Malaysian Physiotherapy Journal (MPJ) is a peer-reviewed journal published annually by the Malaysian Physiotherapy Association. MPJ aims to publish original research, meta-analysis and review papers, single case studies or case series, physiotherapy education reports, reports from scientific conferences and professional training sessions, letter to editors and commentaries concerning physiotherapeutic approaches or interventions which has significant implications to physiotherapy and rehabilitation practices and development locally and worldwide. The mission of MPJ is to provide free access to the articles for the students, academicians and clinicians in various areas of physiotherapy and rehabilitation, and to facilitate the growth of evidenced-based practice among the rehabilitation professionals. MPJ strive to become among the recognised journals for publishing good quality research, particularly in physiotherapy.
Variation in Spatiotemporal Parameters of Gait between Transtibial and Transfemoral Amputees in Physical Rehabilitation: A Preliminary Study
Background: Lower limb amputees often exhibit less efficient gait patterns, potentially attributed to spatiotemporal asymmetries. While there is a common belief that transfemoral (TF) amputees experience more pronounced gait asymmetries compared to transtibial (TT) amputees, this assumption lacks clear and definitive establishment through empirical evidence. Objectives: The objective of this study was to compare the effects of amputation level on the step width, step length, cadence, step time, and walking speed for prosthetic and intact legs. In addition, a degree of asymmetry (DoA) was calculated and tested for each of these five parameters. Methods: Twenty-two (22) participants with transfemoral (11) and transtibial (11) amputation (45.5 ± 12.18 years) participated in the cross-sectional study design. Subjects were tested on 10-meter walkways 10 times at their habitual walking speed and the average of three trails was calculated. Spatiotemporal gait parameters were assessed using Vicon Motion Capture, UK. Results: Prosthetic and intact limbs were averaged together. The step length (p = 0.596), step width (p = 0.618), and walking speed (p = 0.721) were not statistically significantly different between the TF and TT group, p = > 0.05 whereas the cadence (p = 0.011) and step time (p = 0.033) were statistically significant p = < 0.05. The DoA analysis indicated that TF amputee step times were more asymmetrical than TT amputees (DoA = 0.20 ± 0.07 vs. 0.05 ± 0.05, p = < 0.001). Conclusion: TT amputees walk with greater cadence and step time compared to TF amputees as well as DoA. The spatiotemporal performance among transfemoral amputees should be improved to restore a nearly physiological pattern of movement.
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The Effect of High Arch and Flat Foot on Dynamic Balance among College Students
Background and Objectives: Foot arch plays an important role in maintaining dynamic balance. Dynamic balance involves stabilizing the body when the body is moving on a stable surface. However, studies which focus on the effect of high arch and flat foot on dynamic balance remains limited. Thus, this study aimed to assess the effect of high arch and flat foot on dynamic balance among college students. Methods: A cross-sectional study was employed involving 50 students from a college in Perak, Malaysia (mean age± SD = 22.28±1.68). The participants were recruited using convenience sampling technique. The participants were then divided into two groups of foot arches based on the navicular drop test measured: high arch (≤4 mm) and flat foot (≥ 10mm). Dynamic balance was measured using the star excursion balance test (SEBT). The data were analysed using SPSS version 23. Results: The results revealed that there was a significant difference between high arch and flat foot groups in posteromedial direction (p=0.009) and posterior direction of SEBT (p=0.002). However, there was no significant difference in other directions of SEBT scores between high arch and flat foot groups (p>0.05). Conclusion: Foot types affecting dynamic balance in certain directions, suggesting that college students need to be aware of their foot types to prevent balance problem in future. Both high arch and flat foot problems can be corrected, and physiotherapists play an important role in these.
Profile of Transient Ischemic Attack (TIA) Patients Receiving Care in A Teaching Hospital of Malaysia
Background and Objectives: Transient ischemic attack (TIA) is a health issue of cencern due to its potential progression to stroke. Information on the profile of individuals with TIA may assist in the prevention strategy of the condition. However, no studies have published data regarding this. This retrospective study aimed to identify the socio-demography and disease profile of TIA patients who received care in a Malaysian teaching hospital and assess the factors correlated with their length of hospital stay (LOS). Methods: A cross sectional study was carried out using patients’ database from the International Training Center for Casemix, UKM Medical Center. Data of patients coded as G45.9 (TIA) in the past 5 years (2019-2023) were analysed using descriptive statistics (for profiles) and Correlation test (for factors of interest). Results: A total of 97 cases were found; of these, 59.8% (n=58) were males and the remaining were females. The mean age of the patients was 64.27 ± 13.31 years, with , with a median duration of hospital stay of 5.00 days (IQR: 3.50 days). Besides TIA (G45.9), patients were also presented with a variety of comorbid conditions including essential (primary) hypertension with 69.07% (n=67), type 2 diabetes mellitus with kidney complications (44.33%, n=43), and unspecified hyperlipidemia (53.42%,n=39). In addition, beside TIA, a total of 17.7% (n=17) of patients have 5 additional diseases, 15.5% (n=15) have 6 other diseases, and 11.3% (n=11) have additional 9 diseases. There is a weak positive correlation between LOS and age (r = 0.205, p < 0.05), a weak negative correlation between LOS and gender (r = -0.092, p > 0.05), and a moderate positive correlation between LOS and number of diseases (r = 0.477, p < 0.01). Conclusion: This study highlights the the importance of addressing comorbidities in the management of transient ischemic attack (TIA) patients. While physical therapists may not typically be involved in the acute treatment of TIA, they can play a crucial role in rehabilitation and comorbidity management.
