Study aim: To compare the effect of Mirror Visual feedback therapy combined with a home dexterity program and home dexterity program in improving hand function of patients with Parkinson's Disease Design: Two arms Parallel group, single-blind, randomized controlled trial Settings and conduct: • The study will be conducted in Neurology department Fauji Foundation Hospital. • Patient will be included in study after taking full informed consent. • Participants will be screened thoroughly for any exclusion, before getting enrolled. • Severity of disease will be determined by means of the MDS Unified Parkinson Disease Rating Scale, Part III: Motor (MDS-UPDRS III). Participants/Inclusion and exclusion criteria: Inclusion Criteria: All patients with stages 1to 3 in Hoehn and Yahr and who would be on a stable medication regimen. Patients with impaired hand dexterity Exclusion Criteria: 1. Patients with history of other neurological conditions, 2. deep brain stimulation, 3. Patients cognitive status < 24, 4. Patients with visual field defects, which will prevent the patient to see their reflection of hand 5. Patients with severe orthopedic conditions of upper limb Intervention groups: The intervention group (Mirror visual feedback therapy combined with home dexterity program group) will receive Mirror visual feedback therapy combined with home based dexterity Program for 1 hour 3 times a week for 6 weeks. A patient will have to perform six various types of exercises, either bi-manually or unimanually, Both hands will have to be trained equally. The control group (Home dexterity program group) will receive only home dexterity program for 1 hour 3 times a week for 6 weeks Main outcome variables: Independent Variable: • Mirror Therapy combined with Home based dexterity program • Home dexterity program Dependent Variables: • Hand function

Study aim: To determine the effects of virtual reality on burden, quality of life and satisfaction and to find out the association between caregiver burden and quality of life in informal caregivers of stroke survivors Design: Randomized, parallel groups Settings and conduct: Rawal General Hospital Participants/Inclusion and exclusion criteria: Inclusion Criteria: Both Genders of 20 to 40 years Taking care of a stroke patient ≥ 3 months. Exclusion Criteria: Caregivers taking care of more than one patient Caregivers who are suffering from a Neurological or Orthopedic disease. Included caregiver was no longer the primary caregiver. Intervention groups: Group A: Virtual reality therapy applied, every subject will be treated individually. Before the intervention, there will be a 5-minute warm-up time, and after the session there will also a 5-minute cool-down time. The virtual reality time will be 25 to 30 minutes periods, 3 days per week for 4 weeks. Group B: Undergo the psychotherapy using Cognitive Behavioral therapy. The therapy will be 25 to 30 minutes periods per day, 3 days per week, for 4 weeks. Group C: Provided with both cognitive behavioral therapy and virtual therapy training for 25 to 30minutes per day, 3 days per week for 4 consecutive weeks. Main outcome variables: 1. Caregiver Strain Index 2. 36-Item Short Form Health Survey 3. Adult Carer- Quality of Life

Study aim: To compare the effect of modified constraint induced movement therapy with mirror therapy in addition to neuromuscular electrical stimulation on upper extremity of chronic stroke patients Design: Randomized Control Trial (RCT) Single blind study Study groups: mCIMT group and MT+NMES group Phase: N.A Sample size : 20 Randomization: In this study simple random sampling technique is used by sealed envelop method by using a computerized random number generator. The study is single blinded as participants is not aware of the intervention group they are placed in. Study center: Single center study Settings and conduct: Smart Medical & Diagnostic Center Islamabad. Physiotherapy department In this study simple random sampling technique is used by sealed envelop method by using a computerized random number generator. The study is single blinded as participants is not aware of the intervention group they are placed in. Participants/Inclusion and exclusion criteria: Inclusion criteria: age 40 to 65 years; both gender; Hemiplegic stroke patients past 6 months; minimal function of hand includes 10° wrist extension, 10° thumb extension, 10° finger extension; absence of severe attentive deficit; will able to understand and follow simple verbal instructions; have no severe cognitive disorder that interferes with the study. Exclusion criteria: upper limb fracture; peripheral nerve injury; Apraxia; visual field defect; serious cardiac disease ( arrhythmias and pacemakers); skin or peripheral circulation disorder; those who participate in other studies or rehabilitation program; chronic synergies. Intervention groups: There are 2 groups A and B. Group A : modified CIMT group; Group B: Mirror therapy MT group Main outcome variables: 1. Modified Barthel Index 2. Wolf Motor Function test 3. Upper Limb Motor assessment Scale

