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Background: The COVID-19 (Coronavirus Disease of 2019) virus has affected millions of people around the world, and it is likely to induce mental health issues in those who have never had one before, as well as worsen the condition of those who already have. Objective: To determine the effect of COVID-19 on mental health and quality of life. Methodology: The non-probability convenient sampling strategy was utilized in this cross-sectional research. A sample of 300 Males and Female with age above 30 who have gone through COVID-19 and recovered before one month or more are included in the study. All patients who already had cognitive issues even before COVID-19 were excluded from the study. The study variables were measured using the MMSE (mental health) and WHOQOL-BREF (quality of life). Results: The results revealed that 128 participants (43%) of the respondents were male and 172 participants (57%) were female. The findings showed that 32 people were with normal mental health, 100 were with mild and 36 were with moderate mental health between the ages of 30-39. 52 people were with normal mental health, 24 were with mild and no one was with moderate mental health between the ages of 40-49. 4 people were with normal mental health, 4 were with mild and 24 were moderate mental health between the ages of 50-59. 12 people were with normal mental health with, 4 were with mild and no one was with moderate mental health between the ages of 60-69. The results also showed that there was a significant association between mental health and quality of life. chi-square test of independence showed significant association between mental health and quality of life with ꭓ2 (N = 300) = 600.0, p = .000. The findings showed that people with normal mental health had very good quality of life, people with mild mental health have poor quality of life and people with moderate mental health have very poor quality of life. Conclusion: It was concluded from the study that COVID-19 has badly effected mental health and quality of life of the patients suffered from coronavirus. Keywords: COVID-19, Mental Health, Quality of Life, Mental State Examination, Chi-Square

Background: Shoulder pain during sleep leads to poor quality sleep. It is a common problem in patients with Rotator cuff syndrome. Rotator cuff syndrome is a condition where your rotator cuff tendons are intermittently trapped and pinched during shoulder movements Objective: To evaluate the relationship between sleep quality and nocturnal pain in patients of rotator cuff syndrome. Methods: Current study was conducted in orthopedic and physiotherapy department of Jinnah Hospital Lahore. Cross-sectional survey was used in this study. Subjects with age group 18-75 years, both genders, diagnosed with rotator cuff syndrome with positive shoulder impingement test and empty can test were included. Patients were requested to fill the comprehensive questionnaire about current medical history, shoulder pain, impact on daily life activities and quality of sleep. Patients with coexisting neck pain and radiculopathies (spleen, kidney, gallbladder) and also with other disabilities e.g., osteoarthritis, rheumatoid arthritis, back pain were excluded from current study. Thirty-six patients were enrolled and examined by using Pittsburgh Sleep Quality Index (PSQI). Data was analyzed using SPSS 20.0. Results: The results showed that sleep quality was disturbed in patients of rotator cuff syndrome with a mean Pittsburgh Sleep Quality Index score of 11.3333. The results showed that among 36 patients, 18 (50%) had moderate disturbance of sleep as calculated by PSQI scale and 11 (30.6%) had severe disturbance of sleep while 7 (19.4%) had mild disturbance of sleep due to rotator cuff syndrome. Conclusion: The current study concluded that subjective sleep disturbance connected to shoulder pain was obvious in patients with rotator cuff syndrome. Patients experienced low quality of sleep associated with rotator cuff syndrome and affected their activities of daily living causing severe pain and physical disability. Keywords: Shoulder pain, rotator cuff syndrome, Sleep quality.

