a 1:1 ratio into Group A (control group) and Group B (treatment group). Group A will be given routine physical therapy in 40-min sessions and 20 min of walking and cycling with a short period of rest, every alternate day (3 days per week) for 12 weeks, while for Group B routine physical therapy protocols along with VR and MI will be used in 60-min sessions, every alternate day (3 days per week) for 12 weeks. The primary outcome measures are as follows: (i) the Unified PD Rating Scale (UPDRS; part III), (ii) the Berg Balance Scale (BBS), and the Activities-Specific Balance Confidence Scale (ABC). The secondary outcome measure is the UPDRS (part II). Assessments will be recorded at baseline, the sixth and twelfth weeks of therapy, and 1 month after the discontinuation of therapy. Clinical Study Registration: This randomized controlled prospective study was registered with the Iranian Registry of clinical trials (IRCT20200221046567N1) on April 1, 2020 (https://www.irct.ir/trial/46073).

Factors influencing the community integration of patients following traumatic spinal cord injury: a systematic review.

BACKGROUND: Spinal cord injury (SCI) is a high-cost disabling condition, which brings a huge number of changes in individual's life. The emphasis of rehabilitation has moved from medical administration to issues that affect quality of life and community integration. This systematic review was conducted to identify the factors associated with community reintegration of patients with spinal cord injury. . METHODS: Google Scholar, PEDro, Pakmedinet, AMED, BIOMED central, Cochrane Library, MEDLINE, PsychoINFO, PUBMED, ScienceDIRECT, Scirus and Wiley Online Library databses were searched by using key words 'Spinal cord injury' 'Paraplegia' or 'Spinal Cord Lesion' or Tetraplegia. They were cross-linked with 'Community reintegration', 'Community participation' and 'Community access'. The methodological quality of the studies included was analysed by using McMaster University Tool and Thomas Tool. The data extracted included sample size, intervention, duration, results, outcome measures, and follow-up period. RESULTS: A total of 11 relevant studies were located. The evidence extracted was classified into four groups; health-related barriers or facilitators, environment-related barriers or facilitators, psychological barriers and social barriers that are associated with community reintegration of such individuals. CONCLUSIONS: The review revealed that there were more barriers in the form of health-related issues, personal and environmental, psychological and social issues that hinder the community reintegration of individuals with spinal cord injury compared to facilitators. Most studies identified special challenges related to environment in the sense of accessibility of home and public buildings and transportation. Removing barriers related to health, environment, and psychological and social factors can enhance community reintegration of such patients.

Parent's perception of constraint induced movement therapy in cerebral palsy management in rehabilitation centers of Lahore.

OBJECTIVE: To assess the perceptions of parents about constraint-induced movement therapy to treat their children with cerebral palsy. METHODS: The qualitative study was conducted in three rehabilitation centres situated in Lahore, Pakistan, from January to July 2014, and comprised parents with enough experience of constraint-induced movement therapy. Therapy session was given to children with hemiplegic spastic cerebral palsy for 4 5 hours per day for at least a month. The interview was recorded and then transcribed verbatim. RESULTS: There were 5 sets of parents whose children were aged 4-12 years. Five main themes emerged from the interviews and they were: child behaviour towards the therapy is variable; increase in cognitive level of the child; group therapy is more beneficial than individual therapy; after therapy the children developed a habit to use the affected hand in their activities; and other than change in the physical condition, parents also observed change in the social behaviour. CONCLUSIONS: Constraint-induced movement therapy seemed to offer a promising opportunity to tackle and promote both social and physical outcomes in cerebral palsy children.

Opinion of Pakistani physiotherapists/students about anatomy as a subject and method of teaching anatomy: a cross sectional survey.

OBJECTIVE: To recognise and identify the importance of Anatomy as a subject for physiotherapists/students. METHODS: The cross-sectional descriptive study was conducted from January to October 2011 at Riphah International University, Lahore, and comprised physiotherapists registered with Pakistan Physical Therapy Association and students pursuing undergraduate physiotherapy studies at the University. A survey proforma consisting of six questions was used for data collection which was analysed using SPSS 17. RESULTS: Of the 500 questionnaires distributed among physiotherapists and students, 286(57.2%) were collected back duly filled. Overall, 280(97.9%) respondents said Anatomy was important in physical therapy, 179(62.58%) said Anatomy was a difficult subject to retain knowledge of, 155 (54.38%) were of the view that only Clinical Anatomy should be studied, 204 (71.32%) were in favour of performing dissection, 259 (90.55%) found that teaching videos were essential for the study of Anatomy, and 89 (31.11%) believed Anatomy could be memorised by multiple readings. CONCLUSION: Despite being a difficult subject, Anatomy is an essential subject for medical professionals.