Journal Riphah College of Rehabilitation Sciences

Effects of Upper Limb Progressive Resistance Training Along with Core Stability Exercises on Pain, Core Muscular Endurance and Upper Limb Balance in Cricket Fast Bowlers with Shoulder Disorder: A Randomized Controlled Trial

Mon, 21 Sep 2026 00:00:00 +0000

Background: Cricket fast bowlers are generous and particularly susceptible to shoulder problems due to the repetitive overhead movements they perform, and the substantial biomechanical stress associated with fast bowling. Shoulder disorders among them are normally associated with shoulder pain, poor core muscular endurance and some dysfunction in upper limb dynamic balance. Thus, it may be reasonable to expect that the integration of upper limb progressive resistance training and core stability training would be somewhat more comprehensive as a rehabilitation program and enhance functional performance.

Objective: To investigate the effect of the upper limb progressive resistance training with core stability on shoulder pain, core endurance, and upper limb dynamic balance in fast bowlers with shoulder disorders.

Methodology: Four-month randomized controlled trial (April-July 2025) at cricket clubs of Hyderabad and Jamshoro, Pakistan. Forty-eight male fast bowlers aged 18-35 years with shoulder disorders were divided randomly into two groups through the lottery method. Group A was exposed to a six-week intervention consisting of upper limb progressive resistance training with core stability exercises, whereas Group B only had progressive resistance training alone. The outcomes were measured both at baseline and post-intervention using the Visual Analog Scale (VAS), the Upper Quarter Y-Balance Test (UQYBT), and the plank endurance test. The statistics were performed using the Statistical Package for the Social Sciences (SPSS) version 23, and the level of significance was determined to be p<0.05. (ClinicalTrials.gov Registry No. NCT07055685)

Results: Significant improvements in pain, upper limb dynamic balance, and core muscular endurance were observed in both groups immediately after the intervention (p<0.05). Nevertheless, the combination of interventions group demonstrated significant decreases in pain, as well as increased upper limb dynamic balance and core muscular endurance, when compared to progressive resistance training group. In relation to the between group outcomes, there was a significant difference in all major outcome measures favoring the combined intervention group.

Conclusion: The study concluded that performing upper limb progressive resistance training in combination with core stability exercises is more beneficial than conducting only progressive resistance training regarding pain reduction and upper limb dynamic balance and core muscular endurance in fast bowlers with shoulder disorders.

Keywords: Core endurance, Fast-bowler, Resistance Training, Shoulder Disorders

DOI: 10.53389/JRCRS.2026140302

Bimanual Coordination Deficits Among Patients with Middle Cerebral Artery Stroke: A Cross-Sectional Study

Mon, 21 Sep 2026 00:00:00 +0000

Background: Middle cerebral artery stroke is the most common type of ischemic stroke. MCA stroke results in the motor impairments of the affected upper limb, which can lead to the disruption of the bimanual hand coordination and increase limitations in activities of daily living.

Objective: To determine bimanual coordination deficits among patients with Middle cerebral artery stroke.

Methodology: 70 patients were selected according to inclusion criteria (Middle cerebral artery stroke, 4 months post stroke, age ranging from 30 to 60 years. Exclusion criteria included the stroke of any other artery, fractures, or other pathologies affecting the upper limb function, pain, and discomfort while doing the tasks. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 26. Bimanual coordination was determined by using the ABILHAND Questionnaire. The study was done using non-probability convenience sampling. The sample size is limited to 70 participants because of the strict eligibility criteria (chronic MCA stroke, Brannstrom ≥4). While it limits external generalizability, enhances the internal validity, limits the homogeneity and allows the focused profiling of the persistent bimanual deficits. The findings will be preliminary, however clinically indicative within the context of similar tertiary care.

Results: The study assessed the bimanual coordination in 70 patients with the middle cerebral artery stroke via using the ABILHAND questionnaire. The findings revealed the mean score of 18.9 ± 10.7, markedly below the standard values, indicating the significant deficits. Tasks which required fine bimanual dexterity were perceived as most difficult, while the simpler, unimanual-sequence tasks were rated as easier. The results highlighted the substantial limitations in the self-perceived daily hand activities, underscoring need for the targeted rehabilitation strategies.

Conclusion: Bimanual coordination deficits were present in patients with Middle cerebral artery stroke, as a mean of the total score of the ABILHAND Questionnaire was lower.

