Nor Azlin Mohd Nordin

Work-related injuries among physiotherapists in public hospitals: a Southeast Asian picture

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 (χ2 = 9.0, p = 0.003) and the group with a BMI of 18–25 (χ2 = 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.

Function and quality of life following stroke rehabilitation: have our stroke patients gained optimum recovery?

Materials and methods This was a cross-sectional study of 91 stroke patients; mean age 58.9±10.6 years, 79% male, median stroke duration 13 months who have completed intensive individual rehabilitation at the Universiti Kebangsaan Malaysia Medical Centre in the years 2010 and 2011. Rehabilitation outcome was measured with the use of standardised tools; Rivermead Mobility Scale (RMI), Berg’s Balance Scale (BBS), Sit to Stand Test (STS) for lower limb strength and Timed 10 metre walk test for walking speed. Post-rehabilitation disability level and quality of life were also assessed on a Modified Rankin Scale (mRS) and Euro-Qol 5 Dimensions-Visual analogue Scale (EQ5D-VAS), respectively. All data were analysed descriptively using SPSS version 18.

Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists

BackgroundProvision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services.MethodsA semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached.ResultsResponse rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on ‘as needed’ basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS’ perceived 4 important ‘needs’ in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support.ConclusionsPost discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.

DEVELOPMENT AND EVALUATION OF 'NECK PAIN AND FUNCTIONAL LIMITATION SCALE': A VALIDATION STUDY IN THE ASIAN CONTEXT

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 Cronbachs 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 Cronbachs 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.

The integrated care pathway for post stroke patients (iCaPPS): a shared care approach between stakeholders in areas with limited access to specialist stroke care services

BackgroundLack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking.MethodsExpert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres.ResultsIndication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems.ConclusionCoordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services.Trial registrationNo.: ACTRN12616001322426 (Registration Date: 21st September 2016).

Can virtual reality balance games enhance activities of daily living among stroke survivors

Background Stroke survivors with residual physical disabilities are reported to have decreased muscle strength and balance. Balance ability is one of the prerequisite for performing activities of daily living independently. Virtual reality balance games performed in the community based rehabilitation settings may be beneficial for stroke survivors to improve their functional balance resulting in increased independence in activities of daily living. The aim of this study was to evaluate the use of virtual reality balance games in improving activities of daily living among stroke survivors.

What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI). Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05. Results: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2−100) to 90.5 (range: 27−100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0−22) to 3.0 (range: 0−19) though the change was not significant (Z= −0.744, P = 0.457). Conclusions: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.

Evaluation of Pictorial Dietary Assessment Tool for Hospitalized Patients with Diabetes: Cost, Accuracy, and User Satisfaction Analysis

Although nutritional screening and dietary monitoring in clinical settings are important, studies on related user satisfaction and cost benefit are still lacking. This study aimed to: (1) elucidate the cost of implementing a newly developed dietary monitoring tool, the Pictorial Dietary Assessment Tool (PDAT); and (2) investigate the accuracy of estimation and satisfaction of healthcare staff after the use of the PDAT. A cross-over intervention study was conducted among 132 hospitalized patients with diabetes. Cost and time for the implementation of PDAT in comparison to modified Comstock was estimated using the activity-based costing approach. Accuracy was expressed as the percentages of energy and protein obtained by both methods, which were within 15% and 30%, respectively, of those obtained by the food weighing. Satisfaction of healthcare staff was measured using a standardized questionnaire. Time to complete the food intake recording of patients using PDAT (2.31 ± 0.70 min) was shorter than when modified Comstock (3.53 ± 1.27 min) was used (p < 0.001). Overall cost per patient was slightly higher for PDAT (United States Dollar 0.27 ± 0.02) than for modified Comstock (USD 0.26 ± 0.04 (p < 0.05)). The accuracy of energy intake estimated by modified Comstock was 10% lower than that of PDAT. There was poorer accuracy of protein intake estimated by modified Comstock (<40%) compared to that estimated by the PDAT (>71%) (p < 0.05). Mean user satisfaction of healthcare staff was significantly higher for PDAT than that for modified Comstock (p < 0.05). PDAT requires a shorter time to be completed and was rated better than modified Comstock.

Community Service Learning among Health Sciences and Medical Undergraduates at a Malaysian setting: Providers’ and Recipients’ Portraits

Abstract Community Service learning (CSL) or Community engagement integrated teaching and learning (CEITL) offers reciprocal learning to both the providers and recipients. While it is important to consider the opinions of both parties for successful CSL, limited information exists in this topic area locally. The objective of this study was to explore undergraduates′ and communities′ perceptions regarding their experience and services provided during CSL. Recollections of 12 health sciences and medical undergraduates, and 18 members of the community whom participated in CSL programmes were sought using focus group discussions. This included their understanding of the programme, its benefits, challenges and their solutions and preferred activities. Undergraduates perceived CSL as an activity considered important to provide interactions between students and community. The perceived benefits of CSL were enhancement of interpersonal communication skills, negotiation of mutual understanding and experiencing real life situations. Undergraduates suggested that CSL should be well planned and scheduled. The CSL was seen by the communities as a platform for the recipients′ children to learn from the undergraduates as role models, future collaboration opportunities and health knowledge sharing. Weaknesses highlighted were; unstructured schedules, lack of variation in activities and CSL programme duration been too short to be effective. Suggestions provided for improved CSL were; extended time for health screening and better planned schedules. The findings suggest that undergraduates are aware of the significance of CSL in complementing their learning whereas the community have a positive outlook regarding CSL rendered by undergraduates. Further improvements are warranted in the implementation of more effective CSL programmes.

Promoting seamless transfer-of-care for stroke patients in primary care: development of the integrated care pathway for post stroke services

Background Post-stroke care after hospital discharge suffers from lack of intersectoral collaboration within the public health sectors. Hence, primary care remains the only option in managing stroke patients in underserved areas in Malaysia. This study aimed to identify the areas, which can be better coordinated to deliver optimal poststroke care in community setting. A seamless transfer of care model known as integrated Care Pathway for Post Stroke patients (iCaPPS) was designed to address this issue.