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Fulltext The impact of a submaximal level of exercise on balance performance in older persons

Alias HA, Justine M

ScientificWorldJournal, 2014;2014:986252.
PMID: 25383386 DOI: 10.1155/2014/986252

The purpose of this study was to determine the impact of a submaximal level of exercise on balance performance under a variety of conditions.
A multicomponent exercise program for institutionalized older adults

Justine M, Hamid TA

J Gerontol Nurs, 2010 Oct;36(10):32-41.
PMID: 20438009 DOI: 10.3928/00989134-20100330-09

This study examined the effects of a multicomponent exercise program on depression and quality of life in institutionalized older adults. A quasi-experimental pretest-posttest design was used. Participants were recruited from a publicly funded shelter home in Seremban, Negeri Sembilan Malaysia. The experimental group consisted of 23 volunteers 60 or older who performed 60 minutes of supervised exercise three times per week for 12 weeks. The control group consisted of 20 volunteers who continued with a sedentary lifestyle. At 12 weeks, the exercise group demonstrated an improvement in quality of life by 10.74% (p > 0.05) but not depression (-1.6%, p > 0.05). The control group demonstrated a decrease in both quality of life by 11.26% (p > 0.05) and level of depression by 17.7% (p > 0.05). This study suggests a multicomponent exercise program is a feasible intervention to improve quality of life in institutionalized older adults.
Fulltext Prevalence and Pattern of Musculoskeletal Injuries Among Malaysian Hockey League Players

Manaf H, Justine M, Hassan N

Malays Orthop J, 2021 Mar;15(1):21-26.
PMID: 33880144 DOI: 10.5704/MOJ.2103.004

Introduction: Hockey is a team sport that involves running, sprinting, and making sudden changes in directions of movement to control a ball against the opposing team. Therefore, due to its nature of fast movement, hockey players may be at risk of various musculoskeletal injuries. This study aimed to identify the prevalence and pattern of musculoskeletal injuries sustained among Malaysian Hockey League players.
Materials and Method: Data were collected from 84 field hockey players that participated in the Malaysian Hockey League competition from June 2016 until December 2016. All injuries were recorded by the participating medical team using a structured questionnaire. A descriptive statistical analysis and Chi-Square test were used to explore the prevalence of the injury.
Result: More than half of the players were reported to have lower limb injuries (51.6%). Sprain and strain were the most prevalent injuries (63%) and mostly affected the ankle (29%). Male players sustained more injuries (50.8%) compared to female players (49.2%).
Conclusion: This study suggests that a guideline is needed for injury prevention strategies that will benefit the hockey players in preventing injuries.
Effects of a Behavioral and Exercise Program on Depression and Quality of Life in Community-Dwelling Older Adults: A Controlled, Quasi-Experimental Study

Azizan A, Justine M

J Gerontol Nurs, 2016 Feb;42(2):45-54.
PMID: 26651863 DOI: 10.3928/00989134-20151124-01

Sedentary behavior and low participation in exercise among older adults can lead to depression and low quality of life (QOL). The current study investigated the effects of behavioral and exercise programs on depression severity and QOL among Malaysian community-dwelling older adults. A controlled, quasi-experimental, pre-posttest design was used. A total of 63 participants were divided into three groups: (a) exercise and behavior group (EBG), (b) exercise only group (EG), and (c) control group (CG). Results showed a significant difference in depression among groups (F(2,58) = 33.49, p < 0.01, η(2) = 0.54; mean, EBG < EG < CG) and in physical (F(2,58) = 5.33, p < 0.01, η(2)= 0.16; mean, EBG > EG > CG) and mental (F(2,58) = 4.08, p < 0.01, η(2) = 0.12; mean, EBG > CG > EG) scores of QOL. A combination of behavioral and exercise programs has superior effects on depression and QOL of older adults. [Journal of Gerontological Nursing, 42(2), 45-54.].
Fulltext Functional Balance and Motor Impairment Correlations with Gait Parameters during Timed Up and Go Test across Three Attentional Loading Conditions in Stroke Survivors

