Journal of Health and Rehabilitation Research

Background: Burn injuries are a significant health issue leading to physical and emotional complications, impacting both social life and mental health. They necessitate a comprehensive approach for recovery, intertwining various physical and psychological aspects. The primary aim is to sustain a satisfactory level of functionality and life enjoyment, tailored to the individual's essential needs, for an extended period. Objective: The principal objective of this study was to quantitatively evaluate the quality of life and functional outcomes in burn patients. Methods: In this cross-sectional study, data was gathered from 156 burn patients from three medical facilities: Aziz Bhatti Shaheed Teaching Hospital in Gujrat, CMH Kharian, and Jinnah Hospital in Lahore. The Burn Specific Health Scale-Brief (BSHS-B) questionnaire was employed for data collection. The sample included patients aged 18-65 years with varying degrees of burn severity. Results: Data was processed using SPSS version 25. The average age of the patients was 34 years, with a gender distribution of 53.21% female and 46.79% male. Marital status was divided into 66.03% married and 33.97% unmarried individuals. Socio-economic status revealed 4.49% from upper-class, 41.67% from middle-class, and 53.85% from lower-class levels. The average Quality of Life (QoL) score was 70.42 ± 33.75, indicating a diverse range of experiences among participants. Conclusion: The findings suggest that individuals with burn injuries can achieve a satisfactory quality of life and functional independence. This underscores the importance of comprehensive care and support for burn patients to enhance their overall well-being.

Background: Stroke remains one of the leading causes of disability worldwide, with significant impacts on the quality of life (QoL) of survivors. This cross-sectional survey aims to evaluate the level of QoL among post-stroke patients and explore the associations with socio-demographic and clinical variables. Objective: The objectives of this study was to determine the level of quality of life among post-stroke patients. And to check the survival rate that either the stroke patients taking the therapeutic interventions or not, having a good independency or bad independency. Methodology: Cross-sectional study was conducted on 100 stroke patients having the age of less than 60. For the collection of data stroke specific quality of life scale (SS-QOL) was used to properly assess the quality of life among the selected population. Sample size was collected by using the convenient sampling technique. Written consent was taken from the respective hospitals Results: Results analyzed by SPSS version 25. The mean age of the patients was 50.28, ± 8.196 the minimum age was 32 years and maximum were 60 years. Out of 100 patients maximum were male 64% and female were 36%. There were 14% patients from upper-class level, 48% patients with a middle-class and 38% patients from a lower-class level. The overall quality of life among post stroke patient were poor with 52%, worst with 5%, fair with 39% and good with 4%. Conclusion: In this study it was observed that stroke has a negative impact on almost all the domains of quality of life. Majority of the patients were living with poor quality of life few of them were in good quality of life. On whole the quality of life is totally hampered and the patients were totally dependent.

Background: Low back pain (LBP) is a major cause of disability worldwide, affecting millions and increasing healthcare costs. Accurate assessment tools are essential for managing LBP effectively.Objective: To evaluate the effectiveness of the Low Back Outcomes Score (LBOS) and SF-36 questionnaire in assessing health status among patients with LBP across different age groups.Methods: This prospective cross-sectional study included 300 participants divided into age groups: 13-30 years, 31-50 years, and over 50 years. Data were collected using the SF-36 and LBOS questionnaires at baseline and two-year follow-up. The study measured physical, mental, and social functioning, and used statistical analysis, including regression models and Cronbach’s alpha, to evaluate internal consistency and correlation with international benchmarks.Results: The study found high internal consistency for LBOS (Cronbach’s alpha >0.7) with the lowest correlation for physical function (0.38). Significant improvements were observed across all SF-36 domains, except physical function (p < 0.05). LBOS scores showed a significant association with better psychological well-being, with mean scores of 74 (SD=55) in the excellent/good group versus 43 (SD=32) in the fair/poor group.Conclusion: LBOS and SF-36 are effective tools for assessing LBP outcomes, demonstrating good reliability and validity across different age groups in Pakistan.

