Journal of Precision Medicine and Health Research
*]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" tabindex="-1" data-turn-id="request-WEB:cf21a282-9006-40ed-8a24-d3c6e40d6d0a-0" data-testid="conversation-turn-2" data-scroll-anchor="true" data-turn="assistant"> The Journal of Precision Medicine and Health Research (JPMHR) is a peer-reviewed, fully open-access journal published biannually by BMU Ventures (Private) Limited, Pakistan. The journal advances precision and personalized approaches across medicine, health sciences, and allied disciplines by publishing methodologically rigorous research that integrates biological, clinical, technological, and population-level perspectives—supporting individualized care and improved health system performance. JPMHR follows a documented double-blind peer review model and a transparent editorial governance framework, with defined procedures for plagiarism screening, conflict-of-interest disclosure, corrections and retractions, and complaints and appeals. All articles are published with immediate, free access under CC BY 4.0, with authors retaining copyright. APCs are payable only after acceptance, and the journal documents its long-term archiving and digital preservation arrangements. Full policies are publicly available on the journal website. Open Access • Double-Blind Peer Review • CC BY 4.0 • Biannual • APC After Acceptance Tagline: Advancing precision medicine together—where rigorous science matters more than seniority or sensationalism. Journal Identity Journal Title: Journal of Precision Medicine and Health Research (JPMHR) Publisher: BMU Ventures (Private) Limited, Pakistan Publisher Address: 8 Commercial, Sunny Park, Lahore 54000, Pakistan Publisher Email: info@bmuventures.com Publisher Website: https://bmuventures.com Journal Website: https://jpmhr.com Journal Contact: editor@jpmhr.com ISSN (Online): 3106-9495 ISSN Portal Record: https://portal.issn.org/resource/ISSN-L/3106-9495 Publication Frequency: Biannual (Two Issues Per Year) Open Access, Licensing & Copyright JPMHR is a fully open-access journal. Published articles are immediately available online without subscription barriers. Readers may read, download, copy, distribute, print, search, link to, and reuse content for any lawful purpose, provided appropriate attribution is given to the author(s) and source. All articles are published under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Authors retain copyright and grant the journal a non-exclusive license to publish and distribute the work. The journal supports self-archiving (Green Open Access) as outlined in its official policy. Aims and Scope JPMHR publishes interdisciplinary research that enables precision prevention, diagnosis, treatment, rehabilitation, and healthcare system optimization. The journal prioritizes work that strengthens patient stratification, risk prediction, therapeutic targeting, implementation feasibility, and translational impact. Key areas include: precision and personalized medicine; genomics/pharmacogenomics and multi-omics; personalized rehabilitation and allied health sciences; precision public health and epidemiology; artificial intelligence, digital health and wearables; clinical informatics and decision support; implementation science and health policy; nursing, pharmacy, and interdisciplinary care models. The journal welcomes diverse methods—clinical trials, observational studies, diagnostic accuracy research, qualitative and mixed-methods, translational research, and implementation evaluations—when supported by robust methodology and ethical compliance. Article Types • Original Research Articles • Systematic Reviews and Meta-Analyses • Brief Reports and Pilot Studies • Case Reports demonstrating personalized diagnostic or therapeutic approaches • Methodology and Protocol Papers • Perspectives and Scholarly Commentaries Peer Review & Editorial Integrity All submissions undergo initial editorial screening followed by double-blind peer review by a minimum of two independent reviewers. Editorial decisions consider scientific validity, methodological rigor, ethical compliance, clarity of reporting, and alignment with scope. JPMHR maintains structured processes for plagiarism screening, authorship verification, conflict-of-interest disclosure, correction of errors, and management of misconduct, supporting the integrity of the scholarly record. Data Sharing & Transparency The journal promotes responsible data sharing and transparent reporting consistent with ethical approvals, participant consent, and applicable regulations. Article Processing Charges (APC) An APC of PKR 25,000 (or equivalent in USD) is payable only after acceptance. The APC supports editorial operations, peer review management, production, hosting, and online publication. Waiver provisions (where applicable) are described in the official policy. Archiving, Preservation & Privacy JPMHR ensures long-term preservation and accessibility through documented archiving and digital preservation arrangements. Personal data entered on the journal site is used exclusively for editorial and publication purposes (submission handling, peer review, production, publication, and journal communications). Data is not sold or shared for unrelated marketing; lawful basis, retention, security, and user rights are defined in the privacy policy. Complaints, Appeals & Governance The journal maintains a fair, confidential, and structured mechanism for handling complaints and appeals, with defined procedures and timelines. JPMHR also maintains transparency in ownership, management, and editorial governance, with full policies publicly accessible. Editorial Leadership Editor-in-Chief: Dr. Maryam Shabbir, PhD Associate Professor & Head of Department University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan Email: maryam.shabbir@uipt.uol.edu.pk A complete list of editorial board members is available on the Editorial Board page.
BMU Ventures (Private) Limited, Pakistan
Copyright is retained by the Author(s). Published in JPMHR under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Unrestricted reuse is permitted with proper attribution to the author(s) and source.