Objective: This comparative study was conducted to investigate the knowledge and practice of correct postural biomechanical awareness among male and female paramedical staff during patient transfer. Methods: Data was collected from Surgical, Orthopedic, Emergency, Operation Theater, Gynae & Labor wards of 20 different hospitals and institutes of Lahore i.e. Services Hospital, Jinnah Hospital, UOL Teaching Hospital, Gulab Devi Hospital, Mayo Hospital, Bajwah Hospital, Iqra Medical Complex, Gosha e Shifa Hospital, Farooq Hospital, Fatima Memorial Hospital, Hajrah Hospital, Ganga Ram Hospital, Life Care Hospital, General Hospital, Hameed Latif, Wapda Hospital, Najam Hospital, PSRD Hospital, Children Hospital, Rescue 1122 (EMS=Emergency Medical Services). Data was collected from these paramedics including Ward boys, Nurses, Midwives and EMS. A comparative cross-sectional survey was conducted and 210 members were studied. A well-structured questionnaire(1) based on Thurston scale “yes” and “no” was used, which was filled by both gender paramedics working in these settings. All participants were chosen via simple random sampling. Results: Results were divided in three domains. First assessed demographics, second assessed knowledge while Third domain assessed the practice of knowledge by the participants. Results were represented in Graphs, Tables and Cross Tabulations. Data was analyzed on SPSS (version 20). First domain showed that participants are usually from lower class and least from middle class, second domain determines that female participants have good knowledge in contrast to third domain that showed that male participants have good practice. Conclusion: Valid Conclusion showed that both gender participants should increase both knowledge as well as practice of Correct postural biomechanics. Keywords: Body mechanics, Knowledge, Practice, Paramedical staff, male and female, Lahore, Pakistan.

Objective: Quadratus Lumborum is actively used in our daily life for example in sitting and climbing stairs and trigger points are common in this region. The objective of this study was to find the effectiveness of dry needling and dry cupping in positional faults of pelvis due to myofascial trigger points in quadratus lumborum and to check if any of the techniques is superior to the other so that the best treatment option should be selected for patients. Methodology: This was a randomized clinical trial. A rehabilitation camp was arranged in Physiotherapy department of Islam Central Hospital, Sialkot Pakistan. 26 participants (by keeping 10% attrition rate) fulfilled the inclusion criteria. Convenient Random sampling method was done to divide the participants equally into 2 groups. Group A was treated by dry needling and Group B was treated by dry cupping. A conventional physiotherapy treatment (hot pack and stretching) was also given to both groups. The outcome measures of the study were numeric pain rating scale for subjective pain assessment, algometer for pressure pain threshold, pelvic goniometer for functional positional fault and measuring tape for muscle length. Participants were treated twice a week over a period of 3 weeks. Pre and Post treatment readings were taken in 1st and 6th session over a 3 week period. A follow up reading was also taken after 1 month for checking prolonged treatment effects. Results: To analyze data independent t-test (for Inter group comparison) and Repeated measure Anova (for Intra group comparison) were used. The research accepted Alternate hypothesis as the P value for all parameters was

Objective: To Compare the Effects of Functional Training Program and Conventional Therapy on Postural Control and Functional Mobility in Chronic Stroke Place and duration of Study: This study was conducted in Qureshi Hospital Sahiwal, from September 2019 to March 2020. Methodology: A randomized clinical trial was conducted through non-probability convenient sampling technique in which 12 participants were recruited, randomization was done by Lottery method and participants were divided into 2 groups. Group A received functional training treatment and group B received conventional therapy. Participants of both genders with age 40-65 years were included in study with 6 months of confirmed stroke. Patients with any other neurological disorder or those who were Unable to keep any (Sitting or Standing) position for 30 Second were excluded from the study. Berg balance scale, trunk control measurement scale , 6 Min walk test and time up and go test were used as outcome measuring tools. Pre-treatment and post-treatment readings were taken. And data was analyzed by using SPSS version 21. Results: Mean age and standard deviation of the participants was 48.08±4.833. TUG pre value is 20.25± 2.26 while post treatment value is 15.25±1.14 and pre-value for BBS is 39.75±3.54 while post 48.42±3.2. in 6 MWT pre of the participants was Functional training program improves postural control and functional mobility in chronic stroke patients. Conclusion: It was concluded that functional Training program is better technique to improve patient’s condition as compare to Conventional therapy in TUG and BBS. Both interventions showed non-significant difference on TCMS and 6MWD. Keywords: Functional training program, chronic stroke, Postural control, Functional mobility