Public speaking anxiety is increasingly prevalent among students, adversely affecting their academic performance, particularly in oral presentations and group discussions. However, the impact of fear of negative evaluation as a mediator in this context has not been thoroughly examined among university students. Therefore, this study aims to investigate the adverse impact of public speaking anxiety on academic performance, with a specific focus on the mediating factor of fear of negative evaluation. Employing a correlational research design and convenient sampling, data were collected from students aged 18 to 25 (M=20.67, SD=2.12). The study employed three measures: the Public Speaking Anxiety Scale, Fear of Negative Evaluation Scale (Revised) and Academic Achievement Scale. Correlational analysis revealed a significant positive correlation between public speaking anxiety and fear of negative evaluation. However, fear of negative evaluation significantly and negatively correlated with academic performance. Mediation analysis depicts that direct and total effect of public speaking anxiety on academic performance is significantly negative despite indirect path is insignificant. There were no significant gender differences observed in public speaking anxiety, fear of negative evaluation, and academic performance. However, women scored higher on public speaking anxiety (M=59.86, SD=7.9) and fear of negative evaluation (M=39.05, SD=10.18) compared to men. Men scored higher in academic performance (M=16.45, SD=7.51) than women. The study discussed recommendations, limitations, and implications for the benefit of students.

Background: Diabetes Mellitus (DM) significantly elevates the risk of surgical site infections (SSIs), a major postoperative complication that increases morbidity, prolongs hospital stay, and escalates healthcare costs. The complex interplay between hyperglycemia-induced immunosuppression, impaired wound healing, and the increased propensity for infections in diabetic patients underscores the need for a comprehensive understanding of the mechanisms at play and effective management strategies. Objective: This narrative review aims to synthesize current evidence on the relationship between DM and the risk of SSIs, emphasizing the pathophysiological mechanisms, the impact of glycemic control on surgical outcomes, and the role of advanced surgical techniques in mitigating this risk. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published up to April 2023, using keywords related to DM, SSIs, and perioperative management. Inclusion criteria targeted studies on the association between DM and SSIs, focusing on outcomes in diabetic versus non-diabetic patients, and the effectiveness of glycemic control. Data extraction and synthesis were performed using a narrative approach, with quality assessment based on study design-specific appraisal tools. Results: The review highlights that diabetic patients exhibit a significantly higher risk of developing SSIs compared to non-diabetic individuals, attributed to impaired immune response, microvascular complications, and delayed wound healing associated with hyperglycemia. Effective preoperative and postoperative glycemic control, maintaining hemoglobin A1c (HbA1c) levels below 7%, has been shown to reduce the incidence of SSIs. Furthermore, advancements in minimally invasive surgical techniques have contributed to lower SSI rates by reducing tissue trauma and preserving immune function. Conclusion: Diabetes mellitus is a significant risk factor for surgical site infections, underscoring the importance of stringent glycemic control and the adoption of advanced surgical techniques in the perioperative management of diabetic patients. Future research should focus on refining glycemic control strategies, understanding the genetic and molecular mechanisms underlying increased SSI risk, and developing targeted therapies to improve surgical outcomes in this high-risk population.

Background: The increasing prevalence of online gaming among university students has raised concerns about its potential impact on psychological well-being. Ludo Star, a popular mobile game in Pakistan, has been associated with both positive and negative effects on social and mental health. Understanding the relationship between Ludo Star game addiction, social connectedness, and psychological well-being is crucial for developing effective interventions. Objective: This study aimed to investigate the relationship between Ludo Star game addiction and psychological well-being, with social connectedness as a mediator, among university students in Lahore, Pakistan. Methods: A correlational research design was employed, utilizing a non-probability purposive sampling strategy to select 300 university students (157 men, 143 women) aged 18-25 years who regularly played Ludo Star. The Gaming Addiction Scale, Revised Social Connectedness Scale, and Psychological Well-being Scale were used to measure the study variables. Ethical considerations adhered to the Helsinki Declaration, and informed consent was obtained from all participants. Data analysis included descriptive statistics, correlation analysis, mediation analysis, and independent sample t-tests using SPSS version 25. Results: Ludo Star game addiction was positively correlated with social connectedness (r = .15, p < .01) but negatively correlated with psychological well-being (r = -.12, p < .05). Social connectedness was also negatively correlated with psychological well-being (r = -.21, p < .01). Mediation analysis showed that social connectedness significantly mediated the relationship between Ludo Star game addiction and psychological well-being (β = -.08, 95% CI: -.05 to -.007). Independent sample t-tests revealed no significant gender differences in the study variables. Conclusion: The study highlighted the dual-edged nature of Ludo Star game addiction, where increased social connectedness does not translate to better psychological well-being. Interventions should focus on promoting balanced gaming habits and enhancing awareness of the potential psychological risks associated with excessive gaming.

