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. e-ISSN: 2821-3718
PRESIDENT’S MESSAGEMALAYSIAN PHYSIOTHERAPY JOURNAL,4TH EDITION
The 4th Edition of the Malaysian Physiotherapy Journal (MPJ) marks a significant milestone in the advancement of physiotherapy in Malaysia, reflecting a transformative period characterized by strengthened professional governance and academic sustainability. This edition underscores the Malaysian Physiotherapy Association’s (MPA) renewed commitment to transparency, strategic financial planning, and the promotion of evidence-based practice. A historic development highlighted in this volume is the approval of a dedicated RM10,000 allocation for the journal during the 1st MPA Budget Extraordinary General Meeting (EGM) in December 2025, signifying institutional recognition of research as a core pillar of professional identity. The featured research contributions, spanning areas such as neurorehabilitation and digital health integration, reinforce the profession’s role within the Malaysian healthcare ecosystem. Emphasizing collective leadership under the 2025–2027 presidential term, this edition advocates unity, professional autonomy, and sustained academic excellence. Overall, the journal serves as both a reflection of progress and a strategic platform for strengthening physiotherapy’s voice, credibility, and long-term sustainability in Malaysia.
Copyright (c) 2026 Malaysian Physiotherapy Journal
IMPROVING PHYSIOTHERAPY STUDENTS’ UNDERSTANDING OF PAIN: THE IMPACT OF PAIN NEUROSCIENCE EDUCATION
Introduction: Pain is one of the most common reasons individuals seek medical care, as chronic pain can significantly affect daily activities, quality of life, social relationships, and work performance. In addition to physical discomfort, chronic pain is often associated with psychological distress such as stress and anxiety. Given its prevalence and impact, pain neuroscience education (PNE) has emerged as an important physiotherapy intervention for chronic pain management. This study aimed to examine the effect of a PNE lecture on physiotherapy students’ knowledge of pain and to compare outcomes between a PNE group and a control group. Methods: A quasi-experimental pre-test/post-test study was conducted involving 67 undergraduate physiotherapy students (mean age 22.06 ± 0.86 years). Participants were assigned to either a PNE intervention group (n = 31) or a control group (n = 36) using purposive sampling. The intervention group received a single 70-minute lecture on pain neuroscience, while the control group attended a 70-minute lecture on basic neuroanatomy. Pain knowledge was assessed before and immediately after the lectures using the 12-item Revised Pain Neurophysiology Questionnaire (RPNQ). Results: RPNQ scores in the PNE group increased significantly following the lecture (p < 0.001), with post-intervention scores (6.32 ± 2.02) exceeding pre-intervention scores (3.81 ± 1.60). A 2 × 2 mixed ANOVA revealed a significant effect of time (p < 0.001) and a significant group-by-time interaction (p = 0.011, partial eta squared = 0.096), indicating greater knowledge gains in the PNE group. No significant main effect of group was observed (p = 0.400). Conclusion: A single 70-minute PNE lecture significantly improved physiotherapy students’ understanding of pain neurophysiology. Integrating PNE into physiotherapy education may enhance future clinicians’ ability to manage pain effectively and empathetically.
PHYSICAL FITNESS AND ACTIVITY STATUS AMONG COMMUNITY-DWELLING INDIVIDUALS WITH SPINAL CORD INJURY IN THE KLANG VALLEY, MALAYSIA
Background and Objective: Spinal cord injury (SCI) leads to substantial impairment in physical function and mobility, making it essential to understand the physical fitness and activity levels of community-dwelling individuals for guiding rehabilitation strategies. This study aimed to determine the physical fitness and physical activity levels of individuals with SCI living in the community and to examine the relationship between these variables. Methods: A cross-sectional study was conducted in the Klang Valley, encompassing Kuala Lumpur, Petaling Jaya, Shah Alam, and Putrajaya. Sociodemographic data were collected using online forms and email responses. Physical fitness was assessed through upper limb strength, handgrip strength, and predicted peak oxygen uptake using a handheld dynamometer, handgrip dynamometer, and the 6-minute wheelchair push test. Physical activity levels were measured using a validated questionnaire commonly used in populations with physical disabilities. Results: Participants demonstrated a mean handgrip strength of 32.00 (15.11) kg, mean shoulder flexor strength of 15.08 (7.35) kg, mean predicted peak oxygen uptake of 2152.22 (384.44) mL/min, and a moderate physical activity level with a mean score of 54.65 (33.2). No significant correlation was found between physical fitness measures and physical activity levels. Male participants recorded higher physical activity scores and peak oxygen uptake than females, although these differences were not statistically significant. Conclusions: Physical fitness and physical activity levels among individuals with SCI in the community were not significantly correlated. Future studies should include a larger and more diverse sample to better understand these relationships across various demographic and functional groups.
