Clinical trials

This clinical study is planned to be conducted to compare retention rates of pits and fissure sealants on non carious (ICDAS score 0) vs Initial carious enamel lesions (ICDAS Score 1,2) in posterior permeant teeth at 3 months, 6 months and 12 months follow-up. This will help us guide follow-up strategies for optimal caries prevention.

Plantar fasciitis is a common musculoskeletal condition characterized by inflammation and microtears of the plantar fascia, leading to heel pain, particularly during initial steps after rest. It negatively impacts gait, mobility, and overall quality of life. Physiotherapy interventions such as stretching, strengthening, electrotherapy, and taping techniques are commonly used for management. Among these, Low-Dye taping and calcaneal taping provide biomechanical support by reducing strain on the plantar fascia and improving foot posture; however, comparative evidence between the two is limited. This study aims to evaluate the effectiveness of Low-Dye taping versus calcaneal taping in reducing pain and improving foot function in patients with plantar fasciitis. A total of 36 participants will be randomly assigned to either intervention group and treated over a two-week period. Outcome measures will include pain (VAS), functional ability (FFI), ankle range of motion (goniometer), and gait analysis, assessed before and after intervention. Data will be analyzed using SPSS v27, with statistical significance set at p \< 0.05.

This study aims to evaluate the combined effectiveness of Mulligan mobilization and core strengthening exercises in managing postpartum sacroiliac joint dysfunction (SIJD). Postpartum SIJD is a common condition resulting from biomechanical and hormonal changes during pregnancy, often leading to pelvic instability and pain. Mulligan mobilization, a manual therapy technique, aims to correct joint alignment and restore pain-free movement. For the SIJ, Mulligan MWM aims to correct subtle positional faults or movement restrictions that may cause pain and dysfunction-especially common postpartum due to ligamentous laxity, hormonal changes, and altered biomechanics.The core muscles provide stability to the pelvis and lumbar spine. When these muscles are weak or imbalanced, it can lead to increased strain on the SIJ, contributing to pain and dysfunction. Strengthening the core improves load transfer through the pelvis and enhances neuromuscular control, thereby reducing SIJ stress and symptoms. Core strengthening exercises enhances outcomes by targeting both mechanical alignment and muscular stability. Core strengthening exercises target muscles that support pelvic stability, including the transverse abdominis and pelvic floor. The study hypothesizes that integrating Mulligan mobilization with core strengthening may provide superior outcomes in pain reduction, joint function, and overall quality of life compared to core exercises alone.

This study examines the effects of autogenic inhibition (PFS) versus reciprocal inhibition in individuals with lower cross syndrome

The purpose of this study is to evaluate the comparative effects of post-isometric relaxation (PIR) and active isolated stretch (AIS) techniques on reducing pain, improving range of motion, and decreasing functional disability in individuals with piriformis syndrome. A total of 40 participants will be recruited, aged 20-55 yrs, with confirmed piriformis syndrome. Participants will be randomized into two equal groups. Group A (post isometric relaxation) and Group B (active isolated stretch). Both groups will receive Conventional Therapy (Thermotherapy, Electrotherapy). Study variables include: * Independent Variable: Post Isometric Relaxation and Active Isolated Stretching. * Dependent Variables: Pain (measured by Visual Analog Scale), Functional Disability (assessed via Oswestry Disability Index), Range of Motion (assessed via Goniometer). * Control Variables: Age, Gender, BMI, Baseline Pain/ Disability Scores/ROM The intervention will last 2 weeks with 6 sessions (3 sessions per week). Assessments will be conducted at baseline (Week 1, Pre-treatment) and Post every second session. Data will be analyzed to compare immediate and short-term effects of the two interventions. This study aims to provide evidence for targeted manual therapy approaches in priformis syndrome, potentially guiding clinicians toward the most effective technique for pain reduction, improve ROM and decrease functional disability.

