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PAKISTAN JOURNAL OF
PHYSICAL THERAPY
VOL. 01 ISSUE 01
Jan-Mar 2018
FACULTY OF
ALLIED HEALTH
SCIENCES
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UNIVERSITY INSTITUTE OF
PHYSICAL THERAPY
PJPT
ISSN NO: (PRINT)
ISSN NO: (ONLINE)
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UNIVERSITY INSTITUTE OF
PHYSICAL THERAPY
PUBLICATION SECRETARIAT
University Institute of Physical Therapy
Main Campus
1-Km Defence Road, Near Buptian Chowk,
Off Rawind Road, Lahore.
Tel: (042) 111-865-865 | Email: pjpt@uipt.uol.edu.pk
The advancement in technology has been fast during the past two decades. Although it has
rendered many positive impacts and made life extremely fast, just one click away; on the other hand, it
has converted life into sedentary mode. Hence, comes the need and utility of physical therapy. It is one
of the allied health professions that uses biomechanics or kinesiology, manual therapy, exercise
therapy and electrotherapy. It helps to rehabilitate and improves mobility and function.
Here, we are introducing the “Pakistan Journal of Physical Therapy” (PJPT), a pioneer,
international, peer reviewed, open access and quarterly journal. Scope of the journal includes
manuscripts mainly from physical therapy profession and research. It will cover aspects on:
Physical therapy in lifestyle-related health problems
Functioning, activity and participation
Behavioural medicine in physical therapy
Disability and health in areas of pain
Physical activity in health promotion and rehabilitation
The journal prioritizes original studies, systematic reviews, reports of clinical trials, economic
analysis, experimental studies, qualitative analysis, epidemiological studies and observational
studies. Scientic contributions will be accepted in the form of
Case Study
Guest Editorials
Meta-Analysis
Original Research Article
Short communications
Systematic Review
The aim is to improve implementation of research ndings into clinical physical therapy and practice.
There is no author fees for publication
Research scripts can be sent at the following address for review and publications.
Dr. Syed Amir Gilani (Editor in Chief)
Dr. Ashfaq Ahmed (Editor)
Dr. Riffat Mehboob (Editor)
pjpt@uipt.uol.edu.pk
About the Journal
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Human and animal rights
Conict of interest
To prevent the information on potential conict of interest for authors from being overlooked or
misplaced, it is necessary for that information to be part of the manuscript. It should therefore
also be included as a single line on title page.
Submission declaration and verication
Changes to authorship
Pakistan Journal of Physical Therapy (PJPT) welcomes contributions that are relevant to the
science or practice of physiotherapy and other allied health sciences.
If the work involves the use of human subjects, the author should ensure that the work described
has been carried out in accordance with ‘The Code of Ethics of the World Medical Association’
(Declaration of Helsinki) for experiments involving humans; Uniform Requirements for
manuscripts submitted to Biomedical journals. Authors should include a statement in the
manuscript that informed consent was obtained for experimentation with human subjects. The
privacy rights of human subjects must always be observed.
All animal experiments should comply with the ARRIVE guidelines and should be carried out in
accordance with the U.K. Animals (Scientic Procedures) Act, 1986 and associated guidelines,
EU Directive 2010/63/EU for animal experiments, or the National Institutes of Health guide for
the care and use of Laboratory animals (NIH Publications No. 8023, revised 1978) and the
authors should clearly indicate in the manuscript that such guidelines have been followed.
Submission of an article implies that the work described has not been published previously
(except in the form of an abstract, a published lecture or academic thesis, that it is not under
consideration for publication elsewhere, that its publication is approved by all authors and
tacitly or explicitly by the responsible authorities where the work was carried out, and that, if
accepted, it will not be published elsewhere in the same form, in English or in any other
language, including electronically without the written consent of the copyright-holder.
If additional papers have or will be published with any overlap of the current dataset, it is the
authors' responsibility to notify the editor at the time of submission.
Authors are expected to consider carefully the list and order of authors before submitting their
manuscript and provide the denitive list of authors at the time of the original submission. Any
addition, deletion or rearrangement of author names in the authorship list should be made only
before the manuscript has been accepted and only if approved by the journal Editor. To request
such a change, the Editor must receive the following from the corresponding author: (a) the
reason for the change in author list and (b) written conrmation (e-mail, letter) from all authors
that they agree with the addition, removal or rearrangement. In the case of addition or removal
of authors, this includes conrmation from the author being added or removed.
Only in exceptional circumstances will the Editor consider the addition, deletion or
Instruction to the Authors and Reviewers of the Manuscripts
Pakistan Journal of Physical Therapy (PJPT)
Open access
Informed consent and patient details
This is an open access journal: all articles will be free for everyone to read and download.
Studies on patients or volunteers require ethics committee approval and informed consent, which
should be documented in the paper. Appropriate consents, permissions and releases must be obtained
where an author wishes to include case details or other personal information or images of patients and
any other individuals in PJPT publication. Written consents must be retained by the author but copies
Clinical trial results
Reporting clinical trials
Registration of clinical trials
Authorship Letter:
The policy of PJPT regarding clinical trial registration is consistent with the position of the International
Committee of Medical Journal Editors(ICMJE). Results may be posted in the same clinical trials registry
in which primary registration resides. This will not be considered to be prior publication if the results are
posted in the form of a brief structured (less than 500 words) abstract or table. However, divulging
results in other circumstances (e.g., investors' meetings) is discouraged and may jeopardise
consideration of the manuscript. Authors should fully disclose all posting in registries of results of the
same or closely related work.
Randomized controlled trials should be presented according to the CONSORT guidelines. At
manuscript submission, authors must provide the CONSORT checklist accompanied by a ow diagram
that illustrates the progress of patients through the trial, including recruitment, enrollment,
randomization, withdrawal and completion, and a detailed description of the randomization procedure.
Registration in a public trials registry is a condition for publication of clinical trials in this journal in
accordance with ICJME recommendations. Trials must register at or before the onset of patient
enrolment. The clinical trial registration number should be included at the end of the abstract of the
article. A clinical trial is dened as any research study that prospectively assigns human participants or
groups of humans to one or more health-related interventions to evaluate the effects of health outcomes.
Health-related interventions include any intervention used to modify a biomedical or health-related
outcome (for example drugs, surgical procedures, devices, behavioural treatments, dietary
interventions, and process-of-care changes). Health outcomes include any biomedical or health-related
measures obtained in patients or participants, including pharmacokinetic measures and adverse events.
Purely observational studies (those in which the assignment of the medical intervention is not at the
discretion of the investigator) will not require registration.
The corresponding author has to submit an authorship letter at the time of submission of manuscript,
duly signed by all co-authors along with description of their contributions, afliations and email
addresses. Declaration of any potential conict of interest, transfer of copyrights and funding will also
be mentioned in it.
rearrangement of authors after the manuscript has been accepted. While the Editor considers
the request, publication of the manuscript will be suspended. If the manuscript has already been
published in an online issue, any requests approved by the Editor will result in a corrigendum
Instructions to the Authors
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Article length
Manuscript length (not including title page, abstract, references, tables or gure legends) depends on
the type of study:
Systematic reviews: up to 5000 words
Clinical trials, experimental and qualitative studies: up to 3500 words
Observational studies: up to 2500 words
This journal operates a double blind review process. All contributions will be initially assessed by the
editor for suitability for the journal. Papers deemed suitable are then typically sent to a minimum of two
independent expert reviewers to assess the scientic quality of the paper. The Editor is responsible for
the nal decision regarding acceptance or rejection of articles. The Editor's decision is nal.
Peer review
Title. Concise and informative. Titles are often used in information-retrieval systems. Avoid
abbreviations and formulae where possible.
Running title: Write a short running title on title page
Author names and afliations. Please clearly indicate the given name(s) and family name(s) of each
author and check that all names are accurately spelled. Present the authors' afliation addresses (where the
actual work was done) below the names. Indicate all afliations with a lower-case superscript letter
immediately after the author's name and in front of the appropriate address. Provide the full postal address
of each afliation, including the country name and, if available, the e-mail address of each author.
Corresponding author. Clearly indicate who will handle correspondence at all stages of refereeing and
publication, also post-publication. This responsibility includes answering any future queries about
Methodology. Ensure that the e-mail address and contact number is given and that contact details are kept
Editorials
Pakistan Journal of Physiotherapy (PJPT) publishes two editorials on scientic or professional issues of
physiotherapy practice and other health related matters and innovations in each issue. Editorials are
usually commissioned; however, anyone wishing to write an editorial should contact the Journal Editor
for discussion about the topic. Editorials should be no more than 2000 words with a maximum of three
authors and 20 references. Commissioned editorials are not formally peer reviewed, but may be subject
to informal review. Non-commissioned editorials will be formally peer reviewed.
should not be provided to the journal. Only if specically requested by the journal in exceptional
circumstances the author must provide copies of the consents or evidence that such consents have been
obtained.
Submission
Manuscripts may be submitted to the following email address:
pjpt@uol.edu.pk
All correspondence, including notication of the Editor's decision and requests for revision, is sent by
e-mail.
Manuscript preparation
Essential title page information
Instructions to the Authors
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Abstract
Abstract should comprise of the following: Background,Objective , Design, Methodology, Results,
Conclusion, Recommendations. A concise and factual abstract is required. The abstract should state briey
the purpose of the research, the principal results and major conclusions. An abstract is often presented
separately from the article, so it must be able to stand alone. For this reason, References should be avoided,
but if essential, then cite the author(s) and year(s). Also, non-standard or uncommon abbreviations should
be avoided, but if essential they must be dened at their rst mention in the abstract itself.
Introduction
State the objectives of the work and provide an adequate background, avoiding a detailed literature
survey or a summary of the results
Methodology
Provide sufcient details to allow the work to be reproduced by an independent researcher. Methods
that are already published should be summarized, and indicated by a reference. If quoting directly from
a previously published method, use quotation marks and also cite the source. Any modications to
existing methods should also be described.