THE COMPARISON OF LOWER LIMB MUSCLES STRENGTH AMONG ADOLESCENT HOCKEY PLAYERS WITH AND WITHOUT CHRONIC ANKLE INSTABILITY
Backgorund and Objectives: Chronic ankle instability (CAI) is recurrent sprain, episodes of giving-way of the ankle joint, pain, swelling and decreased function. Ankle sprain is the most prevalent injury among Malaysian hockey players with 53% of them developing CAI. : To identify the prevalence of CAI among adolescent hockey players, to evaluate and compare lower limb muscles strength among adolescent hockey players with and without chronic ankle instability. Methods: The cross-sectional study was conducted on 103 adolescent hockey players assessing the presence of CAI using the Identification of Functional Ankle Instability (IdFAI-M) questionnaire and lower limb muscle strength was measured using a hand-held dynamometer (HHD). Descriptive statistics were performed to summarise the sociodemographic and muscle strength. Mann-Whitney U test was used to compare muscle strength between CAI and without CAI groups. Results: The prevalence of CAI among the participants was found to be 49.5%, significantly higher than in the general adolescent athlete population. The CAI group showed significantly stronger knee flexor in non-dominant (p= 0.040), ankle inversion muscle for dominant and non-dominant (p= 0.022; p=0.045) respectively and eversion muscle strength for non-dominant (p=0.009) compared to the without CAI group with moderate effect sizes. Conclusion: Effective CAI management in adolescent hockey players requires targeted strength training for hip, knee, and ankle muscles, alongside proprioceptive exercises. Larger studies are needed to confirm these findings and optimize injury prevention strategies in sports.
UNCOVERING NOVEL ASSOCIATIONS OF PHYSICAL ACTIVITY WITH SHOULDER PAIN AND DEPRESSION AMONG SPINAL CORD INJURY COMMUNITY IN KLANG VALLEY, MALAYSIA
Background and Objective: Individuals with spinal cord injury (SCI) frequently experience shoulder pain and depressive symptoms, both of which negatively affect daily functioning and quality of life. Physical activity is commonly promoted to improve physical and psychological health; however, its relationship with pain and depression among individuals with SCI remains inconsistent, particularly in densely populated urban settings such as the Klang Valley, Malaysia. Urban environmental demands, accessibility, and psychosocial stressors may influence these relationships. This study aimed to examine the associations between physical activity levels, shoulder pain, and depressive symptoms among adults with SCI living in the Klang Valley, and to describe the overall levels of physical activity, pain, and depression in this population. Methods: A cross-sectional study was conducted among wheelchair-dependent adults with SCI aged 18–55 years residing in the Klang Valley. Participants were recruited using snowball sampling and completed face-to-face assessments. Sociodemographic and injury-related information was collected. Physical activity, shoulder pain, and depressive symptoms were assessed using validated Malay versions of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), Wheelchair User’s Shoulder Pain Index (WUSPI), and Patient Health Questionnaire-9 (PHQ-9), respectively. Spearman’s rank correlation was used to examine associations between variables. Results: Eighteen participants were included in the analysis. No significant associations were found between physical activity and shoulder pain (ρ = –0.030, p = 0.904) or between physical activity and depressive symptoms (ρ = 0.105, p = 0.679). Years since injury were also not significantly related to pain or depression. Overall, participants demonstrated moderate physical activity levels, variable shoulder pain intensity, and predominantly minimal depressive symptoms. Conclusion: Physical activity alone did not predict shoulder pain or depressive symptoms among urban-dwelling individuals with SCI in the Klang Valley. These findings suggest that environmental and psychosocial factors may play an important role. Larger, longitudinal studies are needed to clarify these relationships and inform context-specific rehabilitation strategies.