Background: Changes in knowledge and technology are continually shaping the educational environment, thereby influencing curriculum implementation. Innovations are being made to meet the evolving educational goals, which includes overcoming various barriers to curriculum implementation. Objective: The aim of this study was to examine the existing literature on curriculum implementation problems, particularly focusing on the issues faced by educational institutions in effectively applying educational theories and practices. Methods: A comprehensive literature review was conducted, utilizing databases such as PubMed, ERIC, Google Scholar, and JSTOR. Articles published from 1997 to 2022 that discussed challenges and strategies in curriculum implementation across various educational levels and settings were included. Thematic analysis was employed to synthesize the data, identifying common themes related to the challenges and solutions of curriculum implementation. Results: The review identified critical challenges related to four main areas: teachers, students, the curriculum itself, and institutional factors. Teacher-related challenges included inadequate professional development and inefficient teaching methods. Student-related challenges highlighted diverse learning needs and varying levels of engagement. Institutional challenges pointed to resource limitations and insufficient stakeholder support. Curriculum-related challenges were mostly about alignment and compatibility with educational goals. Conclusion: Effective curriculum implementation is pivotal in educational settings and requires comprehensive strategies to address the myriad of challenges identified. Enhancing teacher training, improving resource allocation, and ensuring curriculum relevance are crucial for improving educational outcomes.

Background: The advent of Artificial Intelligence (AI) within organizational frameworks, particularly in the realm of Human Resource Management (HRM), has initiated a transformative shift in operational efficiencies and strategies across various sectors. This integration aims to leverage AI's capabilities to augment human decision-making, enhance operational efficiency, and foster a culture of innovation within organizations. Despite the potential benefits, the practical application and tangible impact of AI strategies on organizational effectiveness remain areas of significant academic and practical interest. Objective: This study aimed to investigate the influence of AI strategies and creativity oriented HRM practices on organizational effective performance. It sought to explore the synergistic relationship between AI implementation and innovative HR practices, and their collective impact on enhancing organizational efficiency and performance metrics. Methods: Employing a cross-sectional survey design, the study collected data from employees working in private hospitals in Lahore, Pakistan. A total of 144 valid responses were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to assess the relationships between AI strategy implementation, creativity-oriented HRM practices, and organizational effective performance. Reliability and validity of the constructs were evaluated through Cronbach's alpha, composite reliability, and average variance extracted (AVE) measures. Results: The findings revealed that AI strategy implementation (Cronbach's alpha = 0.942, AVE = 0.611) and creativity oriented HRM practices (Cronbach's alpha = 0.932, AVE = 0.585) were both significantly associated with enhanced organizational effective performance (Cronbach's alpha = 0.932, AVE = 0.533). The path analysis indicated strong positive relationships between AI strategies and creativity-oriented HRM practices (β = 0.688, p < 0.001), between AI strategies and organizational performance (β = 0.228, p = 0.004), and between creativity-oriented HRM practices and organizational performance (β = 0.597, p < 0.001). The model explained 59% of the variance in organizational effective performance. Conclusion: The study concludes that the strategic integration of AI within HRM frameworks significantly contributes to organizational effectiveness. Emphasizing creativity-oriented HRM practices in conjunction with AI strategies can lead to substantial improvements in organizational performance. These findings underscore the importance of a strategic approach to AI integration in HRM, highlighting the need for organizations to foster environments that promote innovation and creativity.