Keywords: ABILHAND, Bimanual coordination, Middle Cerebral Artery, Stroke

DOI: 10.53389/JRCRS.2026140303

Comparison of Achilles Tendinopathy among Regular and Irregular Prayer Performers in Lahore and Sheikhupura: A Cross-Sectional Study

Mon, 21 Sep 2026 00:00:00 +0000

Background: Achilles tendinopathy (AT) is a common overuse condition characterized by pain and functional limitation during weight-bearing activities. Repetitive movements involved in daily prayer may influence tendon health.

Objective: To determine the comparison of Achilles Tendinopathy in Regular and Irregular prayer offers of Lahore and Sheikhupura.

Methodology: The cross-sectional survey employed non-probability convenient sampling, enrolling 384 male participants age between 25-55 years with Achilles tendinopathy. Tendinopathy was assessed using the VISA-A questionnaire. The sample population to 384 people who were divided into two groups which were regular and irregular prayer offers from different mosques of Lahore and Sheikhupura. The specified inclusion criteria encompass the Achilles tendon which may experience pain or discomfort when individuals engage in weight-bearing plantar flexion actions, such as running or leaping. Participants with a history of total Achilles tendon rupture, other therapies, exercise limitations, or pain from insertional tendinopathy or bursitis were excluded. Data analysis is done by using the IBM SPSS Statistics 25.

Results: Among 384 participants, 192 were regular and 192 were irregular prayer performers. Regular performers demonstrated higher VISA-A scores, indicating better tendon function. Asymptomatic AT was reported in 79.7% of regular performers compared to 40.1% of irregular performers. Symptomatic AT was more prevalent among irregular performers (59.9%) compared to regular performers (20.3%). A statistically significant association was found between prayer frequency and AT status (p = 0.039).

Conclusion: A significant association exists between prayer frequency and Achilles tendinopathy status. Regular prayer performers showed better tendon-related outcomes compared to irregular performers. However, causal relationships cannot be established due to the cross-sectional design.

Keywords: Achilles Tendinopathy, Musculoskeletal Health, Prayer, Physical Activity, VISA-A

DOI: 10.53389/JRCRS.2026140304

Sexual Dysfunction and Associated Factors Among Post-Stroke Patients in a Rehabilitation Setting in Kinshasa: A Cross-Sectional Study

Mon, 21 Sep 2026 00:00:00 +0000

Background: Although common, post-stroke sexual dysfunctions are rarely screened for systematically in routine practice in rehabilitation units in Kinshasa.

Objective: To determine its prevalence and associated factors among post-stroke patients in rehabilitation settings in Kinshasa.

Methodology: Cross-sectional analytical study conducted on 169 patients. Male and female sexual function, depression and cognition, motor skills, and disability were assessed using validated tools. Statistical analyses (Pearson's χ² and logistic regression) were performed using Jamovi 2.6.44, with a significance threshold set at p < 0.05.

Results: Half of patients were aged 62 years old, with 58% being men. The prevalence of sexual dysfunction (SD) was 56.2 %. In multivariate analysis, female sex was associated with lower odds of sexual dysfunction (OR = 0.34; 95% CI: 0.14–0.81), whereas obesity (OR = 2.45; 95% CI: 1.05–5.74), cognitive impairment (OR = 3.21; 95% CI: 1.31–7.86), and post-stroke depression (OR = 6.29; 95% CI: 2.40–16.50) were independently associated with higher odds of sexual dysfunction. Smoking was associated with lower odds of sexual dysfunction (OR = 0.28; 95% CI: 0.10–0.79). Age showed a non-significant trend.

Conclusion: Sexual dysfunction is highly prevalent among stroke survivors in rehabilitation in Kinshasa and is strongly associated with depression, cognitive impairment, and obesity. These findings support systematic screening and multidisciplinary management of sexual health in post-stroke care.

Keywords: Associated factors, Rehabilitation, Stroke, Sexual dysfunction

DOI: 10.53389/JRCRS.2026140305

Correlation of Cardiorespiratory Fitness and Perceived Fatigue Among Young DPT Students: A Cross-Sectional Study

Mon, 21 Sep 2026 00:00:00 +0000

Background: Cardiorespiratory fitness is a measure of how well oxygen is transported to the body during exertion and perceived fitness is the measure of perceived exhaustion and tiredness.

Objective: The aim of this study is to determine the correlation between cardiorespiratory fitness and perceived fatigue among young DPT adults.