Cervicogenic headache (CGH) is a secondary headache that originates from dysfunction in the upper cervical spine, particularly the atlanto-occipital and C1-C3 segments, and is perceived in one or more regions of the head and/or face. The underlying mechanism involves convergence of cervical and trigeminal afferents in the trigeminocervical nucleus. Structures innervated by the C1, C2, and C3 spinal nerves are capable of producing referred pain to the head. CGH is relatively common, accounting for approximately 15-20% of all chronic headaches. It typically worsens with neck movement and is often associated with limited cervical range of motion. One of the key impairments in individuals with CGH is disrupted cervical sensorimotor control, particularly affecting proprioception and deep cervical muscle coordination. Physical therapy is widely recognized as the first-line treatment for CGH, with emerging evidence supporting interventions aimed at improving cervical proprioception and neuromuscular control. This study aims to compare the effectiveness of two sensorimotor-based physical therapy approaches-eye-cervical re-education and pressure biofeedback training of deep cervical flexors (DCF)-in patients with CGH. The primary outcomes include pain intensity, functional disability, cervical range of motion (ROM), and cervical joint position sense (proprioception). Participants will be recruited using purposive sampling from Fauji Foundation Hospital and Foundation University College of Physical Therapy (FUCP), Islamabad. After providing written informed consent, eligible participants will be randomized into two groups. Group 1 will receive conventional physical therapy along with eye-cervical re-education exercises, while Group 2 will receive conventional therapy combined with pressure biofeedback DCF training. Data will be collected at baseline and after the 10th treatment session to assess within- and between-group changes in the outcome measures. This study aims to inform evidence-based physical therapy practice in the management of cervicogenic headache.

Sacro-iliac joint act as the shock absorber of the body. It is responsible for transferring vertical load of the whole body to lower limb hence contributing to stability of pelvic girdle. However, SI joint dysfunction is one of the most common causes of low back pain among the patients suffering from non-radicular low back pain. There can be a mechanical source which is due to muscle insufficiency or instability or a non-mechanical source which is osteoarthritis, infection or any trauma. It is thought to affect females more commonly with prevalence of about 46.71% in females and with the prevalence of about 15 to 30% in general. This poses great threat to bio mechanics of the body which can significantly lead to disability that can affect mobility, daily activities and quality of life of the individual. According to a study the pain caused by SIJD caused activity limitation and participation restriction of about 25% of the individuals. Hence making it difficult for them to continue their jobs. increased pain leads to worsening of the ability to perform ADLs which ultimately effects the quality of life. Altered biomechanics also leads to alteration in spatio temporal gait parameters.This study aims to compare the effects of autogenic inhibition technique and reciprocal inhibition technique in addition with conventional therapy in reliving low back pain, improving functional disability and alteration in spatio-temporal gait parameters in patients with sacroiliac joint dysfunction. Patients with SIJD will be recruited and will be randomly divided into two groups 20 in each group. Group 1 will receive autogenic inhibition technique of iliopsas, hamstrings, erector spinae and piriformis muscles along with standard core stabilization exercises and group 2 will receive reciprocal inhibition technique on iliopsas, hamstrings, erector spinae and piriformis muscles along with standard core stabilization exercises. The treatment will be continued for 3 weeks with 4 sessions of 25 minutes per week.