Prescribing Patterns and Clinician Perceptions of GLP-1 Receptor Agonists Beyond Diabetes Management: A Cross-Sectional Study
Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used beyond diabetes, yet real-world prescribing behaviors and clinician perceptions remain heterogeneous, particularly regarding gastrointestinal tolerability and cardiometabolic benefit. Objective: To characterize prescribing patterns and clinician perceptions of GLP-1–based therapies beyond diabetes management and identify factors associated with beyond-diabetes prescribing. Methods: A cross-sectional clinician survey (N=160) assessed clinician characteristics, prescribing behaviors, titration strategy, gastrointestinal adverse-event (GI-AE) discontinuation, perceived benefits (weight, cardiovascular, heart failure), perceived GI risk, and implementation barriers. The primary outcome was clinician-reported prescribing beyond diabetes (yes/no). Associations were evaluated using chi-square tests and multivariable logistic regression with odds ratios (aORs) and 95% confidence intervals (CIs). Results: Overall, 86.3% prescribed GLP-1–based therapy and 68.1% prescribed beyond diabetes. Among prescribers, 37.7% used slower-than-label titration due to GI tolerability and 28.3% reported GI-AE discontinuation in the prior 6 months. Beyond-diabetes prescribing was independently associated with formal incretin training (aOR 2.48, 95% CI 1.23–5.00) and endocrinology vs family medicine specialty (aOR 3.12, 95% CI 1.27–7.69), while higher perceived GI-AE burden (aOR 0.71 per Likert point, 95% CI 0.52–0.98) and access-barrier severity (aOR 0.66 per Likert point, 95% CI 0.44–0.98) reduced the odds of beyond-diabetes prescribing. Conclusion: Beyond-diabetes GLP-1 prescribing is common and is shaped by training and specialty context, but constrained by GI tolerability and access barriers, supporting targeted education and implementation strategies.
GLP-1 receptor agonists; prescribing patterns; clinician perceptions; obesity; gastrointestinal adverse effects; cardiovascular risk
Copyright (c) 2025 Mahrukh Badar, Fazeela Tahir, Sana Majeed Rizvi (Author) https://creativecommons.org/licenses/by/4.0
Knowledge, Attitudes, and Implementation Barriers Regarding Artificial Intelligence in Radiology Practice: A Cross-Sectional Survey of Radiologists and Radiographers
Background: Artificial intelligence (AI) tools are increasingly available for clinical radiology, yet routine implementation remains limited by governance, technical, and workforce-related constraints. Objective: To assess AI knowledge, attitudes, and perceived implementation barriers among radiologists and radiographers in private healthcare centers in Lahore, and to identify predictors of intention to adopt AI in routine practice. Methods: A multi-center cross-sectional survey was conducted from January to June 2025 using a structured questionnaire assessing participant characteristics, objective AI knowledge (0–10), attitudes, and barrier severity (Likert 1–5). Group differences were tested using chi-square and t-tests, and multivariable logistic regression estimated adjusted odds ratios (AORs) for high adoption intention. Results: Of 312 participants (182 radiologists, 130 radiographers), current AI tool use was reported by 44.2% and was higher among radiologists (53.8% vs 30.8%, p<0.001). Mean knowledge score was 6.1±2.1, with higher scores among radiologists (6.8±1.9 vs 5.2±2.0; mean difference 1.60, 95% CI 1.16–2.04; p<0.001). The most frequent major barriers were ethical/legal liability (62.8%; mean 4.1/5), lack of AI knowledge (58.0%; mean 3.9/5), and trust/black-box concerns (55.8%; mean 3.8/5). In adjusted analysis, prior AI training (AOR 2.45), good knowledge (AOR 2.12), and higher trust (AOR 3.08) increased adoption intention, while high legal concern reduced intention (AOR 0.62). Conclusion: AI adoption intention was common but constrained by liability concerns, capability gaps, and trust, supporting implementation strategies centered on training, local validation, and clear governance frameworks.
artificial intelligence; radiology; radiographers; radiologists; barriers; knowledge; attitudes; implementation
Copyright (c) 2025 Muhammad Waseem, Suleman Raza (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Telerehabilitation Programs on Functional Recovery and Quality of Life in Patients Following Total Knee Arthroplasty
Background: Access to postoperative rehabilitation after total knee arthroplasty (TKA) is limited in many middle-income countries. Telerehabilitation has emerged as a promising alternative, yet evidence from South Asian populations remains sparse. Objective: To compare the effectiveness of a 12-week synchronous telerehabilitation programme versus standard outpatient physiotherapy on functional recovery and quality of life after TKA. Methods: Assessor-blinded, two-arm randomised controlled trial involving 90 patients (45 per group) 2 weeks post-unilateral primary TKA in Lahore, Pakistan. The intervention group received live videoconferencing-guided physiotherapy three times weekly plus daily home exercises; controls attended in-person hospital sessions with identical content. Primary outcome was change in Knee Injury and Osteoarthritis Outcome Score (KOOS) total at 12 weeks. ANCOVA adjusted for baseline values was used for between-group comparisons. Results: Telerehabilitation produced significantly greater improvements in KOOS total score (adjusted mean difference 4.0 points, 95% CI 0.2–7.8; p=0.038), knee flexion ROM (+6°), pain reduction, TUG (−1.4 s), gait speed, quadriceps strength, SF-12 physical component, and patient satisfaction (all p<0.05). Allocation to telerehabilitation independently predicted higher final KOOS score (β=3.68, p=0.011). Conclusion: Telerehabilitation is at least as effective as, and in several domains superior to, conventional rehabilitation after TKA, offering a highly accessible alternative in resource-constrained settings.
