Displaying publications 1 - 20 of 30 in total

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  1. Manal B, Suzana S, Singh DK
    J Frailty Aging, 2015;4(2):100-6.
    PMID: 27032052 DOI: 10.14283/jfa.2015.49
    Frailty is one of the major health concerns in aging. It is considered a geriatric syndrome characterized by muscle weakness, sarcopenia and fatigue. It is also associated with several adverse health outcomes, including disability. Literature shows that there are a number of studies conducted to define the relationship between frailty and nutrition. The majority is from cross sectional, longitudinal, and cohort studies. Few intervention studies using micronutrients, macronutrients, nutritional supplement, or food regimens have been found. This review examines the nutrition intervention studies targeted towards older adults with frailty, and evaluates the effectiveness of nutrition interventions on frailty indicators. Twenty-four intervention studies from six electronic databases met the inclusion criteria. Sixteen were randomized controlled clinical trials; one was a quasi-experimental design, whilst the rest were controlled trials. Participants included in the studies differed in terms of age and frailty status. The studies were inconsistent in intervention type, duration, and targeted outcomes. Most of the studies indicated that modification of nutrition quality, either by giving supplements or by improving diet intake, could improve strength, walking speed, and nutritional status in majority of frail or pre-frail older adults. However, there was limited evidence on the effectiveness of intervention on inflammatory status and other biomarkers related to frailty due to limited number of studies targeting frailty biomarkers as a major outcome.
  2. Ajit Singh DK, Bailey M, Lee R
    Muscle Nerve, 2011 Jul;44(1):74-9.
    PMID: 21488056 DOI: 10.1002/mus.21998
    Loss of lumbar extensor muscle strength and fatigue resistance may contribute to functional disability.
  3. Mani S, Sharma S, Singh DK
    J Telemed Telecare, 2021 Feb;27(2):88-97.
    PMID: 31272309 DOI: 10.1177/1357633X19861802
    INTRODUCTION: The aim of this study was to determine the concurrent validity and reliability of telerehabilitation (TR)-based evaluation of the cervical spine among adults with non-specific neck pain (NS-NP).

    METHODS: A total of 11 participants with NS-NP were recruited. Pain intensity, active range of motion (AROM), posture, deep neck flexor (DNF) endurance, combined neck movements and disability were measured using face-to-face and TR methods, with a one-hour break in between. TelePTsys, an image-based TR system, was used for TR assessment.

    RESULTS: A high degree of concurrent validity for pain (bias = 0.90), posture (bias = 0.96°), endurance (bias = -2.3 seconds), disability (bias = 0.10), AROM (extension bias = -0.60 cm, flexion bias = 1.2 cm, side flexion bias = -1.00, rotation bias = -0.30 cm) was found. Standard error of measurement and coefficient of variation (CV) values were within the acceptable level for concurrent validity, except the CV for cervical flexion and endurance. There was a high degree of reliability demonstrated for pain, posture, AROM, endurance and disability measurements. The average-measure interclass correlation coefficient (ICC(3,1)) ranged from 0.96 to 0.99 for inter-rater, and 0.93 to 0.99 for intra-rater reliabilities. There was moderate agreement for combination movement for validity (78.5%, p 