Methodology: The methodology was approved by the Ethical Review Committee of Foundation University Islamabad. The study design was cross-sectional correlation analytical. The data was collected from undergraduate students of Foundation University Institute of Rehabilitation Sciences, Islamabad. The sampling technique was non-probability consecutive sampling. The sample size was 218. Data of 176 participants was collected due to limitation of time. Informed consent was taken. Participants were selected through inclusion and exclusion criteria and screened out using Physical Activity Readiness-Questionnaire. They were asked to fill the Situational Fatigue Scale and then perform the Single Stage Sub Maximal Treadmill Walking Test/Ebbeling Treadmill Test. During the test, participant's level of exertion and fatigue was measured using Borg Rating of Perceived Exertion. Then VO2 max and Situational Fatigue Score were calculated.

Results: There was weak positive correlation between cardiorespiratory fitness and perceived fatigue which was statistically insignificant (p value 0.545 and spearman’s rho 0.046).

Conclusion: Cardiorespiratory fitness varies among young DPT students and is not related to their perceived fatigue.

Keywords: Cardiorespiratory fitness, Perceived fatigue, Physical exertion

DOI: 10.53389/JRCRS.2026140306

Attitudes And Beliefs of Physiotherapists Towards Chronic Low Back Pain in Rawalpindi and Islamabad: A Cross-Sectional Study

Zoha Sabir, Afsah Shahid, Manahil Anees, Zartasha Zia — Mon, 21 Sep 2026 00:00:00 +0000

Background: Chronic low back pain affects 44.9% of the global population and is characterised as non-specific pain in the lower back lasting longer than three months. Patients often develop fear-avoidance behavior, which exacerbates their condition. Physiotherapists’ attitudes and beliefs can influence both the treatment approach and rehabilitation outcomes for patients. Two main approaches are used in managing chronic low back pain: the biomedical approach, which focuses on pain due to physical damage, and the biopsychosocial approach, which also considers psychological and social factors.

Objective: To assess whether physiotherapists in Rawalpindi and Islamabad lean more towards the biomedical or the biopsychosocial approach in managing chronic low back pain.

Methodology: A descriptive cross-sectional study was conducted from June 2023 to June 2024. A total of 191 physiotherapists were selected via non-probability convenience sampling. The PABS-PT was employed to measure physiotherapists’ attitudes and beliefs, featuring two subscales: biomedical and biopsychosocial, scored on a six-point Likert scale. Data was analysed using SPSS version 21. Descriptive statistics and graphical representations were used.

Results: Of the 191 participants, 57.6% were females and 42.4% males. 48.7% of physiotherapists attended specialised workshops for pain management. The mean biomedical score was 42.43±4.97, compared to 32.07±6.56 for the biopsychosocial subscale, indicating a stronger biomedical orientation.

Conclusion: The study concluded that most physiotherapists in Rawalpindi and Islamabad have a stronger inclination towards the biomedical approach in managing chronic low back pain, compared to the biopsychosocial approach.

Keywords: Attitudes, beliefs, chronic low back pain, physical therapist

DOI: 10.53389/JRCRS.2026140307

Association Between Sleep Disturbance and Cervical Radicular Pain in Karachi, Pakistan: A Cross-Sectional Study

Khurram Yamin, Javeria Rehan, Maheera Waseem, Rabia Khan, Muhammad Usman — Mon, 21 Sep 2026 00:00:00 +0000

Background: The neurological condition known as cervical radiculopathy, rather prevalent. When nerves from cervical spine compressed it causes radiculopathy and pain in neck. Good sleep quality has been acknowledged as a crucial factor in both physical and mental health and well-being, making it an essential physical requirement for a healthy life.

Objective: To find out the association between sleep disturbance and cervical radicular pain.

Methodology: A cross-sectional study was conducted over 6 months in Karachi, Pakistan, involving 377 male and female patients (aged 30–50 years) diagnosed with acute or sub-acute cervical radicular pain. Data were collected from various public and private hospitals and clinics using non- probability convenience sampling. The study assessed sleep disturbances in these patients through bio-data questionnaires, the Neck Disability Index (NDI), and the Pittsburgh Sleep Quality Index (PSQI). Statistical analysis was performed using SPSS 23.0 to evaluate the relationship between cervical radicular pain, disability levels, and sleep quality

Result: Among 377 participants with cervical radicular pain, a significant association was observed between sleep disturbance and neck disability (p = 0.010), age (p = 0.025), and working duration (p = 0.007) among patients with cervical radicular pain. Moderate disability was most prevalent (35.5%), followed by mild (27.9%) and severe (22.8%) disability. Sleep disturbances were common, with 41.1% reporting moderate and 33.2% severe difficulty. Females and participants aged 30–40 years exhibited higher sleep disturbance levels. Prolonged working hours showed a significant association with poorer sleep quality (p = 0.007).