total knee arthroplasty; telerehabilitation; randomised controlled trial; functional recovery; quality of life; Pakistan
Copyright (c) 2025 Umer Farooq, Muhammad Tahir, Muhammad Junaid Ilyas (Author) https://creativecommons.org/licenses/by/4.0
Physician Readiness for Pharmacogenomics and Genomic-Guided Prescribing: A Cross-Sectional Study at Government College University, Faisalabad, Pakistan
Background: Pharmacogenomics (PGx) enables genotype-guided prescribing to improve drug safety and efficacy; however, implementation in low- and middle-income countries remains limited. Physician readiness—encompassing knowledge, attitudes, competence, practice behavior, and perceived barriers—is critical for clinical integration. Objective: To evaluate PGx knowledge, attitudes, self-efficacy, practice patterns, barriers, and predictors of readiness among physicians affiliated with Government College University (GCU), Faisalabad, Pakistan. Methods: A cross-sectional survey of 137 physicians was conducted using a structured instrument assessing objective knowledge (0–15), attitudes (1–5), self-efficacy (1–5), practice index (0–6), barrier score (1–5), and composite readiness (0–100). “Ready” was defined as ≥65. Associations were examined using t-tests, chi-square tests, and multivariable logistic regression with adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Mean readiness was 61.2±12.8, with 32.1% classified as ready. Formal PGx training (23.4% prevalence) was associated with higher knowledge (10.8±2.0 vs 8.1±2.3; p<0.001; g=1.20) and readiness (72.0±10.0 vs 58.0±12.0; p<0.001). Training independently predicted readiness (OR=3.6; 95% CI 1.5–8.7; p=0.004), as did knowledge of local ordering pathways (OR=4.2; 95% CI 1.8–10.0; p=0.001), while higher barrier scores reduced readiness (OR=0.55 per unit increase; p=0.009). Conclusion: Physician readiness for PGx at GCU Faisalabad is moderate but suboptimal; structured education and system-level infrastructure are essential to translate favorable attitudes into genomic-guided prescribing.
shared decision-making; decision aids; cardiovascular risk; primary prevention; randomized controlled trial
Copyright (c) 2025 Bint-e-Kulsoom, Amir Nazir (Author) https://creativecommons.org/licenses/by/4.0
Biomarker-Guided Oncology Practice in Non–Small Cell Lung Cancer: Utilization Patterns, Turnaround Time, and Sector-Associated Access Barriers
Background: Biomarker-guided therapy has become standard in advanced non-small cell lung cancer (NSCLC), yet real-world implementation varies across healthcare sectors. Objective: To evaluate biomarker utilization, turnaround time, and structural access barriers among oncology clinicians and to assess whether public-sector practice is associated with higher implementation burden. Methods: A cross-sectional survey of 125 oncology professionals assessed utilization of five NSCLC biomarkers, turnaround time for single-gene and next-generation sequencing testing, and the frequency and severity of access barriers. A composite Barrier Burden Score was calculated, and sector-based comparisons were performed using ANOVA. Results: EGFR testing in at least 50% of eligible patients was reported by 64.8%, PD-L1 by 68.8%, and KRAS by 53.6%. NGS turnaround exceeded 21 days in 57.6% of respondents. Patient affordability (61.6%) and absence of reimbursement (52.0%) were the most frequently reported barriers. Public-sector clinicians demonstrated significantly higher Barrier Burden Scores compared with private-sector clinicians (17.96 ± 5.82 vs. 12.23 ± 5.23; mean difference 5.73; p = 0.003). High biomarker utilization, defined as at least 4 of 5 markers tested in at least 50% of eligible patients, was observed in 40.8%. Conclusion: Biomarker utilization was moderate and sectorally variable, with higher cumulative barrier burden associated with public-sector practice. Financial and infrastructural constraints correspond with implementation disparities and warrant targeted system-level interventions.
Precision oncology, NSCLC, biomarker utilization, implementation barriers, molecular diagnostics, healthcare disparities.
Copyright (c) 2025 Tooba Aftab, Faryal Ilyas (Author) https://creativecommons.org/licenses/by/4.0
Outcomes of Early vs. Delayed Physiotherapy Intervention in Adhesive Capsulitis
Background: Controversy persists regarding optimal timing of physiotherapy in adhesive capsulitis, with traditional approaches favouring delayed intervention while emerging evidence supports early treatment. Objective: To compare the effectiveness of early (within 4 weeks) versus delayed (after 12 weeks) structured physiotherapy on pain, disability, and range of motion in adhesive capsulitis. Methods: Eighty patients with unilateral idiopathic adhesive capsulitis were randomised to early (n=40) or delayed (n=40) physiotherapy groups. Both received identical 12-week structured mobilisation, stretching, and home exercise protocols three times weekly. Primary outcome was Disabilities of the Arm, Shoulder and Hand (DASH) score; secondary outcomes included pain (VAS), active range of motion, sleep quality, global rating of change, and analgesic use at 12 weeks. Analyses used ANCOVA adjusted for baseline values and multiple regression. Results: Early physiotherapy yielded significantly greater improvements: pain reduction (−4.6 vs −2.8 VAS points), DASH (−38.4 vs −25.8 points), flexion (+66° vs +50°), abduction (+64° vs +50°), and external rotation (+30° vs +22°); all between-group differences p ≤ 0.002. Early intervention independently predicted 11.8-point lower post-treatment DASH (95% CI −16.3 to −7.4, p < 0.001). Conclusion: Early physiotherapy within 4 weeks of symptom onset produces superior short-term clinical and functional outcomes compared with delayed intervention and should be the preferred management strategy.
