Purpose: Cardiopulmonary physiotherapy plays a crucial role in cardiac rehabilitation after surgeries. The deterioration of respiratory parameters occurs after coronary artery bypass grafting (CABG) procedure. Manual hyperinflation (MHI) is done according to clinical experiences and there are no specific guidelines for it. The objectives were to determine the effects of structured manual hyperinflation for improving respiratory parameters in post-operative CABG patients. Methodology: Duration of study was 6 months (January 2019-June 2019) with a sample size of 76 post-operative CABG patients. Non-probability purposive sampling technique was used. Patients were divided into two groups’ i-e MHI and VHI depending upon the treatment protocol. In protocol, endotracheal tube (ETT) suctioning was done followed by MHI and VHI in assigned group in randomized controlled trial design. Respiratory parameters were measured by ABG’S, equations for static lung compliance and alveolar-arterial oxygen tension difference. Data was recorded pre and post ETT suctioning, immediately, 30 min and 60 min post intervention. Both males and females were included. Inclusion criteria involves patient must be intubated, hemodynamically and vitally stable, and age range 55-77 years. Those were excluded who have past medical history of diagnosed pulmonary pathology and any post-operative complications. Patient was withdrawn from the study if any subject who have unstable cardiovascular status and high levels of respiratory support. Data was analyzed on SPSS 21. Findings: All the respiratory parameters showed significant differences (p<0.05) in pre and post values of structured MHI. Significant difference (p<0.05) was observed immediately after intervention in terms of acidity (pH), partial pressure of carbon oxide (PaCO2), partial pressure of oxygen (PaO2), oxygen saturation and arterial oxygen to fraction of inspired oxygen ratio between the groups with scores higher for experimental group. HCO3 showed significant difference (p<0.05) immediately after intervention and 30 min and 60 min post intervention with the scores higher for control group. Static lung compliance showed significant difference (p<0.05) at 30 min and 60 min post intervention with scores higher for control group. Alveolar-arterial oxygen tension showed no significant difference (p>0.05) between the groups at any point. No significant difference (p>0.05) was observed between the groups at any other point of measurement for all respiratory parameters. MHI and VHI are both effective in improving respiratory parameters in post-operative CABG patients but the values were more significant in MHI group. But the difference between the groups was not significant and conclusive. Recommendations: This study should be conducted in different patient populations having different pulmonary conditions and other types of cardiac surgeries and in other patients who are intubated and mechanically ventilated. Moreover, the effects of both techniques on different variables must be studied after multiple numbers of sessions during the whole period of intubation.  

Background: Asthma is a bronchial airways disease which is characterized by chronic inflammation and repetitive Asthma attacks. Quality of life is also affected by asthma control. Objective: The objective is to determine the correlation of the asthma control with the health-related quality of life in Asthma patients. Methods: This descriptive cross-sectional study was conducted at N.I.H Islamabad and Federal General Hospital Islamabad. The asthmatic patients who had suffered from asthma for at least 6 months and were aged between 15-40 years, had received anti-asthmatic drugs and should have had residence at Islamabad/Rawalpindi were included. The subjects having cardiac, pulmonary or traumatic shortness of breath, any dermatological issues and those undergoing surgery were excluded from the study. The quality of life of asthmatic people was calculated using Urdu version of Mini Asthma Quality of Life Questionnaire (AQLQ). The study was spread over 6 months and 100 asthmatic patients, calculated through G-Power, were selected in the survey through convenience sampling. Spearman's correlation statistics on SPSS was used to find relation between health related quality of life and control on asthma Results: Out of total patients, 31% asthma patients had uncontrolled asthma and 63% had partially control asthma symptoms and only 6% with controlled asthma. The correlational value of r = 0.886 shows a strong relationship between control on asthma and quality of life. P<0.05 so relationship is strong and significant. Quality of Life was poorer when the asthma was uncontrolled (2.12± 0.36) and it was better (5.46±0.30) when asthma was controlled. Conclusion: The study concluded that the patient's with controlled asthma had better quality of life as compared to the patients with poor control on asthma symptoms. These asthmatic patients had poor quality of life in all domains of emotional, environmental and activity limitation.

