Journal Riphah College of Rehabilitation Sciences

The Silent Epidemic: Confronting the Invisible Communication Crisis in Multiple Sclerosis

Hans Bogaardt — Tue, 23 Dec 2025 00:00:00 +0000

Synchronization of Exercise Timings Relative to Glycemic Control - A Systematic Review

Sheeza Ayub, Sausan Fatima, Anwar Zaib, Muhammad Faisal Qureshi — Tue, 23 Dec 2025 00:00:00 +0000

Background: Diabetes mellitus is a chronic metabolic disorder characterized by impaired glucose regulation. Exercise is a key non-pharmacological strategy to improve insulin sensitivity and metabolic control. Emerging evidence indicates that the timing of exercise, especially in the afternoon, may optimize glycemic outcomes.

Objective: To analyze the effect of exercise timing on glycemic markers in individuals with metabolic diseases like diabetes.

Methodology: For this review, two authors performed literature searches in numerous databases. For quality assessment Modified Downs and Black Checklist has been used. After a comprehensive analysis, seven studies met the inclusion criteria.

Results: Afternoon timing results had favorable outcomes, showing a decline in their glucose parameters. Unlike morning timing also showed considerable results in a decrease of glycemic factors. Studies reported statistically significant findings in favor of afternoon exercise. For example, Savikj et al. (2018) reported reduced blood glucose levels based on CGM in the afternoon group (6.1 ± 0.4 mmol/l) compared to the morning group (6.6 ± 0.4 mmol/l; p < 0.05). Mancilla et al. (2020) showed a decline in fasting plasma glucose in the afternoon group (−0.3 ± 1.0 mmol/l) versus an increase in the morning group (+0.5 ± 0.8 mmol/l), with a significant intergroup difference (p = 0.02). VO₂ max improvements were significant in both groups with p-values of 0.003 (morning) and 0.001 (afternoon). Additionally, Gomez et al. (2015) found that hypoglycemic events were significantly lower following morning exercise sessions compared to afternoon (p < 0.001).

Conclusion: Afternoon timing plays a pivotal role in reducing the glycemic parameters. Future research endeavors should focus on incorporating larger sample sizes, and more randomized control trials should be conducted on the female population

Keywords: Circadian Rhythm; Diabetes; Exercise Timing; Muscle Clocks; Morning Exercise; Afternoon Exercise

Comparative Effects of Neural Mobilization of Sciatic Nerve Versus Stretching Among Patients with Piriformis Syndrome: A Randomized Clinical Trial

Tue, 23 Dec 2025 00:00:00 +0000

Background: Piriformis syndrome is considered as painful musculoskeletal condition resembling sciatica. It is responsible for 6% of cases of low back pain and is frequently unrecognized in clinical setting.

Objective: To compare the effects of neural mobilization of Sciatic nerve versus stretching of piriformis muscle in patients with piriformis syndrome.

Methodology: All patients coming to Physiotherapy OPD complained about radiating pain in back and legs were screened for sciatica and piriformis syndrome. A total of 40 patients were selected. They were randomly divided into 2 groups; each group contained 20 patients. Group A received neural mobilization of sciatic nerves while Group B received stretching of piriformis muscle. Both groups received treatment for 3 days a week for 2 weeks. Visual analogue Scale (VAS), hip range of motion (ROM) (flexion, abduction and external rotation) and FAIR test were performed pre and post intervention and results were compared for any improvements. SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for Statistical analyses. Paired t-tests were applied for within-group comparisons, and independent t-tests for between-group comparisons. Effect sizes (Cohen’s d) and 95% confidence intervals were also calculated. (Clinical Trial Registry Number: NCT06808659)

Results: The difference in means for all the assessment parameters pre and post treatment showed significant improvement in both groups. Hip flexion ROM, Hip external rotation, Hip abduction ROM, FAIR test, and VAS showed no significant difference when both groups were compared.

Conclusion: This study concluded that both neural mobilization of the sciatic nerve and piriformis stretching significantly improved pain and hip function, but neither technique was superior. These findings suggest that both approaches are effective and may be considered equally viable treatment options for piriformis syndrome.

Keywords: Visual analogue scale, physiotherapy, pain management, Piriformis syndrome, FAIR test, Range of motion.

Comparison of Passive Translatoric Intervertebral Glides and Manual Segmental Traction in patients with Mechanical Low Back pain: A Randomized Controlled Trial

Mahnoor Zia , Zainab Noor Qazi, Sana Javaid, Huma Mehrin Khan, Shakeel Ahmad — Tue, 23 Dec 2025 00:00:00 +0000

Background: Low back pain is a global health issue and leading cause of disability. It is frequently treated by using manual treatments in physiotherapy clinics including mobilizations and spinal traction.

