Saud Al-Obaidi

The First Physical Therapy Summit on Global Health: Implications and Recommendations for the 21st century

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.

Hydrocortisone and Exercise Effects on Articular Cartilage in Rats

The combined effects of hydrocortisone and running exercise on articular cartilage were assessed in female Sprague-Dawley rats. Animals were divided into three groups: 12 control (C), 12 who received an injection of 0.1 mL hydrocortisone once a week for three weeks (HC), and 12 rats who received three weekly injections of hydrocortisone and ran twice daily for six weeks (HC + run). Previous study revealed that rats that ran on a treadmill for three to 12 months did not have articular cartilage that was different from controls and thus a fourth group of rats, runners only, was not included in this analysis. At sacrifice, both knees were examined, photographed, and subsequently decalcified, then sectioned at 6 mu and stained. HC + run rats had significant more surface degeneration on femoral cartilage than HC or C rats. Eight of 12 HC + run rats displayed fibrotic invasion and/or subchondral bone replacement of degenerated articular cartilage, a feature not seen in HC or C rats. Cross-sections from HC + run rats displayed areas of cell death, and loss of matrix staining. Results suggest that, in rats, running exercise combined with intraarticular injections of hydrocortisone is more detrimental to articular cartilage than hydrocortisone or running alone.

Smoking Impact on Grip Strength and Fatigue Resistance: Implications for Exercise and Hand Therapy Practice

BACKGROUND Grip strength assessment reflects on overall health of the musculoskeletal system and is a predictor of functional prognosis and mortality. The purpose of this study was: examine whether grip-strength and fatigue resistance are impaired in smokers, determine if smoking-related impairments (fatigue-index) can be predicted by demographic data, duration of smoking, packets smoked-per-day, and physical activity. METHODS Maximum isometric grip strength (MIGS) of male smokers (n = 111) and nonsmokers (n = 66) was measured before/after induced fatigue using Jamar dynamometer at 5-handle positions. Fatigue index was calculated based on percentage change in MIGS initially and after induced fatigue. RESULTS Number of repetitions to squeeze the soft rubber ball to induce fatigue was significantly lower in smokers compared with nonsmokers (t = 10.6, P < .001 dominant hand; t = 13.9, P < .001 nondominant), demonstrating a significantly higher fatigue-index for smokers than nonsmokers (t = -8.7, P < .001 dominant hand; t = -6.0, P < .001 nondominant). The effect of smoking status on MIGS scores was significantly different between smokers and nonsmokers after induced fatigue (β = -3.98, standard error = 0.59, P < .001) where smokers experienced on average a reduction of nearly 4 MIGS less than nonsmokers before fatigue. Smoking status was the strongest significant independent predictor of the fatigue-index. CONCLUSIONS Smokers demonstrated reduced grip strength and fast fatigability in comparison with nonsmokers.

Evaluation of the McKenzie Intervention for Chronic Low Back Pain by Using Selected Physical and Bio-Behavioral Outcome Measures

To assess the bio‐behavioral and physical performance characteristics of individuals with chronic low back pain who demonstrated the pain centralization phenomenon and received the McKenzie intervention using selected bio‐behavioral and physical performance measures at intake and at 5 weeks and 10 weeks after treatment.

Religious Faith and Psychosocial Adaptation among Stroke Patients in Kuwait: A Mixed Method Study

Religious faith is central to life for Muslim patients in Kuwait, so it may influence adaptation and rehabilitation. This study explored quantitative associations among religious faith, self-efficacy, and life satisfaction in 40 female stroke patients and explored the influence of religion within stroke rehabilitation through qualitative interviews with 12 health professionals. The quantitative measure of religious faith did not relate to life satisfaction or self-efficacy in stroke patients. However, the health professionals described religious coping as influencing adaptation post-stroke. Fatalistic beliefs were thought to have mixed influences on rehabilitation. Measuring religious faith among Muslims through a standardized scale is debated. The qualitative accounts suggest that religious beliefs need to be acknowledged in stroke rehabilitation in Kuwait.

Fatigue Susceptibility of the Lumbar Extensor Muscles among Smokers

Summary Background and Purpose Cigarette smoking is associated with poor physical fitness and muscle strength. These conditions are related to the development of mechanical low back pain. The specific effect of smoking on the characteristics of lumbar extensors has not previously been investigated. The objective of this study is to determine the isometric lumbar extensor strength, before and after fatigue challenge, among smokers and non-smokers. Methods A pre-test and post-test design was used to determine the differences in the lumbar extensor strength between smokers and non-smokers. Fifty-three male volunteers (29 smokers and 24 non-smokers) aged 21-47 years had their isometric lumbar extensor strength measured at seven spinal angles, from 72° to 0° of lumbar flexion, before and after fatigue challenge. Volitional muscle fatigue was induced by dynamic exercise with a load equal to 50% of the subjects peak torque on the pre-fatigue test. A composite fatigue index was then calculated. Descriptive statistics, analysis of covariance and multivariate analysis of variance were used. Results Smokers showed a significant reduction in strength both before and after fatigue challenge across all angles (p Conclusions Strength deficit and fatigue susceptibility of the lumbar extensors among smokers may indicate that they are susceptible to back injuries, specifically after repetitive mechanical stress to the lumbar spine.