Conclusion: Cervical radicular pain is significantly associated with neck disability and sleep disruption, predominantly affecting female individuals aged 30–40 years. Prolonged working hours and postural stress were major contributing factors.

Keywords: Disability, Pinched Nerve, PSQI, Radiculopathy, Sleep Disturbance.

DOI: 10.53389/JRCRS.2026140308

Assessing the Impact of Knee Osteoarthritis on Elderly Women’s Daily Activities in Peshawar, Pakistan: A Cross-Sectional Study

Manzoor, Nayesha Jamil, Arif Shah, Ali Rahman — Mon, 21 Sep 2026 00:00:00 +0000

Background: Osteoarthritis is the most common source of pain in aging population, affecting 43% of individuals aged 65 and older, with women accounting for 62% of those affected.

Objective: To assess the impact of knee osteoarthritis (OA) pain on the ability of elderly women in Peshawar to perform daily activities.

Methodology: The study was carried out in a tertiary care hospital. A total of 250 women were selected for this study using a non-probability consecutive sampling method. The study involved women aged 65 or older who had been diagnosed with knee OA for at least one year. Exclusion criteria comprised serious or functionally impairing health conditions other than knee OA, such as carcinoma, heart disorder, or COPD. Data was collected through the Katz scale, an interview questionnaire, and the Visual Analog Scale (VAS).

Results: The results show that 59.4% of the aged women had been experiencing knee joint issues for less than five years. 30.4% of elderly women who have knee pain described the pain as moderate, and 69.6% reported severe pain. Additionally, when it came to dressing, 71.5% of the participants required supervision. The impact of knee OA was widespread, with all participants (100%) reporting impaired physical activity, over 91.4% experiencing fatigue, and 72.1% reporting anxiety and 71.1% faced limited social engagement.

Conclusion: Knee OA pain in elderly women significantly affects their social, psychological, and physical well-being.

Keywords: Knee Osteoarthritis, Social, Psychological, Physical

DOI: 10.53389/JRCRS.2026140308

Knowledge, Attitude, and Practice of Antenatal Exercises and Physical Activity Levels Among Pregnant Women in Islamabad and Rawalpindi: A Cross-Sectional Study

Mon, 21 Sep 2026 00:00:00 +0000

Background: A healthy and active pregnancy period benefits both the mother and the fetus indicating the value of antenatal exercise knowledge and which was not as well discussed. Pregnant women who pay little attention to antenatal exercise and physical activity may gain too much weight and experience additional problems during and even after pregnancy.

Objective: To evaluate the knowledge, attitudes, and practices related to antenatal exercises and to identify the levels of physical activity among the pregnant women.

Methodology: The Polish Version of the Pregnancy Physical Activity Questionnaire (PPAQ-PI) and the knowledge Attitude and Practice Questionnaire (KAP) were used in a descriptive cross-sectional study with a sample size of 137 pregnant women to gauge their level of physical activity and knowledge. We determine the relationship between age, miscarriage history, and knowledge score using a chi-square. Physical activity and KAP patterns were interpreted as Frequency tables. SPSS version 25 was used for data entry and analysis.

Results: Current study show that 55% of participants have adequate knowledge of antenatal exercises, while 44% lack sufficient knowledge. 47% of women engage in physical activity, whereas 51% do not meet the recommended levels.

Conclusion: This study explored pregnant women (primigravida, multigravida) knowledge and practices regarding antenatal exercises and physical activity. Factors like age, family size, and daily habits were found to impact their understanding and adoption of healthy physical activity during pregnancy.

