Study aim: • To determine the effect of Spinal Manipulative Therapy on Thoracic Spinal Pain,ROM & QoL Design: A double blind randomized controlled trial. Settings and conduct: This RCT will be conducted according to CONSORT guidelines . A parallel group RCT with 1:1 allocation ratio will be conducted at physical therapy department of Services Hospital Lahore. Patients will be asked to sign an informed consent. The assessor & patients will be blinded to allocation of treatment groups. Participants/Inclusion and exclusion criteria: Inclusion: • Age between 40 and 60 years. • Mid line upper back pain, • Decreased thoracic range of motion Exclusion: • Severe spinal deformity • Any systemic disease e.g. cardiovascular or neurological etc. • Traumatic history and any other red flags of spinal pain Intervention groups: Experimental group will be managed with spinal manipulative therapy while the control group will be managed with routine physiotherapy and both the groups will receive ergonomic advice. The treatment will be given maximum for four weeks; three sessions per week. Then patients will be followed up at 8th and 12th week of treatment to check the consistency of effects. Main outcome variables:  The Pain threshold will be measured with VAS  Quality of pain and the sensory dimensions will be assessed with McGill Pain Questionnaire  The subjective outcome of pain and disability will be obtained with the Oswestry Back Pain Disability Index  Objective measurement of ROM in the thoracic spine will be measured with the Goniometer.  Chest expansion will be measured by Measurement Tape  HR will be recorded by pulse oximeter and BP recording will be done by Digital sphygmomanometer.  QOL improvement will be judged by using QOL questionnaire .

Study aim: To compare the incidence of postoperative delirium in elderly patients receiving propofol-based versus sevoflurane-based general anesthesia Design: A randomised, parallel group, superiority clinical trial comparing propofol-based versus sevoflurane-based anesthesia in elderly surgical patients, with concealed allocation and blinded outcome assessment using the Confusion Assessment Method over seven postoperative days.The study enrolled 200 patients, with 100 patients in each group. Settings and conduct: The study was conducted at the Department of Anesthesia, Allied Hospital, Faisalabad over 6 months. After ethical approval and informed consent, patients aged 60–90 years undergoing elective moderate-risk surgery under general anesthesia were randomly assigned to receive either propofol- or sevoflurane-based anesthesia. Postoperative delirium was assessed twice daily for 7 days using the CAM by trained, blinded assessors. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Patients of both genders having age 60-90 years .Patients undergoing for elective surgery under general anesthesia American society of Anesthesiology I-III Exclusion criteria: Patients with Preoperative delirium, History of dementia ,Psychiatric disease like schizophrenia, epilepsy, Parkinson's disease or myasthenia gravis ,Hepatic or renal dysfunction ,Requirement for postoperative mechanical ventilation ,History of surgery within the recent six months ,Allergy to any of the study drugs Intervention groups: Group A patients will receive sevoflurane based anesthesia while Group-B patients will receive propofol based anesthesia Main outcome variables: The primary outcome variable is the incidence of postoperative delirium within 7 days after surgery, assessed using the Confusion Assessment Method. Delirium is recorded as a binary outcome (Yes/No) based on CAM diagnostic criteria during twice-daily evaluations

Study aim: To compare the effect of Diaphragm training and myofascial release back pain patients with non- specific chronic low back pain. Design: A concealed, randomized, blinded, clinical trial with a parallel group design of 44 patients, enrolled between April 2025 and June 2025 Settings and conduct: The study was held at Arif Memorial Teaching hospital and Hameed Latif Hospital Lahore. The blinding is achieved by concealment in which the treatment allocation for each patient. This is done to avoid biasness Participants/Inclusion and exclusion criteria: Inclusion Criteria: Participants were included if they had intermittent nonspecific CLBP for ≥12 weeks, with VAS between 3 to 7. All participants were active at a recreational level, for 2–4 times per week, since at least 3 years. Patients with low back pain without radiculopathy. Individual willing to participate in study Exclusion Criteria: Upper abdominal surgery, lumbar surgery experience, inflammatory spinal disease, spinal deformities, neurologic radiating pain Intervention groups: Group A: Diaphragm Training Group B: Myofascial Release technique Main outcome variables: Numeric pain rating scale was used to measure the intensity of pain, Oswestry Disability Index for the measurement of disability and Schober’s test for lumbar flexibility