Objective: To determine and compare the effects of joint mobilizations and manual spinal traction on pain, disablity and joint range of motion in mechanical low back pain

Methodology: In the Physiotherapy Department of Aziz Bhatti Hospital, Gujrat, 34 participants with the complaint of diagnosed and confirmed cases of mechanical low back pain, aged 25 to 65 years were split into two equal groups for a randomized clinical trial. Group A received Passive Translatoric Intervertebral Glides while Group B received Manual Lumbar Traction (MLT) and both received conventional core stability exercises. Data was gathered using Numeric Pain Rating Scale (NPRS), Modified Oswestry Diability Index (MODI), and a universal goniometer at baseline, 2nd week and 4th week using Non-probability convenient sampling technique. SPSS version 22 was used for data analysis. (Clinical Trial Registry Number: NCT05522543)

Results: A significant improvement in pain, disability and range of motion was seen in both groups at the 4th week of intervention (p< 0.001). However, Group B (MLT) showed more improvement in NPRS compared with Group A (PTIG). Both the treatment groups including PTIG (p< 0.001) and MLT (p< 0.001) showed significant reduction in disability scores however no statistically significant difference was found in inter-group analysis for disability score (p=0.274), Flexion(p=0.610) or Extension (p=0.170).

Conclusion: The study concluded that both treatments are effective in lowering the pain, disability and improving lumbar range of motion. However, significant improvement was found in group B in reducing pain, while overall no significant group differences were observed.

Keywords: Joint range of motion, Mechanical low back pain, Mobilizations, Traction

Role of Self-Managed, Semi-Supervised Physical Therapy in Urinary Incontinence Rehabilitation: A Quasi Pre–Post Experimental Trial

Anashia Aftab, Seema Gul — Tue, 23 Dec 2025 00:00:00 +0000

Background: Urinary incontinence (UI) is widely recognized as a debilitating condition. Regardless of its type, UI can significantly affect an individual’s quality of life across multiple domains, including emotional well-being, functional capacity, and social participation. A comprehensive physical rehabilitation program has been shown to offer beneficial effects in the management of urinary incontinence.

Objective: To determine the role of self-managed, semi-supervised physical therapy in urinary incontinence rehabilitation.

Methodology: This was a quasi-experimental clinical trial, conducted at Lady Reading Hospital, Peshawar, involving patients diagnosed with urinary incontinence. Based on predefined inclusion criteria, a total of 31 participants were recruited through a convenience sampling technique. The sample comprised 9 male and 22 female patients, with a mean age of 40.93 ± 13.9 years. All participants underwent a comprehensive, self-managed, semi-supervised rehabilitation program over a period of four weeks. Bladder behavior—including the severity, frequency, and volume of urine leakage—was recorded. The effectiveness of the intervention was evaluated using the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF).

Results: The results of this study show that 45.16 % participants were suffering from Stress Urinary Incontinence (SUI); 25.80% complained of Urge Urinary Incontinence (UUI) and 29.03% were having symptoms of both SUI and UUI so they were classified as Mixed Urinary Incontinence (MUI). The paired t-test for the comparison of bladder-related quality of life at baseline (ICIQF initial =12.37 + 3.64) and at the end of the treatment (ICIQF final =5.44 + 3.61) shows clinically and statistically significant results. (p=0.01).

Conclusion: This study determines that a self-managed and semi-supervised physical rehabilitation protocol can be effectively implemented in patients with any type of urinary incontinence to improve bladder related quality of life.

Keywords: Physical Therapy, Urinary Incontinence, Quality of Life

Effectiveness of Individual Narrative Therapy with Specialized Adaptations in Children with Intellectual Disability – Pre-Post Experimental Study

Maham Ikram, Nayab Iftikhar — Tue, 23 Dec 2025 00:00:00 +0000

Background: The present study analyzed the effectiveness of Narrative Therapy in developing narrative proficiency in Children with Intellectual Disabilities.

Objective: To determine the effect of story retelling and narrative comprehension with Narrative Therapy in children with Intellectual Disability

Methodology: The study employed a within-subjects design. The study sample included participants diagnosed with a mild level of Intellectual Disability. The study involved ten participants (N = 10), comprising five males and five females, whose mental age ranged from four to six years. The sample was recruited using a nonprobability purposive sampling technique from Amin Maktab and Rising Angel's institutes in Lahore from January 2023 to January 2024. Multilingual Assessment Intervention for Narratives (MAIN) assessed story retelling and comprehension. The therapy lasted for eight weeks. Each participant had twenty-four sessions of intervention.

