Leonard Joseph

Effectiveness of exercise and protein supplementation intervention on body composition, functional fitness, and oxidative stress among elderly Malays with sarcopenia

Sarcopenia, characterized as muscle loss that occurs with aging, is a major health problem in an aging population, due to its implications on mobility, quality of life, and fall risk. Protein supplementation could improve the physical fitness by increasing protein anabolism, and exercise has a documented evidence of positive effect on functional status among the elderly. However, the combined effect of both protein supplementation and exercise has not been investigated among sarcopenic elderly in the Asian population. Thus, this study aimed to determine the effectiveness of exercise intervention and protein supplementation either alone or in combination for 12 weeks, on body composition, functional fitness, and oxidative stress among elderly Malays with sarcopenia. Sixty five sarcopenic elderly Malays aged 60–74 years were assigned to the control group, exercise group (ExG), protein supplementation group (PrG), or the combination of exercise and protein supplementation group. A significant interaction effect between body weight and body mass index (BMI) was observed, with the PrG (−2.1% body weight, −1.8% BMI) showing the highest reductions. Further, there was a decrease in % body fat (−4.5%) and an increase in fat-free mass (kg) (+5.7%) in the ExG after 12 weeks (P < 0.05). The highest increments in lower and upper body strength were observed in the PrG (73.2%) and ExG (47.6%), respectively. In addition, the ExG showed a reduction in superoxide dismutase (SOD) levels, and both interventions did not alter either lipid or protein oxidation. In conclusion, the exercise program was found to improve muscle strength and body composition, while protein supplementation reduced body weight and increased upper body strength, among sarcopenic elderly in Malaysia.

Learning pathways during clinical placement of physiotherapy students: a Malaysian experience of using learning contracts and reflective diaries

Purpose: Learning contracts and reflective diaries are educational tools that have been recently introduced to physiotherapy students from Malaysia during clinical education. It is unclear how students perceive the experience of using a learning contract and reflective diary. This study explores the learning pathways of the students after using a learning contract and a reflective diary for the first time in their clinical placement. Methods: A total of 26 final-year physiotherapy students completed a learning contract and a reflective diary during clinical placements. Two researchers explored the data qualitatively by the thematic content analysis method using NVivo. Results: A total of four and six main learning themes were identified from the data of the students through a learning contract and reflective diary. Conclusion: These learning themes reflected the views of the students about what they have considered to be important learning pathways during their clinical placements. They give valuable insights into the experiences and opinions of students during their clinical education process, which should be useful for enhancing teaching and learning methods in physiotherapy education.

Reliability, agreement, and validity of digital weighing scale with MatScan in limb load measurement

Limb loading measurements serve as an objective evaluation of asymmetrical weight bearing in the lower limb. Digital weighing scales (DWSs) could be used in clinical settings for measurement of static limb loading. However, ambiguity exists whether limb loading measurements of DWSs are comparable with a standard tool such as MatScan. A cross-sectional study composed of 33 nondisabled participants was conducted to investigate the reliability, agreement, and validity of DWSs with MatScan in static standing. Amounts of weight distribution and plantar pressure on the individual lower limb were measured using two DWSs (A, B) and MatScan during eyes open (EO) and eyes closed (EC) conditions. The results showed that intra- and interrater reliability (3, 1) were excellent (0.94-0.97) within and between DWS A and B. Bland-Altman plot revealed good agreement between DWS and MatScan in EO and EC conditions. The area under the receiver operating characteristic curve was significant and identified as 0.68 (p = 0.01). The measurements obtained with DWSs are valid and in agreement with MatScan measurements. Hence, DWSs could be used interchangeably with MatScan and could provide clinicians an objective measurement of limb loading suitable for clinical settings.

Clinical evaluation of the anterior translation of glenohumeral joint using ultrasonography: an intra- and inter-rater reliability study.