Effectiveness of Exercise and Physiotherapy Modalities onIncreasing ROM and Muscle Strength in Elderly with KneeOsteoarthritis
Background: Knee Osteoarthritis (OA) primarily affects the elderly. MoH Indonesia (2021) reported the prevalence of knee OA among elderly population keeps increasing within last 5-years thus it needs an effective intervention on minimalizing its effects. Thus, managing effective intervention focusing on improving range of motion (ROM) and muscle strength is crucial for elderly with knee OA. However, there were lacks on study which focusing about how exercise and physiotherapy modalities affecting ROM and muscle strength among elderly Objective: This study aimed at analysing the effectiveness of physiotherapy modalities and exercise towards ROM and muscle strength among elderly with knee OA. Methods: It is a quasi-experimental approach which assess the efficacy of strengthening exercise and physiotherapy modalities in enhancing range of motion and muscular strength. This study had a total of 20 participants. Intervention was given for 8 session (1-month), while follow-up was monitored during baseline (T0) and after intervention given (T1). Purposive sampling was utilized in this study. Paired T-test were used to analyse each patients’ condition during pre-post test. Results: The paired t-test analysis on ROM and muscle strength were significant with p value were 0.015 and 0.011, respectively after given the intervention. Conclusion: It can be concluded that strengthening exercise and physiotherapy modalities can increase the ROM of joints and muscle strength in the elderly with Knee OA, and it is recommended for geriatric management policy on including the exercise program and physiotherapy modalities on improving their ROM and muscle strength.
The Validity of Newly Developed Portable Wheelchair Treadmill (PARAFiTGo) among Individuals with Spinal Cord Injury
Background and Objectives: Individuals with spinal cord injury (SCI) face low physical fitness due to barriers like expensive equipment and limited access to training facilities. A new portable and affordable wheelchair treadmill prototype (PARAFiTGo) that can replicate wheelchair propulsion has been developed. However, PARAFiTGo lacks a validity study matching it with SCI consumers. This study aimed to determine the predisposition level of the PARAFiTGo among individuals with SCI. Methods: Surveys were conducted with ten participants, content experts and health professionals to suggest the matching level of PARAFiTGo with SCI consumers. A valid questionnaire called ‘Assistive Technologies Device Predisposition Assessment (ATD-PA) was used for the study purpose. One-sample t-test was employed in data analysis. Results: The mean score given by the health professionals for the wheelchair treadmill was 116 (out of a total score of 156). Statistical analysis revealed that the scores varied minimally among the evaluators, indicating significant match and high predisposition level of PARAFiTGo with SCI individuals p<.001. Conclusion: The study confirms the significant match and high predisposition level of the PARAFiTGo among individuals with SCI. This validates its potential as an effective tool for enhancing physical fitness in SCI population. The results from this study will support the findings of positive impacts of PARAFiTGo innovations and should be promoted for improvement of physical activity, fitness, and function among individuals with SCI.
Game-Based Circuit Exercise Enhances Functions and Motivation Level of Stroke Survivors: A RandomisedControlled Trial
Background and Objectives: Stroke survivors are commonly at risk of functional decline, which increases their dependency on activities of daily living and eventually affects their motivation. This study merged the 'usual circuit exercise' and enriched environment of training to evaluate the effects of game-based circuit exercise compared to conventional circuit exercise on lower limb strength, postural stability and motivation level of stroke survivors. This study also assessed whether the effects could be sustained at 12-, 24-, and 36-weeks post-trial. Methods: This research was randomized controlled trial involving 88 stroke survivors who received either a game-based circuit exercise (experimental group, n = 44) or a conventional circuit exercise (control group, n = 44) for 45 minutes, twice per week for 12 weeks. Interventions’ outcomes were measured using the 30-second chair rise test (for lower limb strength), Dynamic Gait Index (for postural stability) and Intrinsic Motivation Inventory (for motivation level). Results: Data were analysed involving 88 participants (mean age ± standard deviation =57.1 ± 10.8 years; mean Montreal Cognitive Assessment score = 26.4 ± 3.4). Results showed significant time and effects interaction (p<0.05), with a small to large effect size between 0.05 and 0.99, for lower limb strength and motivation level following the two therapies. Stroke survivors in the experimental group performed better in postural stability endurance (p<0.05). Conclusion: Game-based circuit exercise appears comparable to conventional circuit exercise and may be a relevant alternative for enhancing post-stroke lower limb strength, postural stability and motivation level. The interventions’ outcomes could be sustained at week 12, 24 and 36 post-trials.
Effectiveness of Buerger-Allen Exercise with Kinesio Taping on Lower Extremity Perfusion among Diabetic Individuals: A Randomised Controlled Trial
Background and Objectives: Diabetes Mellitus presents a significant global health concern, accompanied by a substantial economic burden. In the diabetic demographic, the heightened prevalence of peripheral arterial disease is attributed to compromised lower extremity perfusion, adversely affecting functional capabilities. Despite the conventional use of the Buerger-Allen exercise to enhance lower extremity perfusion, a literature gap exists regarding the concurrent application of Buerger-Allen exercise and kinesio taping. This study aims to investigate the immediate effect of Buerger-Allen exercise with kinesio taping on lower extremity perfusion among individuals with diabetes. Methods: In this randomised controlled trial, 40 participants with Type 2 Diabetes Mellitus were randomly assigned to the experimental group (n=20) or the control group (n=20). The experimental group received Buerger-Allen exercise with kinesio taping applied to the gastrocnemius muscle, while the control group received Buerger-Allen exercise only. The ankle-brachial index (expressed as the common circulatory score of the left and right) was used to measure the lower extremity perfusion. Dependent t-tests and independent t-tests were employed for data analysis. Results: A total of 40 diabetic individuals with a mean age of 69.72 (±6.47) were enrolled. Significant improvements in lower extremity perfusion were observed in both groups. The mean difference in the ankle-brachial index value was 0.072(±0.05) for the experimental group (p<0.05) and 0.07(±0.06) for the control group (p<0.05). No significant difference was found between the two groups. Conclusion: Buerger-Allen exercise is effective in improving lower extremity perfusion among diabetic individuals. The addition of kinesio taping does not yield additional significant improvement.