  4. Harithasan D, Ajit Singh DK, Omar B
    MyJurnal
    Plantar pressure, force and contact area information may provideinsights regarding stresses imparted to the foot when performing functional tasks. There is limited information regarding plantar pressure, force and contact area when carrying incremental loads (no load, 5 kg, 7.5 kg and 10 kg) using one hand between adults with and without low back pain (LBP). The aim of our study was to investigate the changes in the plantar pressure, force and contact area when carrying incremental loads (no load, 5 kg, 7.5 kg and 10 kg) using one hand between adults with and without low back pain (LBP). A total of 20 adults with non-specific LBP and 20 matched individuals without LBP were recruited according to the predefined recruitment criteria. Plantar pressure (PP), maximum force (MF) and contact area (CA were measured in standing position and during walking while carrying incremental loads (no load, 5 kg, 7.5 kg and 10 kg) using their right hand on a Matscan pressure assessment system. A two-way mixed analysis of variance (group× load) was conducted to analyse the data. No significant main effectof group was demonstrated on both the right and left foot during standing (PP: p = 0.74, p = 0.32; MF: p = 0.17, p = 0.67; CA: p = 0.25, p = 0.24) and walking (PP: p = 0.61, p = 0.48; MF: p = 0.19, p = 0.06; CA: p = 0.16, p = 0.26. Similarly, there was no interaction effect between the loads and groups on the PP (p = 0.89, p = 0.47), MF (p = 0.76, p = 0.83) and CA (p = 0.88, p = 0.20) on theright and left foot, respectively during standing. However, a significant interaction effect (p < 0.05), between the loads and groups was demonstrated on the PP, MF and CA on the left foot during walking. The results of our study suggest that stresses imparted to the foot alters during dynamic postures and this may be a compensatory mechanism. Plantar pressure, force and contact area were similar in adults both with and without LBP when standing and walking. Further biomechanical information that includes both kinematic and kinetic data in lumbopelvic and lower limbs in relation to the foot may be required to justify for prevention and management strategies among adults with LBP.
  5. Singh DK, Bailey M, Lee R
    BMC Musculoskelet Disord, 2013 Jul 22;14:215.
    PMID: 23875830 DOI: 10.1186/1471-2474-14-215
    BACKGROUND: Muscle morphology, age and gender may be determinants of muscle strength in older adults. However, very few research studies have directly examined such correlation in the ageing spine. The aim of the study was to examine the correlation between lumbar extensor muscle strength, its muscle fibre angles, thoracolumbar curvature, age and gender in the older and younger adults.

    METHODS: Muscle fibre angles of lumbar extensor muscles, thoracolumbar curvature and lumbar extensor muscle strength were examined in 26 young (mean age 27.9, SD 5.2) and 26 older (mean age 72.1, SD 5.9) participants. Pearson's correlation was employed to determine the association among lumbar extensor muscle fibre angle, thoracolumbar curvature, age, gender and lumbar extensor muscle strength. Multiple stepwise linear regression analysis was used to identify significant determinants of lumbar extensor muscle strength.

    RESULTS: The results demonstrated a significant correlation between lumbar extensor muscle strength, muscle fibre angle, age and gender. In the step wise regression analysis, both gender and age were identified as the most robust determinant for lumbar extensor muscle strength in older adults. However, gender was the only determinant of muscle strength in the young.

    CONCLUSION: These results suggest that the decline in the lumbar extensor muscle strength in older adults was more dependent on age when compared to younger adults.