adhesive capsulitis, frozen shoulder, physiotherapy, early intervention, randomised controlled trial
Copyright (c) 2025 Hussain Shakeel, Asif Saleem (Author) https://creativecommons.org/licenses/by/4.0
Wearable-Derived Cardiovascular Phenotyping of Smokers During Intense Physical Activity: A Cross Sectional Precision Exercise Study
Background: Smoking is a major modifiable risk factor for cardiovascular and pulmonary disease, yet its impact on individualized cardiovascular response patterns during intense physical activity remains insufficiently characterized. Advances in wearable technology offer opportunities for continuous physiological monitoring and precision exercise assessment. Objective: To evaluate wearable-derived cardiovascular response profiles and exercise performance among smokers and non-smokers during standardized physical activity protocols. Methods: In this analytical cross-sectional study, 43 young adults (22 smokers, 21 non-smokers) underwent the Six-Minute Walk Distance test, Balke treadmill protocol, and Ekblom-Bak cycle ergometer test. Heart rate was continuously monitored using a smartwatch, and perceived exertion was assessed using the Borg CR-10 scale. Between-group comparisons were performed using independent samples t-tests. Results: Smokers demonstrated significantly lower exercise-induced heart rate responses during the Balke treadmill and Ekblom-Bak tests (p = 0.001 and p < 0.001, respectively), while no significant difference was observed during the Six-Minute Walk test. Smokers also covered shorter walking distances and achieved lower work rates and exercise durations at higher intensities. Conclusion: Smoking is associated with blunted chronotropic adaptability and reduced exercise tolerance during intense physical activity. Wearable-derived monitoring reveals distinct cardiovascular response phenotypes, supporting its role in precision exercise assessment and personalized cardiovascular risk evaluation.
Precision exercise medicine, Smoking, Wearable technology, Cardiovascular response, Heart rate, Physical performance
Copyright (c) 2025 Qaisar Farooq, Saira Noreen (Author) https://creativecommons.org/licenses/by/4.0
Visual Outcomes and Clinical Predictors of Recovery After Medical Management of Idiopathic Intracranial Hypertension: A Prospective Cohort Study
Background: Idiopathic intracranial hypertension is a disorder of raised intracranial pressure that predominantly affects young women and poses a substantial risk of irreversible visual impairment if not promptly and effectively managed. Although medical therapy is effective in many cases, visual outcomes vary, and reliable clinical predictors of recovery remain incompletely defined, particularly in low- and middle-resource settings. Objective: To evaluate visual outcomes following medical treatment in patients with idiopathic intracranial hypertension and to identify baseline factors associated with good visual recovery. Methods: This prospective cohort study enrolled 68 adults diagnosed with idiopathic intracranial hypertension at a tertiary care hospital in DHQ Hospital, Mandi Baha ud Din, Pakistan between February 2021 and June 2024. Baseline demographic, clinical, anthropometric, and cerebrospinal fluid parameters were recorded at diagnosis. All patients received standardized medical therapy and underwent neuro-ophthalmic assessment at baseline and at three months. Visual outcomes were classified using the Wall and George grading system. Multivariable logistic regression analysis was performed to identify independent predictors of good visual outcome. Results: At three months, 54 patients (79.4%) achieved a good visual outcome. Cranial nerve palsy at baseline was significantly more frequent among patients with poor outcomes and was independently associated with reduced odds of good visual recovery. Higher body mass index was also an independent predictor of poorer visual outcome. Age, sex, cerebrospinal fluid opening pressure, and presenting symptoms were not significantly associated with visual recovery after adjustment. Conclusion: Most patients with idiopathic intracranial hypertension experienced significant visual improvement with medical therapy; however, cranial nerve palsy and higher body mass index were associated with poorer visual outcomes. Early recognition of high-risk features and close neuro-ophthalmic monitoring may improve visual prognosis.
Idiopathic intracranial hypertension; Visual outcome; Cranial nerve palsy; Body mass index; Neuro-ophthalmology
Copyright (c) 2025 Naeem Afzal, Muhammad Kashif Ali (Author) https://creativecommons.org/licenses/by/4.0
Clinical Decision-Making, Financial Incentives, and Ethical Challenges in the Escalation of Mechanical Ventilation: A PRISMA-Guided Review
Background: Mechanical ventilation is a life-saving intervention in critical care; however, decisions regarding its escalation are complex and influenced by clinical uncertainty, ethical challenges, and health system constraints. Increasing concerns have emerged regarding potential overutilization and its impact on patient outcomes and healthcare resources. Objective: To synthesize available evidence on clinical decision-making, financial influences, and ethical dilemmas associated with the escalation of invasive mechanical ventilation in adult critical care settings. Methods: A focused literature review guided by PRISMA 2020 principles was conducted using PubMed, Scopus, and Google Scholar. Studies addressing clinical, ethical, and economic aspects of mechanical ventilation were included and narratively synthesized. Results: The evidence indicates substantial variability in ventilation practices driven by prognostic uncertainty, institutional incentives, and resource pressures. Proactive ethics consultation and structured decision aids improved communication, reduced non-beneficial treatment, and shortened ICU length of stay. Long-term outcomes of prolonged mechanical ventilation were poor, with high mortality and limited functional recovery among survivors. Conclusion: Escalation of mechanical ventilation is shaped by intersecting clinical, ethical, and systemic factors. Integrating ethical frameworks, shared decision-making, and evidence-based de-escalation strategies is essential to promote patient-centered and ethically sound critical care.