Background: Composting, a cost-effective and efficient method for managing solid waste rich in organic matter, faces challenges when contaminants, particularly heavy metals, are present. These contaminants can significantly impact various environmental aspects and human health. Objective: This study aims to provide a comprehensive review of the effects of heavy metal contamination in compost, focusing on its impact on soil quality, plant growth, aquatic ecosystems, and human health. Methods: An extensive examination of current literature was conducted to analyze the consequences of heavy metal presence in compost. This involved reviewing studies on soil microbial activity, plant health, the accumulation of metals in the food chain, and the resultant effects on animal and human health, as well as on aquatic systems. Results: Elevated levels of heavy metals in compost were found to be toxic to soil microorganisms, vital for numerous soil processes, leading to a reduction in their abundance and functionality. Plants exposed to these metals showed disrupted physiological processes and compromised growth. The absorption of heavy metals by plants leads to their entry into the food chain, posing risks to animal and human health. In aquatic environments, these contaminants contribute to oxidative stress, negatively affecting aquatic life. Conclusion: The presence of heavy metals in compost presents significant environmental and health risks. It is crucial to ensure the absence of such contaminants in compost intended for agricultural use. This study underscores the need for sustainable waste management practices and stringent monitoring of compost quality to safeguard environmental health and human well-being.

Background: Fertilizers play a crucial role in modern agriculture, significantly boosting crop yields and global food production. However, their widespread use has unintended consequences that raise significant environmental and health concerns. Nitrogen-based, phosphorus-based, and potassium-based fertilizers contribute to nutrient replenishment in soils but can lead to soil and water contamination, posing risks to ecosystems and human health. Objective: This narrative review aims to comprehensively examine the health and environmental impacts of excessive soil fertilization, with a focus on understanding the mechanisms by which fertilizers affect soil and water quality and the subsequent implications for human health. Methods: An extensive literature search was conducted across multiple electronic databases, including PubMed, Web of Science, Scopus, and Google Scholar. Articles published between 2000 and 2023 were selected based on predefined inclusion criteria, focusing on studies that provided empirical data or substantial theoretical insights into the environmental and health impacts of fertilizer use. A qualitative analysis was performed to synthesize findings and identify common themes. Results: The review highlighted that nutrient runoff from excessive fertilizer use leads to significant water quality degradation, with nitrate concentrations in some regions exceeding recommended safety limits by 30-50%. Prolonged exposure to contaminated water is linked to various health issues, including a 20% increased risk of methemoglobinemia in infants and a 15-25% higher risk of gastric and colorectal cancers in adults. Additionally, heavy metal accumulation in crops due to fertilization practices raises concerns, with cadmium levels in some crops surpassing safe consumption limits by 40-60%. Conclusion: While fertilizers are essential for enhancing agricultural productivity, their excessive use poses significant environmental and health risks. A balanced approach integrating sustainable agricultural practices, effective water management, and comprehensive regulatory frameworks is imperative to mitigate these adverse effects. Continued research and collaboration among scientists, policymakers, and the agricultural community are necessary to promote a sustainable and health-conscious approach to fertilizer use.

Background: Differentiating complicated from uncomplicated acute appendicitis before definitive treatment is increasingly important because disease severity influences operative urgency, antimicrobial therapy, suitability for nonoperative management, and postoperative outcomes. Numerous clinical, biochemical, inflammatory, and computed tomography (CT) predictors have been proposed, but their performance varies across populations, and evidence from Saudi Arabia remains fragmented across individual predictors. Objective: To narratively synthesize contemporary evidence on predictors of complicated acute appendicitis in adults, with particular emphasis on Saudi Arabian studies and comparison with clinically relevant international settings. Methods: Evidence from Saudi Arabia and comparable populations was synthesized thematically, supplemented by recent literature on clinical predictors, inflammatory and biochemical biomarkers, CT characteristics, and multivariable prediction models. Greater interpretive weight was given to adjusted associations and studies reporting discrimination, calibration, or internal/external validation. Results: Prolonged symptom duration, peritoneal signs, higher appendicitis severity scores, C-reactive protein and other inflammatory abnormalities, hyperbilirubinemia, hyponatremia, appendicolith, increasing appendiceal diameter, periappendiceal fluid, bowel inflammatory changes, and other advanced CT findings were recurrently associated with complicated disease. Saudi studies specifically support associations involving symptom duration, Alvarado score, neutrophil-to-lymphocyte ratio, systemic inflammatory response, bilirubin, and CT abnormalities. Recent integrated prediction models combining clinical, laboratory, and imaging variables generally achieved greater discrimination than isolated biomarkers, with reported AUCs commonly approaching 0.80–0.86. However, most Saudi evidence remains retrospective, single-center, and without geographical external validation. Conclusion: Complicated appendicitis is best approached through multidomain risk assessment rather than a single biomarker. A prospectively developed, multicenter, externally validated Saudi prediction model integrating clinical, laboratory, and structured CT variables represents the principal remaining research priority.