IMPACT OF SOCIAL ISOLATION ON FALLS AND HOSPITALIZATION AMONG OLDER ADULTS WITH AND WITHOUT KNEE OSTEOARTHRITIS: 1 YEAR PHONE-CALL FOLLOW-UP STUDY
Background & Objectives: Osteoarthritis increases the risk of falls among older adults, and limited social support may further exacerbate this risk, potentially leading to adverse health outcomes such as falls and hospitalization. This study aimed to determine the impact of social isolation on the risk of falls and hospitalization among older adults with and without knee osteoarthritis (OA) in Malaysia. Methods: A longitudinal study with a one-year follow-up was conducted among adults aged 50 years and above in Klang Valley and Selangor. Baseline data included demographic information, clinical examination for knee OA, and the Lubben Social Network Scale to assess social isolation. After one year, participants were contacted via telephone to collect information on falls and hospitalization. Results: The study included 174 participants, of whom 113 (65%) had knee OA and 61 (35%) did not. No significant association was observed between social isolation and the risk of falls or hospitalization, regardless of knee OA status. Gender, social engagement, and living arrangement did not significantly modify these outcomes. Conclusion: Social isolation did not significantly impact falls or hospitalization among older adults with or without knee OA over a one-year period. These findings should be interpreted with caution due to limitations such as recruitment from socially active community centres and a relatively short follow-up. Future studies should consider longer follow-up periods, diverse recruitment settings, and the role of physical activity and functional status in influencing these outcomes.
EVALUATION OF E-PHYSICAL ACTIVITY COACHING PROGRAMME ON STROKE KNOWLEDGE AND ANXIETY LEVEL AMONG STROKE SURVIVORS
Background and Objective: Education and training on self-management are important component of post-stroke care. Since the past few years, education and training to stroke survivors are delivered through an online platform due to various reasons. However, the effectiveness of this type of patient education and training delivery is still unknown. Therefore, this study was intended to evaluate an online education program for stroke survivors living at home post-stroke. Methods: A total of 52 stroke survivors were recruited to participate in the study. Subjects were respondents to a previous local survey on knowledge, attitude and practice of physical activity conducted in the Klang Valley area of Malaysia. Selected subjects were those who scored low in the knowledge part of the survey. The stroke education focused on stroke in general and the benefit of physical activity on stroke survivors and was given online using an e-Physical Activity Coaching program (e-PAc). The effect of the e-PAc was assessed in term of change in knowledge and anxiety level with the use of Stroke Knowledge Test: Malay version (SKT-Malay) and Hamilton Anxiety Rating Scale (HAM-A) after 6 weeks of enrolment. Results: All 52 participants completed the e-PAc without any adverse effects. There was a statistically significant improvement in SKT (p<0.001) and positive change in HAM-A after the intervention (p<0.001). Conclusion: Our study shows that an online education program is effective in improving stroke related knowledge and lowering anxiety level among stroke survivors. The e-PAc may be recommended to physiotherapists managing post-stroke patients as an alternative to a face-to-face program.