Mechanical Ventilation, Critical Care, Decision Making, Ethics, Health Resources
Copyright (c) 2025 Fiza Nasir, Anam Rehman (Author) https://creativecommons.org/licenses/by/4.0
Phenotype-Guided Rehabilitation Versus Standard Physiotherapy for Symptomatic Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial
Background: Knee osteoarthritis is a heterogeneous condition in which conventional rehabilitation yields variable outcomes, partly due to differences in dominant pain mechanisms, biomechanical impairments, and metabolic contributors; clinically applicable phenotype-based approaches may improve the effectiveness of conservative care. Objective: To compare the effectiveness of phenotype-guided rehabilitation versus standard physiotherapy on pain and functional outcomes in individuals with symptomatic knee osteoarthritis. Methods: In a pragmatic, assessor-blinded randomized controlled trial conducted at a tertiary care rehabilitation center, 42 adults with symptomatic knee osteoarthritis were randomized to phenotype-guided rehabilitation or standard physiotherapy for 8–12 weeks. Participants in the intervention arm received rehabilitation matched to their dominant clinical phenotype (pain-dominant, strength/biomechanical deficit–dominant, or obesity/metabolic), while controls received standard knee osteoarthritis physiotherapy. The primary outcome was knee pain assessed using WOMAC or KOOS pain scores. Secondary outcomes included WOMAC function, numeric pain rating scale, 6-minute walk test, Timed Up and Go, adherence, and analgesic use. Results: Phenotype-guided rehabilitation resulted in significantly greater improvements in pain and function compared with standard care, with larger reductions in WOMAC pain (Δ −1.85, p=0.003), WOMAC function (Δ −6.02, p=0.001), and numeric pain intensity (Δ −1.55, p<0.001). Functional performance improved more substantially, with greater gains in 6-minute walk distance and Timed Up and Go, alongside higher adherence and reduced analgesic use. Conclusion: Phenotype-guided rehabilitation provides superior short-term clinical outcomes compared with standard physiotherapy and represents a pragmatic, implementable precision-rehabilitation strategy for knee osteoarthritis.
knee osteoarthritis; phenotype-guided rehabilitation; precision physiotherapy; randomized controlled trial; pain; function.
Copyright (c) 2025 Suhail Ikram, Basit Mehmood (Author) https://creativecommons.org/licenses/by/4.0
Clinician Knowledge, Attitudes, and Practice Regarding Pharmacogenomics
Background: Pharmacogenomics has the potential to optimize prescribing by individualizing drug selection and dosing; however, its integration into routine clinical practice remains limited due to clinician- and system-level barriers. Objective: To assess clinician knowledge, attitudes, and practice regarding pharmacogenomics, with a focus on prescribing confidence, perceived utility, implementation barriers, and training needs. Methods: A cross-sectional observational survey was conducted among prescribing healthcare professionals across multiple clinical settings in Karachi. Data were collected using a structured questionnaire assessing pharmacogenomics knowledge, perceived utility, prescribing confidence, barriers to implementation, and training exposure. Multivariable logistic regression was used to identify factors associated with high prescribing confidence. Results: Although most clinicians perceived pharmacogenomics as clinically valuable, fewer than one-third reported high prescribing confidence. Knowledge level, prior pharmacogenomics training, access to pharmacist consultation, and decision-support resources were independently associated with greater confidence. Cost and turnaround time were commonly reported barriers but were not independently associated with prescribing confidence. Conclusion: Bridging the gap between pharmacogenomics awareness and confident prescribing requires targeted education, interdisciplinary support, and clinical decision-support integration rather than reliance on cost or infrastructure improvements alone.
Pharmacogenomics; prescribing confidence; clinician knowledge; implementation barriers; precision medicine.
Copyright (c) 2024 Amna Iram, Masood Akhtar (Author) https://creativecommons.org/licenses/by/4.0
Effect of a Family History– and Risk Score–Based Decision Aid on Shared Decision-Making and Screening Outcomes: A Precision Prevention Randomized Trial
Background: Effective shared decision-making is central to cardiovascular disease prevention, yet patients frequently experience decisional conflict, limited confidence, and inadequate engagement when risk information is conveyed through usual care alone. Decision aids have been shown to improve decision quality, but comparative evidence on the impact of decision aid intensity remains limited, particularly in primary care settings within low- and middle-income countries. Objective: To evaluate the comparative effectiveness of two decision aid intensities, strong and moderate, versus usual care in improving decision quality among adults undergoing cardiovascular risk assessment. Methods: A single-center, parallel-group randomized controlled trial was conducted at Lahore General Hospital, Lahore, enrolling 39 participants allocated equally to control, moderate decision aid, or strong decision aid groups. Continuous outcomes included decisional conflict, decision self-efficacy, knowledge, decisional regret, and participation/satisfaction, while binary outcomes assessed decision attainment, family history behaviors, lifestyle changes, and screening completion. Group differences were analyzed using analysis of variance with effect sizes, followed by Bonferroni-adjusted pairwise comparisons, and categorical outcomes were evaluated using chi-square tests and odds ratios. Results: Significant between-group differences were observed across all continuous outcomes (all p ≤ 0.002), with the strong decision aid demonstrating the largest effects, including marked improvements in decision self-efficacy (d = 3.42) and participation/satisfaction (d = 2.82), and substantial reductions in decisional conflict (d = −1.45) and regret (d = −1.92). Binary outcomes showed favorable trends for decision aids but were underpowered for statistical significance. Conclusion: Decision aids significantly enhance decision quality in cardiovascular risk assessment, with greater benefits observed with higher intervention intensity, supporting the clinical value of comprehensive decision aids in primary prevention. Keywords: shared decision-making; decision aids; cardiovascular risk; primary prevention; randomized controlled trial
Copyright (c) 2024 Kainat Ilyas, Hina Abdullah, Shaheen Aftaab (Author) https://creativecommons.org/licenses/by/4.0
Determination of Nurses’ Knowledge and Practice about Post-Cesarean Wound Infection in a Tertiary-Care Hospital, Lahore: A Cross-Sectional Study
Background: Access to postoperative rehabilitation after total knee arthroplasty (TKA) is limited in many middleincome countries. Telerehabilitation has emerged as a promising alternative, yet evidence from South Asian populations remains sparse. Objective: To compare the effectiveness of a 12-week synchronous telerehabilitation programme versus standard outpatient physiotherapy on functional recovery and quality of life after TKA. Methods: Assessor-blinded, two-arm randomised controlled trial involving 90 patients (45 per group) 2 weeks post-unilateral primary TKA in Lahore, Pakistan. The intervention group received live videoconferencing-guided physiotherapy three times weekly plus daily home exercises; controls attended in-person hospital sessions with identical content. Primary outcome was change in Knee Injury and Osteoarthritis Outcome Score (KOOS) total at 12 weeks. ANCOVA adjusted for baseline values was used for between-group comparisons. Results: Telerehabilitation produced significantly greater improvements in KOOS total score (adjusted mean difference 4.0 points, 95% CI 0.2–7.8; p=0.038), knee flexion ROM (+6°), pain reduction, TUG (−1.4 s), gait speed, quadriceps strength, SF-12 physical component, and patient satisfaction (all p<0.05). Allocation to telerehabilitation independently predicted higher final KOOS score (β=3.68, p=0.011). Conclusion: Telerehabilitation is at least as effective as, and in several domains superior to, conventional rehabilitation after TKA, offering a highly accessible alternative in resource-constrained settings.