Moderate Intensity Physical Exercise Effectiveness on Stress and Happiness Level Among Parents of PhysicallyDisabled Children
The upbringing of a physically disabled child involves huge monetary funds and constant attention from the parent. It leads to minimal sociability and personal attention for the parents, which contributes to high stress and low happiness in the long run. Hence, this experimental study was conducted to measure the effect of moderate physical exercise on stress and happiness among parents of physically disabled children using the Perceived Stress Scale and Subjective Happiness Scale. The study goals were to evaluate the potential sociodemographic variables and the benefits of moderate-intensity exercise in stress and happiness management. Participants were allocated into either an exercise group or a control group; parents in the exercise group were given clear-cut instructions on moderate-intensity exercises to complete in 6 weeks. The data were analysed using Chi-square, Pearson correlation, and ANOVA from SPSS software. The findings showed socio-demographic variables and physical activity level have no significant relationship (p>0.05) on stress and happiness level among parents of physically disabled children except for employment status (p<0.05). The moderate intensity exercise has a significant effect on stress levels (p<0.05) but no significant effect on happiness levels (p>0.05) among parents of physically disabled children. Altogether, the findings from this study proclaimed that moderate-intensity exercise affects stress but not the happiness level of parents of physically disabled children. With that, a potential intervention tool through exercise adoption can be utilized as a medium to manage stress in parents of physically disabled children. On that account, elucidation on physical exercise towards stress levels in parents of physically disabled children can be achieved and explained in an informative manner. Further studies are warranted to confirm this study findings.
Nurul Husna Khairuddin, Amirul Ridzuan Abu Bakar, Eliza Hafiz, Ashril Yusof
The Effect of Massage Therapy on Spasticity in Children with Cerebral Palsy: A Systematic Review
Background and Objectives: Cerebral palsy (CP) is a neurodevelopmental disorder that affects children muscle function as well as motor tone. Massage therapy has been proven to be effective in improving motor function, muscle tone and stiffness, sensory deficit and pain. This study is conducted to critically analyse the published literature on the benefit and effect of massage therapy as a treatment for spastic cerebral palsy. Methods: Three databases were searched from August 2023 until September 2023 (MEDLINE via PubMed, Cochrane Library, Scopus) for randomized trials study with keyword; massage, massage therapy, spastic, and cerebral palsy. Final selection was made by the authors, who independently checked the titles, abstracts, inclusion and exclusion criteria and the full text. The articles were assessed for its quality using PEDro scale and relevant data were extracted. Results: Out of 242 articles which were reviewed, only 30 articles met the inclusion criteria. Four out of 30 articles were selected (range of PEDro scale is 7 to 9 over 11). The results showed that massage therapy with different techniques have a beneficial effect on spastic cerebral palsy patients. The combination of massage with physiotherapy treatment produces a significant improvement in spasticity reduction. Conclusion: The quality of the studies was mixed, ranging from higher-quality experimental to lower-quality of studies. Overall, the studies reported positive outcomes of massage therapy. This review findings may serve as a good foundation for future randomized controlled trials to understand the long-term effects and optimize treatment approaches for children with cerebral palsy.
Novel Approach on Pulmonary Rehabilitation for AECOPD GOLD 1-3: A Single-blinded Randomised Controlled Trial Protocol
Background and Objectives: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common progressive chronic lung disease characterized by irreversible airflow limitation, leading to worsening quality of life (QOL). Pulmonary rehabilitation is an essential treatment in the management of AECOPD patients. We aim to develop a novel approach to a pulmonary rehabilitation program for hospitalized AECOPD. Methods: This randomized controlled trial will include a total of 62 inpatient AECOPD and will randomly be divided into experimental (n=31) and control (n=31) groups. The experimental group will receive autogenic drainage (AD) and walking exercise, whereas the control group will receive conventional chest physiotherapy. Treatment will be conducted for four consecutive days, two sessions per day. The primary outcome will utilize the VAS pain scale, Modified Borg Dyspnea scale, lung spirometry test and six-minute walk test (6MWT). All these assessments will be measured at baseline and post intervention. The secondary outcome is quality of life and will be measured by using the St George’s Respiratory Questionnaire, Malay version (SQRQ- CM). QoL will be assessed at baseline and post four weeks hospitalization. Results: The novel approach by combining AD and walking exercise is expected to be able to improve pain, dyspnea, lung volumes, aerobic capacity and QOL in patients with GOLD 1 -3 AECOPD. This approach is easy and convenient to be carried out in ward setting as well as giving clinician an evidence-based practice guidance.
