Annals of Allied Health Sciences

STRENGTHENING CLINICAL TRIALS: SOLUTIONS FOR RECRUITMENT CHALLENGES IN PAKISTAN

Arshad Hussain, Iftikhar Ali — Tue, 31 Dec 2024 00:00:00 +0000

Medical research advances healthcare by generating knowledge that enhances patient care and strengthens systems worldwide. Scholarly communication, especially in medicine, is crucial for improving health outcomes. Randomized controlled trials (RCTs) are considered the "gold standard" in establishing causal relationships between interventions and outcomes, minimizing bias through the comparison of control and intervention groups. However, bridging the gap between research findings and real-world clinical applications necessitates collaboration among basic and clinical researchers and healthcare providers, fostering a multidisciplinary approach to healthcare innovation.

Despite the well-documented value of research evidence in healthcare decision-making, its integration remains inconsistent due to gaps in funding, limited training for healthcare professionals, and inadequate infrastructure to support research implementation. Limited resources and inadequate investment in healthcare have contributed to a substantial treatment-naïve population, compounded by a high burden of communicable and non-communicable diseases, minimal health coverage, and restricted access to care. As a lower-middle-income country, Pakistan faces significant gaps in scientific and technological advancements, which hinder research output and result in minimal representation in international research repositories. Clinical trials play a crucial role in advancing medical care by evaluating the efficacy, safety, and potential side effects of new therapeutic interventions before widespread adoption. Given the high disease burden and resource constraints in developing countries, clinical research in these settings must prioritize cost-effective and innovative treatment strategies. The landscape of clinical research in developing nations is continuously evolving, with international collaborations playing a critical role in enhancing research output in LMICs. Key factors driving the relocation of clinical trials to LMICs include lower operational costs, faster participant recruitment, and more streamlined regulatory approval processes. The earliest documented clinical trials in Pakistan, available on PubMed, date back to the field trials of the cholera vaccine conducted in East Pakistan in 1963-1964.

Recruitment challenges are among the most significant obstacles in both published and unpublished RCTs. Researchers often overestimate recruitment feasibility, assuming a higher willingness to participate and underestimating logistical challenges, which leads to diminished enthusiasm as challenges become evident. Key barriers include participant reluctance, logistical constraints, and ineffective engagement strategies. Common concerns, such as mistrust of the research process, fear of adverse effects, and difficulties in identifying willing and eligible participants, further hinder recruitment efforts. In mental health RCTs, additional complexities arise due to stigma, fluctuating mental states, and difficulties in obtaining informed consent, particularly during crisis situations, which can compromise recruitment rates and the validity of studies.⁹ Furthermore, participants often experience physical and emotional distress due to their condition, and time constraints imposed by the urgency of clinical interventions add another layer of difficulty.

Despite substantial public funding allocated to healthcare research and RCTs, failure to meet recruitment targets results in significant financial waste. Recruitment and retention have been identified as critical challenges in the successful conduct of RCTs by both trialists and funding bodies. For instance, in England, the National Institute for Health Research (NIHR) allocated over £250 million to 310 research projects in 2019–2020, with a significant portion dedicated to RCTs. Recruitment challenges in LMICs stem from underfunded healthcare systems and a shortage of skilled researchers, resulting in inefficient resource use. Barriers such as patient burden, conflicts with standard care, and uncertainty regarding trial protocols often deter healthcare professionals from participating in recruitment efforts. In Pakistan, these challenges are further compounded by a critical shortage of qualified research assistants and skilled personnel. Participant recruitment remains a significant hurdle in the execution of RCTs across diverse healthcare settings, from high-income countries to resource-limited LMICs in Africa and Asia.

According to the WHO, Pakistan employs 5,185 full-time equivalent health researchers, representing only 7% of the regional total. The country's clinical research landscape is further constrained by inadequate funding, limiting the scope, quality, and impact of health research initiatives. In LMICs such as Pakistan, recruitment bias poses a significant challenge by potentially selecting participants who do not accurately represent the general population. This limitation undermines the generalizability of RCT findings and may result in ineffective policy and public health interventions. Furthermore, participant attrition in longitudinal studies and RCTs presents serious methodological concerns that can compromise study outcomes. Addressing recruitment challenges in Pakistani RCTs is critical to improving the validity and applicability of research findings. Effective recruitment strategies ensure diverse and representative samples, enabling the development of interventions tailored to the unique demographic and healthcare needs of Pakistan.

