Study aim: The objective of this study is to investigate the effectiveness of Proprioceptive paradigm in addition to strength training program on pain, functional disability, and cervical proprioception in the treatment of Cervical Radiculopathy patients. Design: Parallel group Randomised Control trial with double blinded study. Settings and conduct: Physical Therapy Department of Allama Iqbal Teaching Hospital D. G. Khan, Outpatient Clinics. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Age between 30-55 years. Both male and females are included. Patients with pain or numbness of one or both arms. Duration of symptoms is from more than 3 months. Exclusion Criteria: Past fracture or surgery in cervical spine. Deformity of the spine. Inflammatory rheumatologic disease. Intervention groups: Group A (Experimental group) patients were received proprioception training paradigm (eye head coupling based rehabilitation program) described by Revel M in the cervical region along with myofascial release or soft tissue release for 20 minutes as well as a strength training program for 10 minutes and patients in group B (Control group) were received only the same specific strength training program for 30 minutes. Main outcome variables: 1. Pain 2. Functional Disability 3. Cervical Proprioception (ROM) Treatment outcomes such as pain, disability and proprioception were determined from the following scales: scores of Neck Pain from VAS and Scores for functional disability from Neck Disability Index (NDI) as a self-reported measure while for Proprioception Head Position Accuracy, a laser beam device/ Laser Pointer device (LPD) was used

fall. The study will conducted in Combined Military Hospital, Bahawalpur, Pakistan Participants

Hospital, Lahore, Pakistan. 16 individuals will b equally divided into 2 groups that are selected by

Study aim: To compare the effects of manual therapy with and without shockwave therapy on lumber disc herniation in patients with sacroiliac joint dysfunction Design: Two arm parallel group randomized trial with single blind about outcome assessment Settings and conduct: This study will be conducted at University of Lahore teaching hospital .This study will be a single blinded study in which assessor was kept blinded. Participants/Inclusion and exclusion criteria: Inclusion Criteria • Participants aged ≥ 18 years • Both male and female patients • Chronic low back pain lasting over 3 months • Pain localized in unilateral sacroiliac joint • Presence of muscle spasm around the sacroiliac joint • Limited activity of lower limbs and inability to sit for extended periods • Positive findings on pelvic compression and separation tests, the "4" test, and one-foot standing test Exclusion Criteria: • Patients experiencing pain in the waist and legs from alternative etiologies • Pregnant individuals • Individuals with tuberculosis affecting the sacroiliac joint or spine • Participants with inflammatory conditions such as ankylosing spondylitis • Individuals with sacroiliac joint sprain characterized by symmetrical bone marks and no abnormalities observed in X-ray images Intervention groups: All the screened and willing participants will be randomly allocated to two groups (Group A: Shockwave therapy with routine physical therapy group, Group B: Comparative Group / Manual therapy with routine physical therapy) by lottery method. Main outcome variables: Pain , Disability and Quality of life

Study aim: To determine the effects of thoracolumbar myofascial release and Graston technique on pain, range of motion, and disability among chronic low back pain patients. Design: Randomized, parallel group trial with blinded outcome assessment. Randomization was centralized and computerized with concealed randomization sequence carried out at an external site between sample size of 72 patients. All the screened and willing participants will be randomly allocated to two groups by lottery method. This study will be a single-blinded study in which the assessor will be kept blinded Settings and conduct: Department of Physical Therapy, University of Lahore Teaching Hospital, Defense Road, Lahore. Participants/Inclusion and exclusion criteria: Inclusion Criteria will be patients aged between 35 and 50 years both males and females with low back pain for more than 3 months in a year, having a 4 score on the Visual Analogue Scale and the prone position must be pain-free for the patients ; Exclusion Criteria will include patients with history of fracture, tumor, and infections, if had undergone any spine-related surgery between Th 12 and S1, had radiating pain in the legs, and had pacemakers or pregnancy. Intervention groups: All the screened and willing participants will be randomly allocated to two groups by lottery method. This study will be a single-blinded study in which the assessor will be kept blinded. Group A participants will be received Myofascial release technique and Group B participants will be received Graston technique with routine physical therapy. Both groups will be received routine physical therapy which included 15 minutes of electrical muscle stimulation (application of Transcutaneous Electrical Nerve Stimulation (TENS) for 10 minutes (pulse width: 50-100 µs and frequency: 60-120 Hz) at bearable intensity along with heating pad at the same time covering the lumbosacral and gluteal region in a prone position.) with heat therapy. The intervention groups will be received three sessions per week for 8th week of follow-up. Main outcome variables: Pain, ROM (range of motion), Disability