OBJECTIVE The aim of this study was to investigate the intra- and inter-rater reliability of ultrasonography (US) to measure anterior translation of the humeral head (ATHH) among healthy subjects and patients with sacroiliac joint dysfunction. METHODS The study included a total of 22 shoulder joints from 11 subjects. Six subjects were healthy and 5 had sacroiliac joint dysfunction. Anterior translation of the humeral head was measured twice using US by two different investigators. Intraclass correlation coefficient (ICC3,1), standard error of measurements (SEMs), coefficient of variations (CVs) and Bland-Altman plot were used as analytical tests to investigate intra- and inter-rater reliability, amount of error and agreeability of the measurements between investigators. RESULTS Intraclass correlation coefficient was 0.94, showing a high level of intra-rater reliability of the first investigator with SEMs (0.01 cm) and CV (5.1%) in measuring ATHH. Intra-rater reliability of the second investigator was 0.84 with SEMs (0.03 cms) and CV (9.6%), indicating a high level of reliability. Inter-rater reliability was high, with an ICC value of 0.92 with SEMs (0.02 cms) and CV (5.9%). CONCLUSION The use of US as a measurement of ATHH has good levels of intra- and inter-rater reliability in clinical practice.

Prophylactic Effects of Sauna on Delayed-Onset Muscle Soreness of the Wrist Extensors.

Background: High-intensity of exercise or unaccustomed eccentric exercise can cause the phenomenon of Exercise-Induced Muscle Damage (EIMD) which usually results in cramps, muscle strain, impaired muscle function and delayed-onset muscle soreness. Objectives: This study investigated the prophylactic effects of sauna towards the symptoms associated with muscle damage from eccentric exercises of wrist extensor muscle group. Patients and Methods: A total of twenty-eight subjects (mean age 20.9 years old, SD = 1.6) were randomly divided into the sauna group (n = 14) and the control group (n = 14). In the sauna group, subjects received sauna before eccentric exercise of the wrist extensor. The eccentric exercises were conducted on the non-dominant arm by using an isokinetic dynamometer. Pain Intensity (PI), Pressure Pain Threshold (PPT) and passive range of motion of wrist flexion (PF-ROM) and extension (PE-ROM) were measured as pain variables. Grip Strength (GS) and Wrist Extension Strength (WES) were measured as variables of wrist extensor muscle function. All the measurements were performed at baseline, immediately after and from 1st to 8th days after the exercise-induced muscle damage. Results: The sauna group significantly demonstrated a lower deficit in ROM (passive flexion and passive extension), GS and WES following exercise than that of the control group (P < 0.05). Conclusions: Sauna application prior to the exercise-induced muscle damage demonstrated effectiveness in reduction of sensory impairment (PF-ROM and PE-ROM) and improvement of muscle functions (GS, and WES) in wrist extensor muscle group.

Accuracy of a Digital Weight Scale Relative to the Nintendo Wii in Measuring Limb Load Asymmetry

[Purpose] The aim of the present study was to investigate the accuracy of a digital weight scale relative to the Wii in limb loading measurement during static standing. [Methods] This was a cross-sectional study conducted at a public university teaching hospital. The sample consisted of 24 participants (12 with osteoarthritis and 12 healthy) recruited through convenient sampling. Limb loading measurements were obtained using a digital weight scale and the Nintendo Wii in static standing with three trials under an eyes-open condition. The limb load asymmetry was computed as the symmetry index. [Results] The accuracy of measurement with the digital weight scale relative to the Nintendo Wii was analyzed using the receiver operating characteristic (ROC) curve and Kolmogorov-Smirnov test (K-S test). The area under the ROC curve was found to be 0.67. Logistic regression confirmed the validity of digital weight scale relative to the Nintendo Wii. The D statistics value from the K-S test was found to be 0.16, which confirmed that there was no significant difference in measurement between the equipment. [Conclusion] The digital weight scale is an accurate tool for measuring limb load asymmetry. The low price, easy availability, and maneuverability make it a good potential tool in clinical settings for measuring limb load asymmetry.

Evaluation of limb load asymmetry using two new mathematical models.

Quantitative measurement of limb loading is important in orthopedic and neurological rehabilitation. In current practice, mathematical models such as Symmetry index (SI), Symmetry ratio (SR), and Symmetry angle (SA) are used to quantify limb loading asymmetry. Literatures have identified certain limitations with the above mathematical models. Hence this study presents two new mathematical models Modified symmetry index (MSI) and Limb loading error (LLE) that would address these limitations. Furthermore, the current mathematical models were compared against the new model with the goal of achieving a better model. This study uses hypothetical data to simulate an algorithmic preliminary computational measure to perform with all numerical possibilities of even and uneven limb loading that can occur in human legs. Descriptive statistics are used to interpret the limb loading patterns: symmetry, asymmetry and maximum asymmetry. The five mathematical models were similar in analyzing symmetry between limbs. However, for asymmetry and maximum asymmetry data, the SA and SR values do not give any meaningful interpretation, and SI gives an inflated value. The MSI and LLE are direct, easy to interpret and identify the loading patterns with the side of asymmetry. The new models are notable as they quantify the amount and side of asymmetry under different loading patterns.