Study aim: The purpose of this study is find the comparison of effects of ankle position on isometric quadriceps strengthening in osteoarthritis of knee joint Design: Randomized control trial Settings and conduct: Shaikh Zayed Hospital lahore Participants/Inclusion and exclusion criteria: Inclusion Criteria o X-ray findings of primary osteoarthritis patients with grade ≥ 2 according to Kellgren Lawrence scale o Male and female both were included o Age from 40-60 years old patients were included o Unilateral and bilateral involvement, in case of bilateral involvement more symptomatic knee was included; pain in and around the knee Exclusion Criteria Participants were excluded if they exhibited. o less ankle ROM o History with any injury either soft tissue or bony o Pain radiating into leg in patients with lowback pain o Any neurological signs o History with NSAID past three months o Any inflammatory disease such as Gout o History with RA, ankylosing spondylitis, o History with metal implants, noncooperative patient, patient with mental disorders, o Patients with BMI ≥40 kg/m2 (morbid obesity) Intervention groups: Group 1 will perform quadriceps exercise with ankle in planterflexion position + shortwave diathermy , Group 2 will perform quadriceps exercise with ankle in dorsiflexion position + shortwave diathermy and Group 3 will perform quadriceps exercise with ankle in neutral position + shortwave diathermy. Main outcome variables: pain , strength and functional activity

Study aim: To improve balance and functional mobility in children with spastic diplegia by applying proprioceptive training and partial bodyweight supported treadmill training. Design: Randomized controlled trial Settings and conduct: Randomized controlled study was conducted in children hospital Faisalabad. Assessor was blinded. Participants/Inclusion and exclusion criteria: Spastic diplegic cerebral palsy, Both gender, 11-13 years old, Spasticity of grade <2 according to the Modified Ashworth Scale, Level 2-3 (GMFCS), Intact cognitive status, Normal Vision and hearing status were included whereas patients with, Seizures, any surgical procedure 6 months ago, fixed Joint contractures, Bony deformity i.e. Scoliosis, windswept deformity, crouch knee deformity, Rocker Bottom deformity etc. Multiple medical concerns i.e. Any Cardiac issue and Asthma etc. Medicines to reduce spasticity were excluded. Intervention groups: In Control Group patients practiced proprioceptive training in form special seven exercises. All the proprioceptive exercises was performed for 30 minutes per session with 5 minutes rest period in between for 3 days a week and continued for 12 weeks. whereas in Experimental group Patients were treated with proprioceptive exercises in addition of treadmill training program which was conducted 3 times/week for 12 successive weeks. Patients practiced one hour session of treatment including 30 minutes of Proprioceptive training and 30 minutes of treadmill training. A specialized Harness was used with treadmill training to ensure safety of a patient. Treadmill speed started at 0.5 km/h~1.0 km/h and increased gradually according to children’s adaptability by 0.1 km/ h progressively to suit the child’s speed. Main outcome variables: Balance and Functional mobility was the main outcomes measure

Study aim: To compare the effects of the Mulligan two-leg rotation technique and the Muscle Energy Technique on pain, hamstring flexibility, and functional disability in patients with chronic non-specific low back pain. Design: The double-blinded, parallel-assigned, bi-center, randomized clinical trial was done on 108 patients with a history of pain for more than 12 weeks. Patients were assigned by using the lottery method of simple random sampling. Settings and conduct: The study was conducted at the physiotherapy department of Bakhtawar Amin Hospital, Multan. Participants/Inclusion and exclusion criteria: Inclusion Criteria: 1. Both gender, 2. Age group of 18-35years. 3. Non-specific low back pain for more than 3 months. 4. Patients with hamstrings tightness measured by Active Knee Extension (AKE) test. Exclusion Criteria: 1. History of fracture or surgery. 2. Low back pain with active systemic or spine pathology. 3. Upper motor neuron or lower motor neuron lesion 4. Pregnancy, psychological risk factor, or subjects apprehensive for the stretching techniques. Intervention groups: After taking written informed consent, patients meeting the inclusion and exclusion criteria were screened for hamstring tightness by a trained physiotherapist, having greater than 30-degree loss of knee extension.108 patients were randomly allocated into two groups (54 patients each) by a computer-generated random number table. Group A received Mulligan’s two-leg rotation technique with routine physiotherapy and group B received the muscle energy technique with routine physiotherapy. Total 12 sessions were given to both groups, 3 sessions per week. Data was calculated at baseline and after every 6th session. Main outcome variables: 1. Pain measured by Numeric pain rating scale. 2. Hamstring tightness measured by Active knee extension angle. 3. Functional Disability measured by Modified Oswestry Disability Index scale.