PSYCHOSOCIAL BENEFITS OF GAME-BASED CIRCUIT EXERCISE IN STROKE SURVIVORS: A PRE–POST EXPERIMENTAL STUDY IN A MALAYSIA SETTING
Background and Objective: Stroke frequently leads to long-term functional impairments and reduced psychosocial well-being, underscoring the need for engaging and effective rehabilitation strategies. Emerging evidence suggests that game-based exercise may enhance motivation, self-efficacy and adherence, yet its psychosocial effect in stroke survivors remains underexplored. Game-based circuit exercise integrates task-oriented training with interactive elements that may promote active participation and meaningful engagement. This study examines the psychosocial benefits of a game-based circuit exercise intervention among stroke survivors, with specific emphasis on motivation level and self-efficacy, using a pre–post experimental study design. Methods: This trial involved 44 subacute post-stroke participants (mean age ± SD = 58.61 ± 9.91 years; mean Montreal Cognitive Assessment score = 26.43 ± 3.32) and was conducted at Hospital Putrajaya, Malaysia, between June 2021 and March 2023. All participants completed supervised game-based circuit exercise sessions twice weekly for 12 weeks. Motivation and self-efficacy outcomes were assessed using the Intrinsic Motivation Inventory (IMI) and the Stroke Self-Efficacy questionnaire (SSEQ). Measurements were obtained at baseline and at 12 and 36 weeks of intervention. A paired t-test was used for data analysis. Results: Post-training, IMI-interest and IMI-competence scores increased significantly (p<0.001), with gains of 6% and 9%, respectively, while mean SSEQ scores improved by 12% from baseline (p<0.001). Participants also reported reduced pressure/tension, demonstrated by a 12% decrease in this subscale (p<0.05) with small effect sizes of 0.3. In contrast, IMI-perceived choice did not change significantly between baseline and 12-week post-intervention (p>0.05). At six-month follow-up, participants showed sustained significant improvements in interest/enjoyment, perceived competence, reduced tension and clinically meaningful gains in self-efficacy (p<0.05) with medium effect sizes of 0.2 to 0.3, while perceived choice remained stable. Conclusion: Overall, the game-based circuit exercise generated psychosocial benefits that persisted well beyond the active training period.
stroke, motivation, self-efficacy, game-based circuit exercise
EXPLORING ELECTROPHYSICAL AGENT AND REHABILITATION EXERCISE UTILISATION PATTERNS IN THE MANAGEMENT OF LATERAL EPICONDYLE TENDINOPATHY: A RETROSPECTIVE ANALYSIS OF A MALAYSIAN COHORT
Background: Lateral epicondyle tendinopathy (LET), commonly known as tennis elbow, is a prevalent musculoskeletal condition. Rehabilitation involving electrophysical agents (EPAs) and exercises is frequently employed, but the utilization patterns and gender-based preferences of these modalities are not well understood. This study examines the use of EPAs and rehabilitation exercises in managing LET among Malaysian patients, considering gender differences. Method: In this retrospective study, data were collected from 105 patients with LET treated at Hospital Canselor Tuanku Muhriz, Malaysia, between January 2018 and January 2023. Sociodemographic details, clinical profiles, and information regarding the utilization of EPAs and rehabilitation exercises were collected using a structured research form. Data were analyzed using SPSS version 26. Descriptive statistics, independent t-tests, cross-tabulation, and correlation tests were performed. Results: The results showed that LET was more prevalent in females (62.9%), particularly among Malay patients (54.3%), and most commonly affected the dominant arm (76.2%). Female office clerks, housewives, and health professionals were more affected than their male counterparts. There were no significant gender differences in symptom duration, but females underwent more rehabilitation sessions. Therapeutic ultrasound was the most used EPA (81.0%), followed by paraffin wax (72.4%). Strengthening and home exercise programs were prescribed to 97.1% of patients without significant gender-based differences in treatment preferences. Conclusions: The findings suggest a gap in adherence to evidence-based guidelines for LET management, with the frequent use of modalities like ultrasound and paraffin wax despite limited evidence. This highlights the need for individualized treatment plans that align with the best available evidence and consider patient-specific needs.