Effective recruitment of participants is essential for the successful conduct of RCTs. Addressing local challenges through collaboration with community leaders and culturally appropriate communication has proven beneficial. Logistical barriers to recruitment can be mitigated by offering flexible scheduling, transportation assistance, and establishing study sites closer to participants, which have been shown to improve recruitment rates. Providing health benefits, aftercare, and small incentives has also been effective in overcoming participant reluctance in Pakistan. For example, a study conducted in Karachi found that offering transportation assistance and follow-up care increased recruitment rates by 25%.

Enhancing recruiter training in cultural sensitivity and streamlining trial regulations can further facilitate recruitment efforts. Simplifying ethics review and approval processes can accelerate trial initiation with minimal delays. Additionally, integrating telehealth solutions for enrollment and remote follow-ups can enhance accessibility and convenience, reducing travel-related challenges for participants.

In conclusion, clinical trials in Pakistan face significant recruitment challenges, including obtaining informed consent, participant eligibility, and logistical issues due to geographic dispersion and limited resources. Strategies such as community engagement, digital reminders, incentives, and cultural sensitivity training are essential to overcoming these barriers, improving participant recruitment, retention, and compliance. These approaches emphasize the need for tailored interventions to strengthen clinical trials in low-resource settings and to ensure that clinical research in Pakistan provides relevant, actionable insights for improving healthcare outcomes.

ASSOCIATION OF PLASMA LEPTIN AND OMENTIN-1 WITH ORAL VITAMIN D INTAKE IN PATIENTS WITH CORONARY ARTERY DISEASES

Shazia Nazar, Syeda Hina Abbas, Syeda Sana Abbas — Tue, 31 Dec 2024 00:00:00 +0000

Objective: To evaluate the association of oral vitamin D intake on leptin & omentin-1 circulating levels in patients diagnosed with coronary artery disease.

Material & Methods: The study was conducted at the Cardiology unit of Civil Hospital Karachi. A total count of 200 diagnosed patients of coronary artery disease with insufficient vitamin D and were prescribed oral vitamin D by their doctors, were selected for the study. Patients were assigned to the daily dose of 2000IU vitamin D for 8 weeks. Anthropometric measurements and circulating vitamin D, omentin-1 & leptin levels were assessed at the beginning and post-treatment.

Results: A notable decrease in leptin (3776 ± 0.422 vs. 3187 ± 0.144, p<0.001), omentin-1 (245 ± 26.1 vs. 296.5 ± 28.11, p < 0.001), and high density lipoprotein levels (36.80 ± 13.46 vs. 45.2 ± 14.31, p < 0.001) were found after oral vitamin D intake.

Conclusion: Vitamin D supplements over an 8-week period substantially reduced serum levels of leptin, whereas they raised omentin-1 and high density lipoprotein levels in coronary artery disease patients.

PREVALENCE OF CARPAL TUNNEL SYNDROME AMONG OFFICE WORKERS IN TWIN CITIES

Tue, 31 Dec 2024 00:00:00 +0000

Objective: To determine the prevalence of carpal tunnel syndrome (CTS) among office workers in twin cities.

Material & Methods: This was a cross-sectional study that used a non-probability purposive sampling technique to select 134 participants based on predefined inclusion criteria. The frequency of CTS was determined using the Phalen and Tinel test. The Boston Carpal Tunnel Questionnaire (BCTS) was used to evaluate the participants' functional status and severity, and the Numeric discomfort Rating Scale (NPRS) was used to measure their discomfort. SPSS 23 was employed for the purpose of data analysis.

Results: Out of the 134 participants, 80% identified as male and 20% as female. The participants' mean service time was 7.14 ± 8.9 years, and their mean age was 29.6 ± 7.7 years. Employees who work 8.6 ± 2.9 hours a day are more likely to have CTS. According to positive Tinel tests, the prevalence was 13.4%, and Phalen tests showed a prevalence of 25.4%. The Phalen and Tinel tests had positive frequency rates of 25.4% and 13.4%, respectively, with the right hand being the dominant hand (87.3%). The symptoms severity score (SSS) of 1.32 ± 0.48 and a functional status score (FSS) of 1.32 ± 0.55 on the Boston Carpal Tunnel Questionnaire.

Conclusion: This study found that office workers had a higher likelihood of having CTS, with a prevalence of 25.4% for positive Phalen tests and 13.4% for positive Tinel tests.

AN ANALYSIS OF PERSONALITY TRAITS IN UNDERGRADUATE DOCTOR OF PHYSICAL THERAPY STUDENTS AT THE INSTITUTE OF PHYSICAL MEDICINE AND REHABILITATION AND REHMAN COLLEGE OF REHABILITATION SCIENCES: A CROSS-SECTIONAL STUDY

Tue, 31 Dec 2024 00:00:00 +0000

Objective: To determine personality traits among undergraduate Doctor of Physical Therapy (DPT) students, find its association with demographics (age, institute, gender, residence, financial status), and CGPA.