Study aim: To compare the effects of backward walking training and standing balance training in improving the walking speed & balance of the patients in the sub-acute phase of stroke rehabilitation. Design: Single Blind, Randomized Controlled Clinical Trial Settings and conduct: Madinah Teaching Hospital Faisalabad Participants/Inclusion and exclusion criteria: Inclusion Criteria 1. Diagnosis of first stroke in previous 45 days, 2. Patients older than 20 years and less than 50 years, 3. Able to maintain upright standing posture with moderate assistance, 4. Anticipated inpatient rehabilitation length of stay 2 to 3 weeks, Exclusion Criteria 1. Absence of significant balance impairment, defined by Berg Balance Scale (BBS) score greater than 45/56, 2. Lower extremity joint or weight-bearing pain, 3. Inability to follow 2-step command, 4. History of Contraversive pushing syndrome Intervention groups: Group A: Group A participants received the task-oriented training (grasping objects and CIMT) combined with backward walking training. The participants were treated 60 minutes, 3 times per week for 4 weeks. Group B: Group B participants received the task-oriented training (grasping objects and CIMT) combined with standing balance training. The participants were treated 60 minutes, 3 times per week for 4 weeks. Main outcome variables: • 6-Meter walk test • 3-meter backward walk test • Berg balance scale

Study aim: The aim of this study is to compare the effects of instrument-assisted soft tissue mobilization with routine physical therapy and isolated treatment of routine physical therapy on the function of the lumbar spine and pain during the achievement of daily life in patients with chronic low back pain. Design: Parallel group, single-blind, randomized control trial Settings and conduct: 38 subjects will be studied at TABA Medical Complex, Lahore. Participants and assessors will be blinded. During the first visit, the researcher will complete thorough case history and lumbar regional assessment. Patients will be assessed using the Rolland Morris Questionnaire and Modified Oswestry Disability Index score for function and Numeric Pain Rating Scale for pain. Treatment will be then continued according to the allotted group intervention. All participants will receive a total of 12 treatment sessions over a 4-week period, which will consist of 3 treatment sessions per week. The researcher will take a follow-up value after 12 sessions. A follow-up assessment will be done at the end of 12 sessions as the post-treatment reading. Participants/Inclusion and exclusion criteria: Inclusion criteria: Age between 40 and 60 years, Not make use of continuous drugs for low back pain, Previous spine surgeries, Do not present medical restriction to practice physical exercise or if they presented any limitations in lower limbs that physical exercises Exclusion Criteria: neurological signs, specific spinal pathology (e.g. malignancy, or inflammatory joint or bone disease), Patients who will be reported osteoarthritis or disc lesions (prolapse, protrusion, or herniation without neurological compromise) with or without leg pain, Pregnant women Intervention groups: Group A: Instrument assisted soft tissue mobilization with routine physical therapy Group B: Routine physical therapy. Main outcome variables: Pain and function

Study aim: Primary aim of this study is to evaluate effectiveness of core stability exercises with and without routine physical therapy (RPT) on pain and functional mobility in patients with iliotibial band (ITB) syndrome. Secondary aim, evaluate effectiveness of core stability exercises on quality of life in iliotibial band syndrome (ITBS) Design: Single center, parallel group, concealed, double blind, randomized controlled trial of 40 participants Settings and conduct: University Physical Therapy and Rehabilitation Clinic, University of Lahore. Participants and outcome assessor blinded. Participants/Inclusion and exclusion criteria: Participants were included if age between 18-50 years in both the gender, presence of local tenderness over the lateral epicondyle, positive noble compression test and modified ober’s test. Participants with systemic illness, peripheral nerve involvement and any type of Arthritis in lower limb, Tumor and history of previous knee trauma and surgery were excluded. Intervention groups: In control group participants follows RPT that includes 1- Specific stretching exercises of ITB, tensor fascia latae, and gluteus medius 2- Soft tissue and medial patella mobilizations 3- Active release soft-tissue mobilization and myofascial release 5- Strengthening exercises for ITBS 6- Cryotherapy, Phonophoresis, While interventional group participants follow RPT and core stability exercise , which includes: Transversus abdominus (30 reps with 8s hold) Bracing with heel slides, Abdominal bracing, bridging, standing, standing row, walking, leg lifts. Paraspinals/multifidi (30 reps with 8s hold). Quadruped legs lifts and arm lifts with bracing, Quadruped alternate legs and arms lifts with bracing. Quadratus lumborum and obliques (30 reps with 8s hold). Side plank with knees flexed and extended Trunk curl Main outcome variables: Numeric Pain Rating Scale and Lower Extremity Functional Scale

Study aim: To evaluate the effect of Medical Exercise Therapy on Pain, ROM and Function in Adults with Unilateral Idiopathic Adhesive Capsulitis Design: Randomised, parallel-group trial with blinded patient, accessor, and analyst. Settings and conduct: A patient and investigator blinded trial conducted at Ghurki Trust and Teaching Hospital Lahore. Participants/Inclusion and exclusion criteria: 1. Patients with at least a 1-month history of progressively worsening symptoms will be included. 2. Patients with restricted shoulder mobility due to causes other than idiopathic will be excluded. Intervention groups: The patient will receive directly supervised 3 sessions per week for 1 month. MET will consist of 7 exercises that combine global, semi-global, and local exercises. Global exercises involve working the whole organism dynamically, while semi-global exercising involves working an entire limb in a closed or open-chain activity. Local exercises involve specifically working the affected joint, with activation of a smaller number of muscles including grade III and IV mobilizations and capsular stretching. The treatment will be initiated with 10–20 minutes of stationary bicycling/treadmill, followed by 3 to 4 different semi-global and local exercises with three sets of 30 repetitions. Afterward, the patient will perform another global exercise of 5–10 minutes of stationary bicycling/treadmill. Immediately after this, another 3 to 4 semi-global and local exercises with three sets of 30 repetitions will be performed. The treatment ends with another global exercise of 10 minutes of stationary bicycling/treadmill. Main outcome variables: 1.Pain 2.ROM 3.Functional Disability