Keywords: Antenatal, Exercise, Pregnancy, Physical Activity

DOI: 10.53389/JRCRS.2026140310

AI-Assisted Peer Review in Rehabilitation Research: Opportunities, Blind Spots, and the Need for Human Verification

Waqar Ahmed Awan — Mon, 21 Sep 2026 00:00:00 +0000

Peer review is straining under expanding submission volumes and reviewer fatigue, and journals are increasingly testing whether large language models (LLMs) can help, But the evidence so far supports a narrow role of it. An AI model in a sports medicine journal performed just better than chance at matching final editorial decisions. However, when it flagged a manuscript for rejection, it’s accuracy was 90.5% of the time, proving as a screening tool rather than a final decision maker.¹ When tested on RCT bias assessments, AI models agreed with each other 91% of the time but differed sharply from human experts on complex, interpretive domains like blinding and allocation concealment.² One promising approach is a human AI hybrid model, in which AI performs rapid screening and consistency checks under clearly defined protections, while human experts retain ultimate responsibility for scientific judgment and decision making.³

Where AI genuinely helps. While AI struggles with complex decisions and interpretive analysis, it excels at narrow tasks like screening rejections and maintaining consistency, a role currently being tested in a formal systematic review trial.⁴ AI can sort submissions before they reach a human desk,¹ and it can reduce the burden of drafting and editing.⁵

Where it fails. Artificial intelligence struggles with rehabilitation research due to its inability to assess context and clinical judgment. Technology cannot reliably determine whether trial populations and settings translate to routine outpatient care or if statistical results are functionally meaningful for patients,^{1, 2} AI frequently fabricates academic sources despite citing a reference for every single claim. When two leading AI Models were evaluated on academic writing tasks, one model made up 36.7% of its citations, and the other fabricated 2.6%.⁶ Relying on AI for peer review introduces severe risks of fabrication and confidentiality breaches. Reviewers who use AI tools often violate journal policies by uploading confidential manuscripts and neglect their professional duties by outsourcing their judgment. Ironically, articles warning about AI flaws can end up containing invented references themselves.³

Toward responsible use. In a study, anesthesia and pain-medicine chief editors established strict boundaries for AI use: AI may assist with language editing, summarizing, and organization, but are strictly banned from generating references, data, conclusions, or editorial verdicts and any AI assistance must be fully disclosed.⁷ Reviewers welcome AI's efficiency but demand strict, explicit governance over informal norms. While they appreciate the reduced workload, they remain highly cautious regarding bias, transparency, and data privacy.⁸ Narrative reviews mandate treating AI as an augmentative tool rather than a replacement in scientific writing. These evaluations conclude that integrating AI requires structured training and ensuring a named human remains legally and academically accountable for every claim.⁵

Rehabilitation journals must prioritize equity because algorithmic bias and infrastructure gaps actively skew research data, distorting which populations and interventions are accurately modeled. This systemic distortion directly undermines the evidence base that under-resourced regions rely upon for rehabilitation research.

Keywords: Artificial intelligence, Clinical significance Human verification, Peer review Rehabilitation research, Research integrity.

Conclusion

AI serves well for sorting but fails as a final judge. It should flag and draft content, but never decide, self-verify, or invent evidence. Rehabilitation journals must embed these strict boundaries into reviewer guidelines and disclosure policies to strengthen the field rather than erode it.

DOI: 10.53389/JRCRS.2026140301

Barriers to Rehabilitation Among Road Traffic Accident Survivors in Karachi: Clinical Reflections from a Public Sector Setting - Letter to Editor

Dua Adnan — Mon, 21 Sep 2026 00:00:00 +0000

Road traffic accidents (RTAs) are a major cause of injury and disability in Karachi, with many survivors requiring prolonged rehabilitation. However, adherence to physiotherapy in public hospitals remains inconsistent. This commentary draws on recurring clinical observations from a tertiary care public hospital and integrates available local and international literature to highlight common barriers to rehabilitation among RTA survivors. Financial constraints, work-related pressures, transport difficulties, limited awareness regarding the importance of physiotherapy, pain during therapy, and overcrowded outpatient departments were frequently observed. Psychosocial factors, including emotional distress and reduced motivation, further contributed to early discontinuation of rehabilitation. These socioeconomic and structural challenges negatively affect functional recovery and increase the risk of long-term disability. Addressing these barriers through patient education, improved accessibility, community-based rehabilitation models, and strengthening public-sector rehabilitation services is essential to improve outcomes for RTA survivors in resource-limited settings.

Keywords: Barriers, Physiotherapy adherence, Public hospitals, Rehabilitation, Road traffic accidents

DOI: 10.53389/JRCRS.2026140311