Results
Results should be clear and concise.
Units and Abbreviations
This journal does not favour abbreviations in the text. However, 95% CI, SD, OR, RR, MD and such
commonly used terms do not require spelling out in full at rst mention (they would usually appear
within parentheses), but even when presented outside of parentheses these do not require dening. The
journal uses an approved list of units and abbreviations.
Keywords
Immediately after the abstract, provide a maximum of 6 keywords, using Australian / British spelling
and avoiding general and plural terms and multiple concepts (avoid, for example, 'and', 'of'). Be sparing
with abbreviations: only abbreviations rmly established in the eld may be eligible. These keywords
will be used for indexing purposes.
up to date by the corresponding author.The corresponding author details should be included on title
page. Email address should be institutional and including the name of corresponding author.
Present/permanent address. If an author has moved since the work described in the article was done,
or was visiting at the time, a 'Present address' may be indicated as a footnote to that author's name. The
address at which the author actually did the work must be retained as the main, afliation address.
Superscript Arabic numerals are used for such footnotes
Word count
Mention the word count of the manuscript (without references) on the title page.
Highlights
Highlights consist of a short collection of bullet points that convey the core ndings of the article.
Please include 3 to 5 bullet points to explain the key ndings.
Instructions to the Authors
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Instructions to the Authors
Figures
Ensure that each illustration has a caption. Supply captions below the gure. A caption should comprise
a brief title and a description of the illustration. Keep text in the illustrations themselves to a minimum
but explain all symbols and abbreviations used. Include the number of gures on title page. Maximum
number of gures or images is 4.
Discussion
Conclusions
This should explore the signicance of the results of the work, not repeat them. Avoid extensive citations
and discussion of published literature.
The main conclusions of the study should be presented in a short concluding paragraph at the end of the
Discussion section.
Tables
Please submit tables as editable text and not as images. Tables can be placed either next to the relevant
text in the article, or on separate page(s) at the end. Number tables consecutively in accordance with their
appearance in the text and place any table notes below the table body. Be sparing in the use of tables and
ensure that the data presented in them do not duplicate results described elsewhere in the article. Please
avoid using vertical rules and shading in table cells.Write captions below the table. Include the number
of tables on title page. Maximum number of tables to be included is 4.
References
Citation in text
Please ensure that every reference in the text should be mentioned as arabic numerals in
superscript.Reference cited in the text is also present in the reference list (and vice versa). Any references
cited in the abstract must be given in full. Unpublished results and personal communications are not
recommended in the reference list, but may be mentioned in the text. If these references are included in
the reference list they should follow the standard reference style of the journal and should include a
substitution of the publication date with either 'Unpublished results' or 'Personal communication'.
Citation of a reference as 'in press' implies that the item has been accepted for publication.
Reference management software
Reference style
The referencing style used by the journal is the Vancouver style, which can be found as a standard
referencing style in EndNote, RefWorks, Mendeley, and Zotero.
Use the support of Citaion Style Language styles, such as Mendeley and Zotero, as well as EndNote.
Text: Indicate references by (consecutive) superscript arabic numerals in the order in which they appear
in the text. The numerals are to be used outside periods and commas, inside colons and semicolons.
Submission checklist
The following list will be useful during the nal checking of an article prior to sending it to the
journal for review. Please consult this Guide for Authors for further details of any item.
Ensure that the following items are present:
One author has been designated as the corresponding author with contact details:
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Instructions to the Authors
E-mail address
Full postal address
All necessary les have been uploaded, and contain:
Keywords
All gure captions
All tables (including title, description, footnotes)
Further considerations
Manuscript has been 'spell-checked' and 'grammar-checked'
References are in the correct format for this journal
All references mentioned in the Reference list are cited in the text, and vice versa
Permission has been obtained for use of copyrighted material from other sources (including the
Internet)
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
ISSN Applied (Online), ISSN Applied (Print) VOL. 01 ISSUE 01 Jan-Mar 2018
Pakistan Journal of Physical Therapy
University Institute of Physical Therapy
The University of Lahore
Lahore, Pakistan
Patron in Chief
Mr. M.A. Raoof
Patron
Mujahid Kamran, Professor
(Ph.D)
Editor in Chief
Syed Amir Gilani, Professor
(MBBS, DMRD, MD, MPH, Ph.D)
Editors
Ashfaq Ahmad, Associate Prof.
(M.Phil Ph.D- PT)
Riffat Mehboob, Professor
(M.Phil, Ph.D, Post Doc.)
Editorial Assistant:
Sidra Khalid
(M.Phil, Ph.D*)
Farhat Bano, Associate Professor
(M.Phil, Ph.D)
University of Health Sciences, Lahore, Pakistan.
Jamshaid Ahmed, Associate Professor
(Ph.D)
The University of Lahore, Lahore, Pakistan.
Muhammad Imran, Associate Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Nadeem Sheikh, Associate Professor
(Ph.D, Post Doc)
The University of Punjab, Lahore, Pakistan.
Roquyya Gul, Associate Professor
(M.Phil, Ph.D, Post Doc)
The University of Lahore, Lahore, Pakistan.
Shahid Bashir, Associate Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Shahida Parveen, Associate Professor
(MBBS, M.Phil)
Services Hospital, Lahore, Pakistan.
Ammar Ahmed Khan,
Assistant Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Members (National)
Amir Qazi, Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Aurangzaib, Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Fridoon J Ahmad, Professor (Ph.D)
King Edward Medical University,
Lahore, Pakistan.
Nasir Raza Zaidi, Professor (MD, Ph.D)
Gujranwala Medical College Gujranwala Pakistan.
Nazar Ullah Raja, Professor (M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Saira Afzal, Professor
(MBBS, FCPS, Ph.D, Post Doc)
King Edward Medical University,
Lahore, Pakistan.
Syed Shakeel ur Rehman Professor
(DPT, M.Phil, Ph.D)
Riphah International University,
Islamabad, Pakistan.
Asif Hanif, Associate Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Fareeha Hameed, Associate Professor
(Ph.D, Post Doc)
Forman Christian College , Lahore, Pakistan.
Editorial Board & Peer Reviewers
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
ISSN Applied (Online), ISSN Applied (Print) VOL. 01 ISSUE 01 Jan-Mar 2018
Pakistan Journal of Physical Therapy
University Institute of Physical Therapy
The University of Lahore
Lahore, Pakistan
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Editorial Board & Peer Reviewers
Arif Ali Rana, Assistant Professor
(DPT, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Arooj Fatima, Assistant Professor
(DPT, M.Phil, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Arooj Munawar, Assistant Professor
(BSPT, PP-DPT)
The University of Lahore, Lahore, Pakistan.
Asif Naveed, Assistant Professor
(MBBS, FCPS)
King Edward Medical University,
Lahore, Pakistan.
Attia Masood Ahmed Ch,
Assistant Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Ayesha Riaz, Assistant Professor
(M.Phil, Ph.D)
Govt. College Women University, Faisalabad, Pakistan.
Danish Ali Khan, Assistant Professor
(MS, Ph.D*)
Khyber Medical College, KPK, Pakistan
Ehsan Javed, Assistant Professor
(T-DPT, Ph.D*)
University of South Asia, Lahore, Pakistan.
Fahad Tanveer, Assistant Professor
(MSOMPT, DPT, MHA, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Faiza Sharif, Assistant Professor
(MS, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Fareeha Amjad, Assistant Professor
(MSPT, Ph.D*)
The University of Lahore, Lahore, Pakistan
Filza Shoukat, Assistant Professor
(DPT, MSOMPT,)
The University of Lahore, Lahore, Pakistan.
Huma Ikram, Assistant Professor
(M.Phil, Ph.D)
University of Karachi, Karachi, Pakistan.
Ishaq Ahmed, Assistant Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Kashifa Ehsan, Assistant Professor
(MBBS, M.Phil)
Shaukat Khanum Memorial Cancer Hospital,
Lahore, Pakistan.
Kashaf Junaid, Assistant Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Maria Fareed Siddiqi, Assistant Professor
(D-Pharm, Ph.D)
The University of Lahore, Lahore, Pakistan.
Muhammad Kashif, Assistant Professor
(DPT, MSOMPT, Ph.D*)
Riphah International University, Faisalabad
Munir Bhinder, Assistant Professor
(M.Phil, Ph.D)
University of Health Sciences, Lahore, Pakistan.
Muhammad Nazim Farooq,
Assistant Professor (DPT, Ph.D)
Margalla Institute of Health Sciences,
Rawalpindi, Pakistan.
Muhammad Waseem Akhtar,
Assistant Professor (DPT, Ph.D)
Doctors Hospital & Medical Center,
Lahore, Pakistan.
Nighat Yasmin, Assistant Professor
(Ph.D, Post Doc)
King Edward Medical University,
Lahore, Pakistan.
Rabail Rani Soomro, Assistant Professor
(MS, Ph.D*)
DOW University, Karachi, Pakistan
Raham Bacha, Assistant Professor
(M.Phil, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Rizwan Ullah Khan, Assistant Professor
(MBBS, FCPS)
Fatima Memorial Hospital, Lahore, Pakistan.
Saeed Akhtar, Assistant Professor
(MS, Ph.D*)
DOW University, Karachi, Pakistan
Sajid Shaheen Malik, Assistant Professor
(MBBS, DMRD)
The University of Lahore, Lahore, Pakistan.
Sahreen Anwar, Assistant Professor
(MS, Ph.D*)
University of Sargodha, Sargodha, Pakistan.
Sana Batool, Assistant Professor
(MSPT, Ph.D*)
The University of Lahore, Lahore, Pakistan
Shahnai Basharat, Assistant Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Syeda Arooj Fatima, Assistant Professor
(M.Phil, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Syed Ijaz Ahmad, Assistant Professor
(M.Phil, Ph.D*)
Lahore General Hospital, Lahore, Pakistan.
Tamseela Mumtaz, Assistant Professor
(Ph.D)
Govt. College for Women University, Faisalabad, Pakistan.