Study aim: To evaluate the Effects of mobilization with movement at Sacroiliac joint with and without Postero-Anterior Glide at L5-S1 in patients with Sacroiliac joint dysfunction. Design: Randomized, parallel-group trial with blinded patient and assessor in 26 patients randomly assigned by computerised method with concealed randomisation sequence carried out at an external site Settings and conduct: Ghurki trust and teaching hospital National hospital defence max rehabitilation centre patient and assesor will be blinded, them without knowing to which group they belong and whom they are assesing, researcher will allocate and therapist will be treating. Participants/Inclusion and exclusion criteria: INCLUSION CRITERIA: Patients who had an acute unilateral or bilateral SIJ syndrome during the past 6 weeks, level of pain over the previous 24 h increased, no manipulative treatment within the past month, Pain and tenderness at SIJ, FABER, compression, distraction, and Gaenslen's. provocation tests POSITIVE EXCLUSION CRITERIA: Previous spinal manipulative treatment, Having pain and discomfort in the lumbar spine, Destructive lesions of the spine, ribs and pelvis, Cauda equina syndrome, gross instability or active infection, Pregnancy, Spondylolysthesis, and previous back surgery. Intervention groups: Intervention group: After taking consent from both groups, interventional group will be treated with postero-anterior glide at L5-S1 with mobilization with movement at sacroiliac joint CONTROL GROUP will be treated with mobilization with movement at sacroiliac joint only Main outcome variables: Numeric pain rating scale (NPRS) Oswestry Disability Questionnaire (ODQ)

Study aim: To compare the effects of Kinesio taping versus McConnell taping on function and dynamic postural control in athletes with patellofemoral pain syndrome. Design: Parallel groups, single blinded, single setting randomized control trial Settings and conduct: Spine Physiotherapy Clinic, Sahiwal. Participants/Inclusion and exclusion criteria: Inclusion Criteria • Referred athletes with chronic PFPS, Patients diagnosed with chronic PFPS, Subject not received taping before, Subject not receiving any pain killer or medical treatment, Positive Clark’s test , Age: 18 to 40 years, Both gender Exclusion Criteria Patients with history of: Ankle and hip pathology, Any other knee abnormality or arthritis, Lower limb fracture, Subject using corticosteroids, Pregnancy, Irritation from taping,Surgery Intervention groups: 60 athlete patients were randomly allocated into 2 groups, 30 patients in each group. Group A patient were treated with Kinesio taping while Group B patients were treated with McConnell taping technique. Randomization of patients into groups were done by mean of lottery method. Taking in account an inclusion and exclusion criteria before enrolling them in this study. Informed consent was considered in written about their willingness in the study. Volunteers was provided with the detailed information i.e. both verbal and written regarding the study procedure. Both groups receive conventional therapy, that was TENS, ultrasound and quadriceps exercises Main outcome variables: • Functional Activity was assessed by using lower extremity functional scale • Postural and Dynamic Control measured by star excursion balance test

Study aim: To compare the Effects of Virtual Reality Exercises and routine Physical Therapy on pain Intensity, Lumbar range of Motion, Muscle Endurance, Functional disability and Quality of life in patients with chronic low back pain Design: Randomized controlled trial a single blinded study Settings and conduct: The study would be sinlge blinded as assessors of the study would be kept blind of the treatment group to which the patient will be allocated and willbe done at The Physiotherapy Department of Government Services Hospital Lahore. Participants/Inclusion and exclusion criteria: Inclusion Criteria: 25-50 years, Both males and females, Low back pain that persists for more than 12 weeks, Non radiating low back pain, Localized pain in Lumbar region . Exclusion Criteria:History of any trauma or fracture of the spine or lower limb, cardiac ,metabolic, endocrine, Pott’s disease or any other systematic disease, neurological diseases such as Parkinson’s disease, stroke and epilepsy. Previous surgery of spine, corticosteroid or anticoagulants, Drug abuse, Congenital deformity, pathology or musculoskeletal disorder in lower limb,exposure to virtual reality games or exercises in past three monthsand Virtual reality games phobia Intervention groups: Group A will get Virtual Reality Exercises.The Kinect device will be used for Virtual Reality Exercises in which patient will do exercises through Reflex ridge (trunk slide flexion, jumping, sitting to avoid hitting the obstacles combine movemnts of arms and legs) and Body Ball VR games(pushing head,moving arm and kicking ball)as displayed on wall mounted LCD. Group B will get only Routine Physcial Therapy exercies. Both groups will get Patient education, posture care, back exercises etc (as described in detail in main section of Intervention groups) Main outcome variables: Pain intensity,Lumbar range of motion ,Functional disability and Muscle endurance

