Clinical trials

Diabetic foot ulcers (DFUs) are one of the serious complications of diabetes, typically resulting from neuropathy or peripheral arterial disease, and can often lead to amputation. It affects approximately 6.3% of people with diabetes globally. In Pakistan, the overall prevalence of DFUs is 16.83%, with a slightly higher rate in females. Diabetic foot ulcers are the main reason for lower extremity amputation (LEA) with non-traumatic origin, hospitalization, healthcare costs, and mortality.

The goal of this clinical trial is to evaluate whether photobiomodulation therapy (low-level laser therapy) can reduce fatigue and improve quality of life in patients with chronic fatigue syndrome (CFS). The study will include adults aged 18-60 years diagnosed with chronic fatigue syndrome. The main questions it aims to answer are: Does photobiomodulation therapy significantly reduce fatigue levels as measured by the Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory (MFI-20)? Does photobiomodulation therapy improve pain, functional capacity, sleep quality, and psychological well-being in patients with chronic fatigue syndrome? Researchers will compare the low-level laser therapy group with a placebo (sham laser) group to determine whether photobiomodulation therapy leads to greater improvements in fatigue, pain, and overall quality of life. Participants will: Receive either active low-level laser therapy or placebo treatment three times per week for eight weeks Undergo assessments of fatigue, pain, functional capacity, quality of life, sleep quality, and psychological well-being at baseline and follow-up intervals (3, 6, and 12 months)

This randomized controlled trial will investigate the effects of anodal transcranial direct current stimulation (tDCS) on arthrogenic muscle inhibition in athletes following anterior cruciate ligament (ACL) reconstruction. Participants will be allocated into two groups: a control group receiving standard physical therapy and an experimental group receiving standard physical therapy combined with anodal tDCS over the primary motor cortex (M1). The tDCS intervention will be delivered at 2 mA for 20 minutes, three times per week for four weeks, immediately before supervised physiotherapy. The study will assess quadriceps muscle strength, arthrogenic muscle inhibition, neuromuscular control, and subjective knee function at baseline, four weeks, and eight weeks. The study aims to determine whether adding anodal tDCS to standard rehabilitation improves outcomes following ACL reconstruction.

The proposed PhD study, "Effects of Orofacial Myofunctional Therapy and Cervical Stabilization Exercises in Patients with Axis-I, Group II-a Temporomandibular Dysfunction," aims to evaluate an integrated physiotherapy approach for patients with anterior disc displacement with reduction (ADDwR/DDwR) of the temporomandibular joint. The rationale is based on the interaction between the orofacial and cervical systems. Although OMT may improve orofacial muscle coordination and function, evidence specifically addressing ADDwR remains limited. Similarly, cervical dysfunction and impaired neuromuscular control may contribute to altered mandibular mechanics and pain. The study therefore proposes combining OMT with cervical stabilization exercises to address both regional and local dysfunctions. The study will use a randomized controlled design at Lahore Medical and Dental College. A total of 88 participants (44 per group) are planned after accounting for 20% attrition. Participants will be adults aged 18-35 years with clinically diagnosed ADDwR, recruited using convenience sampling and subsequently randomly allocated to two groups. The primary objective is to determine the effects of OMT with and without cervical stabilization exercises on jaw pain, mandibular range of motion, functional limitation, maximum relative occlusal load, oral repetitive behaviours, and burnout syndrome. Cervical pain and cervical range of motion are identified as secondary outcomes. The intervention is planned for 12 weeks. OMT includes education, tongue/lip/cheek and jaw exercises, functional training, TMJ mobilization, soft-tissue release, and home exercises. Cervical stabilization includes deep neck-flexor activation, cervical bracing, progressive stabilization and strengthening exercises. Outcome measures include the Numeric Pain Rating Scale, TheraBite for mandibular ROM, OccluSense for occlusal loading, cervical inclinometer, Jaw Functional Limitation Scale, Oral Behavior Checklist, and Stress Data will be analyzed using SPSS, with intention-to-treat analysis. Linear mixed-effects models or repeated-measures ANOVA will assess group, time, and group × time effects, while ANCOVA/LMM contrasts will examine changes from baseline to 12 weeks. Effect sizes and 95% confidence intervals will also be reported. In essence: the study investigates whether adding cervical stabilization exercises to OMT provides additional improvements in pain, jaw function, occlusal loading, oral behaviours, burnout, and cervical outcomes in patients with Axis-I Group II-a TMD/ADDwR.