Objective: To determine effects of respiratory muscles training on cardiopulmonary parameters and quality of life in patients with dilated cardiomyopathy. Methodology: This Randomized Control Trial was conducted in Shifa International Hospital Islamabad from September 30, 2019 to December 31, 2019 and 22 patients with Dilated Cardiomyopathy were screened. Subjects were divided into 2 groups by sealed envelope sampling method. Bruce protocol according to ACSM guidelines (3 days per week, starting at shorter duration 5-20 min and progress to 30-40 min) was applied in Group 1. Bruce protocol same as in group 1 combined with Incentive spirometry (10-15 repetitions) and slow breathing technique was applied in Group 2. Tools and Outcome measures of study were EF, LV End systolic dimension, LV End diastolic dimension, QOL, PFT (FEV1, FVC, PEF and FEV1/FVC) and Vitals. Data was analyzed on SPSS version 21. Results: All patients in both groups were male with mean age of 51.65±6.5. Group 2 had improvement in LV End systolic dimension (pre training- 53.73+10.57, Post Training- 52.00+11.84), LV End diastolic dimension (pre training- 56.45+13.21, Post Training-55.45+14.08) as compared to Group 1 with LV End Systolic dimension ( pre training- 52.00+6.89, Post Training-51.56+6.71), LV End Diastolic dimension ( pre training- 60.00+6, Post Training-60.00+6.000). Conclusion: Respiratory muscles training by using bruce protocol combined with slow breathing and Incentive spirometry has significant effects on cardiopulmonary parameters and QOL in patients with dilated cardiomyopathy. Keywords: Congestive heart failure, dilated cardiomyopathy, Bruce protocol, Incentive spirometry, slow breathing exercise.

Objective: The objective of this study is to compare effect of balloon blowing exercise & incentive spirometer on Chest expansion, Improvement in lung volumes and capacities, Level of dyspnoea, and on Improvement in progression of walk in post-thoracotomy stable patients. Study Design: Randomized Controlled Trial Place and Duration of Study: Study was conducted in thoracic surgical ICU of Gulab Devi Hospital, Lahore for the period of 6 months from September 2018 - February 2019. Patients and Methods: The sample size was calculated through Open Epi, and it was 48. 24 subjects were assigned to control group A and 24 to experimental group B through non-purposive random sampling technique. Data was collected at base line, 3rd and 5th day after exercise therapy on above stated outcome measures, by using Tape Measure, Digital Spirometer, RPE Scale and Pedometer respectively, from non-critical post-thoracotomy patients. Control Group-A performed routine respiratory physiotherapy + incentive spirometry and Experimental Group- B performed routine respiratory physiotherapy + balloon blowing exercise. Results: BBE + routine respiratory physiotherapy was found equally effective on mentioned outcome measure as Incentive Spirometry + routine respiratory physiotherapy in stated patients. (P >0.05) Conclusion: Based upon statistical analysis, it can be concluded that incentive spirometer can be replaced with balloon-blowing exercise with conventional/routine respiratory physiotherapy in thoracotomy patients who have lung surgeries, to overcome post-op pulmonary complications or to achieve the same outcomes as that of incentive spirometer. Keywords: BBE, Incentive Spirometer, Routine Respiratory Physiotherapy, Post-Thoracotomy Patients

Background: Chronic obstructive pulmonary disease (COPD) is a condition that affects respiratory system. Balance impairments are increasingly seen in patients suffering from COPD resulting in the onset of risk of falls. Objective: To compare balance impairment and fall risk between COPD patients and healthy individuals. Methodology: A comparative cross-sectional study was conducted on 16 clinically stable COPD patients and 16 healthy individuals, with age range of 40-65 years. Berg balance scale (BBS), activity Specific balance confidence scale (ABC) and Time Up and Go test (TUG) were administered to evaluate balance impairments. Results: Independent sample T-test was applied to compare the difference in tests in both groups. Statistically significant difference was observed between two groups in terms of their BBS, ABC and TUG all with p

Objective: To translate and validate the ABC-Scale in Urdu language to predict risk of fall in older population. Study design: Cross-cultural Translation and validation Place and Duration: Study was conducted in older adult community of Sialkot from March 2020 to December 2020. Methodology: Translation of ABC in Urdu was conducted by using Beaton et al guidelines. Two bilingual translators translated the original version into Urdu language step wise, correction process was followed. Then two backward translations were done by language expert. After all this process, the translated version was reviewed by the professionals and the final version was applied on 15 individuals. Its reliability and validity was tested on 60 older adults. Results: For test re test reliability, intra class correlation coefficient ICC was measured with a value of 0.984 Which shows good test re-test reliability. The internal consistency and reliability of ABC was calculated by Cronbach’s alpha for total score with a value of 0.985. Content validity was good with values of CVI ranging from 0.767 to 0.955. To test the discriminative validity, independent t test was used to show the difference between the healthy and unhealthy adults. Factor analysis of UABC showed total variance 81.277 and cumulative variance was also 81.277. To calculate construct validity of U-ABC Pearson’s correlation coefficient was used and measured as 0.558. Conclusion: It was concluded that Urdu version of UABC is a valid assessment tool for older adults with fear of fall. It has good content validity, construct validity and reliability. Keywords: activities specific balance scale, validation, Urdu translation, reliability, tool translation