Study aim: To determine the effects of intensive multidimensional trunk training exercises combined with dual-task compared to routine physiotherapy on balance, mobility and fall risk in stroke patients 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. The sample size was 84 out of which 74 patients completed the study. Settings and conduct: Patients were recruited from the University clinic of the University of Lahore, a 400-bed hospital with separate physiotherapy and stroke rehabilitation facility. It was single-blinded (assessor blinded) study Participants/Inclusion and exclusion criteria: Inclusion criteria: Patient with an ability to stand 30 seconds or more without any assistance, score 24 or over on mini-mental status examination, and ability to sit independently at least for 30 seconds on a stable surface. Exclusion criteria: Patients with comorbid conditions such as cerebellar disorders, Parkinson's disease, a vestibular lesion, arthritis or degenerative diseases of the lower limbs affecting motor performance, self-reported problems with device use (orthopaedic, medical, and/or painful conditions), a body mass index greater than 31 kg/m 2 who are not able to perform exercises for 30 minutes or longer, any medical contraindication against trunk exercise and patient with pusher syndrome. Intervention groups: Intervention group: multidimensional trunk exercises combined with dual-task, flexibility and task-oriented exercises Comparison group: trunk exercises, flexibility and task-oriented exercises Main outcome variables: Balance & mobility measured with time up and go test, timed walking test, go up and down standard 10 stairs, trunk performance measured with trunk impairment scale, and fall risk measured with fall risk assessment tool.

Study aim: To determine the effect of neuromobilization in cervical rediculopathy as this is cost effective treatment. Design: A double blinded randomized controlled trial Settings and conduct: Physiotherapy department of Mayo hospital Lahore Punjab,Pakistan.IRB Approved Participants/Inclusion and exclusion criteria: Inclusion criteria: Age group between 35-50 years . Gender both male and female. Subjects having radiating symptomsof cervical radiculopathy .Subjects with no previous cervical surgeries . Subjects with no loss of the upper limb movement. Exclusion criteria: Subjects having traumatic history . Subjects with Osteoporosis . Hypermobile patients . Subjects with circulatory disturbances . Subjects with peripheral nerve entrapment . Subjects with tumor causing cervical radiculopathy . Patients who are not willing to be included in the study. Intervention groups: (Experimental group): A neural mobilization technique with sliding of median nerve will be applied with 3 seconds hold in each repetition In this group conservative treatment which will include cervical isometrics exercises with 10 repetitions in each direction with 5 seconds hold will also be given. Isometric exercises will be performed with the patient in sitting position. (control group): Conservative treatment will be given which will include cervical isometrics exercises with 10 repetitions in each direction with 5 seconds hold will also be given. Isometric exercises will be performed with the patient in sitting position 3 sets of these exercises will be performed with the rest period of 30seconds. All the subjects will be given hot packs for 10 minutes prior to the treatment. Main outcome variables: Range of motion measured by inclinometer,Pain intensity meaured by visual analogue scale,Muscle endurance bycranio cervical flexion test,Disability by neck diability index

Study aim: • To determine the effect of Spinal Manipulative Therapy on Thoracic Spinal Pain,ROM & QoL Design: A double blind randomized controlled trial. Settings and conduct: This RCT will be conducted according to CONSORT guidelines . A parallel group RCT with 1:1 allocation ratio will be conducted at physical therapy department of Services Hospital Lahore. Patients will be asked to sign an informed consent. The assessor & patients will be blinded to allocation of treatment groups. Participants/Inclusion and exclusion criteria: Inclusion: • Age between 40 and 60 years. • Mid line upper back pain, • Decreased thoracic range of motion Exclusion: • Severe spinal deformity • Any systemic disease e.g. cardiovascular or neurological etc. • Traumatic history and any other red flags of spinal pain Intervention groups: Experimental group will be managed with spinal manipulative therapy while the control group will be managed with routine physiotherapy and both the groups will receive ergonomic advice. The treatment will be given maximum for four weeks; three sessions per week. Then patients will be followed up at 8th and 12th week of treatment to check the consistency of effects. Main outcome variables:  The Pain threshold will be measured with VAS  Quality of pain and the sensory dimensions will be assessed with McGill Pain Questionnaire  The subjective outcome of pain and disability will be obtained with the Oswestry Back Pain Disability Index  Objective measurement of ROM in the thoracic spine will be measured with the Goniometer.  Chest expansion will be measured by Measurement Tape  HR will be recorded by pulse oximeter and BP recording will be done by Digital sphygmomanometer.  QOL improvement will be judged by using QOL questionnaire .