Study aim: To check the comparative effects of Mulligan two leg rotations and bend leg raise techniques in pain intensity and hamstring dynamics in subjects with chronic low back pain. Secondary objective was to compare the disability in patients with chronic low back pain. Design: Single blind, parallel assigned, bi-center, randomized clinical trial that will be done on 34 patients with history of pain for more than 12 weeks. Patients will be assigned by using the lottery method of simple random sampling. Settings and conduct: Hussain memorial hospital Lahore and The Physiotherapy Clinic of The University of Lahore. Participants/Inclusion and exclusion criteria: Patients with age from 20 to 45 years. Both male and female were included. Subjects with pain above 3 on numeric pain rating scale. Pain more than 12 weeks. Score more than 30% and less than 65% on the Modified Oswestry disability questionnaire. Subjects not willing to participate. Patients with Sciatica pain.. Fracture of the Lumber, pelvic and all the spinal regions. Slipping of vertebra or complete tears of intervertebral disc. Recent history of trauma within six months. Patients with Surgical History. Radiating pain to the legs and buttocks. Spinal pathologies i.e. degenrative changes, spinal T.B, discitis, Osteoporosis and neoplasm. Disc herniation at any spinal region. Females with Pregnancy. Intervention groups: Group A: Warmup before the treatment will be given as baseline treatment. Mulligan two leg rotation technique will be applied. Group B: As a baseline treatment warmup before the treatment will be done by the use of hot pack. Then the bend leg raise technique will be applied. Main outcome variables: Pain intensity, Hamstring Flexibility on both sides and disability

Study aim: To see the efficacy of the psychological factor, i.e. craving, uncontrolled aggression, and impulsivity in MBRP in comparison with TAU in Amphetamine type stimulant(ATS) users. To find out enhancing the effect of the psychological factor, i.e. coping, quality of life, and self-efficacy in MBRP in comparison with TAU in ATS users. Design: This randomized control trial comprises pre-test and post-test with a follow-up period. Participants will be assigned to either MBRP + TAU or TAU, with repeated assessments at baseline, mid-treatment, post-treatment (after 8 weeks)and follow up. Settings and conduct: 90 amphetamine-type stimulants users who are receiving inpatient treatment (approximately 60 to 90 days) beyond the period of detoxification and could complete the program were selected by convenient sampling and were randomly assigned into two groups (MBRP and TAU). The data were analyzed by SPSS-15 using the Multivariate Analysis of Covariance (MANCOVA). Participants/Inclusion and exclusion criteria: Inclusion: who have completed detoxification, age 18-40 years; referred by a psychiatrist (diagnosis of stimulant use disorder) based on DSM-V; medical detoxification from any substances. Exclusion: The absence of over two sessions; are suffering from severe medical and neuropsychiatric complications or any psychotic illness; already completed any mindfulness-based programme. Intervention groups: The experimental group will complete 8 sessions (each session is 120 minutes) of Mindfulness-based relapse prevention for the experimental group. While the control group will receive standard 12 steps relapse prevention program for 8 weeks. Main outcome variables: The variables in this research are Quality Of Life, self efficacy, coping.craving, aggression, impulsivity, and Relapse Prevention.