Study aim: To determine the comparative effects of Diaphragmatic breathing exercises and diaphragmatic myofascial release in post-operative patients diagnosed with GERD. Design: Randomized clinical trial Settings and conduct: Following hospitals of FAISALABAD Allied hospital DHQ hospital Madina Teaching Hospital Aziz Fatima hospital Participants/Inclusion and exclusion criteria: Inclusion Criteria  Both genders .  Age 25 to 45 years,  Participants with a confirmed diagnosis of GERD after 1 week of surgery.  Willingness to participate  Participants who have not responded well to conventional treatments for GERD  Patients with stable cardiovascular and respiratory system. Exclusion criteria:  Participants with significant comorbidities that may confound the study results or interfere with the ability to perform diaphragmatic interventions. For example, serious cardiovascular or respiratory diseases.  Diagnosed febrile condition  Individuals who have undergone recent abdominal or thoracic surgeries, as these may affect diaphragmatic function and introduce variability in the study population .  Diagnosed malignancy  Diagnosed psychiatric disorder.  Unwillingness to Participate in Physiotherapy  Osteoporosis  Participants with Smoking and excessive alcohol intake history will be excluded because it can impact GERD symptoms and may influence the study outcomes.  Pregnancy  Diagnosed dermatological condition  Participants who are currently enrolled in other clinical trials to avoid potential confounding factors.  Underline stomach conditions Intervention groups: Diaphragmatic group (DB group) Diaphragmatic Myofascial release group (MFR group) Main outcome variables: Gastrointestinal symptom rating score(GSRS) Reflux Disease Questionaire (RDQ)

Study aim: The aim of this study will be to measure the effects of instrument-assisted soft tissue mobilization using (the graston) vs direct myofascial-release technique in patients with trigger points and tightness in the trapezius due to visual display terminal syndrome Design: Two arm parallel group randomised trial with blinded postoperative care and outcome assessment sample size was 45 and lottery method was used for randomization Settings and conduct: Superior university faisalabad campus. participants were blinded The blinding will be implemented through the use of coded treatments provided by an independent party. Participants/Inclusion and exclusion criteria: Inclusion criteria: musculoskeletal strain (upper trapezius) symptoms for more than 3 months. both males and females. dry eyes. visual blurring. exclusive mobile and laptop users. 4 to 5 hours per day and five to six days a week. history of consecutive near-screen exposure from the past 8 weeks. participants complained of pain of ≥ 3 on the numeric pain rating scale (moderate). age between 18-35 years. a 20° to 30° loss of active neck flexion/extension with a loss of cervical rotation of 20° to 40° to both sides and a 10° to 15° loss of lateral flexion. exclusion criteria: patients who have a history of trauma affecting mainly the neck any radiating pain or prolapsed intervertebral disc-related neurological symptoms. patients with co-morbidities other chronic neck pain and trapezius trigger points and tightness. osteoporosis/ osteoarthritis cervical spondylosis/spondylolisthesis and asymptomatic trigger points. Intervention groups: intervention group 1: direct myofascial release technique intervention group 2: graston technique control group: ultrasonic therapy Main outcome variables: Main outcome variables are pain, range of motion, muscle flexibility, and work performance parameters

Study aim: To compare the effects of Low Level Laser Acupuncture with Dry Needling when using Routine Physical Therapy as an adjunct therapy to them for managing pain intensity, functional disability, Range of Motion and quality of life in Chronic Cervical Myofascial Pain Syndrome. Design: Single Blind Randomized Controlled Trial with a parallel group design of 80 patients will have random allocation by Sealed Envelope Method. Settings and conduct: Patients from the Physical Therapy Department of Rawal Hospital, Islamabad. The outcome Assessor will be kept blind during the whole trial regarding the treatment groups. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Age group between 25- 50 years, Both male and female patients, Newly diagnosed cases of chronic Myofascial Pain Syndrome of Cervical Spine. Exclusion criteria: Patients receiving treatment by other methods like vapocoolants, subdural steroid injections etc, Cervical spine surgery within the past year, Fibromyalgia, Clinical evidence of any tumor or any space occupying lesion, Any co-morbid diseases Intervention groups: Patients will be randomly assigned to a treatment group by Sealed Envelope Method, either Group-A (Low-Level Laser Acupuncture-830nm, 100 Mv/Cm2 and Routine Physical Therapy) or Group-B (Dry Needling and Routine Physical Therapy).The treatment procedures for both groups will be repeated for 3 sessions per week for 6 weeks (18 sessions) and a follow up consultation over a maximum period of Four weeks. The readings will be taken for three times (Pre-Treatment, Mid- Treatment and Post-Treatment) during the whole session. Main outcome variables: Numeric Pain Rating Scale for Pain Intensity, Neck Disability Index for Functional Disability, Goniometer for Cervical Range of Motion and SF-36 Questionnaire for Quality of Life.