Copyright (c) 2025 Malaysian Physiotherapy Journal
DEMOGRAPHICS-RELATED UTILIZATION PATTERNS OF THERAPEUTIC INTERVENTIONS IN KNEE OSTEOARTHRITIS REHABILITATION AT A MALAYSIAN TERTIARY HOSPITAL: A RETROSPECTIVE ANALYSIS
Objective: Effective management of knee osteoarthritis (KOA) requires an understanding of treatment patterns across age groups. This study examines the utilization of therapeutic exercise and electrophysical agents (EPAs) in KOA rehabilitation among different age demographics. Methods: A retrospective review of physiotherapy records was conducted for KOA patients treated at Hospital Canselor Tuanku Muhriz, Malaysia, between January 2022 and April 2023. Sequential sampling identified 331 eligible cases from 2,404 records, excluding those with over 10 percent missing data. Sociodemographic and treatment details were collected using a structured form and analyzed using descriptive and inferential statistics to assess associations between age groups and variables such as ethnicity, gender, and intervention types. Results: An analysis of 331 medical records demonstrated a universal prescription of lower limb strengthening exercises. Additionally, stretching exercises were recommended in 89.1% of cases. A significant association was identified between age groups and the use of balance exercises (P = 0.030), with lower utilization rates observed among middle-aged (45-64 years) and elderly (>65 years) patients, at 14.4% and 13.0% respectively. Among EPAs, hot packs were the most frequently employed (93.7%). In contrast, cryotherapy (9.3%), transcutaneous electrical nerve stimulation (3.7%), and therapeutic ultrasound (1.9%) were less commonly utilized. Although overall treatment choices did not significantly differ by age, EPAs were more commonly used among older patients. Conclusions: Underuse of balance exercises and some EPAs underscore the need for age-sensitive rehabilitation approaches. Physiotherapists should consider age differences in KOA care, and further studies are needed to examine what drives treatment choices.
THE CORRELATION BETWEEN PHYSICAL ACTIVITY AND FATIGUE LEVEL DURING MENSTRUAL PHASE AMONG FEMALE ADOLESCENTS AT YADIKA BANGIL PASURUAN VOCATIONAL HIGH SCHOOL, SURABAYA, INDONESIA
Background: The phenomena of "remaja jompo", that has been known among teenagers in the recent years, describes the physical and mental exhaustion of teenagers. Fatigue is the decreased efficiency, work performance, and physical strength or endurance, which is one of one of the most common reported complaints in primary health care services. Individuals are more likely to experience severe fatigue if they engage in strenuous physical activities, especially in female adolescent. The menstrual phase might worsen fatigue due to hormonal fluctuations and the depletion of iron stores in the blood. Objective: This study aims to determine the correlation between physical activity and fatigue level on menstrual phase among female adolescent at Yadika Bangil Pasuruan Vocational High School. Method: This study utilized an analytical observational method with a cross-sectional approach. The instruments used in this research were the Baecke Questionnaire for physical activity and the Subjective Self Rating Scale for fatigue levels. The statistical analysis was done using SPSS with the Kolmogorov-Smirnov test to examine the data distribution and the Spearman’s Rho correlation test to examine the correlation among variables. Results: Most female adolescent at Yadika Bangil Pasuruan Vocational High School had a moderate level of physical activity (88.3%) and moderate levels of fatigue during the menstrual phase (51.7%). The Spearman’s Rho correlation test revealed a p-value of 0.173 (p>0.05). Conclusion: There is no significant correlation between physical activity and fatigue level on menstrual phase among female adolescent at Yadika Bangil Pasuruan Vocational High School. Keywords: Adolescent Girls; Fatigue; Menstruation; Physical Activity.
INFLUENCE OF BODY MASS INDEX AND BODY WEIGHT ON SINGLE HOP TEST OUTCOMES IN AN ACL SPORT REHABILITATION PROGRAM: A CROSS-SECTIONAL STUDY
Background: Body mass index (BMI) and body weight may influence recovery following anterior cruciate ligament (ACL) injuries, yet their relationship to functional rehabilitation outcomes is not fully established. Objective: To examine the association between BMI, body weight, and performance in the Single Hop Test (SHT) among individuals undergoing an ACL sport rehabilitation programme. Methods: A cross-sectional study was conducted among patients aged 18–60 at the Physiotherapy Unit, Queen Elizabeth II Hospital. BMI and body weight were recorded at the end of the rehabilitation phase, and functional performance was assessed using the SHT. Statistical analysis included Shapiro–Wilk tests for normality and Pearson’s correlation to evaluate associations between anthropometric variables and test performance. Results: BMI showed a modest, statistically significant negative correlation with SHT performance, whereas body weight was not significantly associated with SHT outcomes. Conclusion: BMI may exert a minor but meaningful influence on functional recovery after ACL rehabilitation, while absolute weight alone is less predictive. These findings support integrating BMI considerations into rehabilitation planning to optimise outcomes.
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.
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.