Institute of Child Health Multan, Pakistan Settings and conduct: This open label randomized control trial (...) Multan, Pakistan from November 2020 to October 2023. Total 320 infants (160 each group) will be included

, Peshawar Pakistan. The patients will be recruited in three groups i.e. Group A, Group B and Group C by

Teaching Hospital, Lady Reading Hospital, Peshawar Pakistan. The outcome assessor had been kept blind

Study aim: To compare the effectiveness of lacosamide versus placebo in reducing neuropathic pain in patients with diabetic peripheral neuropathy. Design: Randomized, double-blind, placebo-controlled, parallel-group clinical trial Settings and conduct: Conducted at the Department of Medicine, Nishtar Hospital Multan, after ethical approval. Patients enrolled consecutively, treated and followed for 12 weeks with 4-weekly assessments. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Age 20–60 years, either gender, Diabetes mellitus >5 years, VAS pain score >4, Informed consent given, Exclusion Criteria: Cardiovascular disease, Renal impairment or liver enzymes >2× normal, Pregnant or breastfeeding, Using other neuropathic pain medications (e.g., TCAs, lidocaine patch, mexiletine, tramadol, opioids, AEDs, NSAIDs) Intervention groups: Intervention group: Participants will receive Lacosamide (C13H18N2O3) tablets manufactured by Zakfas Pharmaceuticals Private Limited, orally. Dose will begin at 100 mg once daily, increased weekly by 100 mg to a maximum of 400 mg/day (200 mg twice daily) by week 4. This dose will be maintained for 12 weeks. Tablets will be provided in sealed identical packaging to ensure blinding. Follow-up will occur every 4 weeks. Control group: Participants will receive placebo tablets identical in appearance and schedule to the intervention group. Placebo will be manufactured by Zakfas Pharmaceuticals Privat Limited.Placebo contains inactive ingredients only and will be administered orally for 12 weeks using the same titration schedule to maintain blinding. Follow-ups will occur every 4 weeks. Main outcome variables: Main Outcome Variable: Mean pain score after 12 weeks, measured using Visual Analogue Scale (VAS).

Study aim: To compare the efficacy of intralesional triamcinolone acetonide and cryotherapy vs intralesional triamcinolone acetonide alone in treatment of keloid. Design: Pragmatic ,community based ,parallel group ,not blinded ,randomized controlled trial consisting 64 patients divided in two group 32 in each group Settings and conduct: This study will be conducted in the outpatient clinic of Dermatology PNS Shifa Hospital,Karachi, and will involve patients with keloid. Participants/Inclusion and exclusion criteria: Inclusion criteria: Either gender, Having single or multiple keloids of size not more than 10 cm in the largest diameter. Patient between 12 to 60 years of age, Willing to sign informed consent Patients with infected keloid. Exclusion criteria: Co- existing inflammatory skin diseases. Unrealistic expectation or with psychiatric illnesses, Pre- existing bleeding disorders, Renal and hepatic disease. Lactating or Pregnant women. Immunodeficient patients. Diseases that react adversely to cold (Raynaud's disease, cryoglobulinemia ,cold urticaria ) and with wound healing abnormalities Intervention groups: 64 Patients group A 32 will be received intralesional steroid and cryotherapy group B will received intralesional steroid alone Main outcome variables: Change in vascularity , height ,pigmentation and pliability of scar in both groups. Overall treatment efficacy comparison between the group A (steroid with cryotherapy ) and the group B (steroid only).

Study aim: Aim of the study is to use comma shaped incision for impacted mandibular third molars rather than traditional ward incision because comma incision is expected to be associated with lesser incidence of postoperative pain, swelling and trismus. Design: A concealed, randomized, blinded controlled clinical trial with a parallel group design of 100 patients, enrolled between 3rd October 2018 to 2nd April 2019 ,and followed for 6 months Settings and conduct: Non-probability, Consecutive sampling done in dept of Oral and Maxillofacial Surgery, AFID Rawalpindi. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Patients with fully impacted lower third molars; Patients having physical status 1 according to ASA classification. Exclusion Criteria: Pregnant women, nursing mothers; Patients with non-localized odontogenic infection; Tooth associated with pathologies, Patients on radiotherapy, chemotherapy, bisphosphonates, bone diseases Intervention groups: Intervention group 1: Surgical removal of impacted mandibular third molar using comma-shaped incision. Intervention group 2: Surgical removal of impacted mandibular third molar using traditional ward incision. Main outcome variables: Pain; swelling; trismus.