total knee arthroplasty, telerehabilitation, randomised controlled trial, functional recovery, quality of life, Pakistan
Copyright (c) 2024 Sheraz Niaz, Nazish Yameen, Kymaab Amjad (Author) https://creativecommons.org/licenses/by/4.0
Comparative Effect of Conventional vs. Device-Assisted Myofascial Release on Pain and ROM in Upper Trapezius Trigger Points
Background: Myofascial trigger points in the upper trapezius are a common source of neck pain and functional limitation. Conventional myofascial release is widely used, but device-assisted techniques may provide deeper and more consistent mechanical effects, potentially improving clinical outcomes. Objective: To compare the short-term effects of device-assisted versus conventional myofascial release on pain, cervical range of motion, pressure pain threshold, disability, muscle stiffness, and patient satisfaction. Methods: In this randomized controlled trial, 66 participants with upper trapezius trigger points were allocated to either conventional manual myofascial release or device-assisted myofascial release for six sessions over three weeks. Outcomes were measured at baseline and postintervention using VAS, goniometry, algometry, MyotonPRO stiffness assessment, and the Neck Disability Index. Between-group differences were analyzed using ANCOVA, correlations using Pearson coefficients, and predictors of pain reduction using multiple linear regression. Results: Device-assisted myofascial release produced significantly greater reductions in pain (−4.2 vs −3.0), larger improvements in cervical ROM (+14–17° vs +8–10°), higher pressure pain threshold (+2.3 vs +1.4 kg/cm²), greater reductions in disability (−24.6% vs −16.2%), and lower muscle stiffness (p < 0.001). Regression analysis identified device-assisted treatment as an independent predictor of pain reduction (β = 1.18, p < 0.001). Conclusion: Device-assisted myofascial release is superior to conventional manual techniques for short-term management of upper trapezius trigger points.
Myofascial release, IASTM, trigger points, cervical pain, randomized controlled trial, physiotherapy
Copyright (c) 2024 Sania Niaz, Hina Khalid, Zarwa Batool (Author) https://creativecommons.org/licenses/by/4.0
Influence of Saddle Design and Riding Posture on the Prevalence of Coccydynia in Motorcycle Riders
Background: Motorcycle riders are exposed to prolonged static sitting, constrained posture and whole-body vibration, but the specific contribution of saddle design and riding posture to coccydynia is poorly defined. Objective: To estimate the prevalence of coccydynia among motorcycle riders in Lahore and Gujranwala and to identify independent associations between saddle design, riding posture and coccydynia. Methods: In this cross-sectional survey, 300 professional and commuter riders (mean age 32.4 ± 8.6 years; 99.3% male) completed a structured questionnaire and brief ergonomic assessment. Coccydynia was defined as coccygeal pain aggravated by sitting for ≥4 weeks. Exposures included saddle type, saddle tilt, cushioning rating, saddle width, riding posture score, forward trunk lean, daily riding hours, vibration exposure and shock-absorber condition. Group comparisons used t-tests and chi-square tests; associations among continuous variables were examined with Pearson correlations. Multivariable logistic regression estimated adjusted odds ratios (aOR) for coccydynia. Results: Coccydynia prevalence was 36.0% (108/300). Riders with coccydynia had longer daily riding (8.9 vs 6.1 h; p < 0.001), poorer posture (7.8 vs 5.6/10; p < 0.001), greater trunk lean (34.2° vs 25.4°; p < 0.001) and higher vibration scores (8.2 vs 5.9; p < 0.001). In regression, daily riding (aOR 1.62 per hour), posture score (aOR 1.86 per point), forward saddle tilt (aOR 3.60), vibration (aOR 1.46 per unit), poor shock absorbers (aOR 2.94) and trunk lean (aOR 1.97 per 10°) independently increased odds, whereas soft foam, gel and ergonomic saddles reduced odds by 76–94% (p ≤ 0.001). Conclusion: Saddle design, saddle tilt and forward-leaning posture are major modifiable contributors to coccydynia in high-exposure motorcycle riders. Ergonomic and physiotherapy-based interventions targeting these factors are strongly warranted.