Evaluating the Efficacy of Home-Based Exercise Program Versus Patient Education in Improving Glycemic Control in Patients with Type 2 Diabetes: A Randomized Controlled Trial Protocol
Background and Objectives: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by poor glycemic control and physical impairments, which significantly impact the quality of life (QoL). The study aims to investigate the potential benefits of a home-based exercise program in improving glycemic control, physical functioning, and QoL in patients with T2DM when compared to an education program. Methods: The study will employ a single-blind randomized controlled trial (RCT) design. The intervention group will comprise 30 participants undertaking a 12-week home-based exercise program, which includes 30 minutes of aerobic exercise for five days a week along with two days of resistance exercise. Simultaneously, the control group, consisting of 30 T2DM patients matched for age, gender, and weight, will engage in a four-session education program, with each session lasting 60 minutes. The primary outcome measure will be glycated hemoglobin (HbA1c), while secondary outcomes will include changes in physical fitness parameters such as aerobic capacity, muscle strength, and body composition. These outcomes will be assessed at three time points: baseline, the sixth week, and the 12th follow-up. Results: Statistical analysis will be conducted to determine whether the exercise program exerts a statistically significant positive effect on the outcome measures. Conclusion: If the home-based exercise program proves to be effective, it has the potential to serve as a cost-effective intervention for patients with T2DM. This could minimize the need for physical visits to healthcare providers while positively impacting glycemic control, physical functioning, and QoL in this patient population.
Artificial Intelligence in Rehabilitation
Artificial Intelligence (AI) is revolutionizing rehabilitation by enhancing diagnosis, treatment, and patient monitoring. Through technologies like machine learning, robotics, and virtual reality, AI enables personalized and adaptive therapy—such as robot-assisted exercises and motion tracking using wearable sensors. It also supports virtual rehab platforms, predicts recovery outcomes, and automates administrative tasks. While AI improves efficiency and patient engagement, challenges like data privacy, cost, and training must be addressed. Overall, AI offers great potential to make rehabilitation more effective, accessible, and patient-centered.
Injury Risk Assessment for Low Back Pain: A Scientometric Study
Background and Objectives: Low back pain (LBP) is one of the most common issues in humankind and has a high tendency for recurrence. Considering the harmful effects of LBP, it is crucial to identify the injury risk assessment to detect possible LBP occurrence in the future. The scientometric analysis will provide a fine path for researchers to know the current trend and evolution of the theme research area of LBP injury risk assessment. Therefore, this research objective was to gather data from the literature to determine the present trend of LBP injury risk assessments and current research. Methods: This scientometric study has collected scientific publications from the Web of Science (WOS) database from 2000 to 2023. CiteSpace software was used for co-occurrence, clustering, co-citation, and burst analysis. The search terms that have been used are “injury risk assessment for low back pain”. Results: The most popular author is Michael A. Adams, PhD, Biomechanics Centre for Comparative and Clinical Anatomy Professor from the University of Bristol (sigma: 2.21). The most influential article is The Dominant Role of psychosocial risk factors in the development of chronic low back pain disability from Spine (sigma: 2.74). Quadrant Injury is the most common cluster (size:117), and last but not least, the strongest keyword is low back disorders (strength:4.4). Conclusion: The risk of low back pain is becoming one of the popular future research areas. Furthermore, researchers must know the lack of research being done on elite youth athletes, hence this theme needs more exploration.
Development of a Mobile Application for Personalized Exercise Monitoring in Patients with Type 2 Diabetes Mellitus
Background and Objectives: Despite the well-established benefits of regular exercise in managing Type 2 Diabetes Mellitus (T2DM), patient adherence to exercise regimens remains challenging. Remote monitoring presents an opportunity to obtain real-time tracking of exercise behavior, enabling healthcare workers to provide personalized support. This study investigates the potential of remote exercise monitoring in improving patient adherence. Methods: A 3-phase study was conducted. Phase I entailed conducting a systematic review to establish the exercise protocol, which was subsequently validated by a panel of experts. Phase II focused on developing a mobile application, which experts reviewed for usability and acceptability. In Phase III, seven patients were recruited to participate in an 8-week exercise program consisting of two sessions of resistance exercise and five sessions of aerobic exercise per week. Quantitative and qualitative methods were utilized to capture patient experiences and satisfaction with the application. Results: Patients found the mobile application acceptable, providing constant reminders for exercise adherence. Satisfaction with the application was high. Conclusion: The newly developed mobile fitness application shows promise, particularly for beginner exercisers.
Checkercise® Enhances Functions and Motivation Level of Stroke Survivors
The increase in the prevalence and incidence of stroke has led to a rise in stroke case referrals between 2017 and 2018. However, there has been a decrease in stroke patient attendance due to the unappealing nature of existing exercise prescription programs during 2019 and the Movement Control Order between 2020 and 2021. Factors contributing to the identified problem include: 1) unappealing existing stroke patient exercise prescriptions, 2) insufficient productivity of existing stroke patient exercise prescriptions, 3) lack of savings in existing stroke patient exercise prescriptions, 4) existing stroke patients' lack of empowerment in exercising at home, and 5) inefficient monitoring of stroke patients' home exercises. Thus, Checkercise® innovation has been introduced, with its enriched gaming-themed environment, designed to be enjoyable and easily implemented at home, proves beneficial to stroke patients. To sustain exercise during the Movement Control Order, the Checkercise® website was introduced to help patients stay healthy and active. Comparison of stroke patient exercises using Checkercise® website with exercises in regular environments found: 1) a 3% increase in motivation levels, 2) an 11% increase in leg strength and quality of life status, 3) a 40-minute reduction in treatment time per treatment session, with a monthly exercise frequency of one session with 50% reduction in monthly hospital travel costs for appointments. With the Checkercise® website, 4) home exercise empowerment increased by two sessions per week, with 5) more efficient and systematic monitoring. Checkercise® website proves beneficial and has the potential to pioneer exercise care with an enriched environment among Physiotherapy. Alternatively, the Checkercise® box, which is filled with board games and game cards, can be purchased separately at RM30 per unit.