Study aim: To determine the effects of Theraband assisted treadmill training on GAIT and balance outcomes in stroke patients Design: single blinded, parallel group, randomized controlled trial Settings and conduct: Post-stroke patients referred to the Rehman Medical Institute, Peshawar, during the study period will be enrolled in the trial and will be randomly assigned to the intervention and control groups through block randomization. This trial will be single-blinded so that the outcome assessor does not know about the intervention group. Participants/Inclusion and exclusion criteria: Inclusion: Stroke onset >6 months, Age 30-65 years. Exclusion: Recurrent strokes more than twice Intervention groups: Experimental group: • A total of 50 minutes of training will be given, which will include Treadmill training with theraband for 30 minutes in a harness support and conventional therapy (general stretching and strengthening exercises) for 20 minutes, 5 days a week, for a total of 4 weeks. • 30 minutes treadmill training will be given in three sets of 10 minutes each. with 2 minutes of rest in between. • Participants will walk on a treadmill at a normal pace. Speed for the first 2 weeks will be 1m/s and of the last 2 weeks will be 1.5m/s. Control group: • A total of 50 minutes of training will be given, which will include Treadmill training for 30 minutes in a harness support and conventional therapy (general stretching and strengthening). exercises) for 20 minutes, 5 days a week, for a total of 4 weeks. • 30 minutes treadmill training will be given in three sets of 10 minutes each. with 2 minutes of rest in between. • Participants will walk on a treadmill at a normal pace. Speed for the first 2 weeks will be 1m/s and of the last 2 weeks will be 1.5 m/s. Main outcome variables: Balance, Gait

Study aim: To determine the combined effects of trans-cranial direct current stimulation and mirror therapy on neuromuscular development and mental health in children with spastic quadriplegic CP Design: Single centered double blinded Randomized clinical trial Settings and conduct: Study setting will be Department of Physical Therapy and Rehabilitation, Ghurki Trust & Teaching Hospital, Lahore. A 30-minute session of TDCS will be administered, with 15 minutes dedicated to the upper extremity and 15 minutes to the lower extremity. The overall duration of mirror therapy will be 30 minutes: 15 minutes for the upper extremity and 15 minutes for the lower extremity. There will be a total of 10 sessions (5 times a week for 2 weeks), both for TDCS and mirror therapy treatment. While undergoing routine physical therapy five days a week for 30 minutes each from the beginning of treatment to the completion of the treatment that is follow-up (weeks 1–10). The outcome measures will be taken at baseline (Pre-I), after two weeks (Post-I), and again after ten weeks of standard of care physical therapy treatment (Post-II) which is routine physical therapy. Participants/Inclusion and exclusion criteria: inclusion Criteria Diagnosed patients of spastic quadriplegic CP via physical examination aged from 3-7 years from both genders having Level-I, II & III GMFCS who can walk with or without assistance, respectively Tone less than or equal to 2 on the modified Ashworth scale Exclusion criteria: Athetoid CP, ataxic and mixed variety, Monoplegia, diplegic hemiplegic CP patients or History of any neurosurgery or neurolytic block Intervention groups: Group-A (TDCS, MT with routine Physical Therapy) Group-B (TDCS with routine Physical Therapy) Group-C (MT with routine Physical Therapy) Main outcome variables: Motor Development & Control, Muscle performance, Anthropometry (Height, Weight, Circumference), Mental Health

Study aim: Compare the effectiveness of intra-socket application of HA+gelfoam vs gelfoam (placebo) alone to reduce the post-op pain and trismus. Design: Prospective, Split-mouth, Double-blinded Randomized controlled trial. Intervention group Hyaluronic Acid+Gelfoam, Control group-Gel-foam alone. Single center study. Settings and conduct: After taking ethical approval, 15 patients matching the inclusion criteria will be selected from the Out patient department of Oral and Maxillofacial surgery, CMH Medical College & Institute of Dentistry, Lahore. Surgical extraction will be performed by a single surgeon (researcher herself) under local anesthesia (LA). Decided Material will be placed into the socket and closure with silk sutures will be done. The patient will be prescribed antibiotics and analgesics. Post-operatively pain and trismus will be evaluated on the 1st, 2nd and 7th day by using Numerical rating scale (NRS) and ruler measuring Inter-incisal distance in millimeters. Score will be documented by co-researcher to eliminate bias. Participants/Inclusion and exclusion criteria: Inclusion Criteria: 18-40 years of age Non-smoker, non-alcoholic, similar difficulty level on both sides according to Pederson scale Exclusion Criteria: systolic blood pressure (>140 mmHg,< 90 mmHg ), diastolic (>90mmHg , <60mmHg) Any history of allergy or adverse effects to antibiotics, analgesics, or local anesthetics. Acute infection Any physical or mental disability. Pregnant woman and any use of contraceptives or corticosteroids Any patient taking antibiotics and analgesics for 15 days before operation Taken antidepressants 5 days before the surgery Intervention groups: Group that receives Intrasocket Hyaluronic Acid+ Gelfoam Main outcome variables: Pain and Trismus after Surgical Extraction of Lower Wisdom Teeth on 1st 2nd and 7th post operative day