coccydynia; motorcycle riders; saddle design; riding posture; vibration; logistic regression
Copyright (c) 2024 Qazi Mohammad Irfan, Omer Shujat (Author) https://creativecommons.org/licenses/by/4.0
Impact of Core Stabilization Exercises on Postural Control in Patients with Chronic Nonspecific Low Back Pain
Background: Chronic nonspecific low back pain (CNSLBP) is associated with impaired postural control and persistent disability. Although core stabilization exercises are recommended, objective evidence comparing their effect on posturographic parameters versus conventional therapy remains limited in low-resource settings. Objective: To compare the effects of core stabilization exercises versus conventional physiotherapy on postural control, balance, pain, and disability in patients with CNSLBP. Methods: Assessor-blinded randomized controlled trial involving 64 adults with CNSLBP (≥12 weeks). Participants were allocated to 8-week core stabilization (n=32) or conventional therapy (n=32), three sessions/week. Primary outcomes were static postural sway area, velocity, and COP displacement measured by force plate. Secondary outcomes included Berg Balance Scale, VAS pain, ODI, and trunk endurance. ANCOVA examined between-group differences adjusted for baseline. Results: Core stabilization produced significantly greater improvements than conventional therapy in sway area (−160 vs −94 mm²; between-group difference −66 mm², 95% CI −98 to −34, p<0.001), sway velocity (−9.8 vs −4.9 mm/s; −4.9 mm/s, 95% CI −7.2 to −2.6, p<0.001), BBS (+7.6 vs +3.8 points), pain (−3.6 vs −2.0), and ODI (−20.2% vs −9.2%) (all p<0.001). Group allocation was the strongest predictor of post-treatment sway area (β=−62.4, p<0.001). Conclusion: Core stabilization exercises are superior to conventional therapy for restoring postural control and reducing pain and disability in CNSLBP.
chronic low back pain, core stabilization, postural control, posturography, randomized controlled trial
Copyright (c) 2024 Bostan Anwar, Arfa Rasheed (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Task-Oriented Gait Training on Functional Ambulation in Post-Stroke Patients
Background: Gait impairment is a major cause of long-term disability after stroke, and conventional physiotherapy often yields limited restoration of community-level ambulation. Task-oriented gait training (TOGT), grounded in motor learning principles, may enhance functional walking by engaging patients in repetitive, goal-directed tasks that mimic real-world gait demands. Objective: To evaluate the effectiveness of an eight-week TOGT program compared with conventional physiotherapy on functional ambulation in post-stroke patients. Methods: In this randomized controlled trial, 60 adults with subacute stroke were allocated to TOGT or conventional physiotherapy (30 per group). Both groups received supervised 45-minute sessions, five days per week for eight weeks. Outcomesincluding gait speed (primary), 6MWT distance, FAC, TUG, cadence, step symmetry, BBS, and mobility ratingwere assessed pre- and post-intervention. Results: TOGT produced significantly greater gains in gait speed (+0.30 vs +0.16 m/s; between-group Δ=0.14 m/s, p<0.001), 6MWT distance (+100 vs +50 m, p<0.001), FAC (+1.4 vs +0.9, p=0.002), and TUG (−6.6 vs −3.9 s, p=0.004). Regression analysis showed TOGT independently predicted higher post-treatment gait speed (β=0.12, p<0.001). Conclusion: Task-oriented gait training is superior to conventional physiotherapy for improving multidimensional gait outcomes after stroke.
Stroke rehabilitation; taskoriented training; gait speed; functional ambulation; randomized controlled trial.
Copyright (c) 2024 Umme Kulsoom, Bahadar Khan (Author) https://creativecommons.org/licenses/by/4.0
Relationship Between Smartphone Overuse and Cervical Proprioception Deficits in Young Adults
Background: Excessive smartphone use exposes the cervical spine to prolonged flexed posture, which may impair proprioception and contribute to neck pain among young adults. Objective: To examine the association between smartphone overuse, addiction severity, and cervical proprioception deficits in young adults. Methods: A cross-sectional study was conducted among 200 participants aged 18–30 years in Peshawar. Smartphone use, screen time, and addiction (SAS-SV) were recorded. Cervical proprioception was assessed using laser-guided joint position sense (JPS) testing in flexion, extension, and rotation. Neck pain (VAS) and disability (NDI) were documented. ANOVA, Pearson correlations, and multiple regression were performed. Results: High smartphone users (>6 h/day) demonstrated significantly greater JPS errors (flexion +1.9°, extension +2.1°, rotation +2.4°) compared with low users (<3 h/day) (all p<0.001). Smartphone hours and addiction scores showed strong correlations with JPS errors (r=0.62–0.72) and neck pain/disability (r=0.64–0.82). Regression analysis revealed that smartphone hours, addiction score, neck pain, disability, posture duration, and physical activity independently predicted flexion JPS error, explaining 68% of variance (p<0.001). Conclusion: Smartphone overuse and addiction are strongly associated with cervical proprioception deficits and neck symptoms in young adults, highlighting the need for preventive ergonomic strategies.