tertiary care hospital in Jhelum, Pakistan. A total of 158 eligible participants will be randomized equally

Objective: The objective of the study is to establish the bioequivalence of a commercial product of Dinoprostone 3mg vaginal tablet against reference product and to establish the safety of Kleen enema while use in pregnancy before induction. Inclusion Criteria: pregnant women at or near term gestation (≥ 37 weeks) with a medical or obstetrical indication for the induction of labor; Age: 18-35 years; singleton pregnancy with cephalic presentation; parity ≤ 3; intact membrane; bishop score less than or equal to 4; fetal reactive non-stress test. Exclusion Criteria: neuropathy; renal impairment; liver disease; diabetes; hypertension & CV disease; placenta previa; placental abruption; vasa previa; active herpes genitalia; spontaneous labour; fetal death in-utero; where oxytocic drugs are contraindicated or where prolong contractions of uterus are considered inappropriate. Kleen enema will not be administered if subject is with diarrhoea & vomiting. Study population: pregnant women with an indication for induction of labor at term pregnancy. Sample Size: total 90 subjects & PP-population is minimum 70. Intervention: test product “A” is Dinoprostone 3mg vaginal tablet manufactured by Nabiqasim Industries (Pvt) Ltd; Reference product “B” Dinoprostone 3mg vaginal tablet (Prostin-E2) ; Test product “C” is Kleen enema manufactured by Nabiqasim Industries (Pvt) Ltd. Primary outcomes: An increase of 3 in bishop score; attainment of bishop score of 6 or more; or vaginal delivery occurring within 12 hours of dosing was considered as treatment success.; number & nature of adverse events occurring after kleen enema dosing but before induction with dinoprostone. Secondary outcomes: maternal, fetal and neonatal adverse events.

Study aim: The basic purpose of this study is to assess the effectiveness of upper limb exercise along with diaphragmatic breathing with or without lower limb exercise in COVID-19 survivors Design: Single blinded, randomized, total sample size is 176 and each groups contain 88 participants by lottery method. Settings and conduct: conducted at khawaja farid hospital Participants/Inclusion and exclusion criteria: Inclusion Criteria: Aged 35 and 60 years; male and female; COVID-19 survivors discharged from the hospital six weeks ago (diagnosed with COVID-19, respiratory illness) Exclusion Criteria: having any of the following symptoms in the last 14 days: fever; new or worsening respiratory symptoms; > 38.2 degrees Celsius (e.g., cough, dyspnea); Pregnant Females; Refusal to give consent approval. Intervention groups: group A received upper limb exercise along diaphragmatic breathing while group B received upper limb exercise along diaphragmatic breathing with or without lower limb exercise in COVID-19 survivors Main outcome variables: Respiratory function, exertion, quality of life

Study aim: The aim of the study was to assess the potential of the drug nebivolol on the cardiorespiratory parameters against exercise-induced stress and its related complications. Design: 200 patients were randomized into the control group(100) and treatment group(100) by simple randomization. It was a single-blinded randomized controlled trial. In this study participants will be completely blinded about intervention protocol. Settings and conduct: Muhammad physical therapy and rehabilitation center, KAIMS institute, Times university 200 patients were randomized into the control group(100) and treatment group(100) by simple randomization. It was a single-blinded randomized controlled trial. In this study, participants will be completely blinded by the intervention protocol. Participants/Inclusion and exclusion criteria: Inclusion Criteria: 18-25 years of age, mentally and physically fit, healthy individuals. Exclusion criteria: lactating mother, pregnant females, surgery, trauma Intervention groups: Group 1 was an exercise group that performed only stress-induced exercises Group 2 was the medicine group that performed the stress-induced exercises with the medicine Main outcome variables: Blood pressure, Respiration rate, Heart rate, Oxygen saturation, Temperature, Quality of life, and endurance