Low back pain is the most common symptoms experienced by people throughout the world. Although lifetime prevalence of low back pain among women is more but it is particularly common during pregnancy, affecting approximately 50% of women. Pregnancy induces significant physiological changes, which lead to increased ligamentous laxity that may persist for 3 to 6 months postpartum. Additionally, the expanding uterus shifts the maternal center of gravity anteriorly, resulting in compensatory lumbar hyperlordosis and contributing to lower back discomfort. While these adaptations help accommodate pregnancy, they often do not fully resolve after birth, especially in the presence of abdominal muscle weakness. The result is altered posture characterized by an exaggerated lumbar lordotic curve that may predispose postpartum women to continued pain and lumbar instability. Without a structured postpartum rehabilitation program, these postural abnormalities may go uncorrected. Ensuring adherence and completion of such programs is critical for preventing long-term musculoskeletal complication. There are many efficient way to help in maintaining adherence and completion of program including the use of digital platforms. The increasing availability of low cost internet and communication technologies has enhanced the capacity to deliver healthcare services through internet, enabling broader access to physiotherapy services and follow-up care through telerehabilitation. Telerehabilitation is one of the emerging field of telemedicine, defined as set of tools, procedure, and protocols to deliver the rehabilitation process remotely. The objective of the study is to facilitate implementation of the telerehabilitation for home based program for postpartum female. The objectives of the study is to compare the effectiveness of telerehabilitation-based lumbar stability exercises versus on-site lumbar stability exercises in improving lumbar stability among postpartum female and to facilitate implementation of the telerehabilitation for home based program for postpartum female. It is a randomized controlled trial. Participants meeting the inclusion criteria will be recruited and consent form will be taken than participants will be allocated to group A (On-Site Lumbar Stability exercise) and B (Telerehabilitation) through 1:1 method. Pre-treatment assessment will be carried out on Day 1 using the outcome measures tool like NPRS, ODI and LLA. Participant will receive intervention for 6 weeks, 3 sessions per weeks. After the completion, on 6 week Post-treatment assessment will be carried out using the same outcome measures tool like NPRS, ODI and LLA.

Forward Head Posture (FHP) is a prevalent postural dysfunction characterized by anterior displacement of the head relative to the shoulder line. It is often linked to musculoskeletal pain, restricted cervical mobility, and altered muscle activation patterns. The condition manifests with shortening of the upper trapezius, suboccipital muscles, semispinalis, splenius capitis, Sternocleidomastoid (SCM), and levator scapulae. Concurrently, there is weakness or inhibition in the deep cervical flexors, resulting in an imbalance between the cervical flexor and extensor muscle groups. These muscular imbalances contribute to dysfunctional cervical movement patterns, altered proprioception, and increased joint loading, particularly at the atlanto-occipital and cervico-thoracic junctions. The objective of this randomized controlled trial is to compare the effectiveness of Sub-Occipital Muscle Inhibition (SMI) and Instrument Assisted Soft Tissue Mobilization (IASTM) in improving postural alignment, reducing pain, and enhancing cervical range of motion in individuals with Forward Head Posture. It will address a common postural and musculoskeletal problem that affects a large portion of the population which will contribute to a more effective management approach for Forward Head Posture and will guide clinicians in selecting targeted, evidence-based therapies for their patients with FHP. As there is a lack of comparative studies assessing their relative effectiveness specifically for FHP, it will contribute novel data to the field of physiotherapy and rehabilitation science. A total of 38 participants with FHP will be randomly assigned into two equal groups (n=19). Group A will receive conventional physiotherapy along with Sub-Occipital Muscle Inhibition, while Group B will receive conventional physiotherapy combined with Instrument Assisted Soft Tissue Mobilization. Both groups will undergo 18 treatment sessions over six weeks, administered on alternate days. Both interventions are expected to show positive outcomes in improving FHP; however, the study aims to determine which technique is more effective. The results will help clinicians understand which manual therapy methods work best. This can make it easier for them to choose the right treatment for Forward Head Posture. Using proven techniques can improve patient comfort and recovery. In the end, it will help to provide advance approach and more personalised care for the patients.

Study, titled Effects of Kinect-Based Exergaming versus Wii Fit on Balance and Fall Risk among Healthy Older Adults, is a randomized controlled trial comparing the balance training effects of Xbox Kinect and Wii Fit. After obtaining informed consent, 46 healthy older adults will be randomly allocated (1:1) using sealed envelopes to a 6-week training program in either group. Static, Dynamic, and Anticipatory balance will be assessed at baseline and post-intervention using the Biodex Balance System for objective comparison.

