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@#Children with disability require comprehensive and continuous rehabilitation. Community-based rehabilitation (CBR) was developed to fulfil this need and has benefited children of various ages both in the rural and urban societies. In Malaysia, the government largely fund rehabilitation of children at the CBR centers. However, to date research data on the outcome of CBR on children with disability in the country is scarce. This study was intended to determine the outcome of CBR and its associated factors among children with disability. Outcome of rehabilitation was determined with regard to changes in activity of daily living ability with the use of the Barthel Index at 6 months post-CBR. Analysed factors were age, baseline score of the Barthel Index, frequency of attendance in therapy sessions and number of therapy received. Data was analysed using paired t test, Wilcoxon signed ranks test and Spearman correlation test. A total of 220 children with disability aged 4 to 18 years and 220 caretakers from 29 selected CBR centres in Pahang, Terengganu and Kelantan participated in this study. The results showed a small increase in the Barthel Index score of the children, with mean change ± SD equals 0.90 ± 4.54 (p=0.003) following rehabilitation. Attendance to therapy sessions was low, with <50% attended three quarter or more sessions of the total sessions offered. No analysed factors were found to be associated with the change in the Barthel Index (p>0.05). As a conclusion, the outcome gained through CBR is too small for the duration of rehabilitation implemented. The delivery of CBR program need to be reviewed and enhanced to improve its effectiveness on children with disability.
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@#Introduction: Total knee arthroplasty (TKA) commonly cause physical impairments, which necessitate physiotherapy post-operatively. Low-intensity pulsed ultrasound is an adjuvant treatment to conventional physiotherapy; however, its effects on TKA recovery require further investigation. The study aimed to ascertain the outcome of adding low-intensity pulsed ultrasound therapy into conventional physiotherapy on recovery from physical impairments after TKA. Methods: This assessor-blinded quasi-experimental study was conducted in a tertiary medical centre in Central Malaysia. Patients with TKA due to grade III and IV knee osteoarthritis (Kellgren-Lawrence grading system) were alternately allocated into either an experimental group (n=10) or a control group (n=10). Other than low-intensity pulsed ultrasound as received by the experimental group’s participants, the two groups received the same amount and content of conventional physiotherapy. Participants’ pain, knee swelling, active knee flexion range, and quadriceps strength were assessed at baseline, week 1 of the intervention, and the 1-week follow-up. The two interventions’ effects were analysed using a mixed model ANOVA. Results: The pain score and knee swelling decreased (P<0.05), while the knee flexion range and quadriceps strength increased significantly (P<0.001) after both interventions. The experimental group had a significantly lower pain score [3.07(2.18) at visual analogue scale] and a greater active knee flexion range [80.48(26.42) degrees] compared to the control group [pain score=4.29(1.54); knee flexion=67.00(25.15) degrees] following the interventions. There were no significant interaction effects for all outcomes. Conclusion: The combination of low-intensity pulsed ultrasound into a conventional physiotherapy program demonstrated more promising results in pain alleviation and knee motion recovery following TKA.
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@#A significant percentage of stroke survivors are reported to have anxiety and depression. Autogenic Relaxation Training (ART), a psychophysiological self-control therapy which aims to induce relaxation proved to be effective in reducing the anxiety and depression in some health conditions. However, there is lack of studies which evaluated the effects of ART in the rehabilitation of stroke survivors. The aim of this experimental pilot study is to evaluate the feasibility and outcomes of ART in addition to usual physiotherapy for stroke survivors. A total of 14 sub-acute stroke survivors from a teaching hospital were enrolled in this study. All participants received 20 minutes ART followed by 40 minutes usual physiotherapy once a week and they were requested to carry out the intervention at home for twice per week, for six weeks. Intervention outcomes were assessed using Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Barthel Index (BI), Timed Up and Go (TUG) and EuroQol 5-Dimension 5 Levels (EQ5D5L). Changes in all outcome measures were analysed using paired t-test and Wilcoxon signed rank test, with level of significance set at p<0.05. Post-intervention, there is statistically significant reduction of the HADS-A (p=0.04), HADS-D (p=0.02), TUG (p=0.004) and EQ5D5L (p=0.03) scores of the participants. Although not statistically significant, the mean score ± SD of BI increased from 95 ± 12.5 to 100 ± 6.25. The intervention is feasible and acceptable by the stroke survivors with no adverse events reported. In conclusion, ART in addition to usual physiotherapy is feasible and beneficial in reducing anxiety and depression, and improving functional ability, mobility and quality of life among stroke survivors.