Study aim: To compare the incidence of postoperative delirium in elderly patients receiving propofol-based versus sevoflurane-based general anesthesia Design: A randomised, parallel group, superiority clinical trial comparing propofol-based versus sevoflurane-based anesthesia in elderly surgical patients, with concealed allocation and blinded outcome assessment using the Confusion Assessment Method over seven postoperative days.The study enrolled 200 patients, with 100 patients in each group. Settings and conduct: The study was conducted at the Department of Anesthesia, Allied Hospital, Faisalabad over 6 months. After ethical approval and informed consent, patients aged 60–90 years undergoing elective moderate-risk surgery under general anesthesia were randomly assigned to receive either propofol- or sevoflurane-based anesthesia. Postoperative delirium was assessed twice daily for 7 days using the CAM by trained, blinded assessors. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Patients of both genders having age 60-90 years .Patients undergoing for elective surgery under general anesthesia American society of Anesthesiology I-III Exclusion criteria: Patients with Preoperative delirium, History of dementia ,Psychiatric disease like schizophrenia, epilepsy, Parkinson's disease or myasthenia gravis ,Hepatic or renal dysfunction ,Requirement for postoperative mechanical ventilation ,History of surgery within the recent six months ,Allergy to any of the study drugs Intervention groups: Group A patients will receive sevoflurane based anesthesia while Group-B patients will receive propofol based anesthesia Main outcome variables: The primary outcome variable is the incidence of postoperative delirium within 7 days after surgery, assessed using the Confusion Assessment Method. Delirium is recorded as a binary outcome (Yes/No) based on CAM diagnostic criteria during twice-daily evaluations

Study aim: To compare the effect of Diaphragm training and myofascial release back pain patients with non- specific chronic low back pain. Design: A concealed, randomized, blinded, clinical trial with a parallel group design of 44 patients, enrolled between April 2025 and June 2025 Settings and conduct: The study was held at Arif Memorial Teaching hospital and Hameed Latif Hospital Lahore. The blinding is achieved by concealment in which the treatment allocation for each patient. This is done to avoid biasness Participants/Inclusion and exclusion criteria: Inclusion Criteria: Participants were included if they had intermittent nonspecific CLBP for ≥12 weeks, with VAS between 3 to 7. All participants were active at a recreational level, for 2–4 times per week, since at least 3 years. Patients with low back pain without radiculopathy. Individual willing to participate in study Exclusion Criteria: Upper abdominal surgery, lumbar surgery experience, inflammatory spinal disease, spinal deformities, neurologic radiating pain Intervention groups: Group A: Diaphragm Training Group B: Myofascial Release technique Main outcome variables: Numeric pain rating scale was used to measure the intensity of pain, Oswestry Disability Index for the measurement of disability and Schober’s test for lumbar flexibility

Study aim: To determine the comparative effects of Diaphragmatic breathing exercises and diaphragmatic myofascial release in post-operative patients diagnosed with GERD. Design: Randomized clinical trial Settings and conduct: Following hospitals of FAISALABAD Allied hospital DHQ hospital Madina Teaching Hospital Aziz Fatima hospital Participants/Inclusion and exclusion criteria: Inclusion Criteria  Both genders .  Age 25 to 45 years,  Participants with a confirmed diagnosis of GERD after 1 week of surgery.  Willingness to participate  Participants who have not responded well to conventional treatments for GERD  Patients with stable cardiovascular and respiratory system. Exclusion criteria:  Participants with significant comorbidities that may confound the study results or interfere with the ability to perform diaphragmatic interventions. For example, serious cardiovascular or respiratory diseases.  Diagnosed febrile condition  Individuals who have undergone recent abdominal or thoracic surgeries, as these may affect diaphragmatic function and introduce variability in the study population .  Diagnosed malignancy  Diagnosed psychiatric disorder.  Unwillingness to Participate in Physiotherapy  Osteoporosis  Participants with Smoking and excessive alcohol intake history will be excluded because it can impact GERD symptoms and may influence the study outcomes.  Pregnancy  Diagnosed dermatological condition  Participants who are currently enrolled in other clinical trials to avoid potential confounding factors.  Underline stomach conditions Intervention groups: Diaphragmatic group (DB group) Diaphragmatic Myofascial release group (MFR group) Main outcome variables: Gastrointestinal symptom rating score(GSRS) Reflux Disease Questionaire (RDQ)