Material & Methods: This study was a cross-sectional study, in which 209 participants were recruited from IPM&R and RCRS and convenience sampling was used for data collection. SPSS (Statistical Package for the Social Sciences) version 2022 was used for the analysis of the data.

Results: The personality trait calculated for 209 participants lies within the normal range of their respective domains with the exception of demographic factors such as institute and CGPA, which demonstrated no significant associations with personality traits. Notably, a positive correlation was observed between openness to experience and extraversion with CGPA, while a negative correlation was established between agreeableness, conscientiousness, and emotional stability with CGPA.

Conclusion: From the present study, we conclude that in majority of the undergraduate student’s personality traits were within the normal score while association of personality traits with their demographics clearly showed that agreeableness, extraversion and emotional stability was closely associated with all the demographics except that of institutions and CGPA. While a positive correlation of CGPA existed with openness to experience and extraversion while a negative correlation

FACTORS ASSOCIATED WITH FIBROSIS IN CHRONIC HEPATITIS C PATIENTS

Madiha Zaki, Sadik Memon, Saddat Ali Jiskani, Bushra Qadir, Adil Chaang — Tue, 31 Dec 2024 00:00:00 +0000

Objective: To identify the factors associated with fibrosis progression in a Pakistani cohort of Chronic hepatitis C (CHC) patients.

Material & Methods: A retrospective study was conducted at the Asian Institute of Medical Sciences, Hyderabad involving 350 CHC patients diagnosed between 2021 and January 2024. Data on demographics, clinical characteristics, and laboratory findings were collected. Fibrosis severity was assessed using non-invasive markers (FIB-4 index, APRI score), transient elastography, and, where available, liver biopsy reports. Multivariate logistic regression analysis was performed.

Results: The mean age of participants was 45.2 years, with a male predominance (62.3%). Advanced age (>50 years) was significantly associated with severe fibrosis (OR 2.34, p = 0.001). Other factors linked to advanced fibrosis included male gender (OR 1.89, p = 0.017), HCV genotype 3 (OR 2.61, p < 0.001), prolonged infection duration (>10 years, OR 1.75, p = 0.021), insulin resistance (HOMA-IR >2.5, OR 2.95, p < 0.001), alcohol consumption (OR 3.12, p < 0.001), and co-infection with HBV or HIV (OR 2.58, p = 0.003).

Conclusion: This study identifies critical factors influencing fibrosis progression in CHC patients in Pakistan. Targeted monitoring and management of high-risk groups, along with early diagnosis and timely intervention, can help mitigate complications and improve patient outcomes. Public health efforts should prioritize these strategies to address the burden of CHC-related fibrosis.

A SINGLE BLIND RANDOMIZED CONTROLLED TRIAL REVIEWING THE SUITABILITY OF THE ALEXANDER AND MULLIGAN TECHNIQUES (SNAGS) IN THE TREATMENT OF NON-SPECIFIC NECK PAIN

Sana Fatima, Mujeeb Ur Rahman — Tue, 31 Dec 2024 00:00:00 +0000

Objective: To determine the suitability of the alexander and mulligan techniques (snags) in the treatment of non-specific neck pain.

Material & Methods: A single blind randomized controlled trial was conducted. Subjects were allocated randomly in treatment and control groups through lottery method. The neck disability index and the visual analogue scale served as the outcome measures. The study took place in physiotherapy departments of two hospitals of Peshawar, Pakistan from November 2021 to April 2022. Data was collected from neck pain patients of age 18 to 40 years and randomization was done. Group A received alexander plus mulligan technique and isometric exercises. Group B received mulligan technique plus isometric exercises. Both groups were treated for 4 weeks.

Results: Participants in the experimental group were 30.14±5.367 years old, while those in the control group were 28.69±7.158. With a p-value of less than 0.001, the experimental group's visual analogue scale scores before and after treatment showed a significant difference, falling from 8.48±0.63 to 4.40±0.828. With a p-value of 0.023, the visual analogue scale score in the control group decreased from 7.81± 0.733 to 5.81± 0.734. The experimental group's mean neck disability index scores decreased from 32.93±2.823 to 17.52±2.61 with a p-value of 0.002, while the control group's mean scores decreased from 34.81±3.959 to 25.90±1.445 with a p-value of 0.023.

Conclusion: In treating neck pain and disability, Alexander combined with the Mulligan technique proved to be more effective than the latter alone.