Umair Ahmed, Assistant Professor
[BSPT, MSPT (Neuro), Ph.D*]
The University of Lahore, Lahore, Pakistan.
Usma Iftikhar, Assistant Professor
(MBBS, M.Phil Ph.D*)
Mayo Hospital, Lahore, Pakistan.
Waqar Afzal, Assistant Professor
(DPT, M.Phil, Ph.D*)
The University of Faisalabad, Lahore Campus,
Lahore, Pakistan.
Members (International)
Hossein Karimi, Professor (Ph.D),
Isfahan University of Medical Sciences, Isfahan, Iran.
Humayoun Zafar Professor (Ph.D)
King Saud University Riyadh, KSA.
Muhammad Ali Mohseni Bandpei,
Professor (Ph.D)
University of Social Welfare & Rehabilitation
Sciences, Tehran, Iran.
Ahmad Azam Malik, Associate Professor
(M.Phil, Ph.D)
King Abdul Aziz University, Jeddah, KSA.
Imrana Tanvir, Associate Professor
(MBBS, FCPS)
King Abdul Aziz University, Rabigh, KSA.
Muhammad Akram Tariq,
Associate Professor
(M.Phil, Ph.D, Post Doc)
Qingdao University Medical college, Qingdao, China.
Muhammad Ikram Ullah,
Assistant Professor
(M.Phil, Ph.D, Post Doc)
Al Jouf University, KSA.
Naseer Ahmad, Assistant Professor
(MBBS, Ph.D, Post Doc)
University of Verona Medical School, Verona, Italy.
Agha Khan Medical University, Karachi, Pakistan.
Abida Siddiqa, Research Scientist
(M.Phil, Ph.D, Post Doc)
ICGEB, Trieste, Italy.
Ayisha Shabbir, Research Scientist
(M.Phil, Ph.D, Post Doc)
University College London, London, UK.
Jaspreet Kaur, Research Scientist
(Ph.D, Post Doc)
Aix-Marseille University, Marseille Cedx, France.
Muhammad Sulaiman Yousafzai,
Research Scientist
(Ph.D, Post Doc)
University of Yale, New Haven, CT, USA.
Saima Zafar, Research Scientist
(M.Phil, Ph.D, Post Doc)
Georg-August-University Gottingen,
Gottingen, Germany.
Shakeel Ahmed, Research Scientist
(M.Phil, Ph.D, Post Doc)
Georg-August-University Gottingen, Gottingen,
Germany.
Syed Adnan Shahzad, Research Scientist
(Ph.D, Post Doc)
University of Cologne, Cologne, Germany.
ISSN Applied (Online), ISSN Applied (Print) VOL. 01 ISSUE 01 Jan-Mar 2018
Pakistan Journal of Physical Therapy
University Institute of Physical Therapy
The University of Lahore
Lahore, Pakistan
Biostatisticians
Asif Hanif (M.Phil, Ph.D)
Arslan Saleem Chughtai (M.Phil*)
Humera Waseem (MS*)
Maryam Altaf (MS*)
Sadia Khan (M.Phil*)
Mahreen Fatima (M.Phil, Ph.D*)
Prof. Dr. Riffat Mehboob
Editor
Research Unit,
Faculty of Allied Health Sciences
The University of Lahore,
Defence Road Campus
Lahore, Pakistan
Coordinators
Amber Hassan (M.Phil, Ph.D*)
Sadia Khan (M.Phil*)
Mailing Address: pjpt@uipt.uol.edu.pk
http://journal.uol.edu.pk/pjpt
Publication Office
All articles published represent the view of the authors and do not reect any ofcal policy of the Pakistan
Journal of Physical Therapy. All the copy rights are reserved with PJPT. No part of the journal may be
reproduced by any from or any mean without written permission from the Editor in Chief.
Disclaimer:
Managerial Assistant
Riffat Rehman (M.Phil*)
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
The University of Lahore, feels pride and privileged to launch 'Pakistan Journal of Physical
Therapy'. It was need of the hour and an under-recognized eld in Pakistan. It will include rigorous
research work with clear implications for the clinical practice of physical therapy. It will disseminate
high quality, original research in physical therapy and facilitate continuing education for physical
therapists and other healthcare professionals. Primary health is a state of complete physical, mental
and social well-being which is essential for leading a productive life and is a fundamental right of
every human being.
According to WHO, “Primary healthcare refers to "essential healthcare" that is based on
"scientically sound and socially acceptable methods and technology, which make universal health
care accessible to all individuals and families in a community. It is through their full participation and
at a cost that the community and the country can afford to maintain at every stage of their
1
development in the spirit of self-reliance and self-determination".
Primary medical care system caters a medically ill person for treatment and cure. Physicians
solely treat these patients and only health sector is involved in it. While, primary health care system
deals with prevention, care as well as palliative care leading to cure. It helps in health promotion and
comprehensive care which involve health professional teams, collaborations, community
participation and is joint responsibility of all of them.
2
Pakistan is a developing country, with 60 million people living under poverty line. According
to World Bank, approximately 4% of the population in Pakistan falls into poverty due to health shocks
each year. Majority of the people are without primary health care facilities and there is a shortfall of
2
specialists. Here comes the role of a physical therapist! It is a health care profession involving the
examination, evaluation, diagnosis of patients and treating them with physical interventions for
healing of imapairments and disabilities. Helps in promoting ambulation, functional abilities and
improvement of quality of life.
It is concerned with maximizing the quality of life by increase in movement potential for
promotion, prevention, treatment and ultimately rehabilitation of people. There are no retirement
homes at Government level for the proper care of geriatric population in Pakistan. Proportion of such
immobile population need long term and constant care. Our health care systems are not adequality
equipped and planned for them. Physical therapists may provide callipers, supportive devices and
create public awareness on promotional, preventive and rehabilitative measures. They provide
counselling to the family members of patients for home based care. It will help in managing the per
capita costs, improve team function, cost effective solution for addressing musculoskeletal conditions.
Physical Therapy and primary health care system
World Health Organization. Declaration of Alma-Ata. Adopted at the International
Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978
DAWN: Mubarak Zeb Khan, 2016. www.dawn.com/news/1250694
Reference:
1-
2-
Editor in Chief
Prof. Dr. Syed Amir Gilani
Faculty of Allied Health Sciences
University of Lahore
Editorial
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
01
10
Prevalence of upper extremity
musculoskeletal disorders in
health professionals in Lahore
Wazahat Nasir, Amber Hassan
& Fareeha Amjad
14
Correlation between level of
depression, sleep disturbance
and suicidal thoughts among
lower limb amputees
Anna Zaheer, Faiza Sharif, Nida Fatima,
Ayesha Shaque & Zeeshan Khan
19
The effect of shoulder position
on hand grip strength among
university students
Babar Bashir, Arooj Ashfaq &
Maryam Altaf
2-
3-
4-
Vaping or Smoking:
What is more dangerous? 02
Dr. Nighat Yasmin
Physical therapy and primary
health care system
01
Prof. Dr. Syed Amir Gilani
03
Correlation between hand
circumference and maximum
grip strength
Muhammad Noman Tasawer,
Ashfaq Ahmad & Sadia Khan
1-
24
Awareness & attitude
towards physical activity
among pediatric population
in Pakistan
Muhammad Jawad, Fahad Tanveer,
Wardah Rauf & Haz Zain Pervaiz
MANUSCRIPT SUBMISSION PATHWAY
LETTER OF AUTHORSHIP
35
36
29
Facilities available for cerebral
palsy children in different
setups of Lahore
Muhammad Faizan Hamid,
Muhammad Waqar Afzal,
Arslan Saleem Chughtai
& Khalil Ahmad
5-
6-
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Guest Editorial
Vaping or smoking: What is more dangerous?
E-Cigarette (EC) is an electronic device that is used as an alternative to conventional tobacco
cigarettes (TS). It is gaining popularity in the young adults as it is considered safe for health. EC have
been promoted as an alternative harmless source to deliver the same effects as TS. The term “vaping”
is commonly used for EC while “smoking” is used for TS. EC can deliver nicotine through a gaseous
state because nicotine is dissolved in relatively harmless organic solvents such as glycerol and
propylene glycol that produce aerosols (nicotine stimulants) upon controlled electric heating. Since
EC does not contain any carcinogen, it is believed that EC smoke have no harmful effects on health. On
the other hand, TS contain nicotine and its nitrosamine derivatives alongwith hundreds of byproducts
such as Polycyclic Aromatic Hydrocarbons (PAHs), aromatic amines, aldehydes and benzene that are
mostly reported as human carcinogens. Therefore, TS smoke is not only harmful for the users but also
for the bystanders.
EC users often state that it save you from smoking related health risks, yellowing of skin and
teeth, halitosis and deteriorating physical condition because EC do NOT use tobacco. EC companies
claim that it contains only nicotine alongwith FDA approved food grade components. Moreover,
nicotine is a stimulant just like caffeine and is also found in trace amounts in vegetables such as
tomatoes, potatoes and even eggplants. Therefore, to eliminate the use of TS via EC will not cause
cancer and FDA would not have approved nicotine gums as smoking cessation tools if nicotine really
cause cancer. However, these are irresponsible and irrational marketing tacts.
Studies have shown that EC users are more inclined to become smokers in future. Scientists
have found that heavy metals like chromium, nickel, tin, silver, cadmium, mercury and aluminum are
present in the vapors produced by EC. The existence of various harmful chemicals such as nicotine,
carbonyls, metals, and organic volatile compounds has been proved to be present in EC smoke. A
recent study has shown that EC smoke can damage DNA and reduce the repair capacity of a number of
organs like lung, heart and bladder cells. Therefore, EC smoke may be equally carcinogenic as TS
smoke and EC smokers are also a higher risk of developing lung and bladder cancer and heart
diseases. No data or study is available from Pakistan regarding EC use and its effects on health.
Therefore, this can be a future perspective of Pakistani scientists to study EC effect on health as more
human studies needed to validate that vaping is equally/more dangerous than smoking.