Study aim: The aim of this study will be to measure the effects of instrument-assisted soft tissue mobilization using (the graston) vs direct myofascial-release technique in patients with trigger points and tightness in the trapezius due to visual display terminal syndrome Design: Two arm parallel group randomised trial with blinded postoperative care and outcome assessment sample size was 45 and lottery method was used for randomization Settings and conduct: Superior university faisalabad campus. participants were blinded The blinding will be implemented through the use of coded treatments provided by an independent party. Participants/Inclusion and exclusion criteria: Inclusion criteria: musculoskeletal strain (upper trapezius) symptoms for more than 3 months. both males and females. dry eyes. visual blurring. exclusive mobile and laptop users. 4 to 5 hours per day and five to six days a week. history of consecutive near-screen exposure from the past 8 weeks. participants complained of pain of ≥ 3 on the numeric pain rating scale (moderate). age between 18-35 years. a 20° to 30° loss of active neck flexion/extension with a loss of cervical rotation of 20° to 40° to both sides and a 10° to 15° loss of lateral flexion. exclusion criteria: patients who have a history of trauma affecting mainly the neck any radiating pain or prolapsed intervertebral disc-related neurological symptoms. patients with co-morbidities other chronic neck pain and trapezius trigger points and tightness. osteoporosis/ osteoarthritis cervical spondylosis/spondylolisthesis and asymptomatic trigger points. Intervention groups: intervention group 1: direct myofascial release technique intervention group 2: graston technique control group: ultrasonic therapy Main outcome variables: Main outcome variables are pain, range of motion, muscle flexibility, and work performance parameters

Study aim: To compare the effects of Low Level Laser Acupuncture with Dry Needling when using Routine Physical Therapy as an adjunct therapy to them for managing pain intensity, functional disability, Range of Motion and quality of life in Chronic Cervical Myofascial Pain Syndrome. Design: Single Blind Randomized Controlled Trial with a parallel group design of 80 patients will have random allocation by Sealed Envelope Method. Settings and conduct: Patients from the Physical Therapy Department of Rawal Hospital, Islamabad. The outcome Assessor will be kept blind during the whole trial regarding the treatment groups. Participants/Inclusion and exclusion criteria: Inclusion Criteria: Age group between 25- 50 years, Both male and female patients, Newly diagnosed cases of chronic Myofascial Pain Syndrome of Cervical Spine. Exclusion criteria: Patients receiving treatment by other methods like vapocoolants, subdural steroid injections etc, Cervical spine surgery within the past year, Fibromyalgia, Clinical evidence of any tumor or any space occupying lesion, Any co-morbid diseases Intervention groups: Patients will be randomly assigned to a treatment group by Sealed Envelope Method, either Group-A (Low-Level Laser Acupuncture-830nm, 100 Mv/Cm2 and Routine Physical Therapy) or Group-B (Dry Needling and Routine Physical Therapy).The treatment procedures for both groups will be repeated for 3 sessions per week for 6 weeks (18 sessions) and a follow up consultation over a maximum period of Four weeks. The readings will be taken for three times (Pre-Treatment, Mid- Treatment and Post-Treatment) during the whole session. Main outcome variables: Numeric Pain Rating Scale for Pain Intensity, Neck Disability Index for Functional Disability, Goniometer for Cervical Range of Motion and SF-36 Questionnaire for Quality of Life.

Study aim: To determine the effects of Theraband assisted treadmill training on GAIT and balance outcomes in stroke patients Design: single blinded, parallel group, randomized controlled trial Settings and conduct: Post-stroke patients referred to the Rehman Medical Institute, Peshawar, during the study period will be enrolled in the trial and will be randomly assigned to the intervention and control groups through block randomization. This trial will be single-blinded so that the outcome assessor does not know about the intervention group. Participants/Inclusion and exclusion criteria: Inclusion: Stroke onset >6 months, Age 30-65 years. Exclusion: Recurrent strokes more than twice Intervention groups: Experimental group: • A total of 50 minutes of training will be given, which will include Treadmill training with theraband for 30 minutes in a harness support and conventional therapy (general stretching and strengthening exercises) for 20 minutes, 5 days a week, for a total of 4 weeks. • 30 minutes treadmill training will be given in three sets of 10 minutes each. with 2 minutes of rest in between. • Participants will walk on a treadmill at a normal pace. Speed for the first 2 weeks will be 1m/s and of the last 2 weeks will be 1.5m/s. Control group: • A total of 50 minutes of training will be given, which will include Treadmill training for 30 minutes in a harness support and conventional therapy (general stretching and strengthening). exercises) for 20 minutes, 5 days a week, for a total of 4 weeks. • 30 minutes treadmill training will be given in three sets of 10 minutes each. with 2 minutes of rest in between. • Participants will walk on a treadmill at a normal pace. Speed for the first 2 weeks will be 1m/s and of the last 2 weeks will be 1.5 m/s. Main outcome variables: Balance, Gait