Study aim: To compare the effect of planter vibrator versus Transcutaneous Electrical Nerve Stimulation on life independence. Design: Two arms Parallel group randomized trial Settings and conduct: The study setting was the District medical and Rehabilitation complex charsadda and Shifa Rehab and Research Center Peshawar. It was the single-blinded and Only the researcher doing the study knows which treatment or intervention the participant is receiving. Participants/Inclusion and exclusion criteria: Inclusion criteria: Patients with diagnosed stroke; Stroke patients having issues of balance dysfunction who stands for at least 20 seconds independently; Patient score minimum from 2 on Ashworth scale. Exclusion criteria: Patient under the influence of any sedatives; Any other pathological conditions; Malignancy; Multiple sclerosis; Vestibular dysfunction; Suffering from severe visual problem Intervention groups: Intervention group received plantar vibration for 10 min 3 sessions per week for 4 weeks along with the conventional therapy. In the Planter vibration protocol, the patient was either in a standing or sitting position with 90 degrees flexed knee and support with belts and a frame to avoid the risk of fall. The Control group received the same conventional physical therapy was given as for treatment group. Patients were also received electrical stimulation via TENS. TENS sessions were applied to the tibial nerve branch of the sciatic nerve of the affected limb on the plantar surface of the foot each one was lasting for 10 minutes with 110 Hz frequency 3 times a day. The patient has received 3 sessions per week for 4 weeks. Main outcome variables: Balance

Study aim: The main aim of this study is to see the comparison between stretching of respiratory accessory muscles and ribs mobilisation to improve chest expansion, level of dyspnea and vital capacity in COPD patients Design: Two parallel groups: group A have stretching of respiratory accessory muscles and group B have ribs mobilization. Sample size is 50 which is collected from single center (Rabia Trust Hospital Faisalabad). Randomization will be through lottery method, single blinded study will be conducted in which only patient would be blinded. Settings and conduct: This study is conducted in Rabia Trust Hospital Faisalabad. Randomization is done by lottery method. Sealed envelope method is use for blinding of participant.. grouping of 2 envelopes showed to patient, once he selected one of them, he will be the part of that Two groups are made. Sealed envelope will made upon with allocation of participants in both groups can be possible without biasness Participants/Inclusion and exclusion criteria: Inclusion Criteria: Age: 30-55 years, Patients who are diagnosed with COPD according to GOLD, Patients with acute and moderate history of COPD, Both males and females, Haemodynamically stable patients who will be willing participate in the study. Exclusion Criteria: Patients having lung carcinoma and acute inflammatory condition, Patients having cardiac or neuromuscular disease, Patients having recent surgery history and recent chest injury, Patients having severe or very severe history of COPD, COVID-19 patients, Patients with broken ribs, bruised ribs, fractured ribs, Patients having Fibromyalgia, Patients with costochondritis, Patients with pleurisy. Intervention groups: Two groups Group A stretching of respiratory accessory muscles Group B ribs mobilization Main outcome variables: Xiphisteranl chest expansion, Perceived dyspnea, Vital capacity