Background: Chronic kidney disease (CKD) requires long-term adherence to medications, dietary and fluid restrictions, clinical monitoring, and, in advanced disease, regular hemodialysis. Health literacy may influence patients’ ability to understand and apply treatment recommendations. Objective: To determine health-literacy levels and treatment compliance among patients with CKD and assess associations with medication adherence and dialysis-related compliance. Methods: This analytical cross-sectional study included 125 adults with CKD attending nephrology outpatient and hemodialysis services at Riphah International University, Lahore, Pakistan, from November 2025 to March 2026. Health literacy was assessed using HLS-EU-Q16 and medication adherence using MMAS-8. Dialysis-specific measures included missed hemodialysis sessions, diet/fluid non-adherence, and serum phosphate. Data were analysed using IBM SPSS Statistics version 26.0 with descriptive, correlation, chi-square, Kruskal-Wallis, and logistic-regression analyses. Results: Mean age was 60.86±11.10 years; 62.4% received predialysis care and 37.6% underwent hemodialysis. Low, mid-level, and high health literacy were observed in 26.4%, 53.6%, and 20.0%, respectively, while 57.6% had low medication adherence. HLS-EU-Q16 correlated positively with MMAS-8 (ρ=0.413, p<0.001). Medication non-adherence occurred in 81.8% of patients with low literacy compared with 49.3% and 48.0% with mid-level and high literacy (p=0.005). Higher health literacy independently predicted lower medication non-adherence (aOR=0.66, 95% CI 0.52–0.83; p<0.001) and fewer missed dialysis sessions (ρ=−0.306, p=0.036). Conclusion: Limited health literacy was significantly associated with poorer treatment compliance in CKD. Keywords: Chronic Kidney Disease; Health Literacy; Medication Adherence; Hemodialysis; Pakistan.

Background: Chronic obstructive pulmonary disease (COPD) is associated with airflow limitation, substantial symptom burden, functional restriction, psychological morbidity, and impaired health-related quality of life (HRQoL). Patient-reported measures may capture disease burden not fully reflected by spirometric severity. Objective: To assess HRQoL and symptom burden among patients with COPD in Pakistan and examine their relationships with airflow limitation, respiratory symptoms, and psychological characteristics. Methods: This cross-sectional study included 93 patients with COPD attending Johar Institute of Professional Studies from March to September 2025. Clinical variables included demographics, smoking and biomass exposure, COPD duration, FEV₁ percentage predicted, and GOLD stage. Symptom burden was assessed using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale, while HRQoL was evaluated using the St George’s Respiratory Questionnaire (SGRQ) and estimated EQ-5D index. Depression and anxiety were classified using PHQ-9- and GAD-7-based criteria. Data were analysed using SPSS version 26.0. Results: Mean age was 60.43±8.69 years; 69.9% were male. GOLD 2 disease was present in 68.8%, while 21.5% had GOLD 3–4 disease. Mean CAT and SGRQ scores were 25.19±9.97 and 59.41±15.34, respectively; 79.6% had CAT >10 and 80.6% had mMRC ≥2. CAT correlated strongly with SGRQ (ρ=0.869) and inversely with EQ-5D (ρ=−0.846), while FEV₁ showed weaker correlations. CAT, FEV₁, and probable depression remained independently associated with HRQoL. Conclusion: Pakistani patients with COPD experienced marked symptom burden and HRQoL impairment, supporting multidimensional assessment beyond spirometry alone. Keywords: COPD; quality of life; CAT; SGRQ; dyspnea; EQ-5D; Pakistan.