Background: Stroke is a generic term in use to describe the sudden interruption of blood flow to the part of brain, resulting loss of brain function. A stroke may be also known as cerebrovascular accident. Cerebrovascular accident which defines as pathology in which brain disease occurs secondary to disorders of blood supply of brain. It is essential to know about the magnitude of impact of stroke globally. Aim: To determine effectiveness of constraint induced movement therapy and comparing its efficacy to traditional rehabilitation in acute and sub-acute stroke survivors exhibiting upper limb hemiplegia Methodology: This was a randomized clinical trial study, conducted in Lahore in which eighteen stroke patients had participated. Current study includes MAL and WMFT questionnaire in it and sample size was 18. Patients were treated 4 times a week and unaffected limb was constrained for two hours in therapy session and onwards to 10 hours to motivate the use of effected limb. Readings were taken weekly and patients were reassessed by using MAL and WMFT. CIMT treatment protocol consists of 3 or 4 month of daily intensive training of the affected extremity for 2 hours in association with restriction of the non-affected extremity for 10 hours a day. Group B: Traditional rehabilitation therapy used Sling (shoulder immobilizer) made of poly urethane material. Hair brush, cup, marbles, cards, blocks, tissue paper, cones, Swiss ball, dexterity board. Results: Statistical analysis was set at p ≤ 0.05. huge and direct to vast impacts existed on WMFT (P=0.010) noteworthy and direct to extensive impacts existed When p-value is not as much as the foreordained importance level which is frequently 0.05 or 0.01, showing that the watched results would be profoundly impossible under the alternate theory. In this way, the alternate hypothesis was supported. Subsequently null hypothesis is rejected and alternate hypothesis is accepted. Conclusion: This study concluded that the patients who were treated with CIMT showed remarkable change in upper extremity functions. While patients who were treated with traditional rehabilitation therapy they exhibited less change in their functional activities than Constraint-Induced Movement Therapy. Keywords: Comparison, traditional rehabilitation therapy, Constraint-Induced Movement Therapy (CIMT) Approaches

Background: This ageing is physiological process associated with vestibular dysfunction. The incidence of vestibular problems increases with age and can lead to drops, dropping risk, lack of confidence, pain and depression. Vestibular disorder is commonly characterized by vertigo or body discomfort (look and aggravation of postural stability) (a sense of spinning movement). In older adults with a fall history, peripheral vestibular disorders are among the most frequently known and widespread vestibular dysfunctions. Aim: To associate vestibular dysfunction and motion sensitive vertigo and risk of fall in adults. Methodology: Cross sectional study with convenient non- random sampling. For tests has been applied for screening vestibular dysfunction. If a participant shows 2 tests positive have vestibular dysfunction. SPSS 21 is used for data analysis. Results: Highly significant results between association of age with motion sensitive and age with fall efficacy scale P value is less than 5. Results are also significant between MSQ and FES-1. Conclusion: After conducting this research it has been concluded. That age-related vestibular dysfunction significantly associated with motion sensitive vertigo and risk of fall. As with the age people are more concerned about fall Keywords: vestibular dysfunction, vertigo, risk of fall in adults