Dr Nighat Yasmin
Assistant Professor
Department of Biomedical Sciences,
Kind Edward Medical University, Lahore.
02
Maximum Grip-Strength (MGS) is inuenced
b y g en d e r , B MI , f or ea r m a nd h an d
circumference.
Hand circumference is the best predictive of
MGS in males and females for right and left
hands than forearm circumference and BMI.
Males have higher BMI, hand and forearm
circumference and grip-strength than females.
1University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
*nomanbhatti784@gmail.com
Highlights:
Abstract:
Grip Strength (GS) is a reliable parameter that
reveals general hand condition and to determine
effectiveness of treatment protocol. GS is also
effective for rehabilitation of hand also for
ergonomists as a way of optimizing the
requirements of hand tool design.
Objective:
To measure the relationship between hand
circumference, BMI, forearm circumference and
maximum hand grip strength.
Methodology:
Cross-sectional study design was used. After
obtaining informed consent form 62 healthy
participants, 40 males and 22 females in the age
group 19 to 26 years were recruited. Participants
were selected using a non-random convenience
sampling method. GS was measured using
Jamar Plus Digital Dynamometer. Body mass
index, hand and forearm circumference in males
and femal e s w ere measured . Pe a rson's
correlation coefcient test was applied to
evaluate the correlation and 5% probability level
was applied t o specify the statistical-
signicance.
Results:
Signicant correlation between body mass
index, hand and forearm circumference with
Correlation between Hand Circumference and Maximum Grip Strength
1 1
Muhammad Noman Tasawer *, Ashfaq Ahmad and Sadia Khan
GS. Hand circumference had the strongest
correlation with MGS for both hands in males
(right r=.771**, left r=.731**) and females (right
r=.768**, left r=.737**) Forearm circumference
had the moderate relationship with MGS for
both hands in males (right r=.631**, left r=.629**)
and in females (right r=.639**, left r=.624**). Body
mass index had the weakest correlation with
MGS in females (right r=.424*, left r=.450*)
whereas, males have moderate relationship
(right r=.528**, left r=.527**). Males have higher
hand grip strength than females for right hand
(102.32±13.55, 48.87±7.99) and left hands
(93.99±13.09, 42.66±8.29) respectively.
Conclusions:
MGS was inuenced by gender, BMI, forearm
and hand circumference. Hand circumference is
the best predictive of MGS in males and females
for right a n d left hands than f o r e a r m
circumference and BMI.
Key Words:
Hand circumference, Forearm circumference,
Maximum grip strength
Introduction:
H e al t h a nd ap p r op r ia t e s t re n gt h o f
musculoskeletal system is one of the essential
components to perform routine movement.
Along with routine movement hand grip
strength is fundamental to various games and is
considered while an ingredient in enhancing
1
action and control. The human hand is a
complicated architecture and is most responsible
to the purpose of manipulation. It helps in
transfer o f sensory inform a t i o n about
temperature, shape and surface of any object to
2
the brain. Measuring GS is easy, but evaluation
of the Hand Grip Strength (HGS) has several
03
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
importance that reveal someone's overall health,
3 , 4
muscle strength, or even aging. GS is the
power of many muscles in the hand and its
strength is the strong bending of whole nger
joints, with a maximum intentional force. The
strength has usually been measured in kilograms
(kg) and pounds (lbs), some studies have also
used milliliters of mercury (mmHg) and also
newton's. Anakwe et al., has observed that
relation with hand and lower arm circumference
have also been considered to be exceptional sign
5
of HGS . Studies have also conrmed that HGS is
ch a n g e d thr o u g h p o s i t i o n an d o t h e r
anthropometrical characteristics alike ratio of the
6
fat your body contain and hand circumference
Gender and age are the two main causes
affecting maximum hand grip strength, where
gender accounts for the major percentage of the
7
general change.
The anth r o po m e tr i c t r ai t s d e pe n d o n
populations and are changed for many ethnic
populations. Even for a population of the same
ethnic group, some differences in hand
dimensions are noticed. Furthermore, the
association between GS with interrelated
8
variables is different in many studies. GS testing
is used to make decisions for returning those
who suffer from local hand injuries back to work
and to estimate the amount of bone mineral
7, 9
density. GS is of signicance to ergonomists as
a way of enhancing the demands of workplaces
10
and tools strategy Handheld-dynamometers
have been utilized to evaluate muscle power.
The Jamar Hydraulic Hand Dynamometer was
detected to provide the much precise plus
11, 12
satisfactory measurement of HGS.
Ke Li et al., had done a research in 2010 and
concluded that MGS can be forecasted utilizing
13
hand circumference only. Manjunath Hemberal
et al., had done a research in 2014 and concluded
that the hand circumference had the greatest
14
association with MGS in both genders. Kumar et
al., had done a research in 2016 and established
that hand circumference is a worthy forecaster of
15
GS as compared to body mass index. There is no
published data available on present study in
Pakistan. The main purpose of this study is to
search the correlation between anthropometrical
characteristics like body mass index, hand and
forearm circumference with MHGS in normal
population. The study will be unique that will try
to further characterize and describe the
statistically signicant ant hropo metri cs
variables related to HGS. GS is a reliable
parameter that reveal general hand condition
and to determine effectiveness of treatment
protocol.
Methodology:
Cross-sectional study was done after approval
from the Ethical Committee. Sixty two healthy
participants including 40 males and 22 females in
the age class 19-27 were approached and the
subjects signed an informed consent form before
contribution. Data was collected through
questionnaire planned for the aim of this study
which includes socio demographic information
like name, age, gender, hand dominance,
occupation. Participants with any wrist and
elbow joint complications, fracture history,
upper extremity abnormalities, hand swelling,
any vascular problem, hand edema, any
neurological problem. MHGS was counted by
asking the participants seated in chair without an
arm rest with 90 degrees elbow exed and with
wrist slight extended and slightly deviation on
ulnar side. The subjects were asked to grip the
dynamometer with maximum force. Three trials
for both right and left hands with normal period
of one min rest interval between trials were
acc omplished . The maximum force was
sustained for period of two to three seconds and
best value out of three was recorded and the
result was taken in lbs. The BMI was measured
utilizing person's weight in kilograms divided
by height in meters squared (kg)/(m)².The
forearm and hand circumference w as
measured using exible measuring tape(cm)
and correlated with MGS. The analyses of the
data were accomplished by SPSS version 21.
An independent-sample t test was applied to
04
Hand Circumference and Maximum Grip Strength
Tasawer MN et al.,
Hand Circumference and Maximum Grip Strength
05
Tasawer MN et al.
examine the variances among genders.
More o ver , pair e d-s a m ple t t e s t w a s
implemented to analyse strength variability
among right and left hands. To inspect the
relati onship betwee n MGS and other
anthropometric factors, Pearson correlation
test was used. The cor relation s w ere
16
characterized according to Hopkins' scale
Results:
A total 62 healthy participants (40 males
64.50%, 22 females 35.48%) with mean age
21.45±1.73 years, all of the participants were
recruited from university of Lahore, Lahore.
Table1 represent the a n thropometric
characteristics and MGS of the participants.
Mean Height of male and female subjects were
5.62±0.30, 5.43±0.18 respectively and have p-
value 0.008 whi ch shows statistically
signicant difference between both genders,
males are taller than females.
BMI was signicantly greater in males than
fe ma le s (m a l e s 23 . 4 9 ±3.7 1, f em a l e s
20.96±3.48). Right and left hand circumference
were signicantly larger in males than females
(males 21.11±0.91, females 18.88±1.01), (males
20.75±0.93, females 18.55±0.96) respectively.
Right and left FAC were signicantly larger in
males than females (males 26.54±1.78, females
23.98±2.19), (males 26.02±1.82, females
23.50±2.18) respectively Right hand MGS is
signicantly larger in males than females
(males102.32±13.55, 48.87±7.99). Left hand
MGS is signicantly larger in males than
fema l e s ( m ales 93.99 ± 1 3.09 , fe m a les
42.66±8.29). There were variations in grip-
strength of both hands in males and females;
right hand was stronger than left.
Abbreviations SD= Standard Deviation, BMI=
body mass index, MGS= maximum grip
strength.
*independent sample t test, p-value signicant
at 0.05
Gender
Mean± SD
p-value
Height
Male
5.62±0.3
0.008*
Female
5.43±0.18
Weight Male 69.76±12.19 <0.001*
Female 55.5±8.85
BMI Male
23.49±3.71
0.011*
Female
20.96±3.48
Right Hand Circumference (cm)
Male
21.11±0.91
<0.001*
Female
18.88±1.01
Left Hand Circumference (cm)
Male
20.75±0.93
<0.001*
Female
18.55±0.96
Right Forearm Circumference (cm)
Male
26.54±1.78
<0.001*
Female
23.98±2.19
Left Forearm Circumference (cm) Male 26.02±1.82
<0.001*
Female 23.5±2.18
Right Hand MGS (lbs) Male 102.32±13.55
<0.001*
Female 48.87±7.99
Left Hand MGS (lbs) Male 93.99±13.09 <0.001*
Female 42.66±8.29
Table 1: Anthropometric parameters and
Maximum Grip-strength of the participants
Table 2 represents the Pearson's correlation of
anthropometric parameters with MGS among
males. Hand circumference had the highest
correlation with maximum grip-strength for
both right and left hands in males (right r =
.771**, left r = .731**). Forearm circumference
had the moderate relationship with MGS for
both hands in males (right r = .631**, left r =
.629**). BMI had the moderate relationship
with MGS in males (right r = .528**, left r =
.527**).