Manaf H, Justine M, Omar M

Stroke Res Treat, 2014;2014:439304.
PMID: 24757575 DOI: 10.1155/2014/439304

The aim of this study was to determine whether stroke survivor's gait performance during dual-task Timed Up and Go (TUG) test is correlated with the level of functional balance and motor impairment. Thirty stroke survivors (22 men, 8 women) were recruited for this study. The level of functional balance (Berg Balance Scale) and motor impairment (Fugl-Meyer assessment lower extremity) were assessed prior to the TUG test. TUG test was conducted under three attentional loading conditions (single, dual motor, and dual-cognitive). The time and number of steps were used to quantify gait parameters. The Spearmen's rank correlation coefficient was used to evaluate the relationship between these variables. There was moderate to strong negative correlation between functional balance and gait parameters (range -0.53 to -0.73, P < 0.05). There was a weak negative correlation observed between the time taken to complete the single task and motor impairment (r s = -0.43; P = 0.02) dual motor task and motor impairment (r s = -0.41; P = 0.02). However, there were no significant correlations between lower limb motor impairment and the number of steps in all conditions. These findings suggest that functional balance may be an influential domain of successful dual-task TUG in stroke.
Axial Segmental Coordination During Turning: Effects of Stroke and Attentional Loadings

Manaf H, Justine M, Goh HT

Motor Control, 2017 Jan;21(1):42-57.
PMID: 26595318 DOI: 10.1123/mc.2015-0040

Attentional loadings deteriorate straight walking performance for individuals poststroke, but its effects on turning while walking remain to be determined. Here we compared turning kinematics under three attentional loading conditions (single, dual-motor, and dual-cognitive task) between stroke survivors and healthy controls. Nine chronic stroke survivors and 10 healthy controls performed the Timed Upand- Go test while their full-body kinematics were recorded. Onset times of yaw rotation of the head, thorax and pelvis segments and head anticipation distance were used to quantify turning coordination. Results showed that stroke survivors reoriented their body segments much earlier than the controls, but they preserved the similar segmental reorientation sequence under the single-task condition. For the healthy controls, attentional loading led to an earlier axial segment reorientation, but the reorientation sequence was preserved. In contrast, the dual-cognitive task condition led to a disrupted reorientation sequence in stroke. The results indicate that turning coordination was altered in individuals poststroke, especially under the dual-task interference.
Fulltext Effects of a behavioral program on exercise adherence and exercise self-efficacy in community-dwelling older persons

Azizan A, Justine M, Kuan CS

Curr Gerontol Geriatr Res, 2013;2013:282315.
PMID: 24489539 DOI: 10.1155/2013/282315

Background. This study determines the effects of a behavioral program on exercise adherence (step counts) and level of exercise self-efficacy (ESE) in community-dwelling older persons. Methods. Sixty-three participants (age = 63.8 ± 4.5 years) were enrolled in this controlled quasi-experimental study. They were divided into 3 groups: (1) EBG performed a 6-week exercise intervention followed by a 5-week behavioral program, (2) EG performed exercise intervention similar to EBG, and (3) control group (CG) did not receive any interventions. Step counts were measured based on the scores recorded by a pedometer while ESE was measured by a self-reported ESE scale. Results. Data analysis showed significant differences due to time effect (F(1,2) = 39.884, P < 0.01, and η = .399); time and group interactions (F(2,60) = 112.683, P < 0.01, and η = .790); and between-group effect (F(2,60) = 12.524, P < 0.01, and η = .295) for step counts. As for ESE, significant differences were also found for time effect (F(2,4) = 66.628, P < 0.05, and η = .526); time and group interactions (F(2,60) = 4.562, P = 0.014, and η = .132); and between-group effect (F(2,60) = 13.632, P < 0.05, and η = .312). EBG presented with significantly higher mean changes for both step counts and ESE compared to other groups (all P < 0.05). Conclusion. This study suggests that the addition of a behavioral program is superior as compared to exercising alone on increasing exercise adherence and level of self-efficacy in older persons.
Evaluation of postural control impairment using Balance Error Scoring System among athletes with ankle injury: an effective tool in daily clinical practice