Background: Stroke remains a major cause of death, disability, and long-term functional dependence, particularly in populations with modifiable vascular risk factors such as hypertension and diabetes mellitus. Objective: To assess awareness of stroke warning signs and risk factors among patients with hypertension and/or type 2 diabetes mellitus attending a tertiary-care hospital in Quetta, Pakistan, and to identify factors associated with overall stroke awareness. Methods: This cross-sectional study was conducted from July to December 2025. Using convenience sampling, 210 consenting adults with hypertension, type 2 diabetes mellitus, or both were enrolled. Awareness was assessed using 10 warning-sign and 12 risk-factor items. Composite awareness scores were analyzed using descriptive statistics, group comparisons, correlation analysis, and multiple linear regression in IBM SPSS Statistics version 26.0. Results: Mean age was 55.54 ± 11.86 years. Mean warning-sign awareness was 40.90 ± 19.60%, risk-factor awareness was 48.89 ± 15.85%, and composite awareness was 44.90 ± 14.34%. Only 23.8% had good overall awareness. Unilateral weakness (58.1%) and speech difficulty (51.9%) were the best-recognized warning signs, while hypertension (79.5%) was the best-recognized risk factor. Although 86.2% intended to seek hospital care, only 24.8% would call an ambulance. Increasing age independently predicted lower awareness, whereas urban residence, higher educational attainment, and knowing someone with stroke were associated with greater awareness. Conclusion: Stroke awareness was suboptimal despite established vascular risk. Routine hypertension and diabetes care should integrate targeted education that emphasizes acute warning signs, ambulance activation, and groups with lower awareness, particularly older, rural, and less-educated patients. Keywords: Stroke; Awareness; Warning Signs; Risk Factors; Hypertension; Diabetes Mellitus; Quetta; Pakistan.

Background: Inappropriate antibiotic use, self-medication, treatment discontinuation, and limited understanding of antimicrobial resistance (AMR) remain important antimicrobial-stewardship challenges, particularly in settings where antibiotics can be accessed outside formal prescribing pathways. Objective: To assess antibiotic-use patterns, inappropriate practices, antibiotic knowledge, AMR awareness, and factors associated with appropriate antibiotic use among adult outpatients in Pakistan. Methods: A cross-sectional survey was conducted among 160 adults using convenience sampling. Sociodemographic characteristics, antibiotic use during the preceding six months, indications, antibiotics used, acquisition sources, treatment behaviors, knowledge, and AMR awareness were assessed. Antibiotic practice and knowledge scores were calculated. Data were analyzed using IBM SPSS Statistics version 26.0 using descriptive statistics, chi-square tests, Mann–Whitney U test, Spearman correlation, and odds ratios with 95% confidence intervals. Results: Ninety-one participants (56.9%) had used antibiotics during the preceding six months, of whom 50 (54.9%) obtained or used antibiotics through non-prescription pathways. Cough/cold/sore throat and fever/flu-like illness accounted for 52.7% of reported indications. Failure to complete treatment and stopping antibiotics after symptomatic improvement were each reported by 56.0% of users. Although 81.2% met the predefined criterion for good knowledge, only 31.9% demonstrated appropriate practice. Only 44.4% had heard of AMR and 35.0% reported understanding its meaning. Prescription users were substantially more likely to demonstrate appropriate practice than non-prescription users (OR=9.37, 95% CI 3.27–26.85; p<0.001). Conclusion: Antibiotic misuse was common despite relatively favorable knowledge scores. Non-prescription access, poor adherence, and limited AMR awareness represent important modifiable stewardship targets. Keywords: antibiotics; antimicrobial resistance; self-medication; outpatient care; antibiotic knowledge; medication adherence; antimicrobial stewardship; Pakistan

Background: Stroke is a major cause of mortality and long-term disability, particularly in low- and middle-income countries where delayed recognition of warning signs and inadequate control of modifiable risk factors contribute to poor outcomes. Patients with hypertension and diabetes mellitus are at increased cerebrovascular risk and represent an important target group for preventive education. Objective: To assess awareness of stroke warning signs and risk factors among patients with hypertension, diabetes mellitus, or both attending tertiary-care outpatient services at Mayo Hospital, Lahore, Pakistan. Methods: This hospital-based descriptive cross-sectional study included 281 participants recruited from the Medicine Outpatient Department, Neurology Outpatient Department, and Diabetic Clinic. Stroke awareness was assessed using a structured questionnaire covering recognition of warning signs, risk factors, and overall knowledge categories. Data were summarized as frequencies and percentages. Results: Most participants recognized that stroke affects the brain (267/281, 94.9%), and 225 participants (80.1%) were aware of FAST symptoms. Sudden weakness was recognized by 208 participants (74.0%), whereas awareness of vision problems and altered consciousness was low, reported by 81 (29.0%) and 21 (7.6%) participants, respectively. Smoking, hypertension, and diabetes mellitus were identified as risk factors by 204 (72.6%), 197 (70.0%), and 195 (69.3%) participants, respectively. Adequate overall risk-factor knowledge was present in 129 participants (45.8%). Conclusion: Stroke awareness among high-risk outpatients was partial and uneven, with substantial gaps in recognition of non-motor warning signs and comprehensive risk knowledge. Structured stroke-education strategies should be integrated into outpatient hypertension and diabetes care.