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Right
HC(cm)
Left HC
(cm)
Right
FAC (cm)
Left FAC
(cm)
Right Hand
MGS (lbs)
Left Hand
MGS (lbs)
BMI 0.576** 0.595** 0.732** 0.734** 0.528** 0.527**
Right HC (cm) 0.982** 0.744** 0.742** 0.771** 0.734**
Left HC(cm) 0.747** 0.754** 0.766** 0.731**
Right FAC (cm) 0.992** 0.631** 0.626**
Left FAC(cm) 0.632** 0.629**
Right hand
MGS (lbs) 0.973**
Table 2: Pearson's correlation between anthropometric parameters with MGS among males
Abbreviations HC=Hand circumference, FAC=Forearm circumference, MGS=Maximum grip
strength, BMI= Body mass index.
**. Correlation is signicant at the 0.01 level (2-tailed)
Table 3 represents the Pearson's correlation of anthropometric parameters with MGS among females.
Hand circumference had the highest relationship with MGS for both hands in females (right r = .768**,
left r = .737**) whereas, Forearm circumference had the moderate relationship with maximum grip-
strength in females (right r = .639**, left r = .624**). Body mass index had the weakest correlation with
MGS in females (right r = .424*, left r = .450*).
Right
HC (cm)
Left HC
(cm)
Right FAC
(cm)
Left FAC
(cm)
Right hand
MGS (lbs)
Left hand
MGS (lbs)
BMI 0.625** 0.624** 0.852** 0.833** 0.424* 0.450*
Right HC (cm) 0.995** 0.713** 0.693** 0.768** 0.748**
Left HC (cm) 0.715** 0.696** 0.746** 0.737**
Right FAC (cm) 0.995** 0.639** 0.633**
Left FAC (cm) 0.629** 0.624**
Right hand
MGS (lbs) 0.961**
Table3: Pearson's correlation between anthropometric parameters and MGS among females
Abbreviations HC=Hand circumference, FAC=Forearm circumference, MGS=Maximum grip
strength, BMI=Body mass index.
**.Correlation is signicant at the 0.01 level (2-tailed)*. Correlation is signicant at the 0.05 level (2-
tailed).
Discussion:
Measuring hand grip strength (HGS) is a vital
factor for hand rehablitation. It evaluates the
patients early limitations and delivers a rapid
reexamination of patients progress throughout
17
the management. The current survey was
planned to establish the correlation between
HGS and other anthropometric characteristics
using a standard procedure. The present survey
used the third handle-position of the Jamar Plus
18
Digital Dynamometer , the anthropometrical
characteristics of healthy individuals in the age
06
Hand Circumference and Maximum Grip Strength
Tasawer MN et al.
Hand Circumference and Maximum Grip Strength
07
Tasawer MN et al.
class 19 to 27 years were gathered and it revealed
tha t ther e is s i gni c an t diff e r en c e i n
anthropometrical characteristics of both males
a n d f e m a l e s , o v e r a l l , m a l e
participants(5.62±0.30)are taller than their
c o u n t e r p a r t s ( 5 . 4 3 ± 0 . 1 8 ) a n d t h e i r
anthropometrical characteristics are greater than
female participants including BMI, hand
circumference, forearm circumference. This
shows that height, w e i g h t , BMI, hand
circumference and forearm circumference have
signicantly inuenced by gender. These result
correlates well with the ndings in earlier
20-2 2
studies Overall, it can be concluded that
anthropometrical characteristics like weight,
height, BMI, hand and forearm circumference
were considerably different between both males
and females.
In this study the maximum grip strength of 62
participants [22 (64.5%) male and 40 (35.5%)
female] of mean age 21.45±1.734 years were
a s s e sse d us i ng a J ama r Pl u s D i git a l
Dynamometer to inspect correlation between
MGS and other anthropometrical characteristics
including BMI, hand circumference, forearm
circumference. In our research mean maximum
hand -grip str ength of par ticipants was
83.3 5 ± 2 8.3 5 5 (lbs) f or r i ght hand a n d
75.78±27.316 (lbs) for left hand. The mean MGS of
both right and left hands in males were
(102.32±13.55, 93.99±13.09) respectively higher
tha n their c ounterparts(right48.87±7.99,
left42.66±8.29) which is also constant with earlier
23, 24
result demonstrating that males are constantly
stronger than females.
The present study established correlation
between BMI and MGS whereas, moderate
correlation between body mass index and MGS
in males while, correlation was weak between
BMI and MGS in females. The previous studies
also found the correlation between body mass
24-26
index and maximum grip-strength whereas,
no signicant association was found between
27
BMI and MGS. The present study illustrates that
correlatio n betwe e n MGS and forearm
circumference was found moderate in males and
females for right and left hands. Previous study
results found lower relation between these two
28
variables in both genders whereas, Nicolay and
Walker established a strong association between
29
these two variables.
The present study illustrate that there was
positive correlation between anthropometrical
characteristics like BMI, hand circumference and
forearm circumference and maximum grip
strength in both genders while, strongest
correlation was found between maximum grip
stren gth and hand cir c umferen ce. This
conclusion was related to the report from survey
which revealed strong relationship between
13
MGS and hand-circumference .
Conclusions:
It can be concluded that MGS is inuenced by
gender, BMI, forearm and hand circumference.
Hand circumference is a best predictive of
Maximum Grip Strength (MGS) in males and
females for right and left hands than forearm
circumference and BMI. Males have higher body
mass index, hand and forearm circumference
and grip-strength than females.
Recommendations:
As there is no published data available on
present study in Lahore so further studies should
be conducted to nd the correlation of MGS and
other anthropometric variables to support the
present study results.
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10
Abstract:
Musculoskeletal disorders are dysfunctions
inuencing muscles, bones, nerves, ligaments,
tendons, joints and peripheral nerves leading to
pain or un-easiness.
Objective:
The main objective of the study was to nd out
the prevalence of musculoskeletal problems
among health professionals in Lahore.
Methodology:
In this study, 236 health related professionals
participated including 110 males and 126
females. Data were collected by taking written
information consent form through Nordic
musculoskeletal questionnaire. Data were
analyzed through SPSS version 21.0.
Results:
Out of 236 subjects, prevalence of pain in neck
was 157 (66.5%), shoulder 119 (50.4%), upper
back 106 (44.9%), elbow 30 (12.7%), hand and
wrist 58 (24.6%). Result showed that 127 (53.8%)
participant had sitting posture, 2 (8%) had
squatting posture and 1 (4%) had kneeling
posture and those participants having standing
posture were 106 (44.9%).
Conclusions:
This study concluded that upper extremity
musculoskeletal pain is common in health
professionals depending upon their working
posture.
Keywords:
Musculoskeletal disorders, upper extremity,
health professionals.
Introduction:
Musculoskeletal d i s o r d e r s (MSDs) are
Prevalence of Upper Extremity Musculoskeletal Disorders in Health
Professionals in Lahore
*wazich21@gmail.com
provocative and retroactive conditions affecting
different body parts. MSD are conditions that are
slowly produced from work-related activity.
Three key risk factors associated with these
disorders are analyzed as repetitive movements,
1
awkward positions and high strength levels.
MSDs include a wide range of progressive and
regressive problems especially muscular pain,
tendonitis and occlusion syndrome. This kind of
profession can affect the occurrence of these
diseases, but the increased incidence has been
found in various types of health care workers
such as nurses, nursing assistants, X-ray
2
specialists, patient care staff and doctors. The
work activities including repetition, contact
stress, critical positions, lifting, transferring
patients and sustained attitude have been
associated with increased risk of MSD. The
majority of hospital orders in tertiary care
facilities provide a wide range of tasks related to
3
repeated manual patient care activities.
According to the Bureau of Labor Statistics,
work-related structural musculoskeletal
disorders affect nearly one million workers in the
United States alone each year. This can affect the
ability of workers to perform the necessary
professional activities, which may negatively
affect productivity. It is estimated that economic
losses from these services in Korea is about US $ 1
billion. Studies have revealed that health care
professionals are sensitive to these disorders
during routine work. In the health care sector, a
wide range of workers are affected by them, but
it seems to be a mandatory problem for medical
4
practitioners. It has been shown that different
groups of individual, physical and psychosocial
5
factor s a r e p redisposed to MSD s . The
prevalence ranges from 43% to 78%. Most of the
previous studies have achieved the prevalence of
MSDs through one category of hospital staff
(nurses, nursing assistants, operating theater
nurses, physical therapists, midwives, students,
secretaries, workers) or through one type of
injury (neck pain, shoulder pain). It was
1 1
Wazahat Nasir *, Amber Hassan and Fareeha Amjad
1University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore,
Pakistan.
Prevalence of musculoskeletal disorders
among 236 health professionals in Lahore was
evaluated.
through nordic musculoskeletal questionaire.
Upper extremity musculoskeletal pain was
found to be common.
Highlights:
therefore, decided to conduct an investigation
among all categories of hospital personnel and
6
on all related disorders.
The purpose of the study was to nd out the
prevalence of MSDs in upper extremity in health
professionals making them aware in future of the
risk factors and to evaluate how much these
disorders are affecting their activities of daily
living, social life and professional carrier. This
evaluation helps to identify underlying causes or
adopt life style changes so that opportunities for
disorders and health professionals can be better
adapted to stressful occupation in favor of
t h ems e l ves a n d pa t i ent s in ge n e ral .
Methodology:
A cross sectional study design was designed.
Data were collected through convenient
sampling from 236 health professionals. Data
were collected in 4 months. Both male and female
health professionals between the ages of 20 to 62
years and the data was collected from different
hospitals of Lahore were included, whereas non
responsive health professionals and with body
trauma of upper extremity were excluded. In
demo graphi c data age and g ender was
documented. Among 236 health professionals
participated in the survey including 110 males
and 126 females. Data were collected through
Nordic scale questionnaire as it was the
convenient and appropriate way for data
collection. Data were analyzed through SPSS
version 21.0 and graphs were formulated
afterwards which made it easy to nd out the
exact number of health professionals suffering
from musculoskeletal disorders in upper
extremity.
Results:
Table 1 shows the frequency of male and females
that participated in study. A total of 236 subjects
participated with 110 (46.6%) males and 126
(53.3%) females in this study.