The 6-min walk test (6MWT) and incremental shuttle walk test (ISWT) are widely used measures of exercise tolerance, which depict favorable performance characteristics in a variety of cardiac and pulmonary conditions. Both tests are valid and reliable method of assessing functional ability in cardiac rehabilitation population. Several studies have calculated the minimal clinically important difference (MCID) of these exercise tests in different populations. The current study aims to estimate MCID of 6MWT and ISWT in patients after Coronary artery bypass graft (CABG) surgery. In this descriptive observational study, nonprobability purposive sampling technique was used to assess 89 post CABG patients. The participants performed the 6MWT and ISWT along with vital monitoring on third, fifth and seventh post operative days. The data was with calculation of 6MWT and ISWT MCID through distribution and anchor-based methods. Results showed significant improvement (p < 0.001) in 6MWT as well as in ISWT after seven days of in-patient cardiac rehabilitation. The minimal detectable difference of 6MWT determined by the distribution-based method was 36.11 whereas MCID calculated by Anchor based method was 195 m. The minimal detectable difference of ISWT determined by the distribution-based method was 9.94 whereas MCID calculated by Anchor based method was 42.5 m. In conclusion our results will assist the future researchers and clinicians to interpret clinical trials as well as to observe the clinical course of post operative cardiac patients.

Objectives: To examine the current trends, challenges and future perspectives of physiotherapy in terms of social awareness, job availability and career orientation. Materials and Methods: A cross-sectional study was conducted on 200 physiotherapy students at Rawalpindi Medical University Rawalpindi, Benazir Bhutto Hospital Rawalpindi and Maroof International Hospital Islamabad for 6 months. Non-probability convenience sampling was used. Fresh graduates of physiotherapy and postgraduate students studying physiotherapy were included in this study. All the students having experience of more than 3 years and students other than physiotherapy profession were excluded. Questionnaire was designed according to Likert scale from strongly agree to strongly disagree. Statistical analysis was done to analyse findings and interpret the results. Results: The results showed that Pakistani government is taking initiative to some extent to promote the scope of physiotherapy but in the meanwhile social unawareness, job unavailability, and lack of clinical facilities are yet required to be considered. Conclusion: Physiotherapy in Pakistan is at its developing phase and needs a lot of improvement. There are limited job opportunities and limited education facilities in institutes. Advertisement of the potential benefits of this profession can increase the number of job opportunities in both public and private sectors.

Aim: The aim of the study was to determine the frequency of Erb’s palsy, its associated risk factors and health-related quality of life of these patients in Islamabad and different cities of Punjab. Methodology: A cross-sectional study whereby 242 patients with erb’s palsy were analyzed. Data was collected from different government and private sector hospitals of Islamabad, Rawalpindi, and Lahore, Gujranwala, Okara and D.G khan (Jampur) through direct patient contact and postal and electronic mail during a period of 6 months. Two questionnaires used to assess factors and quality of life, were Questionnaire of Erb’s palsy and WHO Quality of life BREF questionnaire. All patients of erb’s palsy aged below 12 years were included. Results: The frequency of Erb’s palsy recorded in Islamabad and different cities of Punjab is about 1.67% with Okara having the highest frequency rate of 3.13%. Among the Fetal-associated factors; Macrosomia 107(44.2%), among Maternal-associated factors; Multiparity 150(62.0%) and among Obstetric-associated factors; assisted vaginal delivery 134(55.4%) had the highest frequency. Quality of life in patients was found to be moderately affected with mean 3.18±0.47 SD. All the physical, psychological and environmental domains were equally affected with mean 3.19±0.39 SD, mean 3.14±0.56 SD and mean 3.22±0.65 SD respectively. Conclusion: The frequency of Erb’s palsy is highest in Okara among different cities of Punjab and Islamabad, Pakistan. Macrosomia, multiparity and assisted vaginal delivery was the highest associated factors with erb’s palsy. Quality of life was moderately affected in patients with erb’s palsy.