This randomized clinical trial will evaluate the effectiveness of combined postural correction and lumbar stabilization exercises compared with Muscle Energy Technique (MET) in postpartum women with sacroiliac joint dysfunction following cesarean delivery. The study will include women aged 18-45 years who are 12-48 weeks postpartum and meet the specified clinical criteria for sacroiliac joint dysfunction. A total of 82 participants will be randomly allocated into two groups of 41 participants each. The intervention group will receive postural correction and stabilization exercises, while the comparison group will receive Muscle Energy Technique. Treatment will be provided three times per week for four weeks. Pain intensity, functional disability, and pelvic girdle-related pain and activity limitations will be assessed using the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Pelvic Girdle Questionnaire (PGQ), respectively. Outcomes will be assessed before and after the intervention to determine the comparative effects of the two physiotherapy approaches.

The purpose of this study is to compare the effects of Tibial Nerve Mobilization and Multisensory Exercises on balance, quality of life, neuropathy severity and healing in patients with Diabetic Foot Ulcers. The aim is to identify the more effective intervention, which could help improve pain management, foot biomechanics, balance , mechanical loading , enhance blood circulation , nerve function, and promote physical rehabilitation outcomes for these patients. The more effective intervention may lead to a better quality of life, increased independence, and less post-operative discomfort for the patients. For healthcare providers, this could assist in optimizing rehabilitation plans, making them more cost-effective, and reducing the need for extended hospital stays or long-term care.

The goal of this mixed-methods study is to develop and evaluate a teletherapy training protocol and a dedicated teletherapy application for Speech-Language Pathologists (SLPs) in Pakistan. It will also assess the effectiveness, usability, and acceptability of these tools among SLPs and patients receiving speech-language therapy services. The main questions it aims to answer are: Can a standardized teletherapy training protocol be developed and validated for Speech-Language Pathologists? Can a teletherapy application improve the delivery and effectiveness of speech-language therapy services? What are the perceptions, experiences, and satisfaction levels of SLPs and patients regarding teletherapy? Does the use of the developed protocol and application improve the quality and accessibility of speech-language therapy services? Researchers will assess the effectiveness of the developed protocol and application by comparing outcomes before and after implementation among Speech-Language Pathologists and patients receiving teletherapy services. Participants will: Complete questionnaires regarding teletherapy practices, satisfaction, effectiveness, and challenges. Participate in structured interviews to share experiences and perceptions of teletherapy. Contribute to the development and validation of a teletherapy training protocol through expert consultation. Use the developed teletherapy application for speech and language intervention. Participate in evaluations to assess the effectiveness, usability, and acceptability of the protocol and application. The expected outcome of the study is the development of a validated teletherapy protocol and a comprehensive teletherapy application that can standardize telepractice and improve the accessibility and quality of speech-language pathology services in Pakistan.

This clinical trial evaluates rehabilitation strategies for post-thyroidectomy dysphonia. Voice impairment is a frequent complication following thyroid surgery. It often occurs even without direct laryngeal nerve transection. Surgical trauma, tissue edema, and mechanical stretching of the laryngeal nerves or surrounding musculature can cause persistent voice changes. These changes significantly lower a patient's quality of life.This study compares two distinct interventions against standard care:Therapeutic Voice and Neck Exercise AloneTherapeutic Voice and Neck Exercise Combined with Transcutaneous Electrical Nerve Stimulation (TENS)The objective is to determine if adding non-invasive nerve stimulation to standard therapeutic exercises accelerates neuromuscular recovery, improves vocal fold mobility, and enhances overall voice quality more effectively than exercise alone. Background and Rationale Thyroidectomies are common surgical procedures worldwide. Dysphonia post-surgery stems from multiple factors. These include temporary or permanent recurrent laryngeal nerve (RLN) neuropraxia, external branch of the superior laryngeal nerve (EBSLN) injury, laryngotracheal fixation, and peri laryngeal scarring. Patients frequently report hoarseness, vocal fatigue, reduced pitch range, and breathiness. Standard management typically includes watchful waiting or traditional voice therapy. Therapeutic exercises aim to stretch scarred tissues, strengthen paretic intrinsic laryngeal muscles, and optimize respiratory support. Transcutaneous Electrical Nerve Stimulation (TENS) uses low-voltage electrical currents to stimulate peripheral nerves. TENS is hypothesized to reduce local pain, increase regional blood flow, decrease muscle tension, and facilitate neural regeneration when applied to the anterior neck. By combining these therapies, this trial investigates whether sensory and motor electrical stimulation acts synergistically with active physical and vocal exercises. The goal is to provide a superior, faster recovery pathway for patients suffering from post-operative voice disorders.