Background: Chronic obstructive pulmonary disease (COPD) is associated with persistent airflow limitation, systemic manifestations, and progressive reduction in exercise capacity, resulting in impaired functional performance and poor clinical outcomes. Exercise intolerance in COPD is multifactorial and influenced by pulmonary dysfunction, skeletal muscle impairment, pulmonary hemodynamic abnormalities, and psychosocial factors. Objective: To determine the clinical, physiological, and psychosocial factors associated with exercise capacity and poor clinical outcomes among patients with chronic obstructive pulmonary disease. Methods: A comparative observational study was conducted among 94 COPD patients, including 47 participants in the intervention group and 47 in the control group. Baseline assessment included demographic characteristics, smoking status, body mass index, forced expiratory volume in one second (FEV1), GOLD stage, six-minute walk distance (6MWD), Borg dyspnea score, and relevant comorbidities. Clinical outcomes assessed during follow-up included change in 6MWD, dyspnea score, quality-of-life improvement, exercise intolerance, COPD exacerbation, hospitalization, and poor clinical outcome. Inferential analysis was performed using odds ratios with 95% confidence intervals. Results: The mean age was 66.4 ± 8.7 years, and 86.2% of participants were male. Mean baseline 6MWD was 431.8 ± 121.6 meters, which improved to 461.7 ± 118.4 meters during follow-up. Baseline 6MWD ≤350 meters significantly predicted poor clinical outcome (OR 2.84, 95% CI 1.15–7.02, p=0.024). Reduced forced vital capacity (OR 2.37, 95% CI 1.01–5.57, p=0.047), quadriceps weakness (OR 3.18, 95% CI 1.29–7.86, p=0.012), pulmonary hypertension or abnormal pulmonary hemodynamics (OR 3.64, 95% CI 1.22–10.89, p=0.021), and low exercise self-efficacy (OR 2.52, 95% CI 1.01–6.31, p=0.048) were also significantly associated with adverse outcomes. Intervention participation demonstrated a protective effect (OR 0.46, 95% CI 0.19–0.98, p=0.041). Conclusion: Exercise capacity impairment in COPD is influenced by multidimensional physiological, muscular, hemodynamic, and psychosocial factors beyond spirometric airflow limitation alone. Comprehensive assessment and targeted rehabilitation strategies may improve functional outcomes and reduce adverse clinical events in COPD patients

Background: Vitamin D deficiency has emerged as a clinically significant contributor to chronic musculoskeletal pain, functional limitation, and impaired rehabilitation outcomes. Low serum 25-hydroxyvitamin D [25(OH)D] levels may influence pain sensitization, skeletal muscle function, and inflammatory pathways, yet evidence regarding its association with persistent musculoskeletal symptoms remains inconsistent across populations. Objective: To determine the association between vitamin D deficiency and chronic musculoskeletal pain among adults and to identify predictors of poor clinical outcome in patients presenting to rehabilitation and orthopedic services at Riphah International University, Lahore, Pakistan. Methods: A hospital-based analytical observational study was conducted among 178 adults with chronic musculoskeletal pain. Demographic, clinical, and laboratory data were collected using structured assessment protocols. Pain severity was evaluated using the Visual Analog Scale (VAS), while serum 25(OH)D levels were measured using standardized biochemical methods. Vitamin D deficiency was defined as serum 25(OH)D <20 ng/mL and severe deficiency as ≤10 ng/mL. Logistic regression analysis was used to identify predictors of poor clinical outcome. Results: Vitamin D deficiency was identified in 57.9% of participants, while severe deficiency was present in 17.4%. Mean baseline VAS pain score was 6.7 ± 1.9. Poor clinical outcome occurred in 35.4% of participants. Vitamin D deficiency independently predicted poor outcome (OR 2.41, 95% CI: 1.31–4.46, p = 0.004), while severe deficiency markedly increased risk (OR 3.18, 95% CI: 1.42–7.11, p = 0.002). Low sunlight exposure, sedentary lifestyle, obesity, chronic widespread pain, and higher baseline pain severity were also significant predictors. Improvement in serum vitamin D levels was associated with reduced odds of persistent symptoms (OR 0.69, 95% CI: 0.52–0.88, p = 0.005). Conclusion: Vitamin D deficiency was significantly associated with chronic musculoskeletal pain, functional limitation, and poor recovery outcomes. Incorporating vitamin D assessment and lifestyle-based interventions into rehabilitation and musculoskeletal care may improve clinical recovery and functional outcomes in affected adults.