Comparison of Spatiotemporal Gait Parameters among Individuals with Chronic Low Back Pain and Healthy Subjects: A Cross-Sectional Study
Background and Objectives: Chronic Low Back Pain (CLBP), is characterized by persistent pain in the lower back region, lasting for 12 weeks or longer. CLBP can significantly impair an individual's quality of life, leading to limitations in physical activities, including walking. The primary objective of this study is to analyze the disparities in spatiotemporal gait parameters between individuals with CLBP and healthy subjects. Specifically, the study aims to investigate the differences in step length, single limb support, and walking speed between the two groups. Methods: A cross-sectional study was conducted, involving a total of 40 participants; twenty individuals diagnosed with CLBP and 20 healthy subjects. Spatiotemporal gait parameters were assessed using a three-dimensional motion capture system, including step length, single limb support, and walking speed. Each participant completed 10 walking trials at their self-selected walking speed on a 10-meter walking platform. The data obtained from the motion capture system were analyzed using inferential statistics, with an independent t-test employed to compare the means of the two groups. Results: The analysis revealed significant differences between CLBP patients and healthy individuals in terms of spatiotemporal gait parameters. Specifically, the differences were observed in step length (p < 0.002), single limb support (p < 0.001), and walking speed (p < 0.004). Conclusion: The study findings demonstrate that individuals with CLBP display distinct spatiotemporal gait parameters when compared to healthy individuals. These differences have implications for the rehabilitation outcomes of CLBP, suggesting the need for tailored interventions to address the altered gait patterns in this population.
i-StrokeFit+: Integrated Stroke Fitness Training Apps
The i-Strokefit+ app represents a pioneering innovation developed through collaboration between a postgraduate student from Universiti Teknologi MARA (UiTM) Selangor Branch Puncak Alam Campus and seasoned experts including senior physiotherapists, lecturers, and rehabilitation physicians. It serves as a comprehensive resource aimed at enhancing knowledge and well-being among stroke survivors. Comprising two main sections, the app provides invaluable insights into stroke, physical fitness, healthy diets, exercise programs, and self-care strategies. The second section offers a complete exercise program encompassing warm-up, stretching, aerobic exercises, resistance training, and cool- down, facilitating a healthier and more active lifestyle post-stroke. With its intuitive interface and rich content, i-Strokefit+ empowers stroke survivors to take control of their health and rehabilitation journey, thereby enhancing their quality of life. By addressing gaps in traditional rehabilitation methods, the app offers personalized support to users, promoting independence and improved well-being. Positioned as a promising candidate for commercialisation, i-Strokefit+ holds significant prospects for reaching a wide audience and making a profound impact in the field of stroke rehabilitation and wellness. Its distinctive features and comprehensive approach underscore its potential to revolutionise post-stroke care, providing tailored solutions to meet the diverse needs of stroke survivors globally.
Musculoskeletal Strength, Balance, Cardiorespiratory Function, Psychological Status and Physical Activity Level among Morning and Evening Chronotypes
Background and Objectives: Chronotype is an individual’s preferred time of sleep and activity. Sleep disturbance is a common problem among university students that may influence physical and mental health. The objectives of this study were to (i) compare the musculoskeletal strength, balance, and cardiorespiratory function and (ii) determine the association between psychological status and level of physical activity among morning and evening chronotype groups. Methods: A cross-sectional survey was conducted among 257 health sciences students. The participants undergone screening using the International Physical Activity Questionnaire (IPAQ), Morningness-Eveningness Questionnaire (MEQ), Depression, Anxiety, and Stress Questionnaire (DASS-21), Hand grip dynamometer, Countermovement jump, Peak Flow meter (PEFR) and Modified Star Excursion test (SEBT). Results: Participants’ mean ± SD age was 21.3 ± 3.32 years, consisting of 146 female and 111 males students. Of these, 200 students are considered intermediate chronotype, 46 students morning chronotype and 11 evening chronotype. Balance for posterolateral and posteromedial (09:00) shows a significant difference between chronotypes. Conclusion: Our results indicate that the morning chronotype has better balance than evening chronotype. Future study can be focused on the athlete by taking into account of the influence of time of the day and physical performance.
The Impacts of Home-Based Rehabilitation and Self-Management Program on Community-Dwelling Stroke Survivors: A Randomized Controlled Trial Protocol
Background and Objectives: Several barriers that preventing community-dwelling stroke survivors from participating in traditional clinic-based therapy have caused the rise of home-based physiotherapy as a potential alternative. However, there is limited research on the integration of home-based and self-management programs for stroke survivors. Therefore, this study aims to examine the effectiveness of an integrated home-based physical fitness and self-management program (i-StrokeFit+) on aerobic capacity, muscle strength and endurance, walking performance, level of physical activity, and quality of life in stroke survivor. Method: Over the course of 14 weeks, this study will utilize a Randomised Controlled Trial (RCT) design with three measurements. Measurements will be taken at baseline, 8th, and 14th weeks. Block randomization will be used to randomly assign 48 people into the experimental or control group. An integration between home-based program that consist of an aerobic and strengthening exercise, and self-management programs will be provided to the experimental group. A two-week adaptation training will be provided beforehand. The control group will receive usual care treatment. Aerobic capacity, muscle strength, and endurance are the primary outcomes; walking performance, level of physical activity, and quality of life are the secondary outcomes. A linear mixed model ANOVA using time as the within-between dependent variable will be performed to analyse all outcomes. Result: The primary outcomes of this study will focus on the changes in aerobic capacity, muscle strength and endurance, while the secondary outcomes will assess effects on walking performance, level of physical activity, and quality of life among stroke survivors. Conclusion: It is anticipated that the i-StrokeFit+ will have a positive impact on physical fitness, including aerobic capacity and muscle strength and endurance, among community-dwelling stroke survivors.