Background: Stroke is a universal health care disease, the important cause of long time disability in world. Stroke leads to an inactive living, physical restrictions, and not good physical levels, which are related with common post-stroke participation limits. Aerobic capability and walking ability are decreased in old chronic patients of stroke. Aim: To determine the effects of treadmill training and stationary cycling training to improve ambulatory function and cardiovascular fitness in hemiparetic stroke patients Methods: 54 chronic stroke patients were allocated to treadmill training group(n=27) or stationary cycle exercise group (n=27). All participants received conventional physical therapy along with treadmill or stationary cycle training. The 10MWT was conducted to measure gait function and 6 min walk test was used to measure cardiovascular health. Results: The mean of treadmill group for 10 meter walk test is 10.01 + 15.48. The mean of stationary cycle group for 10 meter walk test is 9.80 + 6.77. The mean of treadmill group for 6 min walk test is 22.04+ 17.45. The mean of stationary cycle group for 6 min walk test is 23.20+ 22.92. The p value of 0.000 shows significant difference. This significant difference reflects that both interventions show equal improvement in participants. There is significant difference between pre and post treatment values of both interventions. Both intervention groups displayed significant effect in ambulatory functions and cardiovascular fitness. The results between groups were non significant, it means both interventions showed equal effect but results with in groups were significant. Conclusion: The study showed that treadmill training and stationary cycling training equally enhanced the gait ability and cardiovascular health of chronic stroke patients. Therefore, these exercises could be used to enhance walking and cardiovascular health in management of stroke. Keywords: treadmill training, stationary cycle training, ambulatory function, cardiovascular fitness, stroke

Background: Reflection is the Latin origins means to turn back or to bend. Reflection in the educational context can be considered as a process in which thoughts are ‘turned back’ so that they can be interpreted or analyzed. The trigger to this sense-making process is usually an event or situation and the outcome of the process is increased understanding or awareness. Objectives: The objective of this study is to assess the reflective thinking among doctor of physical therapy students (DPT) at Riphah international university. Methodology: This observational cross-sectional study was done at Riphah international university Lahore and was compiled at RCRS Lahore. Study was completed in 6 months after approval of synopsis. Non probability, convenience sampling was used. Sample size was calculated to be 120.The response rate was 95%. Questionnaire for reflective thinking was used to find out the level of thinking in DPT students. Results: There was significant difference within each semester and between first to eight semesters. But differences were not increases or decreases gradually. According to data collected from different students at Riphah international university the value of habitual behavior is 0.00 which is significant, value of understanding value is also 0.00, value of reflection is 0.005 and value of critical reflection is also significant 0.000. Conclusion: Current study found that reflective thinking can be develop by individuals but guided reflection with a supervisor or mentor is important so that it will gradually increases from 1st to 8th semester. Keywords: Assessment QRT, reflective thinking, critical reflection, habitual behavior, understanding.

Objective: The aim of this study is to compare the effects of strengthening exercises of Hip and conventional Knee exercises on pain, muscle strength and functional status in sprinters with Patello femoral pain syndrome Methodology: A randomized controlled trial was performed on 28 sprinters. Participants were selected through non-probability convenient sampling. The study was single blinded and was completed in 6 months. The assessor was unaware of the treatment given to both groups. Group 1 received Conventional knee exercises and weight bearing hip strengthening exercises and Group 2 received traditional knee exercises and strengthening exercises of hip with resistance. All Exercises were performed with 12 reps and 3 sets, 3 times a week for 6 weeks. Numeric Pain Rating Scale (NPRS) for pain, AKPS (anterior knee pain scale) for functional status and make test applied through hand held dynamometer measured strength through contractions of knee muscles. Results: The mean age of individuals in interventional group is 22.79 ±4.28 and the individuals in control group is 24.07 ±4.51. Both groups showed significant improvements in pain, function and muscle strength with p0.05. Conclusion: Both interventions are equally effective in reducing pain, improving strength and function in sprinters with PFPS which showed that these interventions can be included in the rehabilitation plan of these athletes. Keywords: Knee pain, Runners, Strengthening exercises, Rehabilitation exercises, strength

Objective: To compare the effects of active release technique and post isometric relaxation on pain intensity, hip internal rotation and functional disability in patients with piriformis syndrome. Methodology: A randomized clinical trial extending from September 2020 to January 2021 was conducted at Shifa International Hospital, Islamabad. Thirty patients were included in the study using purposive sampling and were randomized through sealed envelope method. All patients were evaluated using visual analogue scale, goniometer and lower extremity functional scale. A self-structured questionnaire was designed for data collection. Two sessions per week were given for three consecutive weeks and a follow up after one month. Data was taken at baseline, after three weeks and after one month follow up. Data was analyzed using SPSS-20. Results: 30 patients were treated with mean age of 41.30±4.99. 17 females and 13 males were treated. Group A (active release technique) and Group B (post isometric relaxation) showed significant improvement within groups (P0.05). However, active release technique was found to be more effective in improving functional disability than post isometric relaxation (P