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@#Introduction: There is scarcity of research information on upper limb (UL) functionality among Malaysian post-stroke population despite the increasing number of stroke survivors. This study intends to evaluate functionality among stroke survivors residing in the community, with a specific focus on the UL. Methods: This cross-sectional study involved 65 stroke survivors with UL dysfunction (mean (SD) age = 64.83 (8.05) years, mean (SD) post-stroke duration 41.62 (35.24) months) who attended community-based rehabilitation program. Upper limb functionality was assessed using the UL items of Stroke Specific Quality of Life Scale (SSQOL), the Lawton Instrumental Activities of Daily Living (IADL) Scale and the Jebsen-Taylor Hand Function Test (JTHFT). The stroke survivors’ performance in completing JTHFT using their affected dominant hand was compared with standard norms. Results: The three most affected UL daily living tasks were writing (64.7%, n=42), opening a jar (63.1%, n=41) and putting on socks (58.5%, n=38). As for IADL, the mean (SD) score of Lawton scale was 3.26 (2.41), with more than 50% unable to handle finance, do the laundry and prepare meals for themselves. Performances of stroke survivors were much slower than normal population in all tasks of JTHFT (p<0.05), with largest speed difference demonstrated for ‘stacking objects’ task (mean difference 43.24 secs (p=0.003) and 24.57 (p<0.001) in males and females, respectively. Conclusion: UL functions are significantly impaired among stroke survivors despite undergoing rehabilitation. Rehabilitation professionals should prioritize highly problematic tasks when retraining UL for greater post-stroke functionality
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@#Involvement of informal carer in post-stroke care is important to prevent development of secondary complications particularly among stroke survivors with severe disability. However, to date, evidence on the benefit of stroke care training and involving carer to assist in the care for this group of stroke survivors is still limited. In this study, we evaluated the outcome of a carer-assisted care program for stroke survivors with severe disability who live at home. Sixteen stroke survivors with severe disability and 16 primary carers participated in this pre-test post-test intervention study. Carers were trained using a stroke care module which was developed by a group of multidisciplinary researchers from Universiti Kebangsaan Malaysia, prior to implementing the daily care for 8 weeks. Outcome of care on stroke survivors was assessed in term of change in disability level and quality of life using Modified Barthel Index (MBI) and EuroQol health-state measure (EQ-5D and EQ-VAS), respectively. While outcome of stroke care training on carer was determined using Modified Caregiver Strain Index (MCSI). Significant improvement is shown in the stroke survivors’ EQ-VAS component of EuroQol health state measure (average increase by 12%, t = 2.86, p = 0.01) following the care. Although not statistically significant (t = 0.97; p = 0.35), the mean score of MCSI reduced by 14%. No significant change was found in the MBI of the stroke survivors at completion of the program. Carer-assisted care is useful in improving quality of life of stroke survivors and can potentially reduce stress level among carers. Larger study may assist in establishing these preliminary findings.
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Enhancement of physical function had been shown in older adults who actively participate in physical activities,particularly in the form of aerobic training with addition of progressive resistance training (PRT). However, it is quitechallenging and risky for most older adults to exercise in standing position without any support. Chair Based Exercise(CBE) is an alternative mode of exercise for older adult to facilitate exercise participation and increase safety. Its effectwhen combined with resistance training is unknown to date. Therefore, the aim of this study was to evaluate the outcomeof CBE with PRT on physical performances among older adults. A total of 18 older adults (13 females (72%)) and 5 males(28%)), aged 60 to 83 years with mean age (SD) 72.67 (6.17) years completed the study. All subjects performed CBE withPRT intervention twice weekly for 8 weeks, with individually-tailored exercise progressions. Pre and post measurementsof physical performance were performed using Six MinutesWalk Test (6MWT), Five Times Sit to Stand (FTSTS) and HandGrip Strength (HGS) test. Significant improvement in 6MWT (p < .001), HGS Right hand (p = .043), HGS Left hand (p <.001), FTSTS (p < .001) was shown after the eight-week intervention. Adding PRT into seated exercises results in furtherimprovement in physical performance of older adults. CBE-PRT may be recommended as an exercise routine for olderadults living in the community.
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Neurophobia, defined as ‘the fear of neural sciences and neurology’ is reported among medical students, which threatenedtheir performance in neurology course. This phenomenon has not been studied among rehabilitation sciences studentsdespite the significance of neurology as an area for rehabilitation. In this study we aim to assess the perceptions of neurologycourse and the possibility of neurophobia existence among rehabilitation sciences students of Universiti KebangsaanMalaysia (UKM). We also aimed to identify learning methods which are regarded as useful among the students. A surveyusing self-administered questionnaires was conducted among 73 students from School of Rehabilitation Sciences of theuniversity. Questions in the questionnaire were adapted from previous studies, in which neurophobia was indicated by poorknowledge and low confidence level in managing neurology course. Results showed that the percentage of participantswho perceived having good knowledge of neurology was significantly higher than the percentage who claimed of havingpoor knowledge level (90.4% versus 9.6%, p < 0.01). Similarly, the percentage of participants who claimed having highconfidence to handle neurology cases was higher than the percentage who expressed lack of confidence (79.2% versus20.8%, p = 0.03). However, neurology course was perceived as difficult by majority of the participants (78.1%) whencompared to other courses. Majority of the participants (97.3%) perceived clinical teaching as a useful method of learningrehabilitation science courses including neurology followed by problem-based learning (90.4%). While limited exposureto neurology cases was claimed as the main reason to why neurology is difficult. In conclusion, although neurology isperceived as a difficult course among rehabilitation sciences students, the students did not report lack of knowledge andconfidence in the course. This implies that neurophobia does not exist among UKM rehabilitation students. Enhancementof learning methods may assist in reducing the level of difficulty of neurology course among the students.