This study examines the comparison between Impairment Oriented versus Task Oriented Gait Training in Transfemoral Amputee Rehabilitation. A randomized controlled trial conducted with 40 participants divided into two groups .Both groups receive pre-gait training and corrective walking exercises for 10 days .

This study will use a randomized controlled trial to evaluate the added effects of coherent breathing combined with aerobic exercise versus aerobic exercise alone in 40 adults aged 30-65 with stage 1 hypertension. Participants will be randomly assigned to an intervention group (aerobic exercise plus coherent breathing) or a control group (aerobic exercise only) and will undergo a 4-week program with 5 sessions per week. Cardiopulmonary parameters-including blood pressure, heart rate, respiratory rate, and rate pressure product-will be measured, and quality of life will be assessed using the MINICHAL questionnaire at baseline, 2 weeks, and post-intervention. Data will be analyzed using SPSS version 21.0. The study aims to determine whether coherent breathing provides additional benefits, offering a cost-effective, non-pharmacological strategy for hypertension management in low-resource settings.

This randomized controlled trial evaluates the efficacy of oral probiotics compared to placebo in Pakistani patients with moderate Acne Vulgaris. Acne is a multifactorial inflammatory disorder influenced by microbial colonization, seborrhea, and immune dysregulation. Rising antibiotic resistance necessitates alternative therapeutic approaches. Emerging evidence highlights the gut-skin axis, suggesting probiotics may reduce systemic inflammation and acne severity. A total of 64 patients will be randomized into probiotic and placebo groups and treated for 12 weeks. The primary outcome is reduction in total acne lesion count, while the secondary outcome is change in serum Interleukin-6 levels. Clinical assessment includes lesion counts, GAGS scoring, and standardized photography. IL-6 levels will be measured using ELISA at baseline and study completion. Data will be analyzed using SPSS with appropriate statistical tests, considering p ≤ 0.05 as significant. This study aims to provide evidence for probiotics as a safe, effective, and antibiotic-sparing option in acne management, particularly in South Asian populations.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder characterized by airflow limitation, breathlessness, and reduced quality of life. Breathing exercises are commonly used in pulmonary rehabilitation to improve respiratory efficiency and functional capacity. Among these techniques, pursed lip breathing (PLB) helps slow expiration, reduce air trapping, and improve ventilation, while alternate nostril breathing (ANB), a yogic breathing technique, may enhance respiratory control and relaxation. The purpose of this study is to determine the effects of pursed lip breathing alone compared with the combined effect of pursed lip breathing and alternate nostril breathing on pulmonary function and quality of life in patients with Grade I COPD. This randomized controlled trial will include approximately 40 participants diagnosed with mild COPD. The participants will be divided into two groups: one group will perform pursed lip breathing exercises, while the other group will perform a combination of pursed lip breathing and alternate nostril breathing. Pulmonary function tests and quality of life assessments will be used as outcome measures to evaluate the effectiveness of these interventions. The study aims to determine whether combining both breathing techniques provides greater improvement in respiratory function and patient well being than pursed lip breathing alone. The findings may contribute to developing more effective physiotherapy based pulmonary rehabilitation strategies for patients with COPD.

Chronic Obstructive Pulmonary Disease is progressive and irreversible respiratory condition characterized by persistent airflow limitation leading to dyspnea and reduced functional capacity. Pulmonary rehabilitation along with different technqiues of breathing exercises reduces dyspnea and enhance functional capacity by improving ventilatory efficiency, respiratory muscle control and overall exercise tolerance in patients with COPD.