Background: Lifestyle modification is essential for hypertension control, yet adherence remains poor in routine clinical practice. Objective: To assess lifestyle adherence and clinical outcomes among hypertensive patients at Riphah Rehablitation Center. Methods: This cross-sectional study included 317 patients. Demographic, clinical, lifestyle adherence, disease-related knowledge, and cardiometabolic outcome variables were analyzed. Poor clinical outcome predictors were assessed using multivariable logistic regression. Results: The mean age was 64.8 ± 13.9 years, and 66.6% were female. Overall lifestyle adherence was observed in only 23.7% of participants, while 76.3% had poor clinical outcomes. LDL cholesterol was not at goal in 59.9%, BMI was not at goal in 79.8%, and inadequate physical activity was reported by 65.6%. Independent predictors of poor clinical outcome included age ≥65 years, diabetes mellitus, metabolic syndrome, poor disease-related knowledge, and family history of cardiometabolic disease. Secondary or higher education and income above the median were protective factors. Conclusion: Poor lifestyle adherence and adverse clinical outcomes were highly prevalent among hypertensive patients. Structured lifestyle counseling, patient education, and targeted cardiometabolic risk management are needed to improve hypertension outcomes

Background: Diabetic peripheral neuropathy is one of the most common microvascular complications of diabetes mellitus and is associated with substantial morbidity, impaired quality of life, and increased risk of foot ulceration and lower-limb amputation. Chronic hyperglycemia, prolonged disease duration, and associated metabolic comorbidities contribute to progressive peripheral nerve damage and worsening neurological dysfunction. Objective: To determine the association between glycemic control and diabetic peripheral neuropathy and to identify clinical predictors of poor neuropathic outcomes among patients with diabetes mellitus. Methods: This cross-sectional analytical study was conducted at the University of Lahore Teaching Hospital and included 206 patients with diabetes mellitus. Demographic, biochemical, and clinical variables including HbA1c, duration of diabetes, body mass index, blood pressure, fasting glucose, chronic kidney disease, hypertension, smoking status, vibration perception, and monofilament test findings were assessed. Logistic regression analysis was performed to estimate odds ratios and 95% confidence intervals for predictors of poor clinical outcome. Results: The mean age of participants was 54.8 ± 12.6 years, and the mean HbA1c level was 8.4 ± 1.7%. Poor glycemic control (HbA1c ≥7.0%) was present in 70.9% of participants and was significantly associated with poor clinical outcomes (OR 2.84, 95% CI 1.52–5.31, p=0.001). Each 1% increase in HbA1c increased the odds of poor neuropathic outcome by 42% (OR 1.42, 95% CI 1.18–1.71, p<0.001). Diabetes duration ≥10 years (OR 2.36, 95% CI 1.32–4.21, p=0.004) and chronic kidney disease (OR 1.91, 95% CI 1.02–3.59, p=0.043) were also significantly associated with adverse neuropathic outcomes. Reduced vibration perception and abnormal monofilament test findings were significantly more common among patients with poor outcomes (p<0.001). Conclusion: Poor glycemic control, prolonged diabetes duration, and chronic kidney disease were significant predictors of diabetic peripheral neuropathy and adverse neuropathic outcomes. Early neuropathy screening and optimization of glycemic control may help reduce progression of neurological complications in diabetic patients.