THE THERAPIST (Journal of Therapies & Rehabilitation Sciences)

Depression, Anxiety, and Stress in Undergraduate Allied Health Students: A Cross-Sectional Study from Multan, Pakistan

Ayyan Ahmad — 2025-09-30

Mental health problems like depression, anxiety, and stress become more widespread in university students all over the world. The involvement of academic pressure, social pressure, and transitional life stages is one of the factors that build psychological distress that may affect academic performance and general well-being. Objectives: To determine the prevalence and severity of depression, anxiety, and stress among undergraduate students of allied health sciences pursuing their undergraduate degrees at Laeeque Rafique Institute of Health Sciences, Multan, Pakistan. Methods: A cross-sectional study was conducted from January 15 to April 20, 2024, including all students of LRIHS. Participants completed a two-part questionnaire comprising socio-demographic details and the standardized DASS-21 scale. Data were analyzed using SPSS version 26.0 to calculate frequencies, percentages, means, and standard deviations. Results: Depression prevalence was 3.43% extremely severe, 8.57% severe, 22.57% moderate, 18.29% mild, and 47.14% normal. Anxiety levels were 15.43% extremely severe, 8.57% severe, 23.43% moderate, 7.71% mild, and 44.86% normal. Stress was reported as 2.57% extremely severe, 10.86% severe, 15.71% moderate, 19.71% mild, and 51.14% normal. Female students showed higher stress levels, while male students had relatively higher rates of depression and anxiety. Conclusions: The results suggest that undergraduate allied health sciences students experience considerable psychological distress. These findings point to the necessity to invest in specific mental health support, screening, and intervention in academic institutions.

Correlation of Serum Calcium with the Severity of Acute Ischemic Stroke Patients Presenting at Tertiary Care Hospital, Karachi

Fezan Hyder — 2025-09-30

Stroke is a significant chronic illness, death and disability in both developed and developing nations. The interrelation between the level of serum calcium and the processes of ischemic injury is not clear. Objectives: To identify the relationship between the level of serum calcium and the extent of acute ischemic stroke behavior in patients who reported to a tertiary care hospital in Karachi. Methods: The cross-sectional analytic study was done in the Neurology Department of Civil Hospital, Karachi. A total of 138 patients diagnosed with acute ischemic stroke, fulfilling the diagnostic criteria, were included after obtaining verbal consent. Serum calcium levels were measured within 24 hours of admission. Simple descriptive statistics (mean ± SD) were used for quantitative data, while qualitative variables were given in terms of frequencies and percentages. A p-value of less than 0.05 was taken as statistically significant. Results: Among 138 patients, the mean age was 51.14 ± 4.49 years, and the mean calcium level was 10.7 ± 1.32 mg/dl. Based on calcium quartiles, 28 (20.3%), 35 (25.4%), 54 (39.1%), and 21 (15.2%) patients fell into quartiles 1, 2, 3, and 4, respectively. Stroke severity (based on NIHSS scores) distribution was: mild (15.2%), moderate (29.7%), moderate to severe (20.3%), and severe (34.8%). Higher calcium levels were positively correlated with increased stroke severity (p≤0.05). Conclusions: Serum calcium levels measured within 24–48 hours of admission showed a strong correlation with both stroke severity and functional outcome. Therefore, calcium levels may serve as an indicator of disease severity in acute ischemic stroke patients.

Beyond Sleep Hygiene: A Multidimensional Clinical Profile for Precision CBT-I in Distressed University Students

Manahl Imran — 2025-09-30

Sleep disturbance is a core transdiagnostic factor in mental health, intricately linked to the onset and maintenance of depression. Objectives: To identify the underlying clinical dimensions of sleep disturbance in university students and explore their behavioral and cognitive predictors. Methods: This cross-sectional study of 151 students from the University of the Punjab was conducted using a comprehensive sleep questionnaire. Data were analyzed using exploratory factor analysis to identify latent constructs of sleep disturbance, with group differences examined via Mann-Whitney U and Kruskal-Wallis tests. Regression analyses identified key behavioral and cognitive predictors of adverse sleep outcomes. Results: Factor analysis revealed eight distinct clinical dimensions of sleep disturbance: Daytime Impairment, Clinical Sleep Disorders, Perceived Sleep Quality, Sleep Hygiene, Sleep Fragmentation, Pre-sleep Stimulation, Nocturnal Hyperarousal, and Autonomic Symptoms. Clinically significant group differences emerged: females reported greater daytime functional impairment (p=0.009), while males endorsed poorer perceived sleep quality (p=0.027). Lower family income was uniquely associated with increased sleep fragmentation (p=0.034). Critically, regression models identified pre-bed screen use as a significant predictor of reduced total sleep duration (p=0.007) and nocturnal cognitive hyperarousal (worry) as a predictor of prolonged sleep onset latency (p=0.036). Conclusions: Sleep disturbances in university students comprise multiple, co-occurring dimensions rather than a single deficit. Personalized strategies combining stimulus control and cognitive techniques can directly address the core drivers of sleep dysfunction in this population.