Background: Tuberculosis often brings about diffuse fibrotic and other changes to lung tissue also consolidation of lung tissue prompting a decrease in generally lung tissue compliance. Following tuberculosis, the functional status of people is reduced e.g., impaired ventilation and gas exchanges leading to shortness of breath, muscular deconditioning, and a functional status decline is seen Objective: The purpose of this study was to evaluate and compare the six-meter walk distance and physical functional capacity (VO2 max) in 40 – 65 years people with pulmonary tuberculosis and healthy subjects. Methods: Forty healthy subjects (20 males and 20 females) and forty subjects with pulmonary tuberculosis (30 males and 10 females) took part in this study. All the subjects underwent a six min walk test. Walk-work was calculated and used for evaluating functional capacity. To examine for significant relationships Pearson product correlation was used Results: A significant difference was found between the groups in regards to 6MWT distance (p < 0.05). For height and body mass index (BMI) Pearson product correlations with 6MWD were significant in normal individual and for the weight and BMI it was significant in the TB sequelae group. Conclusion: A significant difference was found in functional capacity in terms of VO2max between healthy and patients with TB was found. TB sequelae individuals’ group, 52.6% patients had a VO2 max under 21 milliliter per kilogram per minute that brought about an impressive effect of TB sequelae on endurance in regards to cardiorespiratory system. Keywords: functional capacity, hospital, six-minute walk test, tuberculosis

Objective: This study is aimed to assess knowledge, attitude and practice among women regarding post-natal exercises. Methodology: A cross sectional study was conducted across private sector in the gynecological and obstetrical department of Punjab Social Security Hospital, Ittefaq Hospital, Hameed Latif Hospital and Khair-un-Nisa Hospital. Through non-probability convenient sampling, 120 postpartum mothers were chosen. A structured questionnaire was used to collect socio-demographic and gynecological data, as well as to assess knowledge, attitude, and practice regarding PNE. Married females of ages 18-40 were included and females with postpartum hemorrhage and active infection/sepsis were excluded from the study. An informed consent was taken from the study participants. SPSS 25 was used for data analysis. Results: 53.3% had lower segment caesarian section. Breathing exercises were the most common type of exercise among participants (51.7%).74.2% believed that uterine prolapse can be prevented through PNE.99.2% of the study population agreed that PNE is necessary while 81.7% felt guilty on omitting PNE. For 50% of participants, Household work was the most common barrier in performing PNE. Conclusion: There was significant correlation between knowledge, attitude and practice. More than half of the participants had knowledge (mean score=4.116) about PNE but they were not fully aware of its potential benefits and lack adherence. It is important to create awareness and educate people about the postnatal exercises so that postpartum dysfunctions can be prevented and women health can be improved. Keywords: Puerperal period, pelvic floor muscles, pelvic floor dysfunction, postnatal exercises.

Background: Patient Satisfaction is a standard which measures the level of contentment patients get after having a physiotherapy treatment for the musculoskeletal conditions. Mostly, geriatric population has a greater tendency to suffer from musculoskeletal problems so the research we conducted was purely based upon the satisfaction among elderly people in Pakistan. Objective: The purpose of this study was to check the level of patient satisfaction with musculoskeletal physical therapy treatment and the factors which influence patient satisfaction. Methodology: A cross sectional study using a validated outcome measurement tool (patient satisfaction questionnaire); designed by Arcade university of Applied Sciences in Finland. The Questionnaire comprised of 20 questions and terms used in questionnaire were 1-totally dissatisfied, 2- dissatisfied, 3- neutral, 4- satisfied, 5- totally satisfied. The researcher directly interviewed 400 patients in government hospitals of Punjab like Lahore, Sialkot, Faisalabad, Gujranwala and Multan during the time period of June 2020 to Nov 2020. The research included patients with musculoskeletal problems varies between the ages of 54-74 years. Results were analyzed by SPSS version 21. Results: The results were analyzed by SPSS Statistics 21, demonstrated Totally Dissatisfied 22%, Dissatisfied 31%, Neutral 13%, Satisfied 19% and Totally Satisfied were 15% with physiotherapy services. Conclusion: This outcome of the study concluded a high level of dissatisfaction of 22% in geriatrics by physiotherapy treatment for musculoskeletal conditions. The results of this study concluded that patient centered approach was not followed by physiotherapist and hence it leads to high level of dissatisfaction in geriatrics. Keywords: Patient satisfaction, musculoskeletal problems, Government sector, Physiotherapy treatment.

