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Öğe Comparative Efficacy of Quadratus Lumborum Muscle Energy Technique with Gluteus Medius Strengthening Versus Gluteus Medius Strengthening Alone in Sacroiliac Joint Dysfunction: A Randomized Controlled Trial(MDPI, ST ALBAN-ANLAGE 66, CH-4052 BASEL, SWITZERLAND, 2024) Soomro, Rabail Rani; Karimi, Hossein; Gilani, Syed AmirBackground: Pain in the sacroiliac joint is the most prevalent and often overlooked. The sacroiliac joints are thought to be sources of pain in roughly 10% to 25% of patients with chronic lower back pain. Due to the biomechanical nature of the joint, muscle imbalance is the most important cause of sacroiliac joint dysfunction. The hamstring and gluteus medius are the primary muscles involved in postural dysfunction-related muscle imbalance; however, the quadratus lumborum’s role in the compensatory mechanism is becoming more apparent, and its potential for treatment in conjunction with gluteus medius strengthening has not yet been investigated. Gluteus medius exercises, along with conventional treatment, are routinely given to patients with sacroiliac joint dysfunction; however, the aim of this study is to explore the additional effects of the muscle energy technique (MET) on the quadratus lumborum along with strengthening of the gluteus medius on pain, disability and quality of life of patients with sacroiliac joint dysfunction. Methods: Using a computer-generated random number table, seventy patients with unilateral sacroiliac joint pain were divided equally and randomly into two groups. Prior to initiating treatment, baseline measurements were taken using a hand-held dynamometer, visual analog scale (VAS), Oswestry Disability Index (ODI-U) and short form 36-item survey (SF-36v2) to assess strength, pain, functional disability and quality of life, respectively. Over the course of four weeks, all patients received twelve sessions, and both the preand post-intervention outcome measures were documented. Results: After 4 weeks of treatment, both groups showed statistically significant (p < 0.005) mean improvements in muscle strength, pain, disability and quality of life before and after intervention. However, the mean improvements in post-intervention on a dynamometer, VAS, ODI and SF-36 were better in the MET with exercise group (METGME) as compared to the conventional group with exercise (CTGME), with a larger effect size. Conclusions: The muscle energy technique, applied to the quadratus lumborum in combination with gluteus medius strengthening, is more effective clinically and significantly in improving pain, disability and quality of life in comparison to conventional treatment of sacroiliac joints with gluteus medius exercises.Öğe Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a randomized controlled trial(SAGE PUBLICATIONS LTD, 1 OLIVERS YARD, 55 CITY ROAD, LONDON EC1Y 1SP, ENGLAND, 2021) Ahmed, Umair; Karimi, Hossein; Amir, Syed; Ahmed, AshfaqObjective: We determined whether an exercise regime comprising high-intensity training, multiplanar trunk movements, and dual-task practice could improve trunk control, balance, functional mobility, and reduce fall risk in patients with hemiplegic stroke. Methods: In this randomized controlled trial, 74 patients (mean age 61.71 years) were randomly assigned to the experimental and comparison groups. Primary outcome was trunk impairment scale (TIS) scores. Secondary outcomes were scores on the Berg balance scale, 10-meter walk test, Timed-up-and-go test, timed-Up-Go–cognitive, and Stroke Impact Scale-16 to measure between-group changes from baseline. We used linear mixed modeling to identify changes over time within and between groups on each scale and whether changes persisted at 6- and 12-month follow-ups. Results: We observed significantly increased mean TIS scores from baseline to 3 months posttreatment (7.74); the increased scores were maintained at 6- and 12-month follow-ups (8.60 and 8.43, respectively). In the experimental group, all secondary outcomes showed significant and clinically meaningful results. Fall risk between groups was significantly reduced at 6 and 12 months. Conclusions: Intensive multiplanar trunk movements coupled with dual-task practice promoted trunk control, balance, and functional recovery in patients with stroke, reduced fall risk, and improved independent mobility.