11
Nasir W et al.,
Table 1: Frequency distribution of gender
Female 126 53.4%
Total 236 100%
Male 110 46.6%
Gender Frequency Percentage
Squatting
Kneeling
Standing
Total
2
1
106
236
8%
4%
44.9%
100%
Ergonomic
posture Frequency Percentage
Sitting 127 53.8%
Table 2 shows the frequency of their posture
during work, 127 (53.8%) had sitting posture, 2
(8%) were having Squatting posture , 1 (4%) had
kneeling and 106 (44.9%) had standing posture.
(Table 2).
Table 2: Descriptive statistics of ergonomic
posture
Table 3 shows the frequencies of subjects who
had no neck trouble in past 12 months was 79
(33.5%), those who had neck trouble during
work was 157 (66.5%). The frequencies of
subjects who had no shoulder trouble in past 12
months was 117 (49.6%), those who had shoulder
trouble during work was 119 (50.4%), without
elbow trouble during work was 206 (87.3%),
those who had elbow trouble was 30 (12.7%). The
frequencies of participants who had no
wrist/hand trouble in past 12 months was 178
(75.4%), those who had wrist/ hand trouble was
58 (24.6%). The frequencies of subjects who had
no upper back trouble in past 12 months was 130
(55.1%), and those who had trouble in upper
back was 106 (44.9%) (Table 3).
No 79
Yes 157
Total 236
No
117
Yes 119
Total 236
No 206
Yes 30
Total 236
No 130
Yes 106
Total 236
No 178
Yes 58
Total 236
33.5%
66.5%
100 %
49.6%
50.4%
100%
87.3%
12.7%
100%
55.1%
44.9%
100%
75.4%
24.6%
100%
Neck
Shoulder
Elbow
Upper
back
Wrist /
hand
Region Frequency Percentage
Musculoskeletal Disorders in Health Professionals
Table 3: Frequency of Musculoskeletal Pain in
Different Regions
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Discussion:
In New South Wales and Australian dentists, the
study was conducted which showed that 64%
had different type of pain in the last 12 months.
Southern Thailand study showed that 78%
dentist had musculoskeletal pain in the last 12
months and 78% female staff. A study of dental
hygienists in the United States reported
th a t a p p r o x i m a t e l y 9 3% e x p e r ie nc ed
musculoskeletal sign in the previous 12 months.
In a study of Swedish female labor, the dentists
who had wrist and hand pain since last 12
months was 64% which was compared with 54%
of dentists and 27% of dental assistants. Wrist
and hand was the most extreme sign of pain
(69.5%) in an Musculoskeletal disorder study of
7
dentists in the United States. According to our
study, the frequencies of participants who had
neck trouble during work were 157(66.5%). More
than 50% of the nurses (55%) reported that they
had multiple disorders in their body. Of the 347
nurses selected, 317 lled the questionnaires
(91%).The total age and time period of work as a
nurse was 33.7 (7.7%) years and 10 (7.6%) years
8
respectively. According to our study, a total
number of 236 subjects participated in lling
questionnaires including 110 (46.6%) males and
126 (53.3%) females. A whole m e dical
assessment of the cases show that upper
extremity (38.7%) was the highest main region
for pain. The severity of pain to muscular skeletal
disorder percentage was calculated as medium
and high in 42.9 cases and as low in 23.2 cases.
67.9% of the study showed anxiety and 28.6%
9
show depression. According to our study, the
frequencies of participants of how much work
they perform per day 1-4 hours was 9 (3.8%), 5-8
hours per day was 69 (29.2%), 9-12 hours per day
was 134 (56.8%), 12 and above was 24 (10.2%).
95% of nurses had symptoms in last 12 months.
The frequency of dentists who suffered from
pain in neck region, shoulder, upper back region,
wrist and hand, arms / forearms were 48.8%,
27.3%, 14.7%, 9.3%, 6% respectively. The 18%
dentists did not claimed any pain in the past 6
months. Work-related stress was the most
frequent problem related to mental health
represented by 57.6%, fatigue (38%), waking late
night (8%), and depression before going to work
(7.3%), the level of anxiety (5.3%) and the level of
10
nervousness (3.3%). According to our study the
12
frequencies of participants who suffered from
neck, shoulder, elbow, up per bac k and
wrist/hand were 66.5%, 50.4%, 12.7%, 44.9% and
24.6%.
Conclusions:
This study concluded that musculoskeletal
disorder (MSD) is a common disorder among
health p r o f e s s i o n a ls. U p p e r extremity
musculoskeletal disorders prevalence in health
professionals is relatively high depending upon
their working posture.
Recommendations:
Most of the previous literature was descriptive
cross-sectional surveys. Further studies were
recommended to carry out on a large sample size
to identify e tiolo gy and risk facto rs of
musculoskeletal disorder
References:
1-
Nkhata LA, Esterhuizen TM, Siziya S, Phiri
PD, Munalula-Nkandu E, Shula H. The
Prevalence and Perceived Contributing
Factors for Work-Related Musculoskeletal
Disorders Among Nurses at the University
Teaching Hospital in Lusaka, Zambia.
Science. 2015;3(4):508-13.
2-
Del Campo M, Romo PE, de la Hoz RE,
Villamor JM, Mahíllo-Fernández I. Anxiety
and depression predict musculoskeletal
disorders in health care workers. Archives of
environmental & occupational health.
2017;72(1):39-44.
3-
C H AN C H A I W , S ON G K H A M W ,
KETSOMPORN P, SAPPAKITCHANCHAI
P, SIRIWONG W. Prevalence and factors
associated with musculoskeletal disorders
among Thai hospital orderlies. International
J o u r n a l o f O c c u p a t ion a l H y g i e n e.
2015;7(3):132-8.
4-
Das SK, Mukhopadhyay S. Effect of altered
body composition on musculoskeletal
disorders in medical practitioners. Int J Res
Eng Tech. 2016;5.
5-
Mehrdad R, Dennerlein JT, Haghighat M,
A m in i a n O . A s so c i at io n b e tw e e n
psychosocial factors and musculoskeletal
symptoms among Iranian nurses. American
j o u r n a l o f i n d u s t r i a l m e d i c i n e .
2010;53(10):1032-9.
Nasir W et al.,
Musculoskeletal Disorders in Health Professionals
13
6-
Jellad A, Lajili H, Boudokhane S, Migaou H,
Maatallah S, Frih ZBS. Musculoskeletal
disorders among Tunisian hospital staff:
Prevalence and risk factors. The Egyptian
Rheumatologist. 2013;35(2):59-63.
7-
Hayes M, Cockrell D, Smith D. A systematic
review of musculoskeletal disorders among
dental professionals. International journal of
dental hygiene. 2009;7(3):159-65.
8-
Mehrdad R, Dennerlein JT, Haghighat M,
A m in i a n O . A s so c i at io n b e tw e e n
psychosocial factors and musculoskeletal
symptoms among Iranian nurses. American
j o u r n a l o f i n d u s t r i a l m e d i c i n e .
2010;53(10):1032-9.
9-
Del Campo M, Romo PE, de la Hoz RE,
Villamor JM, Mahíllo-Fernández I. Anxiety
and depression predict musculoskeletal
disorders in health care workers. Archives of
environmental & occupational health.
2017;72(1):39-44.
10-
Kaul R, Shilpa P, Sanjay C. Musculoskeletal
disorders and mental health related issues as
occupational hazards among dental
practitioners in the city of Bengaluru: a
randomized cross-sectional study. 2015.
Nasir W et al.,
Musculoskeletal Disorders in Health Professionals
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
1University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
*annazaheer@yahoo.com
Highlights: females. Depression was presented in 55
(78.57%) amputees, among those 21 (30%)
participants were suffering from mild
depression, 20 (28.6%) from moderate, 12 (17.1%)
with moderately severe and only 2 (2.9%)
participants were presented with severe
depression. Correlation of depression score with
sleep disturbance was 0.492( p 0.000) and that of
depression score and frequency of suicidal
thought was 0.452 (p 0.000).
Conclusions:
Patients who underwent amputation suffered
from various psychological consequences such
as depression. They had sleep disturbances and
suicidal thoughts found to be directly associated
to depression.
Key words:
Amputees, Depression, Suicidal thoughts.
Introduction:
Amputation is an operative removal of a
particular part of the body. Types of this surgical
process vary from patient to patient depending
upon the condition of a patient. Amputation is
the last hope of survival for patients suffering
1
from different pathological condition. The
unilateral or bilateral amputation may be
performed and are divided in minor or major
amputation. Minor part of limb removal like toe
etc. are included in minor amputation and full
and partial limb removal is called major
2
amputation. Most commonly performed were
transfemoral and trans-tibial. Peripheral artery
disease is the second major cause of amputation
3
in deve l o ped c o un t r ies. Lowe r L i mb
Amputations for peripheral arterial disease were
performed predominantly on an elderly people
with concomitant medical complications and
4
poor social support. Lower Limb Amputation
(LLA) because of trauma was seen in young
individuals in road trafc accidents. More
proximal the amputation is, fewer chances to
regain ambulation are present, above knee
amputation is preferable for those where below
knees amputation is not suitable which might be
14
Abstract:
Amputation is an operative removal of a
particular part of the body. Types of this surgical
process vary from patient to patient depending
upon the condition of a patient. Amputees face
various psychological consequences which may
lead to depression.
Objective:
To nd the correlation between sleep, suicidal
thoughts and depression among lower limb
amputees.
Methodology:
It was a cross sectional survey conducted on
amputees. Data were collected from registered
government hospitals and rehabilitation centers
of Lahore, Pakistan. Modied Patient Health
Questionnaire (PHQ-9) was used to nd
frequency score of depression. Patient with
Transtibial and transfemoral amputation were
included in the study. People with other
disabilities, pregnancy, infectious stump, upper
motor disease, lower motor disease and ongoing
malignancy were excluded.