Hypertension or high blood pressure is defined as when the pressure in the blood vessels is too high. According to Joint National Committee 8 (JNC 8) Guidelines, hypertension is defined as systolic blood pressure level of more than ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg. This study aims to study the combined effects of Pilates breathing, Diaphragmatic breathing and Moderate Intensity Continuous Cycling Training on blood pressure, chest expansion, pulmonary function and quality of life. Aerobic physical activity moderate intensity continuous training: (55%- 70% of maximal heart rate (MHR), rate of perceived exertion (RPE) of 11-13 on the Borg scale) continuous training, known as MICT. Pilates breathing exercise enhances lung expansion by focusing on controlled rhythmic breathing methods involving respiratory muscles. Diaphragmatic breathing exercise is slow and controlled deep breathing that has important effects on respiratory system by the modulation of autonomic nervous system. Hypertensive patients will be selected for this study. The study will include three groups. One group will undergo Cycling training with Pilates breathing and the other group will undergo Cycling training with Diaphragmatic breathing and third group will undergo Cycling training only. Before initiating the intervention at the baseline, following outcome measures would be assessed for all the patients: Blood pressure, chest expansion, pulmonary function and quality of life.

Bronchial asthma is a chronic inflmmatory airway disease characterized by recurrent episodes of dyspnea, wheezing, and airflow limitation. Dysfunctional breathing pattern and chronic hyperventilation

Pre-hypertension is defined as systolic blood pressure between 120-139mmHg or diastolic blood pressure between 80-89mmHg and is considered a risk factor for developing hypertension. Early lifestyle interventions such as aerobic exercise and breathing techniques may help prevent progression to hypertension. This randomised controlled trial aims to determine the additional effects of pilates breathing and diaphragmatic breathing combined with moderate-intensity continuous treadmill training on blood pressure, chest expansion, pulmonary function and quality of life in pre-hypertensive patients. A total of 45 participants will be randomly allocated into three groups: treadmill training with pilates breathing, tredmill training with diaphragmtic brething and treadmill training alone. The intervention will be conducted for 6 weeks. Outcome measures including blood pressure, pulmonary function, chest expansion and quality of life will be assesed before and after the intervention.

This randomised single-blind trial will evaluate the immediate effect of a single session of dry needling versus sham needling on calf muscle myofascial trigger points among amateur football players aged 18-25 years. Primary and secondary outcomes are Pressure Pain Threshold (algometer), Sprint Speed (shuttle run test), and Functional Performance (single-leg hop). Outcomes will be measured immediately pre- and post-intervention. Data analysis will be performed in SPSS version 27 using paired and independent t-tests (p \< 0.05).

This randomized controlled trial compares the effectiveness and safety of topical tacrolimus 0.03% and crisaborole 2% in patients with mild to moderate atopic dermatitis over 8 weeks. Atopic dermatitis is a chronic inflammatory skin condition affecting quality of life, and steroid-sparing treatments are increasingly preferred due to adverse effects of long-term corticosteroid use. Tacrolimus, a calcineurin inhibitor, and crisaborole, a PDE-4 inhibitor, are both effective alternatives, though tacrolimus may offer greater efficacy while crisaborole has better tolerability. The study will include 70 patients aged 2-20 years, randomized into two groups receiving either treatment. Outcomes will be assessed using EASI score reduction and adverse effects. Data will be analyzed statistically to determine significance. The study aims to generate local evidence to guide treatment decisions and improve management strategies for atopic dermatitis in the Pakistani population.

This randomised controlled trial aims to compare the efficacy of topical metformin (30%) and topical tranexamic acid (3%) in the treatment of melasma using reduction in the Melasma Area and Severity Index (MASI) score over 12 weeks. Melasma is a common hyperpigmentation disorder with significant cosmetic and psychological impact, and current treatments often have limitations. Both metformin and tranexamic acid have shown promising depigmenting effects through different mechanisms. A total of 70 patients will be enrolled and randomly divided into two groups. Participants will apply the assigned treatment once daily along with sunscreen and will be assessed at baseline and at 4, 8, and 12 weeks. The primary outcome is MASI score reduction, while secondary outcomes include patient-reported improvement and safety. This study seeks to provide comparative evidence for safer and more effective treatment options for melasma management.

