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BACKGROUND In a country like India with a large population, with diverse culture, socioeconomic status and educational levels, there is a need to translate a Patient Activation Scale Measure (PAM®13) into a regional language which will reduce the language barrier, increases the understanding of patient’s disease condition, and improves their self-management skills. Hence, a reliable and validated instrument ‘Patient Activation Measure (PAM®13)’ is used for evaluating patient’s awareness, skills, and trust in self-management of disease. We wanted to translate and validate the PAM®-13 questionnaire in Kannada language and assess activation levels in diabetes mellitus patients. METHODS A cross-sectional analysis done among 200 adults with diabetes mellitus who speak Kannada. Patients of diabetes mellitus, aged 18 - 85 years from both sexes were included in the study. The PAM®-13 – was translated as recommended by World Health Organisation’s procedure for cross-cultural validation and adaptation of selfreport measures. This involved forward translation, synthesis, backward translation, pre-testing and the final version which was performed by the professionals of Kannada and English language. Data was analysed using SPSS ver. 24.0 for mean, median, standard deviation, Pearson’s correlation and Spearman’s correlation. Stata 14 was used to analyse internal consistency using Cronbach’s Alpha, inter-item, inter-rest, inter-test correlation. RESULTS We found that the mean of the Kannada version of the PAM®-13 was 55.68. The level of internal consistency was good (α=0.8357). CONCLUSIONS PAM® -13 in Kannada language has been demonstrated to be a valid and reliable measure of patient activation in the diabetic population and the present study suggests good psychometric properties. KEY WORDS Patient Activation, Self-Management, Diabetes, Chronic Illness, Chronic Disease, PAM®13, Psychometric Properties

Myasthenia gravis (MG) is an autoimmune disease in which muscle weakness and fatigability of the skeletal muscle are as a result of an antibody at the neuromuscular junction against the acetylcholine receptor (AChR) affecting ladies and older men. A thymoma occurs in approximately 15 per cent of adult diagnosed with Myasthenia gravis (MG). Thymectomy is used as a surgical approach which helps to reduce the symptoms. Structured comprehensive physiotherapy rehabilitation post-surgery helps to achieve a successful functional recovery. A 61 year old male patient was admitted with complain of lump in neck region, generalised weakness and early fatigability while doing Activities of daily living since 2 months. Investigations were done for the same which revealed thymoma and surgical intervention i.e. thymectomy was performed. Patient was referred to post opt rehabilitation with complains of incisional pain, cough with expectoration, early fatigue performing basic Activities of daily living and reduced strength. Following the surgery patient underwent physiotherapy which comprised of exercises, breathing retraining and early mobilization. The case report concludes that early excision of thymoma with prompt tailor made supervised exercise program helps in early recovery and achievement of functional goal.

The disorders of the upper extremity and the shoulder is extremely common accounting for 30 % of people who experience shoulder pain and stiffness at some stage of their ageing. A high incidence of shoulder dysfunction is seen in people in recent trends. Shoulder stiffness is the main complication after fracture shoulder immobilization, and Diabetes Mellitus contribute to the frozen shoulder, which is the most typical complication in Diabetes mellitus patients. A case of lateral clavicle fracture with chief complaints of pain on the right shoulder, stiffness around the joint and reduced range of motion was reported to the outpatient physiotherapy department for rehabilitation. A proper assessment was done, and the differential diagnosis was frozen shoulder with supraspinatus tendon tear was reported. The patient also had a reduced range of motion of shoulder abduction and lateral rotation due to frozen shoulder. The investigation of MRI report stated that there is a partial supraspinatus tendon tear. Medical examination of the frozen shoulder confirms the diagnosis. A combination of non-pharmacological treatment with exercises, NSAID and exercise therapy, was planned. He was successfully treated with the combination of physical therapy treatment with the electrotherapy modalities and shoulder girdle mobilization. Comprehensive therapeutic exercises include mobilization of soft tissue using Cyriax technique, peripheral joint mobilization to improve controlled ROM. Mobilization of soft tissue along with home exercise supports patients suffering from frozen shoulder. The treatment primarily aimed at relieving pain and increasing range of motion and thus improving the quality of life in the patient. Only manual therapy alone does not give satisfactory results along with electrotherapeutic modality with proper dose work on the patient.