Öğe The Effects of Spinal Manipulation Added to Exercise on Pain and Quality of Life in Patients with Thoracic Spinal Pain: A Randomized Controlled Trial(Hindawi Ltd, 2023) Waqas, Muhammad Sharif; Karimi, Hossein; Ahmad, Ashfaq; Rafiq, Shazia; Anwar, Naveed; Liaqat, SidrahBackground. There are not enough reliable studies available in physiotherapy to determine the effects of spinal manipulative therapy added to exercise on thoracic spinal pain and quality of life. Objective. To investigate the effects of spinal manipulation on pain and quality of life in subjects with thoracic spinal pain. Study Design. It was an open-label randomized controlled trial. Study Settings. Department of Physiotherapy, Services Hospital, Lahore, Pakistan. Participants. There were one hundred subjects with an age group between 18 and 60 years fulfilling the inclusion criteria. These subjects were divided equally into two groups; an experimental and a control group. Methods. In the experimental group (n = 50), thoracic spinal manipulation was applied along with thoracic muscle strengthening exercises. In the control group (n = 50) thoracic muscle exercises alone were given. Pain was measured by visual analogue scale (VAS) and quality of life with SF-36. Measurements were taken at baseline, immediately after session, after 8th session, and later as follow-ups at 12 weeks. Repeated measure ANOVA and independent sample T-test were used for within and between-group comparisons. Results. Mean age of subjects in control group was 38:56 +/- 12:44 and in experimental group was 36:02 +/- 11:32. Both groups demonstrated significant improvement in VAS score, and all domains of SF 36 but between-group comparison showed greater improvement in VAS of the experimental group compared to the baseline (P < 0:05), but between-group comparison of 8th session to follow-up has shown that effects of exercise persist while health-related quality of life in spinal manipulation group was significantly reduced after discontinuation of treatment. After the 8th session, spinal manipulation group showed notable results in terms of pain (mean diff 1.14 (0.62, 1.65) 95% CI and all aspects of SF 36 (P value <0.05). However, after week 12 of follow-up, no significant difference (P value >0.05) was observed among the study groups for pain and quality of life. Conclusion. Spinal manipulation added to thoracic exercise was more effective than thoracic exercise alone for improving pain and quality of life at the end of 8th session of care. However, the inclusion of spinal manipulation was not found effective at the 12-week follow-up. This trial is registered with IRCT20190327043125N1.Öğe Reliability of hand-held dynamometer in measuring gluteus medius isometric muscle strength in healthy population(PROFESSIONAL MEDICAL PUBLICATIONS, PANORAMA CENTRE, RM 522, 5TH FLOOR, BLDG 2, RAJA GHAZANFAR ALI RD, PO BOX 8766, SADDAR, KARACHI 00000, PAKISTAN, 2022) Soomro, Rabail Rani; Karimi, Hossein; Gillani, Syed AmirObjectives: To determine the inter-rater and intra-rater reliability of the hand-held dynamometer in measuring isometric gluteus medius muscle strength in asymptomatic healthy population. Methods: It was a cross sectional study conducted at the department of physiotherapy, Sindh Institute of Physical Medicine and Rehabilitation from March 2021 to April 2021. Thirty healthy subjects aged 18 to 25 years of both sexes and no previous or current complaints of hip or knee pain were included through nonprobability purposive sampling technique. The strength of the unilateral isometric gluteus medius muscle was measured using a hand-held dynamometer by two raters at the same day and a week later. Pearson Correlation coefficient was calculated to see the relationship of muscle strength measured by each rater within and between day’s sessions. Intra–class correlation was calculated with 95% confidence interval and Standard error of measurements using reliability analysis. Results: In the present study there were thirty participants studied by two raters, the mean age of participants was 21.53 (SD=±1.40) years, the mean BMI was 24.05 (SD=±1.12) kg/m2 and 70% participants were female and 30% were males. This study showed the mean muscle measurement of participants within days was 12.92 (SD=±0.94), with intra-class correlation ICC (2,2) 0.94 and SEM 0.12 and mean muscle measurement of patients between days was 12.99 (SD=±0.91), with intra-class correlation ICC (2,2) 0.90 and SEM 0.12. Conclusion: Hand-held dynamometer has shown excellent inter-rater and intra-rater reliability in measuring isometric strength of Gluteus Medius muscle among healthy population. It is convenient to be used in clinical settings and can be a useful outcome tool to assess strength in interventional studies.