Results:
This study was conducted on 70 patients with
Lower limb amputation that was either trans-
tibial or trans-femoral. Among all participants
53(75.7%) were males and 17(24.3%) were
Correlation Between Level Of Depression, Sleep Disturbance And Suicidal
Thoughts Among Lower Limb Amputees
1 1 1 1 1
Anna Zaheer *, Faiza Sharif , Nida Fatima , Ayesha Shaque and Zeeshan Khan
Current study is a cross sectional survey to find level
of depression and its correlation with sleep and
suicidal thoughts among lower limb amputees.
Patient health questionnaire-9 (PHQ-9) was used
and data was calculated from registered hospitals and
rehabilitation centers in Lahore, Pakistan.
It was concluded that amputees suffered from
depression of varying severities and there was a
significant correlation between depression, sleep and
suicidal thoughts.
counseling for their better physical and mental
health. Most of the previous studies were cross-
sectional and no good prospective data was
present on depression among lower amputees
according to researcher's knowledge, this is
needed to be addressed in future studies.
Methodology:
It was a cross sectional survey conducted on
amputees. Sample size was 70. This study was
conducted on Lower limb amputees that were
either trans-tibial or trans-femoral. Data were
collected from registered government hospitals
(Mayo H o s p i t a l , Jinnah Hospital) a nd
Rehabilitation center (Pakistan Society of
Rehabilitation of Disable) of Lahore, Pakistan.
Patient Health Questionnaire (PHQ-9) was used
13
to nd the frequency and level of depression.
Patient with transtibial and transfemoral
amputation between age 18 to 60 years were
included in the study. People with other
disabilities, pregnancy, infectious stump, upper
motor disease, lower motor disease and ongoing
malignancy and age less than 18 years were
excluded. Data were analyzed statistically using
SPSS version 22.0.
Results:
70 lower limb amputees were included in this
study, among those 53(76%) were males and
17(24%)were females (Figure 1).
due to decreased blood supply to distal portion
5
of the limb or other causes. Amputees also face
various psychological consequences which may
6
lead to depression. This stigma is one of the
major problems o f person undergoing
amputations as it may leads to social pressure
7
and non-acceptability. Experience of depression
varies person to person. Amputation is a strong
enough to causes anxiety and negative thoughts
in amputee which can be related to psychological
6
issues. This situation can be worsened by lack of
social support, self-consciousness of disability
and knowledge which are among common
reasons of psychological disorders. Functional
limitation due to amputation can lead to
joblessness of the survivor which directly causes
nancial and social troubles leading to poor
psychological condition of that person. This can
lead to social isolation due to reduced self-
esteem and lack of condence to face people in
8
presence of disability. Before getting prosthesis,
during the trial and after the adjustment to
prosthesis, physiotherapist plays a signicant
role in rehabilitation process. Standing for the
rst time after amputation require prior
functional independence by physiotherapy
sessions, this will decrease the chance of falling
and thus fear of fall. This will help in decreasing
9
depression and boast self-esteem. The amputees
have a huge number of psychosocial issues
which need to be addressed in order to provide a
holistic approach and a better life. It is essential
to aware the patient's family, the health care
providers and community to the additional
10
psychosocial requirements of amputees. Proper
physiotherapy along with the multidisciplinary
ap p r o ac h i n c o o rd i n a ti o n wit h o t h e r
rehabilitation departments can result in
11
improvement. While treating amputees, it
should always be kept in mind that the focus
should not only be limited to the physical need of
a patient but it is compulsory to consider other
parameters like social, emotional and nancial
factors so we can provide a complete and better
12
rehabilitation. The purpose of this study was to
nd the correlation between sleep, suicidal
thoughts and depression among lower limb
amputees. This study benets in a way that it can
direct further studies to accommodate the
amputees in rehabilitation centers with not only
physical rehabilitation but also on psychological
15
Figure 1: Frequency of gender of participants
Zaheer A et al.
Sleep, Pain & Level of Depression in Lower Limb Amputees
Results showed that 15 out of 70 participants
were not suffering from depression whereas
55(78.57%) amputees had depression, amongst
those 21(30%) amputees had mild depression,
20(28.6%) participants had moderate, 12(17.1%)
were presented with moderately severe and only
2(2.9%) participants were suffering from severe
depression (Figure 2).
Female, 17,
24%
Male, 53,
76%
Male
Female
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
to amputation and start adapting to it. In a
systematic review conducted in India by Sahu E
et al., it was indicated that depression and other
stress related conditions gradually decreases
15
with time . Singh R et al., conducted a cohort
study in which depression was screened in 105
amputees in rehabilitation ward. It was reported
that 28(26.7%) patients had symptoms of
depression and other psychological issues were
16
also present in those participants . Participants
reported that they had trouble sleeping which
was signicantly correlated to their depression.
Those having sleep disturbance were depressed
which n egativel y Affect not on ly their
rehabilitation but also their soc ial lif e.
Amputation is a serious tragedy in a person's life
which can make a person psychologically
unstable that he could have suicidal thoughts
which directly indicates presense of depression
in that person. People having traumatic
amputation suffered from more depression and
anxiousness as their pre-amputation time of life
could be much better than people already had
physical problems and disorders such as
diabetes mellitus, which is common cause of
amputation in Pakistan and it has several
17
adverse effects on body . In previous studies
such as in a study conducted by Sing et al., it was
indicated that incidence of depression after
amputation varies with time. Sometimes,
incidence of depression could be 17.6 and 19.1%
which was comparable to majority of previous
studies but occasionally it could be as high as
18
41% or much higher rate . Frierson RL and et al.,
in their study explained that psychological
issues found in amputees have by far received
very poor attention. Patients undergone an
amputation process not only suffer from a
physical loss but it can also takes away various
parameters of an individual's life having a major
impact on their future life. It is also known that
amputees themselves do not focus on psychiatric
consultation without psychiatric referral
prescribed by any health care provider. Ideally,
such life-event stressors are best handled with
psychiatric referral. The psychological referral is
compulsory in such cases because of various
reasons, some of which are behavior problems,
ashbacks of previous accidental events,
suicidal thoughts and unable to accept body
16
Figure 2: Level of depression among participants
A signican t correlation betwee n sleep
disturbance and suicidal t houghts with
depression in lower limb amputee was found
(Table 1). Depression score of individual
participants was calculated using statistical
analysis. Correlation of depression score with
sleep disturbance was 0.492(p 0.000) and
correlation of depression score and frequency of
suicidal thought is 0.452(p 0.000).
As p value is 0.000 (less than 0.05) so it showed
that sleep disturbance and suicidal thoughts had
direct relation with frequency of depression.
Depression score p value
Sleep disturbance
0.496 * 0.000
Frequency of suicidal thoughts
0.452* 0.000
Discussion:
Amputation may lead to various psychological
issues. Hawamdeh ZM et al., conducted a
research on amputees and concluded that 20% of
56 participants had depressive symptoms.
Patients were recruited from clinics of Jordan
University hospital, and Al-Basheer hospital in
Amman Royal Farah Rehabilitation Center,
14
Jordan . Majority of the responders had mild
depression whereas very few were severely
depressed this may be due to the reason that with
the time patients start excepting their bodies,
gradually they accept the change in their life due
Zaheer A et al.
Sleep, Pain & Level of Depression in Lower Limb Amputees
Table 1: Correlation of depression score with
sleep disturbance and suicidal thoughts
appearance etc. M o r e o v e r , psychiatric
consultation can slightly lessen ICU and clinic
stays and also promote better behavior and
relation with family and friends which directly
improve social support and thus improving
19
overall mental and physical health .
Conclusions:
The patients who underwent amputation
su f f e r e d f r o m va r i o u s p s y c h o l ogi c a l
consequences such as depression. They had
sleep disturbance and suicidal thoughts which
were directly associated to depression. The
psychological referral is compulsory in such
cases because of various psychological reasons to
provide holistic care.
Recommendations:
Most of the studies were cross-sectional and no
good prospec t i ve d ata w as p resent on
depression among lower amputees according to
researcher's knowledge, this is needed to be
address in future studies.
17
Zaheer A et al.
Sleep, Pain & Level of Depression in Lower Limb Amputees
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Hawamdeh ZM, Othman YS, Ibrahim AI.
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1University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
*babarawan401@gmail.com
Highlights:
The Effect of Shoulder Position on Hand Grip Strength among
University Students
1 1
Babar Bashir *, Arooj Ashfaq and Maryam Altaf
Shoulder position affect the hand grip strength
There is a statistically signicant difference
p r e s ent b e t wee n ha n d g r ip s tre n g t h
measurements of both the genders.
There is strong positive correlation present
between most of the shoulder movements.
Abstract:
Hand grip-strength evaluation is an important
variable for assessment of upper extremity
deformities. Many studies have observed hand
grip-strength in different positions and postures
but no importance on further resulting positions
that are being utilized in our clinical setups.
Objective:
To evaluate the effect of shoulder position on
hand grip strength among university students.
Methodology:
42 (22 males, 20 females) physically healthy and
active individuals 22.76 ± 1.96 years old were
involved in this study. Study design was cross
sectional. Hand grip-strength (kg) using hand
grip dynamometer (Jamar dynamometer) was
measured in three different positions of shoulder
join t after obt aining in formed c onsent .
Participants were requested to carry out ve
seconds maximum contractions in each position.
Position of wrist was kept neutral i.e. 0°
Participants were requested to stand with wider
base and to increase further stability they were
made to stand with the wall behind them. Both
right and left hands were tested three times in
every position. At the end average was
calculated from 3 values and 60 seconds rest
interval was also given to the participants.
Results:
Participants with no previous history of
showed that mean right neutral shoulder
rotation value of male participants was 77.18 ±
19.23 whereas mean right neutral shoulder
rotation value of female participants was 20.20 ±
7.34 kilograms where p-value is <0.001 which
showed the presence of statistically signicant
difference between both the genders. Pearson
correlation stated that very strong positive
correlation (r= 0.960) was present between right
neutral shoulder rotation and 90° shoulder
abduction in males.
Conclusions:
Shoulder positions affect hand grip strength.