Sacroiliac joint and weight distribution to feet: An opinion towards clinical and research practice

We enjoyed reading the published manuscript entitled ‘Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint.’ by Grassi et al. (2011) .W e thought of sharing our views on the published article. The authors took a common clinical concept and related it eloquently to sacroiliac joint dysfunction and after effects of sacroiliac manipulation. We would like to comment on few aspects related to record the weight distribution to the feet. Although, use of baropodometry measures are still considered superior compared to using digital weighing scale, the method adopted in the present study creates much interest and queries. The authors collected baropodometry variables such as peak pressure at feet and contact area of feet in standing. We would like to question why the baropodometry measurement was taken in standing and not during walking. This is because the influence of mobility of the sacroiliac joint may be higher during walking rather than standing. Walking is more functional compared to standing. Furthermore, during walking, the sacroiliac joint may be exposed to single leg stance phase where the load might be more exposed to the involved sacroiliac joint as the other side sacroiliac joint remains in swing phase of gait. One may also question the clinical reasoning behind taking pressure difference between the feet as measurement. It is interesting to raise the query why the authors did not consider taking mean peak pressure of the foot concerned with the involved sacroiliac joint. Instead, the authors considered the difference between the feet before and after sacroiliac joint manipulation. As the authors compared the weight distribution to feet before and after sacroiliac joint manipulation, perhaps, it may be appropriate to compare the peak pressure at the foot of the manipulated sacroiliac joint rather than comparing the difference between the feet. We believe that the study will be more interesting if the mean peak pressure or contact area of foot of the involved and uninvolved sacroiliac joint are presented separately. This would provide some reference values for practitioners and enable other researchers to cite such a paper. The validity of the diagnostic criteria used to identify sacroiliac joint restriction and dysfunction patients is another questionable fact. As a battery of clinical tests are suggested to identify patients with sacroiliac dysfunction (Arab et al., 2009), one would query the rationale for choosing only long sitting test and other two complementary screening tests. The reason for choosing paired t test instead of one way repeated ANOVA is questionable as the measurement were taken at three different situations. Also, rationale for using a non-parametric test (Spearman test) and parametric test (paired t test) for analyzing the same variable raises queries. Absence of intervention effect size and no p value for correlation tests makes it difficult for readers to apply the study findings in clinical practice. We appreciate the meticulous work by the authors and thank the editor for publishing such informative articles.

Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain.

Lumbopelvic stabilization training (LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain.

Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: A systematic review

Purpose The purpose of this review is to systematically explore and summarise the validity and reliability of telerehabilitation (TR)-based physiotherapy assessment for musculoskeletal disorders. Method A comprehensive systematic literature review was conducted using a number of electronic databases: PubMed, EMBASE, PsycINFO, Cochrane Library and CINAHL, published between January 2000 and May 2015. The studies examined the validity, inter- and intra-rater reliabilities of TR-based physiotherapy assessment for musculoskeletal conditions were included. Two independent reviewers used the Quality Appraisal Tool for studies of diagnostic Reliability (QAREL) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool to assess the methodological quality of reliability and validity studies respectively. Results A total of 898 hits were achieved, of which 11 articles based on inclusion criteria were reviewed. Nine studies explored the concurrent validity, inter- and intra-rater reliabilities, while two studies examined only the concurrent validity. Reviewed studies were moderate to good in methodological quality. The physiotherapy assessments such as pain, swelling, range of motion, muscle strength, balance, gait and functional assessment demonstrated good concurrent validity. However, the reported concurrent validity of lumbar spine posture, special orthopaedic tests, neurodynamic tests and scar assessments ranged from low to moderate. Conclusion TR-based physiotherapy assessment was technically feasible with overall good concurrent validity and excellent reliability, except for lumbar spine posture, orthopaedic special tests, neurodynamic testa and scar assessment.