Background: Online education is a newer strategy of imparting knowledge .it is two_ way and involves both teachers and students in a virtual environment. Recently, there has been a booming escalation in efforts to shift traditional classrooms into virtual ones. But this has not come without challenges to both teachers and students. Objective: The purpose of current research is determining the level of satisfaction a stress in the students due to the shift from traditional to online classroom. Methodology: This Research reports research from students from medical colleges and universities in an attempt to determine satisfaction and stress due to online in higher education. The sample size was calculated to be N=206.As per inclusion criteria, members of STUDENTS from Lahore, who had previous experience in traditional classes for at least 3 months, Students who had traditional experience of less than 3 months were excluded. Frequencies were calculated to find out prevalence of stress and satisfaction among students after transition of traditional to online classrooms. Results: More than half of the students were satisfied with the online learning and the students have a moderate level of stress during E Learning . Approximately 75% of students agreed that at times it was stressful. One line learning is enhances their self studying habit’(88.1%).Most of the students were pleased with the response of the departments concerned to any problems in the online tests ,classes, and course material. Conclusion: Although recently adopted, the satisfaction of the students towards online classes appears good and prioritizing the identified predictors and working on the weal; inks could assist in enhancing student’s satisfaction an better outcomes. Keywords: Virtual Classroom, Perceived Stress Score, Learning, Stressors, Student Satisfaction, Student Stress.

Background: Maturing is followed by slow physiological changes in body structures, such as decreases in muscle strength, movement speed, response time, and changes in equilibrium and integumentary systems. Deftness is constantly compromised by maturing procedure. Aim: To determine effects of circuit training on vestibular dysfunction in geriatric population Methods: This research included 34 participants with age ranges from 50 to 85. All the participants were divided into two groups. Participants were assessed pre and post treatment by using modified CTSIB, DHI and Fukuda test. Group A received Cawthorne & Cooksey protocol. The standardized protocol consists of 4 steps that include specific exercises carried out during lying, sitting position, position of standing and walking state. These exercises were undertaken during the following 12 weeks until the end of the intervention. Results: Modified CTSIB pretreatment mean±SD for conventional group was 93.64± 20.709 and post treatment was 80.35± 30.211. On the other hand, pretreatment mean±SD for treatment group was 96.07± 15.349 and post treatment was 79.47± 25.169. Pretreatment P.value for CTSIB is .166 and of post treatment is .466 (P= > .05). DHI pretreatment mean±SD of conventional group was 41.41± 22.25 and post treatment was 20.0± 12.74. Pretreatment mean±SD of treatment group was 38.7± 22.404 and post treatment was 19.8± 16.501. Conclusion: Conventional treatment and circuit training both are equally effective for the rehabilitation of vestibular dysfunctions. However, according to the P.value (P=

Background: Stroke, also known as cerebrovascular accident is caused when the brain does not receive enough blood supply, thus preventing brain from receiving oxygen and nutrients. Its divided into two major categories: ischemic and hemorrhagic. A stroke is a medical emergency, and prompt treatment is crucial. Objective: To determine the level of exercise compliance following Physical Therapy treatment in patients with stroke. Methodology: This cross-sectional study was conducted in different hospitals of Lahore on 139 participants in Lahore, ages between 45 to 70, both genders, patients with both ischemic and/or hemorrhagic stroke and those following a home based plan were included for the study. Any participants unwilling for follow-ups, with cognitive impairments, diabetes or ischemic heart disease and unable to communicate were excluded. For the collection of the data, a researcher designed questionnaire was used. An informed consent was taken from the study participants. SPSS 25 was used for data analysis. Results: 31.7% of the participants agreed that exercise was beneficial to health and 36.7% remained neutral. 23.0% strongly agreed and 25.9% agreed their preference were scheduled exercise programs. 35.3% agreed to feel better when they were active and 30.9% disagreed to this. Sense of accomplishment, keep mind active and good for heart were significant motivators to exercise adherence. Lack of strength, shortness of breath and bad weather were significant barriers. Conclusion: There was little to moderate level of compliance with exercise in patients with stroke following physiotherapy intervention. Keywords: exercise, exercise compliance, physical therapy, stroke