Effectiveness of Mckenzie Intervention in Chronic Low Back Pain: A Comparison Based on the Centralization Phenomenon Utilizing SelectedBio-Behavioral and Physical Measures

Objectives: To compare selected physical and bio-behavioral improvements following McKenzie intervention in individuals with discogenic chronic low back pain (CLBP) demonstrating centralization and partial centralization of pain. Design: Prospective cohort study with three assessments; at base line and two follow-ups. Setting: Two out-patient orthopedic Physical Therapy clinics. Participants: 105 volunteers with CLBP (52 men and 53women) average ages 41.9 and 37.1 years. Methods: Subjects filled out pain and related fear and disability questionnaires, performed selected physical tests then underwent a McKenzie assessment protocol. McKenzie assessment protocol utilizes directional preference exercises to determine the pain centralization-phenomenon. Subjects were divided into 2-groups; completely centralized group (CCG) and partially centralized group (PCG), and underwent a McKenzie intervention. Outcome measurements were repeated at the end of the 5th and 10th weeks after completing the treatment Outcome Measurements: Pain related fear and disability beliefs were assessed using the Fear Avoidance Belief Questionnaires (FABQ) and Disability Belief Questionnaire (DBQ). The time of sit-to-stand, forward bending, and customary and fast walking was recorded. Pain (anticipated vs. actual perception), were measured before and after each physical task. Descriptive statistics, Chi-square, paired t-tests, repeated measures ANOVA were used for longitudinal comparisons across assessment intervals at p<0.05 level. Results: Significant improvements in patient physical performance times and bio-behavioral variables were observed on the 5th week following the intervention, but tended to regress thereafter. Conclusions: In this cohort study of CLBP both CCG and PCG patients demonstrated significant measurable improvements in physical performances that remained stable for 10 weeks as a result of improved pain and related fear and disability beliefs.

Outcome Measures and Psychomotor Skills Related to Shoulder Conditions for Clinical Orthopedic Training

Objective: This study was designed to assess the ability of physical therapy (PT) students to utilize selected outcome measures such as range of motion (ROM), pain and a number of psychomotor skills and to determine the efficacy of treatment they carried out during orthopedic clinical training. Materials and Methods: The clinical education booklets in orthopedics of all PT students over a 6-year period were reviewed. Students’ application of psychomotor skills such as peripheral joint mobilizations (PJM), proprioceptive neuromuscular facilitation (PNF) techniques, therapeutic exercise techniques as well as utilization of basic outcome measures such as ROM and pain were analyzed with descriptive statistics and paired t test. Results: A majority of students used PJM techniques (78.6%) and PNF techniques (58.6%). The paired t test indicated that treatment interventions used by the students were associated with improved shoulder joint ROM and decreased pain levels (p < 0.001). At the same time, therapeutic exercises were employed by the students after PJM and PNF. The most common ‘comparable joint sign’ was limitation in shoulder abduction ROM, which occurred in 44% of patients seen by the students. Conclusion: PT students’ application of PJM, PNF, and therapeutic exercise improved ROM and decreased pain in patients with shoulder pathologies.

Benchmarking the health of health sciences students at Kuwait University: a towards a cultue of health

Health professional entry-to-practice programmes are intense, competitive and prolonged. The aims of this study were to benchmark the health of health sciences students at Kuwait University, thereby informing student health services, and to establish a base for individual students health assessments throughout the programmes. We used a convenience sample of 176 students. Assessment included a health/wellness questionnaire (smoking, nutrition, physical activity, sleep and stress) and objective measures (resting heart rate, blood pressure, waist-to-hip ratio and random blood glucose). Students had suboptimal activity, diet, stress and sleep. Health was suboptimal based on significant proportions of students in unhealthy categories for resting heart rate, blood pressure and body composition. Health status of health sciences students at Kuwait University is not consistent with healthy health professionals in training, who should serve as role models for the public. A culture of health on campus is recommended to maximize the health of students and their capacity as health role models.

Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: a preliminary study.

OBJECTIVE This study explores the immune responses following 4 weeks of McKenzie lumbar spine exercise in individuals with acute low back pain (ALBP). PATIENTS AND METHODS Fifteen patients with ALBP and 15 healthy individuals volunteered in this study. Ten ml of peripheral blood were obtained from each patient before and after exercise sessions, and from healthy individuals at the beginning of the study. Flow cytometric analysis was used to evaluate the frequencies of CD4+ T lymphocyte sub-populations and the intracellular cytokine expression within this cell population. Pain perceptions were obtained at baseline and following each week of exercise sessions. RESULTS In comparison with healthy subjects there was an elevated frequency of memory (CD4+CD45RO+) T cells, helper inducer (CD4+CD29+) T cells, CD3+CD16+CD56+ T cells and a lower frequency of naïve/suppressor (CD4+CD45RA+) T cells at base line in back pain patients (p<0.05). After 4 weeks of McKenzie exercise sessions, pain intensity significantly decreased (p<0.05); however, there was no significant difference in the frequency of memory (CD4+CD45RO+) T cells, helper inducer (CD4+CD29+) T cells, CD3+CD16+CD56+ T cells and naïve/ suppressor (CD4+CD45RA+) T cells at base line relative to these cell populations after exercise sessions. The percentage of Pan (CD3+) T cells expressing IL-8 and TNF-α and the CD3+ T cells expressing the anti-inflammatory cytokine IL-4 increased significantly (p<0.05) following exercise sessions in comparison with baseline and healthy references. The reduction in pain scores did not correlate with elevated anti-inflammatory cytokines. CONCLUSION McKenzie exercise sessions induced an immune activation state and simultaneously up regulated anti-inflammatory IL-4 cytokines that boost pain relief.