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Background: Falls are commonly reported among patients after total knee replacement. Previous literature and reviews have largely focused on the risk factors for fall among population undergoing total knee replacement. However, no systematic review has identified specific risk factors among female population undergoing the procedure regarding post discharge falls. Thus, the current review aimed to identify and provide summary of the key risk factors in women with total knee replacement about post discharge falls. Main Body: To identify the current evidence on risk factors among patients undergoing total knee replacement for after-discharge falls. Systematic review was conducted and data bases were searched including Cochrane, Medline, PEDro from 2000 to latest. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was performed using Nottawa Castle Scale for Case Control and Cohort studies and AXIS tool for cross sectional study. 10 articles finally met the inclusion criteria and were included in the review based on eligibility. There were 6 Cohort studies, 1 Cohort study protocol, 2 Case Control and 1 cross sectional, 3 randomized pilot studies and 1 prospective cohort study. Conclusion(s): Patients who underwent total knee replacement are at risk of post discharge falls. Advancing age, reduced proprioception, psychiatric disorders, living alone and operated knee pain were considered to be important risk factors for post discharge falls.

Objective To explore the current evidences on effects of trigger point dry needling as a treatment strategy on pain and range of motion among subjects with lower extremity myofascial trigger areas. Methods The systematic review was conducted at the University Institute of Physical Therapy, Lahore, Pakistan, from February to August 2019, and comprised search of studies on Cochrane Library, PubMed, SPORTDiscus and PEDro databases published in the English language from 2000 to July 2019. The search terms used were 'Dry needling', 'Trigger points', 'Myofascial trigger points', 'Trigger area', 'Acupuncture therapy', 'Lower extremity' and 'Acupuncture'. Cochrane Risk of Bias tool was used to assess the randomised and non-randomised controlled trials. Methodological assessment was performed using Physiotherapy Evidence Database 10-point scale. Data synthesis was performed through vote counting method. Results Of the 564 articles initially found, 30(5.3%) were shortlisted for full-text assessment. Of them, 10(33.3%) were selected for final assessment; with 7(70%) scoring high and 3(30%) fair on the PEDro scale. All the 10(100%) studies documented improvement in the pain over time with dry needling strategy. None of the studies targeted any other outcome, like anxiety and sleep disturbances, related with myofascial trigger points. Conclusions On basis of the best evidences available, dry needling seemed to be effective in pain reduction related to lower extremity myofascial trigger points. Evidence also suggested that there was not much positive effect of myofascial trigger point dry needling on depression, anxiety, muscular strength and quality of life.

Quality refers to the extent of superiority or excellence of something when compared with other things of similar characteristics1. During this era of quality enhancement, more and more emphasis is now being given to raise the standards of providing quality services in health care1. One possible way of ascertaining high quality service provision is by “measuring” the quality of services being provided, as this will help to identify either good or bad providers of services that is the health care practitioners2. This has gained much importance globally and a lot of work has been done by the researchers and stakeholders to measure and to standardize the quality of health care services2.

Objective: Rehabilitation is considered vital aspect of treatment strategy post total hip replacement and results in improvement in functional activities as well as reduction in pain. Telerehabilitation is emerging as alternative to traditional face to face rehabilitation in home care. To explore the current evidence on effectiveness of telerehabilitation as compared to face to face rehabilitation for patients after total hip replacement. Methodology: A systematic review was conducted. Data bases were searched including Cochrane, Medline, Embase and PEDro from 2000 to latest. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was performed using Cochrane risk of bias tool and included studies were critically appraised using PEDro scale. Results: 13 articles finally met the inclusion criteria and were included in the review based on eligibility. However data was not extractable from 1 study due to which 12 studies were finally reviewed. There were 4 Randomized trials, 3 randomized controlled protocols, 3 randomized pilot studies and 1 prospective cohort study. The summary of critical appraisal of included studies through Physiotherapy Evidence Database scale was done which showed that majority of studies had high quality and few studies fall under the category of fair. Conclusion: Telerehabilitation group reported similar improvement in terms of activities of daily living and quality of life as compared to traditional rehabilitation. This systematic review has established that home based telerehabilitation mode of health care services delivery is an acceptable practical alternative among patients who underwent Continuous...

The current research focused on the designing of questionnaire for factors that impact student learning outcomes in tertiary educational system in underdeveloped nation Pakistan. A pilot study was conducted for the designing of questionnaire to collect data on perceived factors that impact student learning outcomes. The selected Higher Education Commission (HEC) recognized private educational institutions were contacted and permission of data collection was obtained from the authorities. Ninety eight students of final semester from HEC recognized tertiary universities at Bachelors level from the department of Science were approached for this study. Participants were informed that the data will be kept in a laptop under password protection. There were 41 total items in the questionnaire. It has been divided into 2 sections. Section A includes the demographic characteristics of participants and includes 7 questions. Section B is divided into 6 subsections, each section capturing the true essence of independent and dependent variables. The results of the study concluded that student perception questionnaire has good to excellent intra rater reliability and indicates that all components have factor loading exceeding 0.50 that also shows the importance of all components. Thus, the questionnaire can be used for the assessment of factors that impact student learning outcomes from educational institutes.