Study aim: This study investigates the effect of virtual reality on trunk control and gross motor function in children with developmental delays Design: Randomized controlled, parallel group trial with blinded outcome accessors. it will be lottery method where numbers will be computer generated. Settings and conduct: The place of the study: The children hospital & institute of Faisalabad; the study population: children with developmental delays; type of the blinding: single blind (outcome assessors kept blind) Participants/Inclusion and exclusion criteria: Inclusion criteria; Willing to give consent; Age limit 3-8 years; Ablility to follow visual and verbal commands; Gross motor function level II-IV; Those with an appropriate cognitive level to understand a VR exercise program. Exclusion criteria: Inability to follow instructions; Other Neurological disorders (polio, epilepsy, seizures, trumatic brain injury) Malignancies and Infectious disorders (encephalitis, meningitis, malignancy, tumors); Patients having musculoskeletal problems (fracture, congenital hip dysplesia); Spastic CP with Ashworth scale 2+; Any surgery within last 6 months; A diagnosis of Autism or attention deficit disorders; Psychiatric disorder Intervention groups: Active control group will receives neurodevelopmental treatment (NDT) focusing on trunk control through dynamic co-activation, weight shift facilitation, and trunk rotation induction for half an hour 3 times a week for 6 weeks. Intervention group undergoes 24 sessions combining NDT with immersive VR protocol targeting trunk control and gross motor function over 6 weeks. Sessions include 15 minutes of NDT followed by 15 minutes of VR gameplay with dynamic adaptations for motor learning including rest period of 1 minute. Main outcome variables: The trunk control measurement scale score; gross motor function scale-88 score, HINE performa section 3

Study aim: To determine the effects of Sustained Natural Apophyseal Glide with Myofascial Release Technique on neck pain and posture in patients with Temporomandibular Joint Disorders. To determine the effects of Sustained Natural Apophyseal Glide without Myofascial Release Technique on neck pain and posture in patients with Temporomandibular Joint Disorders. Design: Randomized Clinical Trial Settings and conduct: The University of Faisalabad Participants/Inclusion and exclusion criteria: Individuals with mild or average TMJ disorders. Subjects having poor posture were measured through Web Plot Digitizer. Female students with a mean age of 18 to 25 years were taken. Temporomandibular pain is associated with joint noises such as clicking and crepitation. Subjects diagnosed with any vascular disorder of the neck. Presence of any deformity like scoliosis, torticollis, and sprengle‟s deformity. Whiplash injuries. Neurological inadequacy. Any prior surgeries of the cervical spine. Cervical radiculopathies. Intervention groups: All the participants will be divided into two groups. A hot pack will be applied at the baseline. SNAG with MFR Technique was applied to the treatment group. The patient sit upright on the treatment table therapist placed the thumb on the spinous process of C3-C4. To provide mobilization force another thumb will reinforce it. Apply glide in the plane of the facet. While maintaining the glide ask the patient to side bend and rotate toward the painful side . SNAG will be applied to the 2nd group. Ask the patient to relax. The therapist placed the fingers deep into the sub-occipital muscles. Hold pressure for 90-120 sec where first position bind is felt. Repeat this procedure until new sense of bind is felt. When mobility is restored release the pressure from fascia. Main outcome variables: Neck Pain Forward Head Posture Temporomandibular Joint Pain