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@#Children with Developmental Coordination Disorder (DCD) have impairments in gross and fine motor skills consequently limit their participation in school activities. The aim of this study was firstly to evaluate motor coordination performance of children with DCD in manual dexterity, hand-eye coordination and balance skills, and secondly, to compare the motor coordination performance between children with DCD and age-matched children without DCD. A total of 47 children with DCD (32 boys, 15 girls) and 16 children without DCD (15 boys, 1 girl) aged between 7 to 10 years old participated in this study. They were recruited from integrative special education classes from six selected primary schools within Klang Valley. The Movement Assessment Battery for Children-2 (MABC-2) evaluated their motor coordination performance. Group differences on the MABC-2 subtest scores and total test score were analysed using independent t-test. Cohen’s d was calculated to obtain the effect size of clinical differences. Children with DCD showed significantly lower score in manual dexterity (p=0.001), aiming and catching (p=0.001), balance test (p=0.001) and total test score (p=0.001) compared to the children without DCD. Effect sizes on manual dexterity (d=0.52), balance (d=0.68), and total test score (d=0.73) indicated moderate clinical differences between the two groups. In conclusion, children with DCD showed deficits in both gross and fine motor skills performance based on the MABC-2 subtests and total test score, in comparison with children without DCD. School-based rehabilitation to improve gross and fine motor problems among the children is warranted.
Assuntos
Transtornos das Habilidades Motoras , Equilíbrio PosturalRESUMO
Falls is one of the main problems in older adults, which indirectly contributes to deterioration of quality of life, morbidityand mortality. The purpose of this study was to examine the difference in values between Timed Up and Go (TUG) andgait speed tests among community dwelling older adults with high and low risk of falls classified using PPA (PhysiologicalProfile Assessment). This cross-sectional study involved 278 older adults aged between 60 to 88 years, recruited fromsenior citizen club around Klang Valley. 40.6% older adults had high risk of falls and mostly were women (75%). Theresults of the study showed that there was a significant (p < 0.05) difference in TUG and Gait speed tests performancebetween older adults with high and low risk of falls. Declined mobility (longer time of TUG test) and increased age wereidentified as significant (p < 0.05) risk factors for falls in this study. The TUG test reference values obtained in this studymay be useful for early identification, prevention and management of falls among community dwelling older adults.
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Purpose: this study aimed to evaluate function and quality of life (QoL) and associated factors among long term stroke survivors in the Malaysian community. Methods: A cross-sectional study was conducted involving stroke survivors living in the community at two or more years post-stroke. Eligible participants with the diagnosis of stroke were identified from 2005-2010 case mix database of a tertiary hospital. the patients’ medical records were analysed and data on demographic and clinical profiles were collected. telephone interviews were conducted to assess existing stroke-related impairments, comorbidities, stroke recurrences, current level of function and QoL, with the usage of rivermead mobility index (rMI), barthel index (bI) and stroke specific quality of life scale (ssQOL). results: A total of 203 stroke survivors; mean age 64.5 (standard Deviation(sD) 12.2) years, 45.3% males, stroke duration 44.7 (sD 13.8) months completed the interviews. Mean rMI was 11.7 (sD 3.4) and bI was 89.8 (sD 19.8). Forty three percent and 99% had difficulty in ascending/descending stairs and fast walking, respectively. Up to 20% had limitations in most of the bI subsets. Mean ssQOL was 207.6 (sD 37.2), with domains mostly affected were ‘energy’ and ‘social role’. Function and QOL were both influenced by age (p<0.01) and stroke related impairments (p<0.05), but not by co-morbidities or stroke recurrence. QoL and function (both mobility and ADL) were strongly positively correlated with each other (p<0.01). conclusions: It was observed that functional limitations especially mobility, remains post-stroke major problem and were attributed mainly to stroke-related impairments.
