Study aim: To compare whether the use of ultrasonography (USG) is superior to blind landmark technique in correctly identifying epidural space in pregnant patients requesting labor analgesia through epidural catheter Design: Prospective observational study Settings and conduct: This prospective observational study was carried out at the Department of Anesthesiology, Combined Military Hospital from after approval from the ethical review board Participants/Inclusion and exclusion criteria: Inclusion criteria included all ASA I and II patients between 20-35 years of age presenting in labor after achieving term. Exclusion criteria included patients with history of back pain, surgeries of the spine, on-going medical treatment for backache, patients unwilling to be included in the study, patients with coagulation disorders or on anti-coagulants and BMI greater than 35 kg/m2. Intervention groups: A total of 250 patients were included in the study protocol divided into Group U (n=125) and Group L (n=125). Primary variables measured were mean number of tries for epidural insertion (taking the needle out and then re-introduction), mean number of needle re-directions (without taking out from skin), difference between actual measured needle length (AML) versus USG measured needle length (UML) and number of dural punctures between the USG and landmark group Main outcome variables: Primary variables measured were mean number of tries for epidural insertion (taking the needle out and then re-introduction), mean number of needle re-directions (without taking out from skin), difference between actual measured needle length (AML) versus USG measured needle length (UML) and number of dural punctures between the USG and landmark group.

Study aim: To determine the effect of periosteal pecking and shock absorbing insoles to improve pain and functional mobility in athletes with Medial Tibial Stress Syndrome. Design: This study will be a Randomized Controlled Trial Settings and conduct: Pakistan Sports Board Participants/Inclusion

Study aim: The main aim of the current study is to examine how well play therapy works to improve the attention and concentration of ADHD children. Design: The current study approach will be quasi-experimental, with an experimental group and a control group. Settings and conduct: The therapist might first want to see the child playing. Sessions needed to be held in a setting where the children feel comfortable and where there are not many restrictions. Participants/Inclusion and exclusion criteria: There will be 10 students in both of the groups, ages 3–14. For this study, there will be five children in each group. Both male and female children with ADHD will have their data collected. The age ranges 3-14 will be chosen. children under ages three and those beyond the age 14 will not be chosen, and children who use medication during treatment will not be included in this study. Intervention groups: Select 10 children; five were to be divided equally between the experimental and control groups. The control does not receive any intervention but the experimental groups receive the play therapy intervention 16 sessions three sessions per week 30 to 50 mints. Main outcome variables: The current study will assess if play therapy is successful at enhancing ADHD children's attention and concentration.

: Conducted at Muhammad physical therapy clinic and rehabilitation centre, Multan, Pakistan after approval

Study aim: The objective of this study is to compare the analgesic efficacy of non-opioid anesthesia (NOA) using intravenous magnesium sulphate combined with intravenous acetaminophen versus intravenous nalbuphine in chronic obstructive pulmonary disease patients undergoing elective laparoscopic cholecystectomy. Design: A Non-Blinded randomized control trial, Single center study with two intervention groups including a sample size of 110 patients Settings and conduct: Quasi experimental Non-Blinded Study was conducted in Department of Anaesthesia Combined Military Hospital Rawalpindi. The Method of Sampling was Non-randomized trial with Sample size of 110 (55 in each of the two groups) Participants/Inclusion and exclusion criteria: Inclusion criteria included all American Society of Anaesthesiology Class II and III patients of Chronic obstructive pulmonary disease diagnosed by pulmonary function test with optimized diasease between ages 45-70 years presenting in the general surgical department for elective cholecystectomy for cholelithiasis. Exclusion criteria included patients with major cardiac or respiratory disease, low ejection fraction, unoptimized for hypertension or diabetes, patients with cholecystitis, patients allergic to acetaminophen, Magnesium Sulphate (MgSO4) or Nalbuphine and patients unwilling to be included in the study. Intervention groups: The study method included all patients as per the inclusion criteria furnished. The patients were divided into Group M (n=55) receiving Magnesium Sulphate (MgSO4) and Acetaminophen and Group N (n=55) receiving nalbuphine. Main outcome variables: Primary outcome variables measured were intraoperative mean heart rate, mean arterial pressure, time to rescue analgesia and median pain scores at 1, 3 and 6 hour intervals. Secondary outcome variables were the incidence of hypotension, respiratory depression, nausea and vomiting between both groups.

group-B Settings and conduct: At Noreen Nishat Welfare Hospital ,Khanewal ,Pakistan (ref no: 1015 (...) Institute of Medical and Allied Sciences, Multan, Pakistan. Participants/Inclusion and exclusion criteria