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

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

The main objective of the study was to investigate postural control impairment in athletes with history of ankle injury by using Balance Error Scoring System (BESS) and to compare with the controls.
Fulltext Effectiveness of Strengthening Exercises for the Elderly with Low Back Pain to Improve Symptoms and Functions: A Systematic Review

Ishak NA, Zahari Z, Justine M

Scientifica (Cairo), 2016;2016:3230427.
PMID: 27293970 DOI: 10.1155/2016/3230427

Objective. To determine the effect of strengthening exercises for older people with low back pain (LBP). Methods. This study is a systematic review of experimental study which evaluated the evidence regarding exercises for older people with LBP by using EBSCO Academic Search Premier, EBSCO EconLit, Science Direct, PUBMED, and PEDro from 2006 to 2016. Search strategy for each database was conducted by using keywords such as "low back pain", "older people", and "strengthening exercise". Boolean operators were used to combine keywords and manual exclusion was conducted to verify studies which met the inclusion criteria. The articles reviewed were evaluated and critically appraised by using PEDro scale and SPSS version 20 was used to analyze the data. Results. Three articles were found regarding strengthening exercise for older people with LBP whereas one study was conducted on multicomponent exercise. The mean, standard deviation, and variance of the PEDro score of all the studies were 5.67, 2.33, and 1.528, respectively. Overall, the qualities of all studies reviewed were fair. Two articles showed significant results when compared to control group (p < 0.05). Conclusions. Strengthening exercise is a beneficial treatment for older people with LBP in reducing pain intensity, disability, and improved functional performances.
Effects of Attentional Loadings on Gait Performance Before Turning in Stroke Survivors

Manaf H, Justine M, Goh HT

PM R, 2015 Nov;7(11):1159-66.
PMID: 25978943 DOI: 10.1016/j.pmrj.2015.05.007

Attentional loadings have significant impacts on turning performance in individuals with stroke. Improper gait modification before turning may contribute to falls after stroke. Therefore, examination of the changes in temporal-spatial gait parameters before turning may reveal important deficits in gait control when stroke survivors are challenged by dual-tasking.
The effectiveness of patient education in improving pain, disability and quality of life among older people with low back pain: A systematic review

Zahari Z, Ishak A, Justine M

J Back Musculoskelet Rehabil, 2020;33(2):245-254.
PMID: 31356191 DOI: 10.3233/BMR-181305

OBJECTIVES: This study aimed to gain an overview of patient education and the effects of patient education for older people with low back pain (LBP).
METHODS: The search strategies were performed via EBSCO MEDLINE, EBSCO CINAHL, Science Direct, PubMed, and PEDro databases from 2006 to 2016. The keywords "patient education", "low back pain", "elderly", "older adults", "older persons" and "older people" were used during the literature search. Boolean operators were used to expand or limit the searching scope and manual exclusion was performed to choose articles eligible for this study.
RESULTS: A total of 2799 articles were retrieved but only five articles were related with patient education for older people with LBP. Findings suggest that patient education for older people may differ in terms of its contents such as health education, self-management, video education, and postural education. The high methodological quality of the studies revealed that patient education showed improvement in terms of pain, disability and quality of life among older people with LBP.
CONCLUSIONS: Patient education improved pain and had positive effects on disability and quality of life among older people with LBP. However, due to the limited number of RCTs more studies are needed to provide evidence for its effectiveness.
Fulltext Relationship between anthropometric characteristics and aerobic fitness among Malaysian men and women