  6. Singh DK, Bailey M, Lee RY
    Clin Biomech (Bristol, Avon), 2011 Jul;26(6):543-7.
    PMID: 21392870 DOI: 10.1016/j.clinbiomech.2011.02.002
    Ageing is associated with geometrical changes in muscle fascicles that may lead to deteriorations in physical functions. The purpose of this study was to study the effects of ageing on fibre orientation and strength of the lumbar extensor muscles.
  7. Rahman NN, Singh DK, Lee R
    Clin Interv Aging, 2017;12:523-529.
    PMID: 28352165 DOI: 10.2147/CIA.S110329
    Aging is associated with alterations in thoracolumbar curvatures and respiratory function. Research information regarding the correlation between thoracolumbar curvatures and a comprehensive examination of respiratory function parameters in older adults is limited. The aim of the present study was to examine the correlation between thoracolumbar curvatures and respiratory function in community-dwelling older adults. Thoracolumbar curvatures (thoracic and lumbar) were measured using a motion tracker. Respiratory function parameters such as lung function, respiratory rate, respiratory muscle strength and respiratory muscle thickness (diaphragm and intercostal) were measured using a spirometer, triaxial accelerometer, respiratory pressure meter and ultrasound imaging, respectively. Sixty-eight community-dwelling older males and females from Kuala Lumpur, Malaysia, with mean (standard deviation) age of 66.63 (5.16) years participated in this cross-sectional study. The results showed that mean (standard deviation) thoracic curvature angle and lumbar curvature angles were -46.30° (14.66°) and 14.10° (10.58°), respectively. There was a significant negative correlation between thoracic curvature angle and lung function (forced expiratory volume in 1 second: r=-0.23, P<0.05; forced vital capacity: r=-0.32, P<0.05), quiet expiration intercostal thickness (r=-0.22, P<0.05) and deep expiration diaphragm muscle thickness (r=-0.21, P<0.05). The lumbar curvature angle had a significant negative correlation with respiratory muscle strength (r=-0.29, P<0.05) and diaphragm muscle thickness at deep inspiration (r=-0.22, P<0.05). However, respiratory rate was correlated neither with thoracic nor with lumbar curvatures. The findings of this study suggest that increase in both thoracic and lumbar curvatures is correlated with decrease in respiratory muscle strength, respiratory muscle thickness and some parameters of lung function. Clinically, both thoracic and lumbar curvatures, respiratory muscles and lung function should be taken into consideration in the holistic management of respiratory function among older adults.
  8. Mohd Nordin NA, Ajit Singh DK, Lim K
    Sains Malaysiana, 2014;43:423-428.
    Identification of associated risk factors is important to enable successful implementation of low back pain prevention strategies. To date, there is limited research data on back pain among young adults in Malaysia despite an increasing incidence of this disabling condition worldwide. A cross-sectional survey was conducted to determine the incidence of low back pain (LBP) and associated factors among health science undergraduates. A self-administered questionnaire was distributed to full time students of a main public university. One hundred and forty undergraduates; mean age 21.4±1.3 years, 70% female, 60% in year 3 of study, participated in the survey. The results showed that 31% spent between 6 and 8 h and another 31% spent more than 9 h sitting in a day. Twelve percent of the undergraduates rated their fitness level as ‘poor’. The incidence of LBP was 40.3% among the undergraduates. LBP incidence was associated with age (X2=12.1, p=0.007), years of study (X2=8.7, p=0.03), self-rated physical fitness (X2=7.0, p=0.02) and hours spent sitting (X2 =8.7, p=0.03). Gender, body mass index and hours spent in sports and physical activity were not associated with LBP. The findings from this study demonstrate that physical fitness and sitting duration is associated with low back pain among health science undergraduates. Health science undergraduates should improve their physical fitness, practice frequent breaks and stretching during sitting. This will help to minimize LBP related to decreased fitness levels and prolonged sitting.
  9. Se To PL, Ajit Singh DK, Whitney SL
    J Vestib Res, 2022;32(1):79-86.
    PMID: 34151874 DOI: 10.3233/VES-190731
    BACKGROUND: Adults with unilateral posterior canal benign paroxysmal positional vertigo (BPPV) may continue to present with residual dizziness and balance impairments after the canalith repositioning maneuver (CRM). Customized Vestibular rehabilitation (VR) in addition to the standard CRM may improve postural control in adults with BPPV. However, the effectiveness of this intervention for improving dyanmic gait measures in adults with BPPV is unknown.

    OBJECTIVE: We aimed to determine the effectiveness of customized VR in addition to the standard CRM on dynamic gait measures among adults with unilateral posterior canal BPPV.

    METHODS: In this double blind, randomized controlled trial, 28 adults with BPPV were randomized to either control (n = 14, age: 54.36±8.55) or experimental (n = 14, age: 50.71±9.88) groups. The experimental and control groups received customized VR plus standard CRM for six weeks and standard CRM for two weeks respectively. Dynamic gait measures (duration of a complete gait cycle, stride velocity, turning duration and number of steps while turning) were recorded using a portable mobility sensor (iTUG) at baseline, week 4 and 6. A mixed model ANOVA was used to estimate the main effects of the interventions.

