PHYSIOTHERAPY AND ORTHOTIC INTERVENTIONS FOR ENHANCING FUNCTIONAL MOBILITY AND MUSCLE STRENGTH IN LOWER LIMB DISORDERS: A REVIEW OF EVIDENCE FROM PAKISTAN

Abstract

Background: Lower limb disorders are a leading cause of disability in Pakistan, frequently resulting in impaired functional mobility, muscle weakness, and reduced quality of life. The burden is amplified by delayed rehabilitation access and variability in clinical practices across healthcare settings. Although physiotherapy and orthotic interventions are widely used, evidence specific to the Pakistani context remains fragmented, limiting informed decision-making and standardized rehabilitation planning.

Objective: This review aimed to systematically evaluate and synthesize Pakistani evidence on the effectiveness of physiotherapy, orthotic, and combined rehabilitation interventions in improving functional mobility and muscle strength among individuals with lower limb disorders.

Methods: A systematic literature search was conducted in accordance with the PRISMA framework using PubMed, Google Scholar, PakMediNet, and ScienceDirect. Studies published between January 2005 and March 2025 were screened. Eligible studies included randomized controlled trials, quasi-experimental, cohort, and interventional studies conducted in Pakistan involving neurological, musculoskeletal, or metabolic lower limb disorders. Outcomes of interest included functional mobility, muscle strength, gait, balance, and functional independence. Methodological quality was appraised using Critical Appraisal Skills Programme checklists.

Results: Twelve studies met the inclusion criteria, comprising randomized controlled trials (n = 3), quasi-experimental studies (n = 3), and interventional clinical studies (n = 6), with sample sizes ranging from 15 to 120 participants. Physiotherapy-based interventions (n = 7) demonstrated statistically significant improvements in pain and function, including reductions in WOMAC pain scores, improvements in Katz Activities of Daily Living, and faster Timed Up and Go performance, with reported p-values <0.05. Pediatric and neurological studies reported significant gains in Gross Motor Function Measure scores (p = 0.003) and reductions in spasticity. Orthotic interventions (n = 5) showed improvements in gait alignment, ankle range of motion, and activities of daily living, though outcomes were inconsistent when orthoses were used in isolation. Combined rehabilitation approaches (n = 6) consistently yielded superior improvements in functional independence, lower extremity function, and quality-of-life measures compared with single-modality interventions.

Conclusion: Physiotherapy emerged as the primary driver of functional recovery in lower limb disorders, while orthotic devices were most effective as adjuncts within integrated rehabilitation programs. Multimodal, context-specific rehabilitation strategies appear essential for optimizing functional mobility and muscle strength in the Pakistani healthcare setting.