Introduction: Medical profession is one of the professions where individual’s long working hours have been reported amongst Asian population. Due to the later fact, medical professional in the region have been reported to be less involved physical activities. This survey was conducted to determine level of physical activity among the medical practitioners working at Rehman Medical Institute at Peshawar. Material & Method: A cross-sectional was conducted at Rehman Medical Institute. A total of 140 medical professionals participated in this survey. General physical activity questionnaire (GPAQ) was used to collect data from the participants. Both male and female participants were included in the study. Analysis of collected data performed by SPSS version 20. Results: A total of 140 medical practitioners participated in this survey. A small number (5%) of the participants were involved in carrying out ‘low level of physical activity’, followed 24% participants involved in performing ‘moderate level of physical activity’ while the rest 71% of the participants were involved in vigorous activity. Conclusion: A big proportion of medical professional are involved in carrying out physical activities weekly.

Spinal Cord Injury is, perhaps, the most devastating injury known to mankind and is associated with incredible human sufferings and financial burden (1). Paralysis, musculoskeletal deformities, osteoporosis and heterotrophic ossifications, bowel and bladder incontinence, neuropathic pain, respiratory complications and sexual dysfunction are some of the common secondary problems in patients with spinal cord injury (2). Besides physical sufferings SCI has profound social, financial and psychological implications (3). Though SCI is incurable but rehabilitation strategies aim to minimize complications and maximize independence according to patients’ functional capabilities (4, 5). Pakistan, a developing country, where even basic health care facilities are not available, rehabilitation of SCI patients are never considered in health care system. This is partly due to the complexity of rehabilitation protocols and partly due to lack of awareness and lack of resources. Though there are some research studies conducted in Pakistan regarding SCI but majority of these studies are single centre-based studies and only reported demographics and complications of SCI patients (6-11). Due to lack of reliable information, exact burden of SCI in Pakistan cannot be estimated. In Pakistan, rehabilitation of SCI patients is subjected to a number of potential barriers. These barriers range from policies level to societal and individual level. Despite the fact that rehabilitation is one of the major pillars of modern medicine, yet in Pakistan there are no such policies to promote rehabilitation medicine. Lack of specialized SCI rehabilitation centers in Pakistan is a proof of the fact that policy makers are not interested in the field of rehabilitation medicine (10,12). Though there are some general rehabilitation centers where wide range of neurological and musculoskeletal conditions are addressed but there is lack of specialized SCI rehabilitation centers in Pakistan. Besides lack of funding and infrastructure, lack of proper referral system, lacks of multidisciplinary team approach and workforce shortages are also major challenges to rehabilitation of SCI patients in Pakistan (13, 14). After initial management of SCI patients in neurosurgery or orthopedic wards, majority of SCI patients are sent to their homes instead of referring them to rehabilitation centers. Most of these SCI patients are referred to rehabilitation centers after developing serious complications. Similarly, paucity of specialized clinical staff in managing SCI patients is another hinder in rehabilitation of SCI patients. Poverty, lack of awareness and education, cultural barriers and lack of research regarding SCI are also major challenges to rehabilitation of SCI patients in Pakistan. Despite the challenges, rehabilitation of SCI patients is important in order to enable them to reintegrate into community life. The challenges to rehabilitation of SCI patients presented here and in previous studies are alarming. Yet, an exemplary specialized SCI rehabilitation center in Pakistan is Paraplegic Centre Peshawar, which provides free of cost, “comprehensive physical rehabilitation services” including, skilled physiotherapy, occupational therapy, orthotic management, psychological counseling, recreational activities, skills building, community re-integration, provision of custom made wheel chairs, adoptive/ supportive equipment and follow up services including minor home modifications along with medical and nursing to spinal cord injury patients. Now that a model comprehensive physical rehabilitation facility for the rehabilitation of SCI patients exists in the form of Paraplegic Center Peshawar, there is a dire need to establish, many more specialized centres in all provinces of Pakistan. Govt. should constitute a committee of experts with representation from all walks of life, including people with SCI, physical therapists, rehab doctors and all other relevant medical & physical rehab professionals, who can carve out a road map for the treatment & comprehensive physical rehabilitation of SCI patients, so that they can also play their role in the society, as equally dignified citizens. That brings us to the conclusion that there is light at the end of the tunnel and a well thought over, sincere effort can quickly fill the gap.