    RESULTS: During walking, a group effect was demonstrated on gait duration, stride velocity, turning duration and number of steps while turning (p 

  10. Badrasawi M, Shahar S, Zahara AM, Nor Fadilah R, Singh DK
    Clin Interv Aging, 2016;11:1675-1686.
    PMID: 27895474
    BACKGROUND: Frailty is a biological syndrome of decreased reserve and resistance to stressors due to decline in multiple physiological systems. Amino acid deficiency, including L-carnitine, has been proposed to be associated with its pathophysiology. Nevertheless, the efficacy of L-carnitine supplementation on frailty status has not been documented. Thus, this study aimed to determine the effect of 10-week L-carnitine supplement (1.5 g/day) on frailty status and its biomarkers and also physical function, cognition, and nutritional status among prefrail older adults in Klang Valley, Malaysia.

    METHODOLOGY: This study is a randomized, double-blind, placebo-controlled clinical trial conducted among 50 prefrail subjects randomized into two groups (26 in L-carnitine group and 24 in placebo group). Outcome measures include frailty status using Fried criteria and Frailty Index accumulation of deficit, selected frailty biomarkers (interleukin-6, tumor necrosis factor-alpha, and insulin-like growth factor-1), physical function, cognitive function, nutritional status and biochemical profile.

    RESULTS: The results indicated that the mean scores of Frailty Index score and hand grip test were significantly improved in subjects supplemented with L-carnitine (P<0.05 for both parameters) as compared to no change in the placebo group. Based on Fried criteria, four subjects (three from the L-carnitine group and one from the control group) transited from prefrail status to robust after the intervention.

    CONCLUSION: L-carnitine supplementation has a favorable effect on the functional status and fatigue in prefrail older adults.

  11. Mohd Nordin NA, Yusoff NAH, Ajit Singh DK
    PMID: 31783575 DOI: 10.3390/ijerph16234746
    Although exercise is proven as an effective strategy to combat post-stroke complications and the risk of stroke recurrence, many stroke survivors fail to engage in this activity following rehabilitation. In this study, we assessed the feasibility and usefulness of a low-frequency group exercise to determine its suitability as an approach to facilitate exercise engagement among stroke survivors. Forty-one stroke survivors, mean (SD) age 59.34 (10.02) years, mean time post-stroke 17.13 (17.58) months, completed a 90 minute, once per week, group exercise supervised by therapists for 12 weeks. The exercise outcomes were measured using standardized clinical tests. We observed improvement in the group's physical performance; balance score by 3 units (Z = -3.88, p < 0.001), speed of repetitive sit to stand by 3.4 s (Z = -4.69, p < 0.001), and walking speed by 8.22 m/min (Z = -3.25, p < 0.001). Scores of seven out of 14 Berg's balance scale items increased significantly, indicating better balance ability among the survivors. In conclusion, a 12-week, once per week group exercise session seems feasible and sufficient to improve the physical performance of community dwelling stroke survivors. This exercise arrangement may be offered to stroke survivors to facilitate exercise practice following rehabilitation.
  12. Bhattacharya S, Saleem SM, Singh DK, Marzo RR, Singh A
    PMID: 33688550 DOI: 10.4103/jehp.jehp_280_20
    INTRODUCTION: We know that risk communication is equally important as risk identification, which is usually not communicated properly to the patients and resulting in poor outcomes, especially in hypertensive patients.

    OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based public health approach to educate the community to deal with problem of hypertension.

    METHODOLOGY: This cross-sectional pilot study was done in March 2020 among purposively approached in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the study and their demographic information was noted. They were given colour coded cards as per the current blood pressure level and previous history of hypertension. On each colour coded card, specific advice was written for that category. For all the participants, blood pressure and treatment seeking behaviour was noted. For hypertensive patients, adherence to medication and non-pharmacological measures was noted.

    RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42 mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension. Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive incidentally.

    DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive disorders in the community level. We merely bother about making their risk profiling, even in the digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front of them and we missed the "Golden Hour" for the treatment by searching patients' medical details.

    CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of chronic patients by colour coded OPD/Health cards.

  13. Sia LL, Sharma S, Kumar S, Ajit Singh DK
    Digit Health, 2024;10:20552076241248916.
    PMID: 38665882 DOI: 10.1177/20552076241248916
    OBJECTIVE: This study explored the perceived benefits, barriers, and recommendations of telerehabilitation for musculoskeletal disorders among physiotherapists in Malaysia.

    METHODS: This study employed an exploratory qualitative methodology to gather the perceptions of government-employed physiotherapists in Malaysia regarding the benefits, barriers, and recommendations for telerehabilitation in treating musculoskeletal disorders. The researchers conducted semistructured focus group discussions (FGDs) via Google Meet, which were recorded, transcribed, and analyzed using thematic analysis.

    RESULTS: Five FGDs were conducted with 24 participants, 37.5% of whom had prior experience with telerehabilitation. The data analysis returned three main themes: (1) perceived benefits, (2) barriers, and (3) recommendations. Four subthemes were derived from perceived benefits: (1a) saving time and money, (1b) convenience, (1c) clients responsible for their treatment, and (1d) alternatives for infectious diseases. Perceived barriers revealed three subthemes: (2a) technology, (2b) organization, and (2c) personal barriers. Finally, participants provided recommendations for improving telerehabilitation services, including training programs to facilitate greater acceptance of this modality.

    CONCLUSION: The findings of this study offer crucial insights into the evolving landscape of telerehabilitation in Malaysia. These findings revealed a greater prevalence of barriers to enablers among Malaysian physiotherapists, potentially influenced by varying experience levels. Despite the prevailing lack of experience among participants, this research underscores the significance of identifying barriers and enablers in implementing telerehabilitation with participants offering recommendations for integrating telerehabilitation into their practices. This study provides clear insights and a roadmap for stakeholders aiming to shape the future of telerehabilitation among physiotherapists in Malaysia.