There is signicant difference present between
both the genders and presence of positive
correlation has been recorded in shoulder
positions which states that shoulder positions
affect hand grip strength.
Key Words:
Hand Grip Strength, Healthy Population,
Shoulder positions, Hand Grip Dynamometer.
Introduction:
Grip strength is an indicator of several necessary
parameters that include energy, nourishment,
1,2
debility and reduced activity. Thus, Grip
Strength (GS) measure necessarily contributes
in screening for individuals that may have the
benet of avoidance or early intercession
2, 3
protocol and observation for more diminution.
These three positions are handy and can be
utilized to evaluate GS: Neutral shoulder
rotation, 90° shoulder abduction and 90°
strength involving leading as well as non-
dominant extremities. According to studies a
usual hand grip activity in a disinterested
position triggered some muscle groups;
4
infraspinatus and supraspinatus. GS is being
correlative with the upper extremity strength
19
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
5
and overall body strength , at the same time as a
6
quantitative measure of upper limb action. GS is
extensively considered just as a forecaster of
7
purposeful performance and it is inuenced by
various factors that include hand dominance,
8
anthropometric indices and positions of the
9 10 11
elbow , shoulder , as well as forearm. Hand grip
dynamometers have been made known as a
precise and dependable for estimating GS and
12, 13
they are user friendly. GS measurement is of
use in evaluation of those individuals who
experience detriments in their everyday life
activities, measure of upper extremity function,
14
and efciency of hand rehablitation procedures.
The value of such an alteration is achieved by
comparing individual's GS with well-known
normal values. Many factors inuence GS it is
very important to evaluate GS in such postures
that are similar to those utilized in standard
15
researches. Some studies tested Hand Grip
Strength (HGS) in two different positions with
16 17
elbow joint exed or in unusual postures but
they didn't use same organized procedure to
evaluate grip in sitting or supine positions. So,
the relationship to standard norms can be
present when arm position is held constant. To
understand when a special individual test can be
contrasted with standard examples, we must be
aware of such body positions which provide
comparable GS value and which one of the
positions p r o v i d e s changed GS v a l u e .
Progression of shoulder muscle's strength is
most important outcome of almost every rehab
exercise course regarding recovery of impaired
shoulder function because it plays a major part in
shou l d er j o int ' s stabil i t y. C o nti n u o us
observation of these variations facilitates
researchers to improvise the rehab protocol
whenever needed and support them, in
formulating conclu sions concerning the
patients, go back to pre-injured state. Shoulder
injuries arise often in participant who execute
18
overhead activities at various stages of sports.
HGS is basic method to evaluate the subject's
condition after injuries. A precise, scientic
evaluation of HGS assists the researchers create
1 9
s e n s i b l e m a n a g e m e n t o b j e c t i v e .
Alizadehkhaiyat et al., proposed in his study that
a c ons i s t e n t ha n d-g r ip m o vem e n t in
disinterested position increased the activity of
4
GS correlated with upper extremity strength .
Julia-Ann Lee et al., carried out a study on how
GS is affected by wrist positions. According to
this study the maximum GS at the neutral
position of wrist is considerably greater than all
20
other ve positions of interest. The objective of
this research was to observe the HGS values
acquired from three different testing positions
and how these positions signicantly affect the
GS among group of young healthy males and
females a n d t o determi n e i f there a r e
considerable differences for both sexes and for
each group in three different testing positions
and to determine association between GS values
whi ch if present could be employ ed in
rehabilitation and other clinical settings to
investigate function of shoulder musculature.
Methodology:
42 physically healthy and active individuals (22
males, 20 females) were recruited from different
Universities of Lahore with no past history of
any kind of upper extremity, shoulder or neck
injury. HGS using Hand grip dynamometerwas
measured in three different testing positions i.e.
neutral shoulder rotation, 90 degree shoulder
abduction, 90 degree abduction of shoulder and
external rotation after obtaining informed
consent. Participants were requested to carry out
ve seconds maximum contraction in all these
positions. Position of wrist was kept neutral i.e. 0
degree. Participants were requested to stand
with wider base in such a way that feet should be
kept at shoulder width away from each other and
to increase stability they were made to stand
with wall at the back. Both right and the left
hands were tested three times in every position
and participants were encouraged verbally to
perform maximum contraction. At the end
average was calculated from 3 values. There was
a rest time of about 60 seconds between every
20
Shoulder Position & Hand Grip Strength
Bashir B et al.
contraction to avoid fatigue.
Results:
Mean age of participants was 22.76 ± 1.96 years
and mean weight of participants was 68.83±15.17
kilograms. Independent t test revealed that there
was a statistically signicant difference present
between both genders. The results indicated the
presence of very strong correlation between
Right hand neutral shoulder rotation and 90°
abduction of right shoulder in males and a strong
correlation was seen between right neutral
shoulder rotation and 90° abduction and
external rotation of right shoulder. There was
also a strong correlation present between 90°
degree shoulder abduction and 90° abduction
and external rotation of right shoulder. There is a
statistically signicant difference between both
the genders for which independent sample t test
was used and there is signicant difference
found (p value <0.001).
Right neutral shoulder rotation Male 22 77.18 19.23 12.44 <0.001
Female 20 20.20 7.34
Right 90° shoulder abduction Male 22 75.02 22.13 11.29 <0.001
Female 20 16.61 6.97
Right 90° shoulder abduction
and ER
Male
22 68.08 21.92 9.84 <0.001
Female 20 16.89 8.11
Left neutral shoulder rotation
Male
22 68.64 13.29 15.61 <0.001
Female 20 17.06 6.74
Left 90° shoulder abduction
Male
22 67.01 15.86 13.3 <0.001
Female 20 16.39 6.44
Gender nMean Std.
Deviation t-test p-value
Left 90° shoulder abduction
and ER
Male
22 64.31 12.65 16.57 <0.001
Female 20 14.98 4.32
Table 1: T-test: Presence of statistically
signicant difference between males and
females
Pearson correlation stated the presence of
positive correlation among each position of
shoulder. Very strong correlation was present
between right neutral shoulder rotation and 90°
shoulder abduction in males.
Right 90 degree
shoulder abduction
and ER .435*.470*.417**
Left neutral
shoulder rotation .877** .848*
Left 90 degree
shoulder abduction .822*
Male Right neutral
shoulder rotation 0.960** 0.873** 0.449*.501*0.507
Right 90 degree
shoulder abduction .881 ** .521*.547** .536**
Gender
Right 90
degree
shoulder
abduction
Right 90
degree
shoulder
abduction
and ER
Left
neutral
shoulder
rotation
Left 90
degree
shoulder
abduction
Left 90
degree
shoulder
abduction
and ER
Table 2: Pearson correlation
Pearson correlation stated that strong correlation
was found between right neutral shoulder
rotation and right 90° shoulder abduction in
females
Female Right neutral
shoulder rotation 0.775** .666** 0.361 0.371 0.355
Right 90 degree
shoulder abduction .564** .168 .27 .159**
Right 90 degree
shoulder abduction
and ER .354 .398 .412**
Left neutral
shoulder rotation .712** 0.725
Left 90 degree
shoulder abduction 0.764
Gender
Right 90
degree
shoulder
abduction
Right 90
degree
shoulder
abduction
and ER
Left
neutral
shoulder
rotation
Left 90
degree
shoulder
abduction
Left 90
degree
shoulder
abduction
and ER
Table 3: Pearson Correlation
**. Correlation is signicant at the 0.01 level (2-
tailed).
*. Correlation is signicant at the 0.05 level (2-
tailed).
Discussion:
Previous studies also state that men have
increased scores of HGS. It also suggest that
there was lot of variation in scores obtained from
females and it can be seen in this study as well.
There may be some other factors that contribute
to variation among females but that need further
research to be done on this topic. Studies also
verify that different positions of joints can
21
inuence HGS particularly the shoulder joint.
As indicated previously in methodology that
participants were asked to perform the HGS task
in standing position as standing position is
expected to provide the highest scores.
22
Preceding studies also agree to this. Preceding
studies have stated that gender, age affect
the GS when being measured with Jamar
Shoulder Position & Hand Grip Strength
21
Bashir B et al.
**. Correlation is signicant at the 0.01 level (2-
tailed).
*. Correlation is signicant at the 0.05 level (2-
tailed).
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
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B o h a n n o n R W . D y n a m o m e t e r
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1-
22
Shoulder Position & Hand Grip Strength
Bashir B et al.
dynamometer. These conclusions can be
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vigorously correlated with varied muscle bulk
throughout their adolescence. In real meaning of
research veries that a variety of joint positions
21
can affect GS particularly the shoulder joint.
With the understanding obtained from current
research specic intervention protocol can be
planned to take care of the patients in a particular
upper extremity functioning.
Conclusions:
Shoulder positions affect HGS. There was very
strong correlation found in right neutral
shoulder rotation and 90° degree shoulder
abduction followed by 90° degree shoulder
abduction and 90° shoulder abduction with
external rotation.
Recommendations:
Upcoming researches are recommended to
observe the results of GS dimensions obtained
with different angles and positions of shoulder
then it may be possible to say that which of the
position affects more. Researchers should be
aware of the effect of different testing positions
on GS evaluation.
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Lack of awareness and inactive attitude
towards physical activity is concluded.
Awareness and attitude towards physical
activity among pediatric population in Pakistan
was determined.
Awareness of healthy lifestyles by promoting
physical activity may be addressed by this study.
Highlights:
24
Abstract:
The importance of Physical Activity (PA) and its
benecial outcomes regarding health are well
known facts. Modernization of the world has
strong impact on lifestyles and behaviors of all
individuals falling in different age groups.
Children start learning routine activities in early
childhood that turns into their habits in
adulthood.
Objective:
This study aimed to determine awareness and
attitude towards physical activity among
pediatric population in Pakistan.
Methodology:
Total 62 children participated in this study from
two institutes of Lahore, Pakistan having age 5-
12 years. Subjective measures (self-report) and
objective measures (pedometer steps) were
collected through Children Physical Activity
Que