As neurodevelopmental technique and mirror therapy had different effects on lower limb coordination, functions and ambulation. Both had proven to be helpful in the stroke patients to gain functional independency. Therefore, there was need to find out the best treatment approach either NDT, mirror therapy or both are equally effective to improve motor functions, coordination and ambulation of lower limb. This study would provide the health professionals the evidence to use best technique among these according to improvement in patients' coordination, function and ambulation.The study will be randomized clinical trial. This study will be conducted at the University of Lahore. A sample size of 40 will be randomly allocated by into two experimentals groups, (20 participants in each group), by the lottery method. All the screened and willing participants will be randomly allocated to two groups (Group A: Experimental group Neurodevelopmental technique, Group B: Experimental Group mirror therapy exercise) by lottery method. This study will be a single blinded study in which assessor will be blinded.

This 12-week RCT investigates the hepatoprotective and immunomodulatory effects of Ganoderma lucidum combined with a probiotic-rich diet in adults with MAFLD, assessing liver enzymes, lipid profile, inflammation, gut microbiota, and oxidative stress. Findings are expected to show dose-dependent improvements in hepatic fat, insulin resistance, and inflammatory markers, potentially reducing reliance on pharmacotherapy in

Carpal Tunnel Syndrome (CTS) is the most common peripheral entrapment neuropathy, causing pain, paresthesia, and hand dysfunction due to median nerve compression at the wrist. While physiotherapy provides symptom relief, it does not effectively address the underlying neuroplastic deficits of the median nerve. Photobiomodulation (PBM), delivered at 830 nm near-infrared wavelength, has shown potential to enhance peripheral nerve regeneration via cytochrome c oxidase activation, ATP synthesis, and upregulation of neurotrophic factors including brain-derived neurotrophic factor (BDNF). This randomized controlled trial will evaluate whether 830 nm PBM (200 mW, 4 J/cm², 12 sessions over 4 weeks) combined with routine physiotherapy produces significantly greater neuroplastic recovery of the median nerve - assessed by high-resolution ultrasound (HRUS) measurement of median nerve cross-sectional area (CSA), nerve conduction study parameters and serum BDNF - compared to sham PBM combined with identical physiotherapy in adults with mild-to-moderate CTS. Neuroplasticity was operationalised as a multimodal construct comprising: (1) functional recovery, indexed by nerve conduction study parameters; (2) structural remodelling, indexed by median nerve cross-sectional area on high-resolution ultrasound; and (3) molecular neuroplastic signalling, indexed by serum BDNF. This multimodal approach was adopted because no single measure captures the full construct of peripheral nerve neuroplasticity (Padua et al., 2020).

This randomized controlled trial aims to compare the effectiveness Weighted dangling exercises versus vastus medialis oblique muscle neuromuscular electrical stimulation(VMO+NMES) in patients with knee osteoarthritis. The study will recruit 48 participants (accounting for 10% attrition), aged 40-60 years, from University of Lahore Teaching Hospital using convenience sampling. Participants will be randomly allocated into two groups: an interventional group receiving WDE and other interventional group undergoing VMO strength training with NMES. Both interventions will be administered three times per week for 8 weeks under professional supervision. Outcome measures including pain intensity (NPRS), Functional Disability (Western Ontario and McMaster Universities Osteoarthritis Index),Muscle Strength (MMT) will be assessed at baseline, 4 weeks, and 8 weeks. Data will be analyzed using SPSS, with appropriate parametric or non-parametric tests applied after checking data normality. Ethical approval will be obtained, informed consent will be secured, and participant confidentiality will be strictly maintained.

Plantar fasciitis is a common musculoskeletal disorder characterized by heel pain and functional limitations, which may become more pronounced during pregnancy due to weight gain, hormonal changes, and altered biomechanics. Conservative physiotherapy interventions are commonly used to manage symptoms; however, evidence regarding the comparative effectiveness of different manual therapy techniques in pregnant women remains limited. This randomized clinical trial aims to compare the effects of Myofascial Release (MFR) and Instrument-Assisted Soft Tissue Mobilization (IASTM) on pain intensity and foot function in pregnant women diagnosed with plantar fasciitis. A total of 44 pregnant women aged 20-40 years in their second or third trimester will be recruited and randomly allocated into two treatment groups. Both groups will receive baseline treatment consisting of therapeutic ultrasound, gastrocnemius and soleus stretching exercises, tibialis anterior strengthening, and a home exercise program. In addition, Group A will receive Myofascial Release, while Group B will receive Instrument-Assisted Soft Tissue Mobilization. The intervention will be delivered over a period of four weeks, with three supervised sessions per week. Pain intensity will be assessed using the Numerical Pain Rating Scale (NPRS), while foot-related pain, disability, and functional limitations will be measured using the Foot Function Index (FFI). Outcomes will be evaluated at baseline and after completion of the intervention. The findings of this study are expected to provide evidence regarding the most effective manual therapy approach for reducing pain and improving functional outcomes in pregnant women suffering from plantar fasciitis.