Results: The data were analyzed using the Wilcoxon signed rank test to report the pre- and post-evaluation scores. The results, which included macrostructural and microstructural analyses, showed a marked improvement in narrative abilities post-intervention, with p < 0.05.

Conclusion: The study's findings, which revealed a significant increase in story retelling and comprehension scores of narratives after the intervention, underscore the effectiveness of narrative therapy in developing narration abilities in children with Intellectual Disability.

Keywords: Narrative Therapy, Intellectual Disability, Microstructure, Macrostructure

Associations Between Obesity, Piriformis Muscle Dysfunction, And Pain in Drivers: A Cross Sectional Study

Tue, 23 Dec 2025 00:00:00 +0000

Background: Obese vehicle drivers are predisposed to piriformis syndrome due to prolonged sitting, poor posture, and increased mechanical stress. Excess body weight may intensify piriformis muscle tightness and compress the sciatic nerve, resulting in chronic pain and functional limitations.

Objective: To determine the associations between obesity, piriformis muscle dysfunction, and pain severity among professional drivers.

Methodology: This cross-sectional study was conducted over six months in District Lahore among 113 male online vehicle drivers (Uber, Careem, Foodpanda) aged 18–60 years, selected through convenient sampling. Participants with prolonged sitting time and elevated BMI were included. Data were collected using a self-designed questionnaire, the Piriformis Stretch Test, and the Visual Analog Scale (VAS) for pain assessment. Ethical approval was obtained, and informed consent was secured from all participants. Statistical analysis was performed using SPSS version 24.0, applying descriptive and Pearson’s correlation tests to evaluate relationships among BMI, Piriformis Stretch Test outcomes, and pain severity.

Results: A significant positive correlation was found between BMI and the Piriformis Stretch Test (r = 0.681, p < 0.001), indicating that drivers with higher BMI were more likely to exhibit piriformis tightness. Piriformis Stretch Test results also showed a strong correlation with pain intensity (r = 0.833, p < 0.001), while BMI correlated significantly with pain severity (r = 0.681, p < 0.001). Approximately 72% of participants reported moderate-to-severe pain (VAS > 5). Longer driving hours (>8 hours/day) and increasing age further amplified pain levels (p < 0.05).

Conclusion: Higher BMI, prolonged driving duration, and piriformis muscle dysfunction were significantly associated with increased pain severity among vehicle drivers. These findings highlight the importance of implementing targeted interventions such as weight management, ergonomic adjustments, and regular stretching programs to reduce musculoskeletal pain in this population.

Keywords: Correlation, Drivers, Obese, Occupational health, Piriformis dysfunction

Impact of cervicogenic headache on work productivity: A Cross-Sectional Survey

Misbah Binte Ilyas, Tayyaba Iqbal, Hifza Arif, Nimra Ilyas Bhutta — Tue, 23 Dec 2025 00:00:00 +0000

Background: One-sided, recurring headache that generally comes with neck pain and stiffness are associated with cervicogenic headache. These headaches have frequent episodes lately, and they alter people’s day to day routines and quality of work. It’s impossible to stay productive or focused while your head and neck is hurting continuously, and for healthcare professionals, it can even effect care services given to patients.

Objective: To assess the impact of cervicogenic headache on job performance among the office workers.

Methodology: Cross-sectional survey was implemented by the researchers, involving the Cervicogenic Headache International Study Group criteria to spot cases of cervicogenic headache. Two hundred and ninty volunteers were selected using convenience sampling and focus on the Work Productivity and Activity Impairment Questionnaire (WPAI) to assess them. The researchers evaluated the data with SPSS version 22. Everyone who took part gave their informed consent.

Results: Age group selected in this study was among 27 - 40 years old. The results showed that the more hours of work each day causes the higher pain scores and shows elevation. Productivity and activity impairment scores also raise with pain. Absenteeism and presenteeism had somehow moderate association with pain (r = 0.408 and r = 0.519), but by giving a thorough look to work and activity impairment, the correlation was even stronger (r = 0.704 for both). Individuals having chronic CGH felt the strongest decline in their productivity, and the difference between all the stages of CGH it was clear that chronic cases had major worst impact (p < 0.001).

Conclusion: This study shows a significant correlation between cervicogenic headaches and lower work productivity. When the pain gets worse or lasts longer, job performance really takes a hit. But it’s not just about the pain itself

Keywords: Absenteeism, Cervicogenic headache, Neck pain headache, Presenteeism, Work productivity, Working population

Frequency of Protracted Shoulders and its Relationship with Inter scapular Distance and Thoracic Expansion in Healthy Young Adults

Baidar Bakht, Saba Murad, Hira aziz, Zara Sajjal, Alina Asim, Rimsha Sajid — Tue, 23 Dec 2025 00:00:00 +0000

Background: Protracted shoulders are common musculoskeletal condition in young population which has impact on thoracic expansion and interscapular distance. The main contributors to protracted shoulders are poor ergonomics, sedentary lifestyle and excessive use of gadgets. In this study frequency of protracted shoulders and its relationship with interscapular distance and thoracic expansion has been evaluated.