It's a prospective, randomised, assessor-blinded clinical study comparing topical 30% metformin with Kligman's regimen for melasma in women aged 35-55 years at Fauji Foundation Hospital, Rawalpindi. The study seeks to ascertain which treatment yields a more significant decrease in the modified MASI score over an 8-week period and which treatment is associated with fewer adverse effects, such as erythema, burning, peeling, and post-inflammatory hyperpigmentation. A total of 82 participants will be enrolled and randomly assigned to either metformin cream or Kligman's regimen, with both groups also using sunscreen. Assessments will be done at baseline, week 4, and week 8 through mMASI scoring, photographs, and side-effect monitoring. Data will be analyzed in SPSS 26 using t-tests and chi-square testing. The study is based on evidence suggesting metformin may offer comparable efficacy with better tolerability.

Orthodontic treatment (OT) is characterized as a lengthy procedure and enormous effort has been harnessed to shorten the OT duration using either surgical or non-surgical approaches. With the emerging concept of "accelerated orthodontics," scientific interest has been focused on chemical and electrical stimuli in combination with mechanical forces for rapid bone turnover and more stable results. Given the role of cytokines, parathyroid hormone, active vitamin D3 (1,25 dihydroxycholecalciferol) in bone regeneration, several studies have been conducted in which exogenous biological molecules have been locally administrated in order to stimulate orthodontic tooth movement. Vitamin D (Vit-D) plays a significant role in bone biology and remodeling.There are two primary forms of Vit-D: 25-OHD (25-hydroxyvitamin D) and 1,25 DHC (1,25-dihydroxycholecalciferol) which is the active form. 1,25 DHC is a potent stimulator of osteoclastic activity by inducing differentiation as well as increasing the activity of osteoclasts. It is also known to work in a dose-dependent way. Although it has a 2-3-hour plasma half-life, its effects on cells might last for days. Injecting the active form of Vitamin D can increase tooth movement, decrease the treatment time of fixed appliances and maintain the integrity of the bone. In the past researches have been done on cats and rodents on the effect of intraligamentary administration of vitamin D3 on tooth movement. Studies performed on human beings are few and inconclusive. Two out of the four studies done on humans were cross-sectional and investigated the role of active vitamin D on external apical root resorption. The other two clinical trials used split-mouth technique and examined the impact of local CTL administration on tooth movement rate, both demonstrating level 1 of evidence and high recommendation. Al-Hasani and colleagues reported that a low dose of 25 picogram/mL produced a higher rate of OTM, with no statistically significant difference between the study and control sides in 15 patients involved in the study. However, Iosub Ciur and colleagues reported 70% acceleration in the OTM when using higher 42 picogram/mL local dose of vit D, but the number of patients was extremely low and not adequate(n=4) in this study. The purpose of our study is to evaluate if higher doses of local vitamin D can accelerate tooth movement in adequate number of adult patients. If vitamin D in our population of adult patients can accelerate tooth movement, then it can allow for more predictable treatment outcome during fixed orthodontic therapy.

1. Patients taking leflunomide as the only disease-modifying anti-rheumatic drug (DMARD) will be recruited after consent. 2. Blood sample for DNA extraction will be taken The patient will be followed up till two visits 3 months apart, and efficacy and toxicity will be checked using DAS28, ultrasonography, and blood tests for ESR, CRP, anti-CCP, liver function tests, etc. The data form for toxicity will be filled. 3. DNA will be extracted in the laboratory, and SNP will be identified. 4. The efficacy and toxicity data will be studied against the SNPs found 5. An algorithm will be constructed for Pakistani RA patients taking leflunomide.

This study is a randomized controlled trial and the purpose of this study is to determined the effects of sacral mobilizations along with the lumbar mobilizations in mechanical low back pain on components such as pain , lumbar range of motion, lumbar proprioception and functional disability.