Investigation of Health Science Students' Knowledge Regarding Healthy Lifestyle Promotion During the Spread of COVID-19 Pandemic: A Randomized Controlled Trial.

Background: Health sciences students as future health care providers, can play a valuable role in protecting societies against the spread of COVID-19 through health promotion and lifestyle modification education. Therefore, proper education of these students is essential. Objective: This study sought to assess and measure the change of knowledge of health sciences students regarding healthy lifestyle promotion strategies during the spread of the Covid-19 pandemic, after participation in different types of online and social media educational programs. Methods: In order to serve the purpose of the study, a methodological research design was first used to ensure the validation of the developed scale; the COVID-19 Healthy Lifestyle Promotion Scale (COVID-19 HLPS). The study utilized a four-arm randomized control research design in which the participants were randomly assigned into one of four groups, (1) control group (placebo intervention), (2) brochure group, who received brochures relevant to healthy lifestyle promotion, (3) Instagram group, who received similar information but through Instagram posts, and (4) online interactive educational workshop group, who also received similar information through an online interactive educational workshop. Results: In total, 155 participants participated in the online and social media intervention programs. There was a significant improvement in the intervention groups in the total knowledge subscale of the healthy promotion strategies compared with the control group (p < 0.001). Overall, the workshop group was the most effective group (effect size = 1.54) followed by the Instagram group (effect size = 0.99) and then the brochure group (effect size = 0.91). Conclusions: In order to meet the challenges posed by this pandemic, the use of such online and social media interventions is essential and may be the key for health promotion during this pandemic. Health science students, as future health care professionals, can play a fundamental role during the COVID-19 pandemic in disseminating knowledge relevant to healthy lifestyle to their families and communities thus promoting healthy living and behavioral changes. We propose the development of research initiatives at both national and international levels targeting changes within health science curricula that can meet potential challenges of future pandemics, leading to advancement of health care services globally.

Health Status, Behaviors, and Beliefs of Health Sciences Students and Staff at Kuwait University: Toward Maximizing the Health of Future Health Professionals and Their Patients.

Health professionals who engage in healthy lifestyle behaviors are more likely to promote their patients' health. We evaluated health status, behaviors, and beliefs of students (future health professionals) and staff in four health sciences faculties, Kuwait University. In total, 600 students and 231 staff participated in this descriptive cross-sectional study. Questionnaire surveys were used to evaluate lifestyle-related practices and participants' beliefs about these practices, in addition to health-related objective measures, e.g., heart rate, blood pressure, and body mass index. Overweight/obesity was prevalent among the participants (staff, 68.7%, students, 48.1%; p < 0.001); 57% of staff had suboptimal resting blood pressures. About half of the participants reported being moderately physically active (staff, 44.8%, students, 52.6%; p < 0.05), and most reported moderate/high stress (staff, 88.8%, students, 90.9%; p > 0.05). Only 25.1% of staff and 27.9% of students reported at least 8 h sleep nightly (p > 0.05). Staff reported healthier dietary practices than students (p-value range < 0.001-0.02). Overall, the participants had sub-optimal health indices. A marked gap existed between participants' beliefs about healthy lifestyle practices and their actual health status. Healthy lifestyle programs are needed on campus with respect to diet, exercise, and stress management. As emerging health professionals, students in health sciences faculties, Kuwait University, need exposure to a health-promoting environment including healthy staff as role models.

Importance Attributed to Cardiovascular and Pulmonary Competencies by Public Sector Physical Therapists in Kuwait: A Population-based Exploratory Study.

BACKGROUND AND PURPOSE: Indications for cardiovascular and pulmonary (CVP) physical therapy competencies are changing with the epidemic of non-communicable diseases in Kuwait, particularly lifestyle-related conditions. The degree to which the country's physical therapists (PTs) perceive the importance of CVP competencies (assessment/evaluation and clinical and laboratory investigation interpretation) in professional practice is relevant. Our study objectives were to (1) explore the importance attributed to specific CVP competencies by PTs to professional practice in Kuwait and (2) establish whether these are related to practitioner traits, for example, age, sex, practice setting and specialty. METHOD: The study design was exploratory with a stratified random sample. Questionnaires (n = 221) were distributed to PTs practicing in the facilities of the Ministry of Health, the primary employer of PTs in Kuwait. Questions included participants' demographics and perceived importance of specific CVP competencies (Likert rating scale 1-not important to 5-highly important). RESULTS: Response rate was 87% (n = 193). Participant mean age was 36(±9) years, 63% were women and 48% were Kuwaiti. Ratings of moderately important or higher were 84% for cardiac assessment/intervention skills, 78.8% for cardiac clinical/laboratory investigations interpretation, 77.2% for pulmonary assessment/intervention skills and 73.6% for pulmonary clinical/laboratory investigations interpretation. PTs in the musculoskeletal area attributed less importance to the competencies than those in other specialties. CONCLUSIONS: Participants perceived CVP competencies as generally relevant to practice. However, greater importance was attributed to these competencies in relation to management of CVP conditions (e.g. those that address lifestyle-related conditions) rather than across practice areas. Research is needed to elucidate whether this finding reflects the profession's commitment to holistic care, the prevalence of lifestyle-related risk factors and conditions irrespective of a patient's primary complaint presenting to the PT, best evidence-based, non-pharmacologic practice to address these or some combination. Copyright © 2015 John Wiley & Sons, Ltd.