Relationship between Incentive Spirometry Training and the Length of Stay in Intensive Care Unit after Coronary Artery Bypass Graft
Background and Objectives: Incentive spirometry (IS) is a device widely used to measure the lung volume and train a slow, and deep breathing. IS is clinically proven to prevent postoperative pulmonary complications. The majority of hospitals in Malaysia follow the practice guidelines of using IS post-operative. However, the rate of Length of Stay (LOS) in the Intensive Care Unit (ICU) is increasing. This study aims to determine the relationship between IS training and the LOS in the ICU after Coronary Artery Bypass Graft (CABG). Methods: A correlational study involving 46 patients undergoing CABG was undertaken between July and November 2023. The participants received pre-operative and post-operative education and exercises that included practice of IS 10 times every hour. Lung volume as measured using the IS was recorded at preoperative, post-extubated, and post-operative before transfer to the ward. The days spent in the ICU and in the hospital were both recorded as LOS1 and LOS2 respectively. Results: The mean±SD age of the study participants (41 [89%] male) were 63±SD years. There was no significant association between post-operative IS and LOS1 (r= 0.11, p= 3.09). However, the study analysis found a significant association between post-extubated IS and LOS1 (r= 0.14, p< 0.0001). The mode of LOS1 is 3 days (σ =1.05). Conclusion: IS did not play an individual role effect on LOS in ICU, because interventions implemented always combined with breathing exercises, encouraged coughing, and earlier mobilization. Further studies are needed to evaluate the effect of IS on lung volume in post-CABG patients.
Highlights On Information, Secondary Stroke Prevention and Holistic Management of Post-Transient Ischemic Attack Population: A Scoping Review
Background and Objectives: Epidemiological evidence suggests that there are residual problems post-Transient Ischemic Attack (TIA), specifically in most domains of life, which led to lower quality of life (QoL). TIA patients’ needs were summarized in past literature, encompassing three aspects: 1) information; 2) stroke prevention; and 3) holistic management (residual impairments and patients' live situations). However, the details of these needs remain limited. Therefore, this scoping review was carried out to identify the extent of existing practices or treatments to address the TIA patients’ needs. The insights of this scoping review are expected to be used to inform the development of a multi-component post-TIA care module for TIA patients. Method: This review utilizes the 5-step framework by Arksey & Malley (2005), and the databases searched cover established databases using keywords related to TIA and care. Result: Sixteen relevant articles were identified from 11,501 articles published between 2014 and 2022. Three studies were found to contain education and information sharing that addressed the needs for information; all sixteen studies focused on stroke secondary prevention programs involving medical adherence, education for lifestyle changes, exercises, and counseling; and only one study reported the impacts of the treatment on post-TIA fatigue. Our review found no study that looked into the context of the impacts of post- TIA care on patients’ lives. Conclusion: Our findings show that available studies were focusing mainly on stroke secondary prevention, leaving a gap in the need for holistic care covering TIA patients’s residual impairments and the impacts on their lives. Future studies specifically targeting a holistic care approach are warranted.
Mobile Application (ScoScreen) for Early Screening of Adolescent Idiopathic Scoliosis
Description: Scoscreen is a mobile application developed to detect Adolescents with Idiopathic Scoliosis (AIS) early. Needs: Scoliosis screening is performed for early detection of spine deformity. Recommended scoliosis screening tools are conventional scoliometer and Adam forward bending test (AFBT). The majority of scoliosis screening applications lack sufficient validation and realibility, hence undermine the confidence of healthcare professionals in utilizing them. Measuring solely using scoliometer can result in both false positive and negative results. Hence, ScoScreen was developed to address the gap in the market and the needs for a more comprehensive solution. Unique Features: ScoScreen application has both AFBT and built-in scoliometer. It has step-by-step instruction both virtual and written. ScoScreen application is a Malaysian application, validated and reliable equivalent to the scoliometer. It incorporates cultural sensitivity in the Malaysia context as it can also be performed at home. ScoScreen is designed to integrates into primary healthcare settings in order to recognised the risk of scoliosis. Impact: ScoScreen enhances the ability to detect scoliosis early, enabling timely intervention and treatment. Healthcare providers can have greater confidence in the screening results, leading to more effective patient management strategies. ScoScreen addresses barriers by offering a user-friendly and cost-effective screening solution. It also facilitates human resource allocation and long-term strategic screening plan in health care settings. Prospects for commercialization: ScoScreen appeals to healthcare providers, schools, parents and individuals seeking reliable scoliosis screening tools. Partnering with healthcare providers, including clinics and agencies with education ministries further expands ScoScreen's market reach and credibility of screening strategies.
Prescriptions used in Training Sit-to-Stand among Post-Stroke Individuals: A Protocol for Systematic Review
Background and Objectives: Independent standing is crucial for ambulation in post-stroke individuals. Therefore, sit-to-stand training plays a vital role in post-stroke rehabilitation. Yet, there is a lack of clear guidance on the parameters for sit-to-stand training in post-stroke individuals. Therefore, this systematic literature review specifically investigates the parameters and prescriptions employed in sit-to-stand training. Methods: This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting the review. The search for eligible articles will be systematic, covering five databases: Scopus, Web of Science, Cochrane Library, EBSCO Medline, and PubMed, using key search terms related to stroke and sit-to-stand training. References from the included articles will also be reviewed and searched to identify more potential articles. This review only included randomized controlled trials and full-text English articles. The screening and quality appraisal process of the selected articles involves two independent reviewers and using PEDro quality appraisal tool. Any disagreement among the two reviewers will be settled through discussion with a third reviewer. Results: This review will present findings on the parameters of training protocol (frequency, duration, repetition) and the impact of positioning factors (such as chair height, foot position, and hand rests) on the overall outcome. Conclusion: This review can assist clinicians in choosing the best prescriptions possible to train sit-to-stand among post-stroke individuals offering valuable guidance for clinical practice.
