Journal of Health and Rehabilitation Research

Quality of Life and Symptom Burden Among Patients with Chronic Obstructive Pulmonary Disease in Pakistan

2026-08-17T07:21:45+00:00

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.

Health Literacy and Treatment Compliance Among Patients with Chronic Kidney Disease Attending a Nephrology Outpatient Department and Dialysis Center in Lahore, Pakistan: An Analytical Cross-Sectional Study

2026-08-17T13:53:00+00:00

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.

Antibiotic Use Practices and Awareness of Antimicrobial Resistance Among Adult Patients Visiting Outpatient Departments in Pakistan

2026-08-18T06:46:51+00:00

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

Awareness of Stroke Warning Signs and Risk Factors Among Patients with Hypertension and Diabetes Mellitus at a Tertiary-Care Hospital in Quetta, Pakistan: A Cross-Sectional Study

2026-08-18T00:54:43+00:00

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.

Predictors of Complicated Acute Appendicitis in Adults: A Narrative Review with Emphasis on Saudi Arabia and Comparable Settings

2026-08-18T03:58:30+00:00

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.