Introduction: Text neck syndrome or ‘Text neck’ refers to pain symptoms on the neck and neighboring regions during or after prolonged looking down posture that smartphone or tablet PC users typically make when they are text messaging. Because of the development of portable information and communication technology, people use phones not only to talk and text but also to play games, listen to music, watches videos, browse the web, send and receive emails and use social media. This review was carried out on the effects of long-term use of smart phones. Material & Method: A literature search using PubMed, Medline and Google scholar was carried out to identify relevant literature. Additional searches were conducted by hand searching. The literature searches were performed in February-March 2017. The initial search terms “text neck” and “smart phone” were used to collect relevant research articles. Those studies were included in the review which were published about the text neck syndrome in young adults with age range of 19-30 years. Studies published from 2013-2016 were included. Studies in languages other than English were excluded. Results: A total of 6 studies fulfilled eligibility criteria. Results showed that 30-degree head flexion angle was associated with lowest fatigue level while head flexion angle above 50 degree was associated with highest fatigue level. 33 degrees to 45 degrees is the average range to use a smartphone measured from vertical. Severe addiction of smartphone use leads to largest errors including impaired proprioception. Conclusion: Chronic use of Smartphone leads to forward head posture, affecting upper cervical muscles and surrounding skeletal structures including ligaments which can lead to spinal deformities.

Introduction: Headaches have been posed to be a common occurring complaint being as frequent as 66% in general population. One the common types of headaches is Cervicogenic Headache which is considered as a secondary headache wherein the symptoms occur due to cervical spine and its bony components, disc or soft tissue structures. Cervicogenic headache is a syndrome described as pain felt on one side of the head, relating same side neck, shoulder and arm pain that is aggravated by neck movements or sustained head posture. Objectively, Cervicogenic Headache is diagnosed by Cervical Flexion Rotation Test (CFRT) or Passive Accessory Intervertebral Movements (PAIVM). Material & Methods: A cross-sectional survey was conducted amongst students of Rehman Medical Institute and a valid questionnaire was distributed amongst all participants. Informed consent form was obtained from all participants prior to their recruitment into this survey. Objectively measuring tools CFRT and PAIVM were used to assess CGH amongst all participants. The responses from these participants were recorded and analysed through SPSS version 22. Data was presented through mean, standard deviation and X2 test was used to see differences between categorical variables. Results: A total of 187 participants with mean age 20.93 ± 1.79 years were included in this cross-sectional survey. On the basis of subjective diagnostic criteria, the frequency of CGH amongst these students was found to be 21.9% (17.6% males and 25.5% females). The common age of students suffering from CGH was 21 years. Out of total population, 36.8% had a positive CFRT and subjective diagnostic criteria for CGH, while 26.1% had positive CFRT alone. More than 1/3 (37.1%) of the population had positive test results for both PAIVMs and subjective diagnostic criteria. Conclusion: Students in medical institutes are prone to developing cervicogenic headache which might be due to wrong posture during their studies.

Introduction: Patients satisfaction is an important and commonly used an indicator for measuring the quality in health care. It affects clinical outcomes, patient retention, and medical malpractice claims. Patient satisfaction affects the timely, eficient, and patient-centered delivery of quality health care. The importance of patient satisfaction in quality health care has been reported but there is scarcity of quality research on patient satisfaction in the field of physical therapy especially in developing countries. This survey was designed to assess level of patients’ satisfaction level receiving physical therapy services at Rehman Medical Institute, Peshawar. Material & Methods: A total of 187 patients from three wards and physical therapy OPD participated in this survey. We used Med Risk instrument for measuring Patient Satisfaction (MRPS) questionnaire for assessing levels of satisfaction among these patients. The questionnaire was modified in order to make it applicable for all the areas including cardiac, musculoskeletal and neurological conditions for both in- and outpatient departments. Data was analyzed through SPSS version 20. Results: A total of 187 with less than half (45.5%) males and the remaining female population participated in this survey. High satisfaction level of patients receiving physical therapy services was witnessed amongst the patients who participated in this survey. Majority of the patients were from cardia ward due to specialized nature of the hospital which is famous for dealing conditions with cardiac conditions. The mean score for the patients’ satisfaction level was recorded to 4.68±0.63 which is higher than reported in other trials. Conclusion: Patient getting physical therapy services at both in- and outdoor facilities at Rehman Medical Institute have high level of satisfaction.

Introduction: Construction is one the blue-collar jobs where individuals are prone to sustain musculoskeletal injuries. As a result, construction workers are forced in abandoning their work prematurely causing a significant burden on the community. Little is known about the frequency of these injuries in construction workers involved in construction industry of Hayatabad and therefore, this survey was designed. Material & Method: A cross sectional study was conducted at seven different construction sites in Hayatabad Peshawar. To collect data, questionnaire was completed from 300 construction workers. Questionnaire consists of two sections involving demographic characteristics and modified Nordic questionnaire for assessing musculoskeletal injuries. SPSS version 20 was used for data analysis. Results: Out of these 300 workers, 244 (81.3%) had symptoms in neck, shoulders, elbow, wrist/hand, upper back, lower back, hip/thigh/buttocks, knee, or ankle/feet. The majority of workers had symptoms in low back (32.83%) followed by neck (17.5%) and knee (16.19%). Conclusion: Majority of the construction workers working at Hayatabad had musculoskeletal injuries in their back and knee joints. Pain, aching and numbness were the chief complaint among these workers.