The Development of a Portable Wheelchair Treadmill (PARAFiTGo) for People with Spinal Cord Injury
Spinal Cord Injury (SCI) often leads to reduced physical fitness, impacting individuals' overall health and quality of life. To address this, innovative solutions like the PARAFiTGo wheelchair treadmill have been developed. PARAFiTGo is a unique wheelchair treadmill designed specifically for individuals with SCI. It integrates seamlessly with wheelchairs, allowing users to engage in effective cardiovascular and strength training exercises while seated. The necessity for PARAFiTGo stems from the limited accessibility of traditional fitness equipment for SCI individuals, hindering their ability to maintain physical fitness and prevent secondary health complications. PARAFiTGo's key features include adjustable resistance levels, ergonomic design for comfort, and compatibility with various wheelchair models. Its portability and ease of use make it a standout solution for enhancing physical activity among SCI individuals. Implementation of PARAFiTGo has shown promising results in improving physical fitness, reducing sedentary behavior, and enhancing overall well-being among SCI individuals. This innovation has the potential to significantly enhance rehabilitation outcomes and long-term health for this population. With increasing awareness and demand for accessible fitness solutions in the healthcare sector, PARAFiTGo has strong prospects for commercialization. Its innovative design, proven effectiveness, and potential for customization for different user needs make it an attractive option for both clinical and home settings. The development and potential commercialization of PARAFiTGo represent a significant step towards improving physical fitness and quality of life for individuals living with SCI. Further research and partnerships are needed to fully realize the widespread adoption and impact of this innovative solution.
Effect of Constraint-Induced Movement Therapy Combined with Neuromuscular Electrical Stimulation onUpper Extremity Function in Stroke Survivors: ASystematic Review
Background and Objectives: Upper extremity (UE) impairment is one of the most common motor disabilities following a stroke. Most stroke survivors have a long-term impairment that restricts daily activities and social participation. Following a stroke, Constraint-Induced Movement Therapy (CIMT) and Neuromuscular Electrical Stimulation (NMES) counteract learned non-use phenomena and enhance motor function and quality of life. This review aimed to identify the impact of combining NMES+CIMT on improving post-stroke UE function. Methods: A comprehensive search was conducted in established electronic databases, including PubMed, Scopus, Embase, Medline, and Cochrane Library, by using search terms: ‘Constraint-Induced Movement Therapy’; ‘Neuromuscular Electrical Stimulation’; ‘stroke’; and ‘upper extremity’ to identify studies that combined CIMT+NMES. Two reviewers conducted article selection, data extraction, and quality assessment independently. Another reviewer was assigned to solve any disagreements. The methodological quality was assessed using the McMaster Critical Appraisal Form, and the results were analyzed using qualitative synthesis. Results: Two studies out of 2894 were included following multi-level screening: one case report and one case series study. Despite both studies indicating improvements in most of the outcomes following the intervention, in the case series study, Electromyography-Triggered Neuromuscular Stimulation (ETMS) did not appear to have functional advantages. However, ETMS significantly increased active wrist extension, allowing patients to be eligible for CIMT. After participating in CIMT, patients demonstrated further motor improvements. However, the effectiveness of both therapies combined is still lacking. Conclusion: Due to the lack of evidence, further good-quality studies are needed to determine the effects of combining CIMT+NMES.
The Immediate Effect of Active and Passive Stretching on Hamstring Flexibility using Active Knee Extension Test
Background and Objectives: There is alarming high rate of hamstring tightness among students due to prolonged sitting hours and lack of physical activity. Various techniques are available for addressing hamstring tightness, including both active and passive stretching. However, studies on the immediate effects of both active and passive stretching on hamstring flexibility among students remains limited. Therefore, this study aimed to investigate the immediate effects of active and passive stretching on hamstring flexibility among undergraduate physiotherapy students in a private university. Methods: A two period crossover study design was conducted involving 38 undergraduate physiotherapy students (20 males, 18 females; mean age±SD = 22.05±1.30 years) using convenience sampling technique. Hamstring flexibility was assessed using an active knee extension test (AKET) before and immediately after both active and passive stretching. The data were analysed using independent t-test. Results: There was a significant difference (p<0.001) between the mean AKET before and after both active stretching and passive stretching (p=0.05). Conclusion: Both active and passive stretching exercises demonstrated effectiveness in improving hamstring flexibility, suggesting that they are valuable immediate interventions for addressing hamstring tightness.
Effects of 4-Week Aquatic Treadmill Training on Gait Parameters, Balance Performance and Walking Endurance in Post-Stroke Individual: A Case Study
Background and Objectives: The existing evidence supporting the efficacy of Aquatic Treadmill Training (ATT) on motor functions among stroke survivors remains insufficient, necessitating further research to understand its effects in this population. Thus, this study aimed to determine the effects of ATT on gait parameters, balance performance and walking endurance in post-stroke individuals. Methods: This is a case study involving a 43-year-old stroke patient who participated in a 4-week ATT program consisting of 12 sessions, 3 times per week, with each session lasting 30 minutes. Gait parameters were assessed using a movement analysis system (VICON NEXUS), balance performance was evaluated using the Berg Balance Scale (BBS), and walking endurance was measured using the 6-Minute Walk Test (6MWT). All outcome measures were assessed before training (week 0) and after training (week 4). Descriptive statistics were used to analyse all collected data. Results: Following the program, the patient demonstrated significant improvements in gait parameters, balance performance, and walking endurance. Specifically, cadence improved from 57.9 steps/min to 112 steps/min, gait speed improved from 0.25 m/s to 0.61 m/s, BBS score improved from 34/56 (medium risk of fall) to 51/56 (low risk of fall), and 6MWT distance improved from 102 m to 228 m. Conclusion: The findings from this case study suggest that ATT has a beneficial training impact on motor functions for stroke survivors and supports the potential efficacy of ATT as an intervention for individuals recovering from stroke.