The aim of the study is to determine the effect of additional virtual reality on mobility, physical performance, balance and gait performance after stroke. The chronic stroke (more than 03month), either type and able to stand for 10 seconds will be included while patients having cognitive impairment and other pathologies will be excluded from study. The sample will be taken from physiotherapy department of Railway hospital Rawalpindi. The 60 patients will be enrolled and then randomly assigned through sealed envelope method into two groups. Virtual reality groups and task oriented training. The additional 15-20 minutes session will be provided to one group while both groups will receive task oriented training. The three games including the river rush, water leaks and reflex ridge will be provided to virtual reality group. The 03 days per week for 08 weeks training will be provided to both groups. The initial assessment will be recorded at baseline then after every 02 weeks till 08 weeks. The standardized assessment tool include Fugl-Meyer assessment for lower extremity, berg balance scale, timed up and go test, dynamic gait index and stroke specific quality of life tool will be used to analyses.

Study aim: 1. To compare the effect of baclofen, TENS & sustain stretch for spasticity management in spinal cord injury. 2. To determine the Range of Motion of ankle joint Design: Randomized Clinical Trail Settings and conduct: Paraplagic Centre Peshawar. single blinded Participants/Inclusion and exclusion criteria: Inclusion criteria: 1. Spasticity (Grade ≥1 and ≤4 as per MAS) 2. Have sustained a traumatic spinal cord injury a Minimum of 3 months before consent. 3. Age = 20 - 45 years Exclusion criteria: 1. Have chronic systemic diseases and have any other serious co-morbidity, e.g. hepatitis C, infections and Deep vein thrombosis etc. 2. Have extensive fixed contractures in the lower limbs 3. Have any contraindications to Baclofen, TENS and sustain stretch such as experience clinically significant orthostatic Hypo-tension in response to electrical stimulation or allergies or Have a history of bone fracture or family history of fragility fractures Intervention groups: 1. Group (I) (oral anti-spasticity drug treatment group): 2. Group (II) (TENS treatment group): 3. Group (III) (Sustain stretch treatment group): Main outcome variables: Spasticity

Pakistan Society for Rehabilitation of differently disabled and rising sun institute Participants

Study aim: Comparison of scapular mobilization with and without scapular recognition exercises on pain, scapular ranges and disability in adhesive capsulitis patients. Design: Single blinded randomised controlled trial, conducted on 36 patients, equally divided into two groups, single centered study. Settings and conduct: Riphah International University, Lahore , patient single blinded. Participants/Inclusion and exclusion criteria: Male and female patients . Patients between the ages of 40 to 60 years old . Patients with shoulder pain that interfered with daily activities . Patients with Numeric pain rating scale score of at least 3 points . Unilateral shoulder adhesive capsulitis . Patients with inability to elevate the arm above 100 degrees in the plane of the scapula . Exclusion criteria Presence of any shoulder condition that is a contraindication for exercising the shoulder joint, such as cancer, active infection, active inflammatory disease, recent dislocations, subluxations, surgery and fractures around the shoulder region z Patients were excluded if they had no signs of scapular dyskinesia . The Scapular Dyskinesia Test (SDT) was performed to confirm the presence of scapular dyskinesia . Intervention groups: 36 patients will be randomly divided into control and experimental groups. The control group will receive routine scapular mobilization while the experimental group will receive spinal recognition exercises along with the scapular mobilization exercises Main outcome variables: 1_Pain Intensity 2_Scapular Ranges 3_Level of Disability

Study aim: The purpose of this study was to compare the effect of rhythmic initiation and slow reversal pelvic PNF technique to improve static and dynamic balance in stroke hemiplegic patients. Design: Randomised controlled trials Settings and conduct: Allied Hospital Faisalabad District Head Quarter Hospital Faisalabad Participants/Inclusion and exclusion criteria: inclusion criteria: 30 participants with hemiplegic stroke, both male and female with 45-60 years of age,With first unilateral stroke within 6 months, were able to walk with walking aids or assistance for 10 meters,No PNF treatment was given to the pelvic area since 6 weeks, Patients on BBS scoring less than or equal to 30 with minimum score 20. Exclusion Criteria: Those participants who had pelvic dysfunction other than stroke, pelvic fracture within last 6 months, having spinal deformity, with cognitive dysfunction, lower limb MSK disorders, Having severe disabling arthritis and patients having cardiopulmonary deficits, having severe degenerative changes and having Benign Paroxysmal Positional Vertigo Intervention groups: Intervention group (Group A) Rhythmic Initiation Intervention group (Group B) Slow Reversals Main outcome variables: Static Balance Dynamic Balance

