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Development and validation of non-adherence to pulmonary rehabilitation questionnaire: a clinical tool for patients with chronic obstructive pulmonary diseases

Ayiesah R, Leonard JH, Chong CY

Clin Ter, 2014;165(3):123-8.
PMID: 24999563 DOI: 10.7417/CT.2014.1708

OBJECTIVE: Non-adherence is a serious issue among the participants in pulmonary rehabilitation program (PRP). Till date, no clinical tool is available to screen participants who will show poor adherence towards PRP. This study aimed to develop and validate a tool called "Adherence to Pulmonary Rehabilitation Questionnaire (APRQ)", a self-administered questionnaire to screen the risk of non-adherence to PRP among the patients with chronic obstructive pulmonary disease. APRQ comprises of 6 main constructs such as disease management behaviour, perceived treatment benefits, emotional factors, perceived severity of disease, barriers towards treatment and coping attitude.
MATERIALS AND METHODS: This was a preliminary validity study carried out in the physiotherapy department and respiratory clinic in an university teaching hospital. A total of 109 patients with average age of 58.8 ± 1 year participated in the study. The inclusion criteria for subjects were: patients diagnosed with chronic obstructive pulmonary diseases (COPD) (Stage II and III). Exclusion criteria include those COPD patients with mental problems and disabled patients. The tool was developed based on thematic analysis and in-depth interview with focus group and literature search on the factors that lead to non-adherence among the PRP's participants. Principal component analysis was carried out to examine the construct validity and content validity of APRQ.
RESULTS: A total of 20 items were created under 6 constructs. However, 2 items (smoking and hospital admission) were eliminated due to poor correlations. Thus, the final version of APRQ was developed and validated with 18 items. Reliability was measured using internal consistency and achieved Cronbach's Alpha of 0.762.
CONCLUSIONS: The findings from this preliminary study supports that APRQ may be a valid and reliable tool to screen adherence towards PRP among chronic lung disease patients.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Evaluation of postural control impairment using Balance Error Scoring System among athletes with ankle injury: an effective tool in daily clinical practice

Vikram M, Sundaraganesh K, Justine M, Kurup M, Leonard JH

Clin Ter, 2012;163(5):383-6.
PMID: 23099965

The main objective of the study was to investigate postural control impairment in athletes with history of ankle injury by using Balance Error Scoring System (BESS) and to compare with the controls.
Changes in transversus abdominis muscle thickness after lumbo-pelvic core stabilization training among chronic low back pain individuals

Leonard JH, Paungmali A, Sitilertpisan P, Pirunsan U, Uthaikhup S

Clin Ter, 2015;166(5):e312-6.
PMID: 26550815 DOI: 10.7417/T.2015.1884

OBJECTIVE: Lumbo-pelvic core stabilization training (LPST) is one of the therapeutic exercises common in practice for rehabilitation of patients with chronic low back pain. This study was carried out to examine the therapeutic effects of LPST on the muscle thickness of transversus abdominis (TrA) at rest and during contraction among patients with chronic non-specific low back pain.
MATERIALS AND METHODS: A total of 25 participants (7 males and 18 females) with chronic non-specific low back pain participated in a within-subject, repeated measures, double-blinded, placebo-controlled comparisons trial. The participants received three different types of experimental therapeutic training conditions which includes the lumbo-pelvic core stabilization training (LPST), the placebo treatment with passive cycling (PC) and a controlled intervention with rest (CI). The interventions were carried out by randomization with 48 hours between the sessions. The effectiveness of interventions was studied by measuring the changes in muscle thickness of TrA at rest and during contraction using a real time ultrasonography.
RESULTS: Repeated measures ANOVA demonstrated that the LPST provided significant therapeutic benefits as measured by an increase in the muscle thickness of the TrA at rest (p<0.05) and during contraction (p<0.01). The percentage change of the muscle thickness observed during LPST was significantly higher (p<0.01) when compared to the other two experimental training conditions.
CONCLUSIONS: The findings indicated that the LPST might provide therapeutic benefits by increasing the muscle thickness and function of TrA. Therefore, it is suggested that LPST technique should be considered as part of management program for treatment of low back pain.
KEYWORDS: Back pain; Core stabilization; Lumbo-pelvic exercise; Rehabilitation; Transversus abdominis
The Internal Reliability of Family Crisis Oriented Personal Evaluation Scale (F-COPES) in Malay version among caregivers of individual with learning disabilities

Alwi N, Harun D, Omar B, Ahmad M, Zagan M, Leonard JH

Clin Ter, 2015 Nov-Dec;166(6):e361-4.
PMID: 26794817 DOI: 10.7417/T.2015.1901

Caregivers face challenges to adapt while handling individual with learning disabilities (LD). The Family Crisis Oriented Personal Evaluation Scale (F-COPES) is a widely used instrument to measure coping strategies among caregivers. The current study performed cross cultural translation of F-COPES in Malay language. This study aims to examine the reliability by testing internal consistency of Malay version of F-COPES which is developed through back to back translation method from original English version.
Prolonged writing task: comparison of electromyographic analysis of upper trapezius muscle in subjects with or without neck pain

Leonard JH, Kok KS, Ayiesha R, Das S, Roslizawati N, Vikram M, et al.

Clin Ter, 2010;161(1):29-33.
PMID: 20393675

Work related musculoskeletal disorders represent a serious public health problem as it is a leading cause for disability and absenteeism in workers. The main purpose of the present quasi-experimental study was to compare the muscle activity of the upper trapezius in subjects with neck pain and compare it to those of normal subjects.

Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Work-related injuries among physiotherapists in public hospitals: a Southeast Asian picture

Nordin NA, Leonard JH, Thye NC

Clinics (Sao Paulo), 2011;66(3):373-8.
PMID: 21552658

OBJECTIVES: A cross-sectional study was conducted to measure the prevalence of work-related injuries among physiotherapists in Malaysia and to explore the influence of factors such as gender, body mass index, years of work experience and clinical placement areas on the occurrence of work-related musculoskeletal disorders.
METHODS: Self-administered questionnaires adapted from the Nordic Musculoskeletal Questionnaire were sent to 105 physiotherapists at three main public hospitals in Kuala Lumpur, Malaysia. The questionnaire had 12 items that covered demographic information, areas of musculoskeletal problems and physiotherapy techniques that could contribute to work-related musculoskeletal disorders. The data obtained were analyzed using the Statistical Package for Social Science version 14 software.
RESULTS: The overall prevalence of work-related injuries during the past 12 months was 71.6%. Female therapists reported a significantly higher prevalence of work-related musculoskeletal disorders than the male therapists (73.0%, p,0.001). Significant differences were observed between the proportion of therapists who had work-related musculoskeletal disorders and those who did not for the group with a body mass index (BMI) .25 (x² = 9.0, p = 0.003) and the group with a BMI of 18-25 (x² = 7.8, p = 0.006). Manual therapy (58.6%) and lifting/transfer tasks (41.3%) were the two physiotherapy techniques that most often contributed to work-related musculoskeletal disorders.
CONCLUSION: Work-related injuries are significantly higher among the physiotherapists in Malaysia compared with many other countries. Female therapists reported a higher incidence of work-related musculoskeletal disorders in this study, and work-related musculoskeletal disorders were more common among therapists working in the pediatric specialty. This study contributes to the understanding of work-related disorders among physiotherapists from a southeast Asian perspective where the profession is in its development stage.
Risk of mental health disorders among farmers involved in palm plantation occupation

Leonard JH, Ali JE, Vikram M, Saraswathy V, Hanif FM, Nihayah M, et al.

Clin Ter, 2013;164(5):403-6.
PMID: 24217825 DOI: 10.7417/CT.2013.1603

The aim of this study was to define mental health status of palm plantation farmers in Muar, Johor, Malaysia.
Fulltext Effect of intercostal stretch on pulmonary function parameters among healthy males

Mohan V, Aziz KB, Kamaruddin K, Leonard JH, Das S, Jagannathan MG

EXCLI J, 2012;11:284-90.
PMID: 27418905

The use of manual stretching procedures has become more prevalent in cardiorespiratory physiotherapy to improve pulmonary functions. However, limited evidence exists regarding evaluation of their effectiveness. The study aimed to determine the impact of Intercostal (IC) stretch in improving the dynamic pulmonary function parameters (Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC) and FEV1/FVC % and respiratory rate among healthy adults. Thirty healthy male subjects were recruited based on inclusion and exclusion criteria. Subjects were assigned to the experimental group and the control group through random sampling method. In the experimental group, subjects underwent IC stretch for ten breaths on the inspiratory phase of the respiratory cycle with breathing control exercises in semi recumbent position, while in the control group, breathing control exercises alone were performed in the semi recumbent position. The results of the study showed, FEV1/FVC % in the experimental group significantly improved with P=0.017 (p<0.05) than the control group, which means IC stretch increased lung volume and lead to improved lung function. This study suggested the IC stretching with breathing control may be more effective in improving dynamic lung parameters especially FEV1/FVC % than breathing control alone.
Development and evaluation of 'neck pain and functional limitation scale': a validation study in the Asian context

Leonard JH, Choo CP, Manaf MR, Md Isa Z, Mohd Nordin NA, Das S

Indian J Med Sci, 2009 Oct;63(10):445-54.
PMID: 19901483

BACKGROUND: There is a paucity of literature on validated outcome measurement tools for evaluation of neck pain and related disability in the Asian context.
AIM: The main aim of the present study was to design a new tool called neck pain functional limitation scale (NPFLS) for measuring disability related to neck pain and observe its reliability, concurrent validity and criterion validity.
SETTING AND DESIGN: This study was performed at the institutional hospital.
MATERIALS AND METHODS: A total of 157 subjects (neck pain group) and 25 control subjects (control group) without neck pain were recruited for this study. NPFLS was framed as a new tool for this study, which consisted of 5 domains - pain intensity, activities of daily living, social activities, functional activities and psychological factors. Neck Bournemouth questionnaire (NBQ) was used as a gold standard to measure the concurrent validity and criterion validity of the NPFLS.
STATISTICAL ANALYSIS: Criterion validity and concurrent validity between the neck Bournemouth questionnaire (NBQ) and NPFLS scores were tested statistically using Mann-Whitney U test and Spearman correlation test. The reliability was tested by examining the internal consistency to calculate the Cronbach's alpha value for each item in NPFLS.
RESULTS: No significant difference between NPFLS and NBQ was observed using Mann-Whitney U Test, with P value greater than 0.05 (P= 0.557). Besides that, NPFLS had a high concurrent validity (r= 0.916) and good internal consistency with high Cronbach's alpha value of (r= 0.948), which demonstrated strong correlation between the items of NPFLS and NBQ.
CONCLUSION: NPFLS demonstrated good reliability, high concurrent validity and criterion validity in this study. NPFLS can be used to assess neck pain and disability among patients with neck pain.