Study aim: The purpose of this study was to find the comparative impact of exercises with navicular mobilization versus exercise alone in patients with flat foot. In flat foot, hence the foot is pronated so the mobilization has to be given in order to improve normal biomechanics of foot or to elevate the medial arch. There is paucity of literature on mid foot mobilization in patients having flat foot. So, a comparative effect of these treatments on the navicular height and foot posture index in patients with flat foot was done to find out which one was superior to the other. Design: Two arm parallel group randomised trial Settings and conduct: Rehman Medical Institute, Peshawar However, assessor, who will assess pre and post measurements, will be blinded. Participants/Inclusion and exclusion criteria: Inclusion Criteria: 1. Subjects aged between 18 to 30 years 2. Both males and females 3. Unilateral or bilateral involvement 4. Subjects having flexible flat feet with navicular drop test positive Exclusion Criteria: 1.History of fractures in the lower limb 2. Skin infections and wounds on the foot 4. Any neurological deficit 5. Peripheral vascular diseases. Intervention groups: Control Group (Group A): Resistive exercises using TheraBand of 12 repetitions and 3 sets. Resistive exercises will contain plantarflexion, inversion, flexion of big toe and abduction of big toe Experimental Group (Group B): Group B will be given talonavicular mobilization along with exercises. In talonavicular mobilization, a dorsal glide of 3 sets and 20 repetitions will be given to the navicular while stabilizing the talar neck. Resistive exercises using TheraBand will be given with 12 repetitions of 3 sets. Main outcome variables: Outcome measures will be used on baseline, 1st assessment (after 3 weeks) and 2nd assessment (after 6 weeks) using Foot Posture Index (FPI) and navicular drop test

Study aim: The aim of this study was to evaluate the comparative effectiveness of upper thoracic sustained stretch mobilization and posterior shoulder stretch glide for management of SIS symptoms severity such as shoulder pain, disability, range of motion and thoracic kyphosis angle. Design: A double blinded randomized clinical trial Settings and conduct: a study conducted at; Bakhtawar Amin Trust and Hospital Multan Faiz hospital Multan Outcome assesor and data analyzer will be unaware of intervention recieved by particular subject/ group Participants/Inclusion and exclusion criteria: Inclusion criteria: (1) Potentially willing patients diagnosed with subacromial impingement syndrome (SIS) (2) Both male and female, of age 25-45 years (3) Patients with thoracic kyphosis >40o (4) At least three positive physical tests from followings Neer impingement test, Hawkins kneddy test, Drop arm test, relocation test and apprehension test will be included. (5) Patients often had painful arc between 70° and 120° pain on forced movement above the head. Exclusion criteria: Patients with following conditions will be excluded (1) History of rotator cuff tear, shoulder and cervicothoracic surgery. (2) Patients of scapulothoracic dysfunction, sensory/ motor deficit and adhesive capsulitis. (3) Osteoporosis, fracture and dislocation.(4) Presence of thoracic scoliosis on Adam’s forward bend test. Intervention groups: Group A- Upper thoracic (T1-T4) centrally posterio-anterior sustained stretch mobilization Group B- Postrior shoulder sustained stretch glide Main outcome variables: shoulder pain, physical disability, range of motion and thoracic kyphosis angle are outcome measures.

Study aim: To evaluate the therapeutic effects of intra-vitreal injection Bevacizumab combined with Diclofenac-Na versus intra-vitreal Bevacizumab alone in the treatment of naïve diabetic macular edema. Design: Prospective, randomized, parallel group, interventional clinical practice trial Settings and conduct: Eye dept. Nowshera Medical College/ Qazi Hussain Ahmad Medical Complex, Nowshera. The trial was non-blinded, prospective interventional study started from Sept. 2020 till March 2021. Participants/Inclusion and exclusion criteria: The ‘ETDRS’ criteria was utilized for enrollment of treatment naïve eyes of DME, defined as any hard exudates/dot blot hemorrhages, retinal thickening/edema within 500µm from the center of the fovea or involving the very center, examined clinically on fundoscopy Exclusions included: 1) Any history of prior retinal laser therapy 2) History of prior intravitreal injections any type (3) Any intra-ocular procedure done within last 6 months 4) Rubeosis irides 5) Any glaucomatous eye damage 6) evidence of ischemic maculopathy, defined as an enlarged foveal avascular zone (FAZ) ≥ 1500µm; 7) Best corrected VA of ≥ 6/12 or ≤ 6/120; 8) significant media opacity precluding fundus view 9) Associated morbid conditions like, monocularity, pregnancy, diabetic nephropathy grade 3 and HbA1c ≥ 10. Intervention groups: INTRAVITREAL DICLOFENAC PLUS BEVACIZUMAB (IV-B/D) VERSUS BEVACIZUMAB (IV-B) ALONE Main outcome variables: Primary outcome variable was Visual acuity in Log MAR Secondary outcome variable was Central sub-field thickness of Macula Tertiary variable was Intra-ocular pressure (IOP)