To delineate a common language for describing Functioning and dysfunctioning of individuals with various health condition to be used by health care professionals all over the world, the International classification of function and disability (ICF) also known as ICF model has emerged as a multidimensional classification system which is based on biopsychosocial model of health system1. ICF model addresses many issues related to various disciplines of Rehabilitation specially Physical therapy2. In Physical therapy ICF model is utilized for making decisions ensuring to cover all aspects of human health and functioning, for documentation purpose as well as to enhance communication by agreeing upon the same standardized terminologies2.

Background: Joint substitution of lower limbs like hip and knee replacements are viewed as a high volume surgery with great achievement rates and physical restoration assumes a significant role in recovery of these patients. However, access to recovery and follow up is restricted. Post joint substitution patients living in remote territories and those with the danger of joint dislocation find difficulty to recovery benefits once they are released from emergency clinic. Access issues produce extra burden. The purpose of current study was to evaluate whether telerehabilitation performed from a health center to patient’s place after discharge from hospital among knee replacement was practically effective as alternative treatment. Methods: A quasi-experimental study was conducted on 50 post total knee replacement patients for a period of 6 months at Ghurki hospital. Patients were divided into two groups. Group A received telerehabilitation. Group B received face to face rehabilitation for 2 months. Ranges, muscle strength and functional status were measured through goniometer, manual muscle testing and timed get up and go test. Assessment was done using Fischer exact test at baseline, after 2 weeks and followed up after 2 months. Results: p-value for knee flexion came out to be 0.03 where as for quadriceps it was 0.02 after 2 weeks, which was found to be statistically significant. After 2 months, p-value for knee flexion was 0.016 and 0.000 for functional status. Conclusion: Use of telerehabilitation is found to be equally effective as compared to face to face rehabilitation among knee replacement patients.

Knee Osteoarthritis (OA) is considered as one of the leading cause of disability around the world1. Total knee Arthroplasty is known to be the best treatment option available for reduction in pain and symptoms in case of failure of conservative management2. Recently enhanced recovery pathways have been followed after knee replacement surgery which includes a combination of early mobility, education of patient and care giver, nutritional and fluid support. These enhanced pathways lead to shorter hospital stay3. Due to the shortened hospital stay, the aspect of self-management by patient becomes fundamental. Post-operative self-management of patients following knee replacement is a crucial factor for successful recovery. Self-management as defined by World Health Organization is the ability of patients, care givers and community to effectively manage with the disease, either with the support of health service provider or independently. In knee replacement, self-management includes pain management, physical therapy exercises, daily self-activities and precautionary measures4.

Background: Musculoskeletal discomfort not related by a syndrome is very communal in juvenile and puberty getting lifetime prevalence as great as 40%. It affects student’s quality of life and their productivity in education. So, the main objective of current study was to access musculoskeletal pain among undergraduate physical therapy students. Methods: A Descriptive type of cross sectional survey was conducted at Lahore Medical and Dental College (LM&DC) for duration of almost six months from April 2018 to October 2018. Sample size recruited was 321 physical therapy students and they were included according to inclusion exclusion criteria. Assessment of Musculoskeletal pain was done using Nordic musculoskeletal questionnaire. An analysis was done using SPSS 21. Results: The findings showed that musculoskeletal pain among students was most commonly prevalent in lower back region constituting 65.4% (n = 210) followed by upper back 53.9% (n = 173) and neck region 48.6% (n = 156). Conclusion: Musculoskeletal pain was highly prevalent among medical students and most commonly found in lower back region.

To evaluate the effect of positioning on tonic labyrinthine reflex in children with cerebral palsy.The quasi-experimental study was conducted at the Institute of Psychological Services and Physical Rehabilitation, Lahore, from July 2016 to June 2017, and comprised children with spastic and athetoid cerebral palsy aged six months to three years. Gross Motor Functional Classification Scale level V was taken as baseline measure. Data was obtained and functional motor abilities were assessed by Motor Function Measure-20 Scale. Participants received intervention in the form of positioning in hammock for 10 hours, in-between sitting in cerebral palsy chair with harness along with sensory motor integration techniques. The readings were compared before the intervention and after the treatment strategies. SPSS 21 was used to analyse the data.Of the 30 subjects, 18(60%) were boys, and 7(23%) had athetoid cerebral palsy. The overall mean age was 18.13±7.33 months. Motor function variables significantly improved post-intervention (p0.05).Positioning provided significant improvement and positive effect in tonic labyrinthine reflex of spastic and athetoid cerebral palsy children.

Education opens numerous revenues to register economic expansion all around the world with specific reference to developing nations. Advancement of Pakistan in education indicators has been severely insufficient during the previous decades. Decreased financing along with inefficiency in budget expenditure plus weak management system have crippled the education sector ensuing poor educational outcomes. Outcome-based Education (OBE) has recently gained much attention in Pakistan. OBE is used in education because it clearly focuses and organizes everything in an educational system around what is necessary for all students to be able to do at the end of their learning. OBE proposes an influential and interesting option of transforming and organizing medical education. Therefore, the basic aim of this review is to highlight the tertiary education system of Pakistan and the need to shift from teacher centered to Outcome Based Education system. The review also addresses the major factors that impact student learning outcomes. Data bases were searched including Cochrane and Medline. Search strategy was designed by combining Boolean operators and key terms related to review objectives. Seven studies were included in the paper regarding the effectiveness of Outcome Based Education in different disciplines of education. The findings suggested five important factors from the literature that impact student learning outcomes including, assessment strategies, learning objectives based on level of complexity, student preferred learning styles, English language competency and Employer requirements. However, limitations were recognized in the methodology section and further recommendations were given for future researchers.