smartphone overuse, proprioception, cervical spine, joint position sense, neck pain, addiction
Copyright (c) 2024 Sana Suhail, Asma Batool, Faiza Shehzadi (Author) https://creativecommons.org/licenses/by/4.0
Effect of Diaphragmatic Breathing Exercises on Stress, Pain Perception, and Functional Mobility in Chronic Low Back Pain
Background: Chronic low back pain (CLBP) is perpetuated by elevated stress, maladaptive breathing patterns, and reduced functional mobility; however, the independent efficacy of diaphragmatic breathing exercises remains insufficiently examined in outpatient settings. Objective: To determine the effect of a 6-week diaphragmatic breathing exercise program on pain, perceived stress, and functional mobility in patients with chronic non-specific low back pain compared with routine care. Methods: Assessor-blinded, two-arm randomized controlled trial conducted in physiotherapy outpatient departments in Faisalabad, Pakistan. Seventy adults with CLBP ≥12 weeks were randomized to breathing exercises (twice-weekly supervised plus daily home practice) or control (routine advice). Primary outcome was pain intensity (VAS 0–10); secondary outcomes included perceived stress (PSS-10), Timed Up and Go test, respiratory rate, lumbar flexion ROM, and sleep quality, assessed at baseline and 6 weeks. Between-group differences were analyzed using ANCOVA adjusted for baseline values. Results: The breathing group achieved significantly greater reductions in pain (−2.8 vs −0.5 VAS points; mean difference −2.3, 95% CI −2.9 to −1.7), perceived stress (−7.2 vs −1.2 PSS points; mean difference −6.0, 95% CI −8.1 to −3.9), and TUG time (−2.8 vs −0.6 s; p < 0.001 for all). Allocation to breathing exercises independently predicted lower post-treatment stress (β = −5.68, p < 0.001). Conclusion: A structured 6-week diaphragmatic breathing program is an effective, lowcost adjunct therapy for reducing pain, stress, and functional limitations in chronic low back pain.
chronic low back pain, diaphragmatic breathing, perceived stress, functional mobility, randomized controlled trial
Copyright (c) 2024 Junaid Alvi, Zeeshan Ali, Sara Mubeen (Author) https://creativecommons.org/licenses/by/4.0
Comparative Effects of Aerobic vs. Resistance Training on Glycemic Control and Joint Pain in Diabetic Patients
Background: Type 2 diabetes mellitus is frequently accompanied by poor glycemic control and musculoskeletal pain, both of which impair functional capacity and adherence to healthy lifestyle behaviors. Exercise therapy is known to improve metabolic outcomes, but limited evidence directly compares aerobic and resistance training within the same trial while concurrently evaluating joint pain. Objective: To compare the effects of aerobic versus resistance training, relative to usual care, on glycemic control, lipid profile, physical activity, and joint pain in adults with type 2 diabetes. Methods: A three-arm randomized controlled trial was conducted over 12 weeks in Multan, enrolling 90 adults with type 2 diabetes allocated to aerobic training, resistance training, or usual care. Participants in the exercise groups completed supervised sessions three times weekly. Outcomes included HbA1c, fasting and postprandial glucose, lipid profile, BMI, waist circumference, physical activity, and joint pain. Repeated-measures ANOVA and multivariable regression assessed intervention effects. Results: Both aerobic and resistance training significantly improved HbA1c (−1.2% and −1.0% vs −0.1%), fasting glucose, lipids, and joint pain (−2.6 and −3.1 vs −0.1 NPRS) compared with controls (p<0.001). Aerobic training showed slightly superior glycemic improvement, while resistance training provided greater pain reduction. Conclusion: Structured aerobic and resistance training are effective adjunct therapies for improving metabolic and musculoskeletal outcomes in adults with type 2 diabetes.
Type 2 diabetes, aerobic exercise, resistance training, HbA1c, joint pain, randomized controlled trial.
Copyright (c) 2024 Yusra Shaheen, Laraib Mushtaq, Shahid Shazeen (Author) https://creativecommons.org/licenses/by/4.0
Efficacy of Virtual Reality–Based Balance Training in Reducing Fall Risk Among Older Adults
Background: Falls are a leading cause of morbidity and loss of independence in older adults, and conventional balance training, while beneficial, may be limited by low engagement and restricted ability to simulate real-world challenges. Immersive virtual reality (VR) offers a potentially more effective and engaging modality for balance rehabilitation. Objective: To compare the efficacy of VR-based balance training versus conventional balance training in improving balance, mobility, gait speed and fall risk among older adults in geriatric and rehabilitation units in Islamabad. Methods: In this single-centre randomized controlled trial, 60 adults aged ≥65 years at risk of falls were randomized to VR-based balance training (n = 30) or conventional balance training (n = 30) for 8 weeks (3 sessions/week, 40 minutes/session). Primary outcome was Berg Balance Scale (BBS). Secondary outcomes were Timed Up and Go (TUG), gait speed, composite fall risk score, Activities-specific Balance Confidence (ABC) score, fear of falling, and near-falls. Outcomes were assessed at baseline and 8 weeks by blinded assessors. Between-group differences in change were analysed using ANCOVA adjusted for baseline. Results: Compared with conventional training, VR training produced greater improvements in BBS (+7.2 vs +3.5 points; adjusted Δ +3.7, 95% CI 2.3–5.1; p < 0.001), TUG (−4.4 vs −2.1 s; Δ −2.3, 95% CI −3.3 to −1.3; p < 0.001), and gait speed (+0.20 vs +0.10 m/s; Δ +0.10, 95% CI 0.05–0.15; p < 0.001). Fall risk decreased more with VR (−19.8% vs −11.4%; Δ −8.4, 95% CI −12.2 to −4.6; p < 0.001), alongside larger gains in ABC and greater reductions in fear of falling and near-falls. Regression analysis showed VR training independently predicted a 7.8-point lower post-treatment fall risk score (p < 0.001). Conclusion: Immersive VR-based balance training is superior to conventional balance training for improving balance, mobility and fall-risk profiles in older adults in geriatric rehabilitation settings.
virtual reality; balance training; falls; gait; elderly; randomized controlled trial
Copyright (c) 2024 Asim Iqbal, Sumra Zateen (Author) https://creativecommons.org/licenses/by/4.0