& Teaching Hospital, Sialkot Pakistan. Participants/Inclusion and exclusion criteria: Patients of Age 35 -65

Study aim: To determine the effects of muscle energy technique with and without functional task training on pain and disability in sacroiliac joint dysfunction. Design: The study will be randomized clinical trial Settings and conduct: • Boston physiotherapy and wellness clinic,lahore • Fatima Memorial Hospital Shadman Lahore. Participants/Inclusion and exclusion criteria: Total forty 40 patients will be recruited in the study. The subjects will be randomly assigned to two groups A &B with each containing 20 subjects according to their number in computer generated table. INCLUSION CRITERIA: 1. Subjects between 18 to 35 year of age 2. Subjects with history of recurrent LBP . 3. At least three out of five tests must be positive. 4. Pain at the fortin area EXCLUSION CRITERIA: 1. Patients with radiating pain past the knee. 2. Lumbar disc herniation 3. Spinal deformities 4. Any spinal surgery history Intervention groups: Total forty subjects will be recruited which will be divided into two groups. Group A will be treated with muscle energy technique (METs) while Group B will receive functional task training along with METs. Main outcome variables: Pain(Numeric Pain Rating Scale.) Function(Modified oswestry disability index) .

Study aim: Assessing the validity of purse-string suturing as an effective modification in TDL placement procedure by comparing incidence of bleeding in patients with and without purse-string suturing Design: Two arm parallel group randomised trial with outcome assessment without blinding Settings and conduct: This trial would be conducted at Department of Nephrology, Pak Emirates Military Hospital. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Patients of either gender aged 18 years or greater, requiring venous access for maintenance hemodialysis. Exclusion Criteria: Acute kidney injury, bleeding disorders other than uremic platelet dysfunction, blood pressure ≥180/110 mmHg, current use of anticoagulants, platelet count < 50,000/µl, deranged prothrombin time / activated partial thromboplastin time, non-cooperative patient. previous tunneled catheter insertions at the same site Intervention groups: Patients in this group would receive a purse string suture approximately one centimeter above the catheter exit site on the upper chest Main outcome variables: Incidence of bleeding after insertion of tunneled hemodialysis catheter

CMH, Quetta, Pakistan. Participants/Inclusion and exclusion criteria: Inclusion Criteria- Adults aged

random and lottery method used Settings and conduct: the study is set in pakistan sports board in lahore

Study aim: To compare the effectiveness of racecadotril versus placebo in the management of acute gastroenteritis among children with some dehydration Design: Open labeled, randomized controlled trial Settings and conduct: Department of pediatrics, Rai Teaching Hospital, Sargodha, Pakistan. Participants

Study aim: To find out comparative benefits of Graston Technique and MET on the pain, foot and ankle impairment and temporospatial gait parameters i.e. cadence, gait speed, stride length, step width, stride time) in individuals with plantar fasciitis Design: randomized clinical trial Settings and conduct: Faisal hospital, Faisalabad  Allied hospital, Faisalabad Participants/Inclusion and exclusion criteria: 48 participants Intervention groups: Group: A (n = 24) Ultrasound therapy, Graston technique and stretching exercises Group: B (n = 24) Ultrasound therapy, Muscle Energy Technique and stretching exercises Main outcome variables: Pain Foot and ankle disability Temporosaptial gait parameter Cadence Step width Stride length Stride time Gait speed

Study aim: This study aims provide evidence about the most suitable tool to be used in oral and maxillofacial surgery for skin incisions in terms of incisional time, intraoperative blood loss due to incision, post-operative skin incision site pain occurring from both methods of skin incision. Design: Two arm parallel group randomized trial with double blinding.Simple randomisation using a randomisation table created by computer software with allocation using concealed envelopes. A sample size of 82 with 41 in scalpel group and 41 in diathermy group at a tertiary care hospital. Settings and conduct: At Combined Military Hospital Lahore and CMH Lahore Medical College and IOD Participants/Inclusion and exclusion criteria: Inclusion Criteria: Patients of any gender, within the age limit of 30-60 years, who underwent maxillofacial surgery including neck dissections, parotid surgery and maxillofacial trauma. Incision size between 2 to 10 cm will be included. Exclusion Criteria: patients with signs of active wound infection and anaemia. Patients om anticoagulant or corticosteroid therapy, patients who already have an existing scar on the probable incision site. patients with known connective tissue disorder and predilection of keloid scars Intervention groups: Incision shall be made using scalpel in scalpel group and diathermy for Incision in the diathermy group. Incision for maxillofacial surgery Main outcome variables: Incision time during surgery, Perop blood loss measured during surgery, pain using visual analogue scale during patient follow ups for the next 3 months