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Balance and motor skills are essential prerequisites for physical development of a child. The aims of this study were to measure anthropometrics, postural balance and motor skills; and examine their correlation among healthy preschool children. Forty nine healthy preschool children aged between 3 to 4 years old participated from PERMATA preschool organization. Pediatric Balance Scale and Peabody Development Motor Scale-2nd Edition (PDMS-2) were administered to measure balance skills for both fine and gross motor skills respectively. Mann-Whitney U test demonstrated that there was no significant difference in balance (p=0.72) and motor skill (p=0.33) between boys and girls. Spearman correlation coefficient demonstrated that there was significant correlation between balance skills with height (r=0.45, p=0.001) and body mass index(r=0.47, p=0.001). No significant correlation was found between balance skills and motor skills (r=0.11, p=0.44). The present study suggests that balance skills in healthy preschool children aged 3-4 years old are correlated with their physical growth such as height and weight but not motor skills.
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This study aimed to estimate cost of in-patient medical care due to stroke in a tertiary hospital in Malaysia. A retrospective analysis of stroke patients admitted to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between January 2005 and December 2008 were conducted. Cost evaluation was undertaken from the health provider’s perspective using a top-down costing approach. Mean length of stay (LOS) was 6.4 ± 3.1 days and mean cost of care per patient per admission was MYR 3,696.40 ± 1,842.17 or 16% of per capita GDP of the country. Human resources made up the highest cost component (MYR 1,343.90, SD: 669.8 or 36% of the total cost), followed by medications (MYR 867.30, SD:432.40) and laboratory services (MYR 337.90, SD:168.40). LOS and cost of care varied across different stroke severity levels (p<0.01). A regression analysis shown significant influence of stroke severity on cost of care, with the most severe stroke consumed MYR 1,598.10 higher cost than the mild stroke (p<0.001). Cost of medical care during hospital admission due to stroke is substantial. Health promotion and primary prevention activities need to take priority to minimise stroke admission in future.
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This study identified the effectiveness between home-based and hospital-based pulmonary rehabilitation program on the quality of life of chronic obstructive pulmonary disease (COPD) patients. Thirty five patients who met the inclusion criteria were referred by physicians and randomized to either hospital-based pulmonary rehabilitation (PRPH) or home-based pulmonary rehabilitation (PRPR). The PRPH program was scheduled twice a week for eight weeks at the Physiotherapy Department, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Whilst, the PRPR group was required to attend sessions at the Physiotherapy Department twice to learn the exercise regimens before carrying out the exercises themselves at home. Subjects were asked to record activitites in a diary and a telephone call was made once every two weeks to ensure compliance towards the exercise regimens. The SF-36 questionnaire and Geriatric Depression Scale were outcome measures used in assessing status of patients prior to treatment and after intervention at the 8th week Seventeen (48.6%) subjects completed the PRPH and 15 (43%), the PRPR. Results indicated that in the PRPH group there were significant improvements in some of the domains of SF-36, i.e., role physical (p = 0.012) body pain (p = 0.040), general health (p = 0.008) and role emotional (p = 0.012). In the PRPR group, the Geriatric Depression Scale mean score was 1.8 ± 0.41 at baseline compared to 1.69 ± 0.48 following intervention (p > 0.05). Whilst, among the PRPH group, the mean was 1.87 ± 0.35 at baseline and 1.53 ± 0.52 after eight week (p < 0.05). In conclusion, hospital-based pulmonary rehabilitation is more effective than the home-based pulmonary rehabilitation in improving the quality of life and reducing depression among patients with COPD.
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The study evaluated the function of median sensory nerve fibers, as well as determining the relationship between its function with the duration of Carpal Tunnel Syndrome (CTS) and body mass index (BMI) among CTS patients in Physiotherapy Unit, Universiti Kebangsaan Malaysia Hospital (HUKM). Thirty subjects (6 males and 24 females) with mean age 53.30 ± 9.20 years and duration of the CTS 51.17 ± 50.22 months participated in this study. The sensitivity of median sensory nerve was evaluated using Current Perception Threshold (CPT) Test with stimulation frequencies of 5 Hz, 250 Hz and 2000 Hz; which demonstrated the function of C, Aδ and Aβ nerve fiber respectively. Majority of the CTS patients had normal function in the 3 types of median sensory nerve fiber. Forty percents of the subjects had abnormality in the Aâ function, 7% had abnormality of the Aβ function and 27% demonstrated abnormality in the C fiber function. Spearman Correlation Test showed no significant relationship between the function of median sensory nerve and the duration of CTS and body mass index (BMI) (p > 0.05). In conclusion, although majority of the patients demonstrated normal median sensory nerve function, abnormality of the Aβ, Aδ and C fibers sensitivity in some patients requires attention to prevent worsening of the nerve function thus avoiding related complications. Physiotherapists in HUKM may intensify the use of nervestimulating modalities such as Transcutaneous Electrical Nerve Stimulation (TENS) to normalize the nerve functions of these patients.