Pistoning versus Holding Dry Needling for Pain, Disability, and Cervical ROM in Upper Trapezius Myofascial Pain Syndrome

Zohreh Ebrahimi — 2025-09-30

Myofascial Pain Syndrome is a prevalent musculoskeletal pain that is characterized by myofascial trigger points. Myofascial trigger points often occur in the upper trapezius. Objectives: To determine the comparison of the effects of the use of pistoning on the pain intensity, the presence of disability, and cervical range of motion in adults with upper trapezius myofascial pain syndrome compared to holding dry needling. Methods: It was a quasi-experimental study in which twenty-four participants were randomized into the pistoning dry needling group (twelve subjects) or the holding dry needling group (twelve subjects). The use of interventions was in three sessions weekly over a three-week continuous period. The outcome measures (prone to pain measured with the help of the Visual Analogue Scale, cervical range of motion assessed with the help of the goniometer, disability measured with the Disabilities of the Arm, Shoulder and Hand questionnaire) were compared at the baseline and one week after the last intervention. Results: The intensity of pain and disability related to the pain was reduced, and the range of motion of the cervix was higher in all directions: flexion, extension, lateral flexion, and rotation. Nonetheless, between-group analysis showed that there were no statistically significant differences in the extent of improvement in any of the outcome measures, which showed that the two techniques were equally effective. Conclusions: Pistoning and holding the dry needling method are effective in pain reduction, cervical range of motion, and disability among upper trapezius myofascial pain syndrome patients.

Detrimental Effect of Prolonged Lower Limb Static Stretching on Dynamic Balance in Older Adults with Knee Osteoarthritis

Mohammad Reza Ghanbarpurshiadeh — 2025-09-30

Due to the fast aging of the world's population, physiological alterations associated with age that impair postural control and boost the risk of falls are becoming more common. Falls are a major public health concern among the elderly, and knee osteoarthritis (OA). Objectives: To investigate the short-term effects of a multi-muscle lower limb stretching regimen on the balance performance of older adults with knee OA. Methods: Twenty-nine individuals with OA, aged 60 to 75 years, participated in a quasi-experimental study. Participants were divided into two groups: a control group (n=15) that performed placebo stretches and an intervention group (n=14) that underwent static stretching for five minutes each, targeting the hamstring, tensor fascia latae, and calf muscles. The Fullerton Advanced Balance (FAB) scale, the Timed Up and Go (TUG) test, the Functional Reach (FR) test, and knee range of motion (ROM) were used to assess mobility and balance outcomes both before and after the intervention. Results: Reduced FAB and FR scores and longer TUG times after stretching were indicative of a statistically significant loss in dynamic balance in the intervention group. The control population, on the other hand, showed no discernible changes in any of the balance metrics. The intervention group's knee range of motion improved somewhat, but this difference was not statistically significant. Conclusions: A single session of prolonged static stretching of lower limb muscles can acutely impair dynamic balance in older adults with knee OA. Immediate rest following such exercises is recommended to reduce the potential risk of falls in this vulnerable population.

Communication and Language Challenges in Autism Spectrum Disorder

Sadaf Hassan — 2025-09-30

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is marked by a lifelong struggle with social communication, interaction, and the occurrence of limited or repetitive behaviors [1]. A broad spectrum of speech and language impairments that may be mild, moderate, or severe in nature and manifestation is one of the most obvious features of this disorder. These communication issues should also be comprehended during diagnosis as well as in the formulation of effective therapeutic interventions [2].

The language development of children with ASD is very heterogeneous. There are those who exhibit age-related or even outstanding language skills and there are those that demonstrate a gross delay or are barely verbal. These variations are seen in various areas of language such as semantics, pragmatics, phonology and morphosyntax. As an illustration, semantic problems can interfere with abstract thinking, word use and word classification, but pragmatic problems are commonly represented by inappropriate conversational behavior, literal language interpretation, echolalia or pedantic speech. Phonological and morphosyntactic difficulties also increase the difficulty in communication, especially when they are accompanied by developmental language disorders or intellectual disabilities [3].

ASD also has a diverse speech production. Most children have disordered prosody, abnormal rhythm or intonation, and motor planning impairments of articulation and fluency. Oral motor impairments are often associated with delays in expressive language, whereas receptive language can be comparatively intact. Dysfluency, such as stuttering, cluttering, and unusual pauses in speech, can also hinder communication, and is usually indicative of cognitive or working memory limitations [4].

The acknowledgment of the heterogeneity of ASD language profiles has prompted researchers to introduce categorizations that can be used to inform clinical practice. One of the approaches distinguishes between children with primary pragmatic problems and those with comorbid language or speech problems, between those with delays due to intellectual disability and where limited language develops as a secondary result of limited social interaction or environmental influences. These frameworks underline that intervention must be based on the individual child profile, and it must be focused on social communication, speech motor skills, and language comprehension simultaneously [5].

Early identification and targeted therapy are critical. Supporting social engagement, fostering language-rich interactions, and addressing motor and phonological skills can help mitigate delays and improve long-term outcomes. Clinicians, educators, and caregivers must work together to recognize individual strengths and challenges, ensuring interventions are personalized and contextually relevant. Speech and language difficulties in ASD are multifaceted, ranging from subtle pragmatic challenges to profound expressive deficits. A careful understanding of these profiles allows for more precise diagnoses and interventions, ultimately enhancing communication, social integration, and quality of life for individuals on the autism spectrum.