– Physical therapy clinic and Pakistan Society Rehabilitation and Disability physiotherapy clinic, Nur

Study aim: To determine the effectiveness of alexander technique combined with mulligan technique (SNAGS) in the management of non-specific neck pain Design: A two-arm, parallel-group, single-blind, randomized controlled clinical trial, 84 participants. Settings and conduct: Maqsood Medical Complex (MMC) Participants/Inclusion and exclusion criteria: Inclusion Criteria: Participants with non-specific neck pain; Participants with age 18-40 years; Both genders. Exclusion Criteria: History of any surgery to neck, shoulder, and upper back; History of fracture or any trauma in the neck, shoulder, and upper back; history of any neoplasm or malignancy; Cervical radiculopathy. Intervention groups: Group A (experimental group): Subjects will receive alexander technique along with Mulligan technique and isometric exercises. Procedure: The alexander technique will include education of patients about mind-body training that helped to correct their posture and it will last for 30 minutes. The mulligan technique will include sustained natural apophyseal glides (SNAGS) to the cervical spine along with active motion followed by overpressure. For the improvement of flexion and extension, central SNAGS will be given to the patients and for improvement of side-bending and rotation, unilateral SNAGS will be given. The procedure will be administered in 3 sets with 10 repetitions for 20 minutes  Neck isometrics will include pressing of the palm against the forehead, side of the head and back of the head while resistance will be provided by the muscle of the neck, holding it for 10 seconds then relax and repeating it for 5 times. Group B (control group): Subjects will receive mulligan technique and isometric exercises only. Main outcome variables: Pain intensity using Visual Analog Scale (VAS) Disability using Neck Disability Index (NDI)

Faiz Hospital, Multan, Pakistan. Participants/Inclusion and exclusion criteria: Inclusion Criteria 2

Study aim: To compare the immediate and prolonged effects of temporomandibular joint mobilization on pain, range of motion and functional disability in hypomobile temporomandibular joint patients Design: Single blind, Randomized controlled trial, superiority analysis of the treatment group Settings and conduct: University Institute of Physical Therapy, The University of Lahore Teaching Hospital. Participants/Inclusion and exclusion criteria: Inclusion Criteria • Aged between 20 and 35 years • Pain in the region of the Temporomandibular joint and masticatory muscles • Associated muscles and limited mandibular movement for at least six months • Complete dentition to provide stable and repeatable base points for jaw measurements. • Diagnosed by an experienced clinician as suffering from Temporomandibular disorders • Decreased mandibular opening Exclusion Criteria • History of severe head trauma or surgery • Known cervical pathology • Taking any medication except for occasional analgesics. Intervention groups: • Temporomandibular Joint Mobilization Group (Group I) • Control Group (Group II) Main outcome variables: • Pain • Range of Motion • Functional Disability

Study aim: The aim of this study is to focus on understanding the mechanics of the spontaneous breathing pattern of people with bronchiectasis, and its determinants, to provide a rational basis for physical therapy management. Interventions that focus on optimizing respiratory mechanics may result in a better therapeutic outcome rather than a focus on breathing patterns that primarily may be the result of impaired respiratory mechanics. Design: A randomized clinical trial with parallel groups, with 20 patients divided into 2 groups by lottery Settings and conduct: The study will be conducted at Gulab Devi Chest Hospital Lahore Participants/Inclusion and exclusion criteria: Inclusion criteria: both men and women; aged between 40-60 years; diagnosed with Acute bronchiectasis. Exclusion criteria: patients with cardiac, metabolic or endocrine disorders, having an acute chest infection, cardiac or other surgeries; patients with a diagnosis of cancer or active gastrointestinal problems; patients requiring supplemental oxygen and patients with chronic bronchiectasis. Intervention groups: Group A will be treated by stacked breathing and group B will be treated by pursed-lip breathing. Both groups will be followed by standardized physiotherapy treatment which includes active cycling breathing techniques (ACBT). Main outcome variables: FEV,FVC,PEF and Wellbeing

hospital, Pakistan. Participants/Inclusion and exclusion criteria: sub-acute stroke patients, aged 40-60