Study aim: Assessment of the impact of BWSTT in combination with electrical stimulation on functional ambulation in patients with incomplete traumatic spinal cord injuries. Design: Three arm parallel group, randomized trial with blinded patients and data analyst. Simple randomization and concealment of the randomization sequence was performed using R software. Settings and conduct: This single center study includes 81 patients having incomplete traumatic spinal cord injuries. The patients will be randomly divided into 3 groups, namely Group I (BWSTT + ES + conventional physical therapy), Group II (BWSTT + conventional physical therapy), and Group III (conventional physical therapy only). Patients will be assessed in terms of the study outcomes before treatment and 6 ,12 week after intervention. Participants/Inclusion and exclusion criteria: Inclusion criteria Patients aged between 16-55 years Both male and female patients Patients with incomplete traumatic SCIs (ASIA scale B, C, D) Patients with stable spines and in the sub-acute rehabilitation phase Patients with mild neuropathic pain (1-3 on Visual Analogue Scale) Exclusion criteria Patients in acute phase of rehabilitation Patients with pressure sores, infections or other complications Patients with visual impairments that may impact participation in rehabilitation Intervention groups: Intervention group 1: Participants in this group will receive body weight supported treadmill training along with electrical stimulation and conventional physical therapy. Intervention group 2: Participants in this group will receive body weight supported treadmill training and conventional physical therapy Control group: Participants in this group will receive conventional physical therapy only. Main outcome variables: Functional ambulation, neuropathic pain level and inflammatory pain markers (CRP, IL-6, IL-2), quality of life and activities of daily living.

Study aim: To determine the effect of core stability exercises on energy expenditure in stroke patients. Design: A Randomized controlled trial Settings and conduct: A study will be conducted at Rehman Medical Institute, Peshawar. Outcome assessor will be blinded. Participants/Inclusion and exclusion criteria: Inclusion Criteria: • Stroke patients between 30 to 55 years of age • Both ischemic and hemorrhagic stroke. • Patients who experienced a single stroke. • Patients who can walk for 10 minutes on ground at a comfortable speed(with or without assistive device) • Patients having MMSE score of 24 or more. Exclusion Criteria: • Patients who has cerebellar and pontine stroke. • Patients who has orthopedic problems. • Patients who have vertigo, dizziness, angina or resting heart rate is not between 40-100bpm range. • Patients who cannot follow instructions given by the therapist. Intervention groups: Control Group: Control group will receive the conventional physical therapy program for the stroke 20 minutes a day for 5 days a week. Conventional group will receive motor relearning program protocol. Experimental group: Experimental group each participant will have to attend a 6-weeks program of core stability exercises with 5 minutes each exercise, 5 days a week along with conventional physical therapy. Core stability exercises includes: 1. Bridging exercises 2. Unilateral pelvic bridging 3. Abdominal drawing in maneuver with leg lifts 4. Curl up. Main outcome variables: 10 m walk test and energy expenditure will be calculated by physiologic cost index formula.

Study aim: To compare the effects of Manual Diaphragm Manipulation and Diaphragm Release Technique on pulmonary functions, dyspnea, chest expansion and exercise capacity in COPD. Design: 60 participants will be recruited. Two parallel groups, double blinded, randomized clinical trial with pre and post assessment. Settings and conduct: Pulmonology ward, Saleem Memorial Hospital Lahore Participants/Inclusion and exclusion criteria: Inclusion Criteria: Patients with COPD according to the GOLD criteria,  Age ranged from 45-65 years  Moderate COPD (50%

IRCTID: IRCT20191117045462N20

1. Effects of Posture Correction Band on Pulmonary Function and Chest Expansion in Asymptomatic Population with Forward Head Posture
2. Comparative effects of Diaphragmatic Stretch technique and Manual Release Technique on Diaphragmatic Excursion and pulmonary function testing in COPD patients.
3. Effects of Pilates breathing versus Rhythmic Initiation Proprioceptive neuromuscular facilitation technique in Chronic Obstructive Pulmonary Disease (COPD) patients
4. EFFECTS OF DIAPHRAGMATIC STRETCH WITH AND WITHOUT RIB CAGE MOBILIZATION ON CHEST EXPANSION, DYSPNEA, PULMONARY FUNCTION TEST AMONG COPD PATIENTS
5. Investigating the effect of Montelukast drug on pulmonary function and clinical symptoms of patients with moderate to severe COPD
6. The effects of pentoxifylline on 6-minute walk test parameters in patients with pulmonary hypertension due to chronic obstructive pulmonary diseases
7. Study of the efficacy of Levothyroxine on pulmonary function tests in patients with subclinical hypothyroidism in comparison with Placebo
8. Comparative Effect of Buteyko Breathing Technique and Lotorp Method Among COPD
9. Investigating the Efficacy of Respiratory Muscle Training on Balance and Gait Performance in Patients with severe COPD: A Randomized Controlled Trial
10. The effect of aerobic exercises on antioxidant indices of pulmonary hypertension (PH) patients with chronic obstructive pulmonary disease (COPD)