Study aim: To determine the combined effects of trans-cranial direct current stimulation and mirror therapy on neuromuscular development and mental health in children with spastic quadriplegic CP Design: Single centered double blinded Randomized clinical trial Settings and conduct: Study setting will be Department of Physical Therapy and Rehabilitation, Ghurki Trust & Teaching Hospital, Lahore. A 30-minute session of TDCS will be administered, with 15 minutes dedicated to the upper extremity and 15 minutes to the lower extremity. The overall duration of mirror therapy will be 30 minutes: 15 minutes for the upper extremity and 15 minutes for the lower extremity. There will be a total of 10 sessions (5 times a week for 2 weeks), both for TDCS and mirror therapy treatment. While undergoing routine physical therapy five days a week for 30 minutes each from the beginning of treatment to the completion of the treatment that is follow-up (weeks 1–10). The outcome measures will be taken at baseline (Pre-I), after two weeks (Post-I), and again after ten weeks of standard of care physical therapy treatment (Post-II) which is routine physical therapy. Participants/Inclusion and exclusion criteria: inclusion Criteria Diagnosed patients of spastic quadriplegic CP via physical examination aged from 3-7 years from both genders having Level-I, II & III GMFCS who can walk with or without assistance, respectively Tone less than or equal to 2 on the modified Ashworth scale Exclusion criteria: Athetoid CP, ataxic and mixed variety, Monoplegia, diplegic hemiplegic CP patients or History of any neurosurgery or neurolytic block Intervention groups: Group-A (TDCS, MT with routine Physical Therapy) Group-B (TDCS with routine Physical Therapy) Group-C (MT with routine Physical Therapy) Main outcome variables: Motor Development & Control, Muscle performance, Anthropometry (Height, Weight, Circumference), Mental Health

Study aim: Compare the effectiveness of intra-socket application of HA+gelfoam vs gelfoam (placebo) alone to reduce the post-op pain and trismus. Design: Prospective, Split-mouth, Double-blinded Randomized controlled trial. Intervention group Hyaluronic Acid+Gelfoam, Control group-Gel-foam alone. Single center study. Settings and conduct: After taking ethical approval, 15 patients matching the inclusion criteria will be selected from the Out patient department of Oral and Maxillofacial surgery, CMH Medical College & Institute of Dentistry, Lahore. Surgical extraction will be performed by a single surgeon (researcher herself) under local anesthesia (LA). Decided Material will be placed into the socket and closure with silk sutures will be done. The patient will be prescribed antibiotics and analgesics. Post-operatively pain and trismus will be evaluated on the 1st, 2nd and 7th day by using Numerical rating scale (NRS) and ruler measuring Inter-incisal distance in millimeters. Score will be documented by co-researcher to eliminate bias. Participants/Inclusion and exclusion criteria: Inclusion Criteria: 18-40 years of age Non-smoker, non-alcoholic, similar difficulty level on both sides according to Pederson scale Exclusion Criteria: systolic blood pressure (>140 mmHg,< 90 mmHg ), diastolic (>90mmHg , <60mmHg) Any history of allergy or adverse effects to antibiotics, analgesics, or local anesthetics. Acute infection Any physical or mental disability. Pregnant woman and any use of contraceptives or corticosteroids Any patient taking antibiotics and analgesics for 15 days before operation Taken antidepressants 5 days before the surgery Intervention groups: Group that receives Intrasocket Hyaluronic Acid+ Gelfoam Main outcome variables: Pain and Trismus after Surgical Extraction of Lower Wisdom Teeth on 1st 2nd and 7th post operative day

Study aim: This study investigates the effect of virtual reality on trunk control and gross motor function in children with developmental delays Design: Randomized controlled, parallel group trial with blinded outcome accessors. it will be lottery method where numbers will be computer generated. Settings and conduct: The place of the study: The children hospital & institute of Faisalabad; the study population: children with developmental delays; type of the blinding: single blind (outcome assessors kept blind) Participants/Inclusion and exclusion criteria: Inclusion criteria; Willing to give consent; Age limit 3-8 years; Ablility to follow visual and verbal commands; Gross motor function level II-IV; Those with an appropriate cognitive level to understand a VR exercise program. Exclusion criteria: Inability to follow instructions; Other Neurological disorders (polio, epilepsy, seizures, trumatic brain injury) Malignancies and Infectious disorders (encephalitis, meningitis, malignancy, tumors); Patients having musculoskeletal problems (fracture, congenital hip dysplesia); Spastic CP with Ashworth scale 2+; Any surgery within last 6 months; A diagnosis of Autism or attention deficit disorders; Psychiatric disorder Intervention groups: Active control group will receives neurodevelopmental treatment (NDT) focusing on trunk control through dynamic co-activation, weight shift facilitation, and trunk rotation induction for half an hour 3 times a week for 6 weeks. Intervention group undergoes 24 sessions combining NDT with immersive VR protocol targeting trunk control and gross motor function over 6 weeks. Sessions include 15 minutes of NDT followed by 15 minutes of VR gameplay with dynamic adaptations for motor learning including rest period of 1 minute. Main outcome variables: The trunk control measurement scale score; gross motor function scale-88 score, HINE performa section 3