Exercise Interventions Influencing Falls Efficacy in Community-Dwelling Older Adults Can Focus Beyond Balance Confidence
Background and Objectives: Falls efficacy helps older adults to have greater agency towards managing falls. Exercise interventions hold promise to bolster specific domains of falls efficacy, such as balance confidence, balance recovery confidence, safe landing confidence and fall recovery confidence. Understanding how various exercise interventions could be designed through various modes of self-efficacy influence is imperative. This review examines the designs of various exercise interventions influencing falls efficacy in community-dwelling older adults. Methods: Arksey and O’Malley’s methodological framework was used for this scoping review. Three databases, Pubmed, EBSCOhost and Web of Science, were used to search keywords such as ‘exercise’, ‘falls efficacy’, ‘confidence’, ‘balance recovery’, ‘safe landing, ‘post-fall recovery’ and ‘older adults’ between January 2013 and December 2022. Three reviewers independently screened the articles. Data were extracted and summarised based on a ‘descriptive-analytical’ method. Results: Fifty-five studies were included in the review, involving a sample population of 4866 older adults from 14 countries. Most of the interventions (97.4%) focused on balance confidence. Generic multicomponent exercise (n=9) and the Otago Exercise Programme (OEP) (n=8) are the most common. The Falls Management Exercise (FaME) is a community-based exercise programme focused on fall avoidance and management ability. Mastery of performance was largely orchestrated within indoor environments. Group classes provided vicarious learning. Verbal persuasion was predominantly given by physiotherapists or certified exercise instructors. Conclusion: Exercise interventions mainly focused on balance confidence. Further research on exercise interventions would be needed to provide evidence of their efficacy in addressing various self-efficacies to help older adults prevent and manage falls.
Physical and Behavioral Barriers to Physical Activity Among Community-Dwelling Stroke Survivors: Preliminary Results
Background and Objectives: The level of participation in physical activities (PA) among the Malaysian stroke survivors remains low due to various barriers. This can lead to deconditioning and stroke recurrence. The most common barriers experienced by stroke survivors are patient-related factors, fear of falls, and pandemics. However, past studies primarily relied on generic questionnaires to assess these barriers, resulting in diverse findings. While one study utilized the Barrier to Physical Activity after Stroke Scale (BAPAS), it was conducted outside of Malaysia. Therefore, this study seeks to address this gap by identifying the specific physical and behavioral barriers to PA among community-dwelling stroke survivors in Malaysia. Methods: This prospective cross-sectional study involved 13 community-dwelling stroke survivors with mild to good cognitive ability (MoCA score ≥ 18) at Hospital Jerantut, Pahang. Face-to-face assessments were conducted, during which participants answered sociodemographic questions and completed a validated Malay version of the BAPAS which measured physical and behavioral barriers. Data from completed questionnaires were analyzed using descriptive statistics. Results: The majority of the participants were male, with an average age of 53.15 years and a time range of 10 months to 6 years since stroke diagnosis. Most participants were Malay, residing in urban areas, with a middle-range economic status and secondary education level. The study revealed higher physical barriers, particularly fear of falls and muscle tightness, compared to behavioral barriers. The primary behavioral barriers included concerns about experiencing a second stroke and feelings of excessive fatigue. Conclusion: The study highlights the primary physical and behavioral barriers to PA among community-dwelling stroke survivors in Malaysia. These findings suggest therapists should design customized exercise programs highlighting safety concerns and fatigue when working with stroke survivors. Larger datasets are needed to strengthen these study findings.
Current Physiotherapy Assessment and Outcome Measure in Pediatric Cases: A Case Study of Extramedullary Ewing Sarcoma
Background and Objectives: The diagnosis and treatment of intradural extramedullary (IDEM) Ewing's sarcoma, a rare spinal tumor, pose particular difficulties. Ewing's sarcoma is a tiny round cell sarcoma that exhibits variable levels of neuroectodermal differentiation in immunohistochemistry along with pathognomonic molecular findings. Intradural extramedullary Ewing's sarcoma lesions are significantly less common than spinal Ewing's sarcoma. This study aimed to evaluate current physiotherapy assessment and outcome measure of Extramedullary Ewing’s Sarcoma in teenagers according to current Evidence Based Practice (EBP). Methods: We present an immensely rare case study report of a 15-year-old teenager who was admitted to hospital with no previous medical history, complaining of gradual onset of back pain in October 2022 with visual analog scale (VAS) 6/10 radiating to bilateral lower limbs. He developed lower limb weakness since November 15, 2022, worsening to wheelchair (WC) bound on November 17,2022. Upon examination, he demonstrated paraplegia, progressive weakening of upper extremities, and impaired bladder and bowel function. Outcome measures used were Toronto Extremity Salvage Score (TESS), Disability of Arm, Shoulder and Hand (DASH) and Wheelchair Outcome Measure (WhOM). Results: The measurement results are evaluated as severely disabled for lower extremity and mild difficulty for upper extremity. WhOM showed positive value post T2 - T1 which indicated an increase in level of satisfaction. Conclusion: This case study illustrates that appropriate assessment tools are crucial in determining an effective physiotherapy management for optimal patient’s outcome.