The goal of this clinical trial is to learn if adding scheduled home-based rehabilitation to clinic-based rehabilitation improves walking ability and daily activities in people aged 40 to 50 with sub-acute stroke. The main questions it aims to answer are: * Does adding home exercises improve walking ability in people with sub-acute stroke? * Does adding home exercises improve the ability to do daily activities in people with sub-acute stroke? Researchers will compare clinic-based rehabilitation plus home-based rehabilitation to clinic-based rehabilitation alone to see if adding home exercises leads to better recovery after stroke. Participants will: * Attend physical therapy at the hospital 3 days per week for 12 weeks * Do walking practice, balance training, and leg exercises at the clinic * Do home exercises including marching, step-ups, sit-to-stand, and balance exercises on non-clinic days (home exercise group only) * Track home exercises using a weekly logbook * Be tested at the start and after 12 weeks

Parkinson's disease (PD) is movement disorder of the nervous system that worsens over time. As nerve cells (neurons) in parts of the brain weaken or are damaged or die, people may begin to notice problems with movement, tremor, stiffness in the limbs or the trunk of the body, or impaired balance. As these symptoms become more obvious, people may have difficulty walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms appear in other diseases as well. Both non-modifiable (age, gender) and modifiable risk factors such as occupation, exposure to pesticides, and depression have an association with PD. Several studies have suggested that Parkinson disease is more common in men. The MT mechanism is based on the concept of visual illusion. The movement of the non-paretic part in front of the mirror (reflective side) is perceived as that of the paretic body part (hidden beside the mirror). MT allows an individual to have an experience of normal movement, even for the severely paralyzed limb. In addition, wherever other rehabilitation methods fail to induce normal movements without any compensation, MT may act as a foundation step for further motor therapy. The perception of movement illusion, a neuropsychological phenomenon may induce neural activation of the lesioned brain and enhance associated motor recovery. Therefore the aim of this study is to compare the effects of truck control exercise program and mirror therapy on balance and postural instability in patients with Parkinson's disease.

This clinical trial will evaluate the effects of High-Intensity Laser Therapy (HILT) on femoral cartilage thickness and other clinical outcomes in people with knee osteoarthritis. Participants aged 40 to 60 years with grade II or III knee osteoarthritis will be randomly assigned to receive either HILT plus conventional physiotherapy or conventional physiotherapy alone. Both groups will receive 12 treatment sessions on alternate days for 4 weeks. The study will assess changes in cartilage thickness using ultrasound, as well as improvements in pain, knee movement, muscle strength, and daily function. Findings from this research may help improve physiotherapy treatment strategies for patients with knee osteoarthritis.

Scapular muscle strengthening combined with core stabilization exercises is an effective intervention for reducing neck pain in telephone operators. Prolonged sitting, forward head posture, and repetitive upper-limb use in this population often lead to scapular dyskinesis and poor trunk control, increasing cervical spine stress. Strengthening the scapular stabilizers (such as the middle and lower trapezius and serratus anterior) improves shoulder girdle alignment and reduces overload on cervical muscles. When combined with core stabilization exercises, which enhance trunk stability and postural control, overall biomechanical efficiency is improved. This combined approach has been shown to decrease pain intensity, improve neck function, enhance posture, and reduce work-related musculoskeletal strain in telephone operators with neck pain.

The goal of this intervention study is to examine the impact of pharmacist-led interventions in psychiatric patients initiating second-generation antipsychotic treatment. The primary purpose is to assess the impact of intervention on antipsychotic induced metabolic outcomes, such as weight gain and other cardiometabolic risk markers, in patients aged 18 to 60 years who have been diagnosed with chronic mental disorder. Participants will be assigned to either the intervention or the control group. The intervention group will receive educational interventions from the pharmacist at baseline, after 4 weeks, 8 weeks, and 12 weeks along with the standard therapy prescribed by the psychiatrist. On the other hand, the control group will receive only the standard therapy with no intervention from the pharmacist.

Cerebral palsy is a common neurodevelopmental disorder that affects movement, posture, and functional abilities in children. This randomized controlled trial focuses on comparing the effects of task-oriented circuit training and group circuit training on functional performance and functional capacity in children with quadriplegic cerebral palsy. Outcomes will be measured using the Gross Motor Function Measure (GMFM-88) and the Activities Scale for Kids-Capability version (ASK-C). The findings of this study may help identify effective rehabilitation strategies for improving functional outcomes in children with cerebral palsy.