Study aim: To determine the effectiveness of flossing techniques on pain and range of motion in patients with patellofemoral pain syndrome Design: It will be a two arm parallel Randomized trial with outcome assessor being blinded Settings and conduct: Data will be collected from outpatient department of REX clinic Lahore Participants/Inclusion and exclusion criteria: Inclusion Criteria: (1)Patients with age 14-40 will be included (2)Diagnosed patients with patellofemoral pain syndrome having three months history of pain (3) patients with positive clinical patellar test Exclusion Criteria: Patients with history of knee Osteoarthritis, fracture of knee joint, malignancy will not be included in the trial Intervention groups: Group A will receive Routine physical therapy which involves standing hamstring stretch, quadriceps stretch, side lying leg lift, Quads sets, straight leg raise, step up, wall squats and stabilization exercises Group B will receive flossing exercises along with routine physical therapy. Floss band which is stretchable will be used for this purpose. Main outcome variables: Pain, functional disability and range of motion

Study aim: Aim of the study is to explore the effects of massage therapy with and without aerobic exercises on glucose, blood pressure and diabetic peripheral neuropathy Design: 94 Patients will be randomized into treatment group(47) and control group(47) by lottery method. It is a single blinded randomized controlled trail. In this study patients will be completely blinded about intervention protocol Settings and conduct: Muhammad physical therapy clinic and rehabilitation cenetr, Al khaliq hospital, Multicare physical therapy clinic Multan Participants/Inclusion and exclusion criteria: Patients with diabetic peripheral neuropathy and hypertension will be included in this study. Patients with angina, stroke, myocardial infarctio, acute illness and any fracture of the lower limb will be excluded from this study Intervention groups: Group 1 will be treatment group in which patients receive massage therapy with aerobic exercises(cycling and walking) and group 2 will be control group in which patients receive massage therapy alone. Main outcome variables: Blood pressure, glucose level and neuropathic pain

Study aim: To compare the effectiveness of motor imagery technique along with conventional therapy and conventional therapy alone on pain intensity, range of motion and physical function in patients who underwent total knee replacement. Design: Randomised, superiority, parallel group trial with blinded outcome assessment. Randomisation was centralised and computerised with concealed randomisation sequence carried out at an external site Settings and conduct: Rehman medical institute, Peshawar Due to nature of study blinding the researcher/therapist and subjects will not be feasible. However, the assessor, who will compare pre and post scores will be blinded. Participants/Inclusion and exclusion criteria: INCLUSION CRITERIA: 1. Age group 45-75 years 2. Males & females 3. Patients who had undergone unilateral total knee replacement EXCLUSION CRITERIA: 1. Uncontrolled hypertension and Uncontrolled diabetes mellitus 2. A history of any neurological disorder, multiple sclerosis, Parkinson’s disease 3. Patients with rheumatoid arthritis or active cancer 4. Previous history of deep veinous thrombosis Intervention groups: Experimental Group (Group A): This group will be same as control group (as having conventional physical therapy) but with addition of the motor imagery techniques session. Each session will be of 30 minutes per day for five days per week. The treatment will be provided for three days during hospitalization and two weeks after discharge. Control Group (Group B): This group will comprise of conventional therapy for the participants. Conventional therapies include CPM (continuous passive machine), Icing and physical exercises. Main outcome variables: Tools to be used are numeric rating scale for pain intensity, western ontario mcmaster universities osteoarthritis index (WOMAC) for physical function and Goniometer for range of motion.