Effects of Contralateral Gravity Eliminated Gluteus Medius and Ipsilateral Quadratus Lumborum Strengthening on Pelvic Alignment, Balance and Functional Mobility on Subacute Stroke Patients

This study aims to compare the effects of contralateral gravity-eliminated gluteus medius strengthening and ipsilateral quadratus lumborum strengthening, both combined with conventional physiotherapy, on pelvic alignment, balance, and functional mobility in patients with subacute stroke. This single-blinded, two-arm, parallel-group randomized clinical trial will be conducted at the Department of Physical Therapy Rehabilitation, Alfalah Medical Center, Lahore, Pakistan. A total of 40 participants aged 45-60 years with a first-ever stroke occurring 1-6 months before enrollment will be recruited and randomly allocated to two groups. Group A will receive 30 minutes of conventional physiotherapy followed by 20 minutes of contralateral gravity-eliminated gluteus medius strengthening, while Group B will receive 30 minutes of conventional physiotherapy followed by 20 minutes of ipsilateral quadratus lumborum strengthening. Both groups will receive treatment three times per week for six weeks. The primary outcome measures will include pelvic alignment assessed using the Palpation Meter (PALM), balance assessed using the Berg Balance Scale (BBS), and functional mobility assessed using the Timed Up and Go (TUG) test. All outcome measures will be assessed at baseline, immediately after the six-week intervention, and at week 12 to evaluate changes following treatment and at follow-up. The study will compare outcomes between the two groups to determine the relative effectiveness of the two targeted strengthening approaches when combined with conventional physiotherapy in patients with subacute stroke.

Inclusion Criteria: Patients aged 45-65 years. Patients with a first-ever stroke occurring 1-6 months before enrollment (subacute stroke). Patients classified within Brunnstrom Recovery Stages III-V. Medically stable patients who are able to follow simple verbal commands. Patients able to stand independently or with minimal assistance. Patients with a Berg Balance Scale (BBS) score below 45 out of 56. Exclusion Criteria: Patients with a history of recurrent stroke. Patients with severe cognitive impairment. Patients with other neurological disorders that may affect rehabilitation outcomes. Patients with severe lower-limb musculoskeletal conditions. Patients with severe spasticity, defined as a Modified Ashworth Scale (MAS) score greater than 3, according to the study protocol. Patients with uncontrolled cardiovascular or respiratory disease. Patients with severe visual or vestibular impairment affecting balance. Patients unable to stand even with assistance. Patients participating in another rehabilitation research study during the study period. \-