Smoking impact on grip strength and fatigue resistance: implications for exercise and hand therapy practice.

BACKGROUND: Grip strength assessment reflects on overall health of the musculoskeletal system and is a predictor of functional prognosis and mortality. The purpose of this study was: examine whether grip-strength and fatigue resistance are impaired in smokers, determine if smoking-related impairments (fatigue-index) can be predicted by demographic data, duration of smoking, packets smoked-per-day, and physical activity. METHODS: Maximum isometric grip strength (MIGS) of male smokers (n = 111) and nonsmokers (n = 66) was measured before/after induced fatigue using Jamar dynamometer at 5-handle positions. Fatigue index was calculated based on percentage change in MIGS initially and after induced fatigue. RESULTS: Number of repetitions to squeeze the soft rubber ball to induce fatigue was significantly lower in smokers compared with nonsmokers (t = 10.6, P < .001 dominant hand; t = 13.9, P < .001 nondominant), demonstrating a significantly higher fatigue-index for smokers than nonsmokers (t = -8.7, P < .001 dominant hand; t = -6.0, P < .001 nondominant). The effect of smoking status on MIGS scores was significantly different between smokers and nonsmokers after induced fatigue (ß = -3.98, standard error = 0.59, P < .001) where smokers experienced on average a reduction of nearly 4 MIGS less than nonsmokers before fatigue. Smoking status was the strongest significant independent predictor of the fatigue-index. CONCLUSIONS: Smokers demonstrated reduced grip strength and fast fatigability in comparison with nonsmokers.

To establish whether McKenzie lumbar flexion and extension mobility exercises performed in lying affect central as well as systemic hemodynamics: a crossover experimental study.

OBJECTIVE: Examine systemic and central hemodynamic responses following McKenzie lumbar flexion and extension mobility exercises performed in lying (FIL and EIL). DESIGN: Crossover experimental study. SETTING: Clinical laboratory. PARTICIPANTS: Healthy male volunteers (n=25) (mean(SD) age: 28(3)years; range 21 to 34). INTERVENTIONS: Based on alternating assignment of either FIL or EIL to participants, three sets of the first exercise (10, 15, 20 repetitions) were performed with 5-minute rest between sets; after 15-minute rest, the protocol was repeated for the other exercise. MAIN OUTCOME MEASURES: Systemic hemodynamic parameters included heart rate (HR), and systolic and diastolic blood pressures (SBP, DBP). Central hemodynamic parameters included abdominal aortic diameter (AD), peak systolic velocity (PSV/AD), end diastolic velocity (EDV/AD) and resistive index (RI). Measures recorded after each exercise set. RESULTS: FIL RPP at baseline was 9.1 (1.4), after 20 repetitions 18.3 (2.5), mean difference 8.9 (95% confidence interval (CI) 7.9 to 9.8) compared to EIL at baseline 9.1 (1.5), after 20 repetitions 13.0 (3.1), mean difference 4.1 (95% CI 3.3 to 5.0). FIL RI at baseline was 0.78 (0.03), after 20 repetitions 0.87 (0.03), mean difference 0.08 (95% CI 0.06 to 0.10) compared to EIL at baseline 0.78 (0.03), after 20 repetitions 0.83 (0.03), mean difference 0.05 (95% CI 0.04 to 0.07). CONCLUSIONS: Although 10 repetitions of FIL and EIL may be regarded as safe, our findings support screening patients with lifestyle risk factors, and cautioning about adhering to recommended repetition number given associated increased work of the heart. The extent of AD mechanical perturbation remains unclear.

Pregnancy-related lumbopelvic pain: prevalence, risk factors, and profile in Kuwait.