Objective: To determine the frequency of protracted shoulders in healthy young adults and its relationship with interscapular distance and thoracic expansion at axillary and T4 level.

Methodology: The study design was a cross-sectional analytical study, conducted among students from Foundation University Islamabad. A total of 357 subjects were selected using convenience sampling based on inclusion and exclusion criteria, and all participants provided written informed consent. Outcome Measures: Plumb line was used to access protracted shoulders and measuring tape was used to measure interscapular distance and thoracic expansion at axillary and T4 level.

Results: The study showed that there is moderately positive correlation between protracted shoulders (PS) and Interscapular Distance. (p=0.436, rs = 0.41). Furthermore, the correlation between PS and Thoracic expansion at axillary level was strongly positive (p=0.162, rs = 0.74) while a strongly negative correlation (p=0.225, rs = - 0.64) was observed at T4 level. 2

Conclusion: The study's findings concluded that the frequency of protracted shoulders is high among healthy young adults. The study showed that there’s a relationship of protracted shoulders with thoracic expansion at the axillary level while no relationship established at T4 level and with interscapular distance among healthy young adults.

Keywords: Posture, Protracted Shoulder, Thoracic expansion

Clinical Approaches and Return to Sport Guidelines Following Anterior Cruciate Ligament Reconstruction: A Survey of Pakistani Physiotherapists

Manzoor, Alam Zeb, Arif Shah, Ali Rahman — Tue, 23 Dec 2025 00:00:00 +0000

Background: Physiotherapists play an important role in the rehabilitation of post-operative Anterior Cruciate Ligament Reconstruction (ACLR). Return to Sport after ACLR is one of the primaries aims of the patients.

Objective: This survey aimed to define the present clinical treatment approach of Pakistani physiotherapists for treating ACLR patients and find out the standards used for return to sports after ACLR.

Methodology: An online questionnaire consisting of four separate sections, demographic data, and medical practice about ACLR post-operative therapy comprising the parameters for return to sports was used to survey Pakistani physiotherapists. Descriptive analysis was performed for demographic and professional characteristics of the physiotherapists.

Results: Out of 1375, 710 physiotherapists responded to the questionnaire. The response rate was 51.6%. Two-hundred and eighteen (40.4%) physical therapists showed that post-ACLR rehabilitation should be started lower than one-week post-surgery, 48.1% recommended that therapy be initiated between one and two weeks and 11.5% said beginning it later three or more weeks. The standards used for return to sports allowance standards were associated to physical aspects such as quadriceps strength (76.5%), hamstring strength (69.1), hip muscle strength (66.3%), and knee ROM (65.1%). A few therapists used functional (17%) and psychological (18.1%) characteristics of their clients to support return to sports choice.

Conclusion: The study showed that the majority of the physiotherapists focused on the parameters related to physical factors for return to sports and a small number worked on the self-reported functional scale and psychological parameters.

Keywords: Anterior Cruciate Ligament, Physiotherapists, return to sports

The Effect of Pulsed Magnetic Field in Combination with Electrical Muscle Stimulation for Improving Muscle Tone and Enhancing Motor Function in Hypotonic Cerebral Palsy – A Case Study

Tehreem Jameel, Muhammad Haroon Asghar — Tue, 23 Dec 2025 00:00:00 +0000

Cerebral palsy is characterized by abnormal tone, posture and movement with multisystem involvement leading to limitation of activity. In the given case, a female patient was reported with hypotonic Cerebral palsy with complaints of floppiness and muscular weakness predominantly affecting right side of body. She was also having poor head and neck control along with instability of trunk. The patient received Pulsed Electromagnetic Field (PEMF) therapy (25–35 Hz, 412 µs, 10 min) followed by Electrical muscle stimulation (EMS) (20–35 Hz, synchronous mode, 10 min), both applied five times weekly. This was followed by physical therapy exercises targeting the affected extremity. Data collection was done at the baseline, 12 and 24 weeks of intervention. Marked improvements in motor function were observed over 24 weeks, as evidenced by higher scores on the GMFM and advancement to GMFCS Level III, indicating enhanced mobility and postural control. Thus, it can be concluded that combination of PEMF with EMS is an effective intervention for improving Muscle Tone and enhancing Motor Function in Hypotonic Cerebral Palsy

Keywords: Cerebral Palsy, Magnetic Field Therapy, Muscle Hypotonic, Postural Balance.