Aim: To measure levels of VWF and ADAMTS-13 in patients of ischemic stroke and healthy controls. Method: Blood samples of forty five patients and forty five controls of age 30-65 years were taken from medical or neurology wards of Lahore General Hospital. VWF antigen assay was determined by Immuno-Turbidimetric method and quantitative ADAMTS-13 antigen assay was measured by ELISA. Results: The mean level of plasma VWF antigen of controls was 114.0±49.7% and mean plasma level of VWF antigen in patients was 137.0±54.3%. The mean plasma VWF antigen level was significantly elevated among patients as compared to controls (p=0.011). The mean ADAMTS-13 antigen level of controls was 151.7± 87.9 U/L and mean ADAMTS-13 antigen level of patients was 107.9±106.7 U/L. Our study also found that mean ADAMTS-13 was significantly lower in patients as compared to controls (p=0.018). Conclusion: In conclusion, Vwf and ADAMTS-13 antigen assays have an important role in pathogenesis of clot formation in patients of ischemic stroke. Keywords: Low ADAMTS, ischemic stroke, high WWF

Objective: To compare the effects of gaze stability exercises with proprioception training to improve gait and functional independence in cerebellar ataxic patients. Methods: A Quasi experimental study was conducted in the physiotherapy department in Lahore General Hospital, Lahore, Pakistan from January 2018 to June 2018.All patients were diagnosed with cerebellar ataxia and referred by neurophysician to physiotherapy department. Forty-six (46) patients were divided into two equal groups by lottery method. (Group A =proprioception training), (Group B =gaze stability with proprioception training). Data was analyzed by using statistical package for social sciences (SPSS) 21. Results: In group A, males were 13(56.5%) and females 10(43.5%) while in Group B, males were 12(52.2%) and females 11(47.8%). Mean ages were (71.3±8.47) years in Group A and (70±7.67) years in Group B. Pre and Post Functional Independence Measure (FIM)score in groups A and B with mean and standard deviation were 13.08±1.86 and 15.43±1.74 respectively. Pre and Post Timed Up and Go (TUG) test score in groups A and B with mean and standard deviation were 0.79± 0.26 and 0.97 ±0.39 respectively. Both groups were statistically significant (P value ≤ 0.05) but on the basis of mean ± standard deviation Group B method was more effective than Group A. Conclusion: Gaze stability exercises added the effects of proprioception training in improving gait and functional independence in cerebellar ataxic patients. Keywords: Cerebellar ataxia, gaze, patients, proprioception

Background: COVID-19 pandemic has become a foremost health concern, many countries have ordered lockdown to stop the spread of COVID-19 due to which many Universities are closed and students are taking lectures online, Pakistan is also one of the countries in which lockdown was imposed, the aim of this study is to examine the level of physical activity and lifestyle of medical students from University of Lahore (UoL) during COVID-19. Aim: To determine the effect of COVID-19 lockdown on the physical activity and lifestyle of medical students of University of Lahore. Materials: Sample size included 151 medical students from the University of Lahore, study was pure cross-sectional and convenient sampling technique was used, data was collected through online questionnaire which contained question from IPAQ-SF to estimate the physical activity and lifestyle of observed University students. Data was analyzed using SPSS version 25. Results: The results showed that from the population of 151 medical students of University of Lahore 75 students (49.7%) reported Low level of physical activity, while 44 students (29.1%) students reported Moderate level of physical activity, and 32 students (21.2%) reported high level of physical activity. Conclusion: Majority of the medical students showed Low level of physical activity, 49.7% in the last 7 days during COVID-19 pandemic. Medical students of University of Lahore showed a decrease in their overall physical activity level. Keywords: COVID-19, lockdown, Medical students, Physical activity