OBJECTIVE: To determine prevalence and risk factors of pregnancy-related lumbopelvic pain (PRLPP) in women in Kuwait. DESIGN: The study was designed as a multisite, cross-sectional design in which self-administered surveys were distributed. Setting and Participants. Public locations and health care facilities in Kuwait. Pregnant women (400) were invited to participate. OUTCOME MEASURES: Demographics, history of PRLPP, risk factors for PRLPP, location of pain, absenteeism due to LPP, management of previous LPP, and functional disability due to PRLPP. RESULTS: Two hundred eighty questionnaires were returned. Mean age was 29.5 years; mean body mass index (BMI) was 29.69 kg/m(2) . Of the participants, 91% reported LPP, 78.8% reported history of menstrual pain, and 58.7% reported previous LPP, and 59% reported PRLPP during previous pregnancies, 42.8% reported activities of daily living were limited. Risk factors included a history of back pain (P = 0.00), PRLPP in a previous pregnancy (P = 0.01), and being in the third trimester of pregnancy (P = 0.02). BMI was not associated with PRLPP. CONCLUSIONS: Clinicians in Kuwait need to screen for risk factors and detect PRLPP early and intervene as needed. Although overweight and obesity may not contribute largely to PRLPP in women in Kuwait, weight control is a major concern for healthy pregnancy. Physical therapy has a role in preventing and addressing this condition.

Evaluation of the McKenzie intervention for chronic low back pain by using selected physical and bio-behavioral outcome measures.

OBJECTIVES: To assess the bio-behavioral and physical performance characteristics of individuals with chronic low back pain who demonstrated the pain centralization phenomenon and received the McKenzie intervention using selected bio-behavioral and physical performance measures at intake and at 5 weeks and 10 weeks after treatment. DESIGN: A prospective cohort study with assessment at baseline and 2 follow-ups after completion of the McKenzie intervention. SETTING: Outpatient orthopedic physical therapy clinics. PARTICIPANTS: Sixty-two volunteers with chronic low back pain (28 men, 34 women; average ages 41.9 and 37.1 years, respectively). METHODS: The subjects completed pain and related fear and disability questionnaires, underwent McKenzie mechanical assessment, and executed selected physical performances. They then received the McKenzie intervention. MAIN OUTCOME MEASUREMENTS: Outcomes measurements were repeated at the end of the 5th and 10th weeks after treatment completion. Pain-related disability and fear beliefs were assessed by using the Disability Belief Questionnaire and Fear Avoidance Belief Questionnaires, respectively. The time for repeated sit to stand, trunk forward bending, and customary and fast walking were measured by stopwatch. Pain (anticipated versus actual reported) was measured before and immediately after a given physical performance. Descriptive statistics, paired t-tests, and repeated measures analysis of variance were used. RESULTS: Significant improvements peaked at the end of the 5th week for all outcome measures (P < .001), with slight increase in bio-behavioral variables at the end of the 10th week. CONCLUSIONS: McKenzie intervention reduced pain and related fear and disability beliefs and improved physical performances in individuals with chronic low back pain. Improvements in physical performances remained stable 10 weeks after treatment, regardless of the elevation in bio-behavioral factors.

Spinal mobilization of postpartum low back and pelvic girdle pain: an evidence-based clinical rule for predicting responders and nonresponders.

OBJECTIVE: To develop a clinical prediction rule (CPR) for identifying postpartum women with low back pain (LBP) and/or pelvic girdle pain (PGP) whose functional disability scores improve with a high-velocity thrust technique (HVTT) conducted by a physical therapist. DESIGN: Prospective cohort. SETTING: Outpatient physical therapy departments. PARTICIPANTS: Sixty-nine postpartum women referred to physical therapy with the complaint of LBP and/or PGP. METHODS: Subjects underwent a physical examination and a HVTT to the lumbopelvic region. MAIN OUTCOME MEASURES: Success with treatment was determined by the use of percent changes in disability scores and served as the reference standard for determining accuracy of the examination variables. Variables with univariate prediction of success and nonsuccess were combined into multivariate CPRs. RESULTS: Fifty-five subjects (80%) had success with the HVTT. A CPR for success with 4 criteria was identified. The presence of 2 of 4 criteria (positive likelihood ratio=3.05) increased the probability of success from 80% to 92%. A CPR for treatment failure with 3 criteria was identified. The presence of 2 of 3 criteria (positive likelihood ratio=11.79) increased the probability of treatment failure from 20% to 75%. CONCLUSIONS: The pretest probability of success (80%) is sufficient to reassure the clinician about the decision to use a HVTT to the lumbopelvic region in postpartum women with LBP and/or PGP. If 2 of 3 criteria for treatment failure are met in the CPR, an alternative approach is warranted. An intervention such as the HVTT is compelling, given the need to minimize pharmaceutical remedies in women who are potentially breast-feeding post partum.