  14. Mohd Zulkifly MF, Ghazali SE, Che Din N, Singh DK, Subramaniam P
    ScientificWorldJournal, 2016;2016:3456943.
    PMID: 27340686 DOI: 10.1155/2016/3456943
    In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.
  15. Singh DK, Manaf ZA, Yusoff NA, Muhammad NA, Phan MF, Shahar S
    Clin Interv Aging, 2014;9:1415-23.
    PMID: 25187701 DOI: 10.2147/CIA.S64997
    The consequences of combined undernourishment and decreased physical performance in older adults are debilitating and increases cost of care. To date, the information regarding the association between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions.
  16. Singh DK, Rajaratnam BS, Palaniswamy V, Pearson H, Raman VP, Bong PS
    Maturitas, 2012 Nov;73(3):239-43.
    PMID: 22884437 DOI: 10.1016/j.maturitas.2012.07.011
    The objective of this study was to quantify the effectiveness of virtual reality balance games (VRBG) to decrease risk and fear of falls among women.
  17. Singh DK, Rajaratnam BS, Palaniswamy V, Raman VP, Bong PS, Pearson H
    Climacteric, 2013 Feb;16(1):141-6.
    PMID: 22640573 DOI: 10.3109/13697137.2012.664832
    The prospective pre-post control study was designed to evaluate the effect of introducing balance-focused interactive virtual-reality games to community-dwelling older women to improve their agility, balance and functional mobility.
  18. Singh DK, Pillai SG, Tan ST, Tai CC, Shahar S
    Clin Interv Aging, 2015;10:1319-26.
    PMID: 26316727 DOI: 10.2147/CIA.S79398
    Physical performance and balance declines with aging and may lead to increased risk of falls. Physical performance tests may be useful for initial fall-risk screening test among community-dwelling older adults. Physiological profile assessment (PPA), a composite falls risk assessment tool is reported to have 75% accuracy to screen for physiological falls risk. PPA correlates with Timed Up and Go (TUG) test. However, the association between many other commonly used physical performance tests and PPA is not known. The aim of the present study was to examine the association between physiological falls risk measured using PPA and a battery of physical performance tests.
  19. Ajit Singh DK, Ngu ACY, Ahmad MA, Mohd Padzil FA, Hendri ENM, Kamsan SS
    Jurnal Sains Kesihatan Malaysia, 2018;16(101):229-230.
    MyJurnal
    Knee osteoarthritis (KOA) is a major cause of disability and significantly reduce quality of life (QOL). There is limited information about knee associated problems and functional mobility among Malaysian adults with KOA. The aim of our study was to examine knee associated problems and functional mobility among this population. Forty-five (45) adults with KOA with mean age of 65.02 ± 8.083 were recruited from Hospital Canselor Tuanku Muhriz, UKM. Knee associated problems and functional mobility were measured using Knee injury and Osteoarthritis Outcome Scores (KOOS) and Timed-Up and Go (TUG) test respectively. The mean score and standard deviation for TUG test was 11.44 ± 2.69 seconds. Median scores (with interquartile ranges [IQR]) for the KOOS subscale domains were; Symptoms: 80.56, (69.44 to 91.67); Pain: 71.43 (50 to 78.57); Functional Activities of Daily Living: 82.3 (67.65 to 86.76); Sports and Recreation Function: 30 (20 to 60); and Knee-Related Quality of Life: 50 (25 to 75). Generally, participants’ TUG test performance showed that time taken to complete the test was higher than the reference values (7.14 to 8.43 seconds) identified among Malaysian community dwelling older adults with low to high risk of falls. The KOOS scores in adults with KOA in our study is similar to previous reports with Sport and Recreation Function and QOL domains been the most affected. It is important to improve functional mobility and balance in order to decrease falls risk and optimise sport and recreation function and QOL among adults with KOA.
    Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  20. Ajit Singh DK, Ng ES, Ng CP, Ab Rahman NNA, Pannir Selvam SB
    Jurnal Sains Kesihatan Malaysia, 2018;16(101):225-226.
    MyJurnal DOI: 10.17576/JSKM-2018-35
    Falls is a global health issue among older adults. Identifying measuring tools that can predict falls risk among older adults can assist in early falls risk detection and prevention. Best measuring tools that can predict falls risk among Malaysian community dwelling older adults is not known. The objective of our study was to determine if Timed Up and Go (TUG) test and Activities-Specific Balance Confidence (ABC) scale could be used as a falls risk predictor tools among Malaysian community dwelling older adults. Hundred and six (n = 106) community dwelling older adults who were attending Klinik Kesihatan Cheras participated in this cross sectional study. Falls incidence in the past one year was obtained from the participants. TUG test was performed and ABC scale was administered. Data was analysed using binomial logistic regression and receiver operating curves (ROC). The cut off values identified for TUG test and ABC scale were 9.02 seconds (area under the curve, AUC was 0.711; 95% CI 0.577-0.844) and 82.81% (area under the curve, AUC was 0.682; 95% CI 0.562-0.802) respectively. Hence, older adults with a score of above 9.02 seconds for TUG test and a score of below 82.81% for ABC scale were noted to have a higher risk of falls. Results of this study demonstrated that both TUG test (p < 0.001) and ABC scale (p < 0.01) were significant predictors of falls risk. Our study results indicated that both mobility (TUG test) and fear of falls (ABC scale) measuring tools, with the present cut off values can be used to identify community dwelling older adults who are at a higher risk of falls. Identifying older adults with higher risk of falls can assist the health professionals to optimise falls prevention and management approaches.
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