Study Design: Randomized Clinical Trial Objective: To find the effects of Progressive Resistance Exercises for balance and risk of falls in elderly population. To find the effects of Functional Training for balance and risk of falls in elderly population. To compare the effects of Progressive Resistance Exercises and Functional Training for balance and risk of falls in elderly population. Inclusion Criteria: Both Males and Female Patients Patients Age 65 years or above Participants with intact cognitive function or mild cognitive impairment who can follow instructions and provide informed consent Individuals medically cleared by their physician to engage in moderate-intensity physical activities, with no unstable medical conditions that could impede participation Participants willing to commit to an 8-week intervention program (3 sessions per week) and attend follow-ups as required. Exclusion Criteria: Elderly individuals who are non-ambulatory or unable to perform basic mobility tasks, such as standing or walking independently, even with assistive devices. Uncontrolled medical conditions such as uncontrolled hypertension, unstable angina, or severe arrhythmias. Participants with severe musculoskeletal conditions that significantly limit mobility or exercise participation (e.g., severe arthritis, recent fractures, or joint replacements within the last 6 months). Presence of acute pain or injury that may worsen with physical activity. Individuals with progressive neurological conditions such as Parkinson's disease, stroke with severe residual deficits, or multiple sclerosis that impede safe participation in physical activities. Group 1: Progressive Resistance Exercises Participants in the Progressive Resistance Training (PRT) group will engage in a structured exercise program designed to progressively increase muscle strength, balance, and overall physical function. Group 2: Functional Training Participants in the Functional Training (FT) group will engage in exercises that mimic daily activities to improve balance, strength, mobility, and functional independence.

Vojta therapy that is reflex locomotion therapy is a neurophysiological rehabilitation approach that stimulates specific "reflex zones" on the body to activate global, innate movement patterns. In stroke rehabilitation, it is used to improve postural control, trunk stability, and functional movement by engaging automatic motor responses. Vojta stimulation can activate motor cortical and subcortical areas as well as postural muscles. Pose estimation will be used to analyze human motion in stroke patients. The study will identify if there is significant difference in the comparative effects of Vojta therapy in addition to routine physical therapy on posture, trunk control and upper extremity motor function in sub-acute stroke patients

This study compared the effects of Muscle Energy Technique and Bowen Therapy on patients with Text Neck Syndrome's pain, function ROM, and posture. Today, text neck syndrome is a growing issue. The majority of us experience this unpleasant condition to some extent. There is no study that has compared the effects of muscle energy technique and Bowen therapy, although they can both be quite effective in helping individuals with text neck syndrome reduce their discomfort, improve their range of motion, and improve their functional impairment. So, the goal of this study was to compare the two treatments' results in order to determine whether one was a better method for treating text neck syndrome patients' discomfort by enhancing range of motion and functional impairment.

The current study is to evaluate the comparative effects of low-level laser therapy and muscle energy technique on pain, range of motion, and functional results in diabetic patients with frozen shoulder. This research aims to enhance the existing data on managing diabetes-related musculoskeletal issues by assessing the comparative advantages of various therapies, therefore assisting physicians in choosing appropriate, patient-centred rehabilitation procedures.

This study tests if low-level laser therapy (LLLT) with different light wavelengths can help people with cervicogenic headache, a type of headache caused by neck problems. Adults aged 18-65 with this headache for at least 3 months will try one of three LLLT treatments (675nm, 820nm, or a mix of wavelengths) along with regular physical therapy like stretching and exercises. The study will check pain levels, how often headaches happen, neck movement, disability, and quality of life over 6 weeks, with follow-ups at 3 and 6 months. the investigators want to find the best LLLT option to reduce headache symptoms safely.

Dual task training enhances gross motor function, reduce fatigue and minimize cognitive motor interference in children with diplegic cerebral palsy by promoting neuroplasticity and improving dual task processing. Vestibular stimulation improve balance triggering the vestibulospinal reflex, which play a key role in maintaining posture and reducing the risk of fall. Integrating dual task training with vestibular stimulation can provide a more holistic rehabilitation strategy by enhancing balance and posture stability through improved vestibular system activation, supporting motor and cognitive coordination by challenging the brain to handle tasks concurrently, and boosting functional mobility by mimicking everyday situations that require divided attention. This RCT evaluates its effectiveness in optimizing motor-cognitive integration, functional mobility and endurance compared to conventional motor training approaches.