Razak S, Justine M, Mohan V

J Exerc Rehabil, 2021 Feb;17(1):52-58.
PMID: 33728289 DOI: 10.12965/jer.2142026.013

This cross-sectional study evaluated the relationships between anthropometric and aerobic fitness (rate of perceived exertion [RPE] and predicted maximal oxygen uptake [VO2max]) among 228 participants (age: 23.78±4.42 years). RPE and predicted VO2max were determined during the cycle ergometer exercise test. Data were also obtained for height, weight, body mass index (BMI), hip and waist (WC) circumferences. Data analysis revealed VO2max is correlated with WC (r=-0.571), weight (r=-0.521), waist-to-height ratio (WHtR) (r=-0.516), waist-to-hip ratio (WHR) (r=-0.487), and BMI (r=-0.47) in men, while, in women with WC (r=-0.581), weight (r=-0.571), WHtR (r=-0.545), BMI (r=-0.545), WHR (r=-0.473), and height (r=-0.287) (all P<0.05). Regression analysis showed WC was a significant predictor for VO2max in men and women (r2=32.6% vs. 33.7%). The receiver operating characteristic curve of WC showed 0.786 and 0.831 for men and women, respectively. WC or abdominal obesity is the strongest predictor for VO2max, which is an indicator of aerobic fitness in Malaysian adults.
Fulltext Kinesiophobia, Pain, Muscle Functions, and Functional Performances among Older Persons with Low Back Pain

Ishak NA, Zahari Z, Justine M

Pain Res Treat, 2017;2017:3489617.
PMID: 28634547 DOI: 10.1155/2017/3489617

OBJECTIVES: This study aims (1) to determine the association between kinesiophobia and pain, muscle functions, and functional performances and (2) to determine whether kinesiophobia predicts pain, muscle functions, and functional performance among older persons with low back pain (LBP).
METHODS: This is a correlational study, involving 63 institutionalized older persons (age = 70.98 ± 7.90 years) diagnosed with LBP. Anthropometric characteristics (BMI) and functional performances (lower limb function, balance and mobility, and hand grip strength) were measured. Muscle strength (abdominal and back muscle strength) was assessed using the Baseline® Mechanical Push/Pull Dynamometer, while muscle control (transverse abdominus and multifidus) was measured by using the Pressure Biofeedback Unit. The pain intensity and the level of kinesiophobia were measured using Numerical Rating Scale and Tampa Scale of Kinesiophobia, respectively. Data were analyzed using Pearson's correlation coefficients and multivariate linear regressions.
RESULTS: No significant correlations were found between kinesiophobia and pain and muscle functions (all p > 0.05). Kinesiophobia was significantly correlated with mobility and balance (p = 0.038, r = 0.263). Regressions analysis showed that kinesiophobia was a significant predictor of mobility and balance (p = 0.038).
CONCLUSION: We can conclude that kinesiophobia predicted mobility and balance in older persons with LBP. Kinesiophobia should be continuously assessed in clinical settings to recognize the obstacles that may affect patient's compliance towards a rehabilitation program in older persons with LBP.
Muscle Functions and Functional Performance among Older Persons with and without Low Back Pain

Ishak NA, Zahari Z, Justine M

Curr Gerontol Geriatr Res, 2016;2016:8583963.
PMID: 27872641

This study aims to compare muscle functions and functional performances between older persons with and without low back pain (LBP) and to determine the association between muscle functions and functional performances. This is a cross-sectional study, involving 95 older persons (age = 70.27 ± 7.26 years). Anthropometric characteristics, muscle functions, and functional performances were measured. Data were analyzed using ANOVA, Pearson's correlation, and multiple linear regression. The functional performances showed no significant differences (females LBP versus non-LBP, males LBP versus non-LBP) (p < 0.05). For muscle functions, significant differences were found (females LBP versus non-LBP) for abdominal muscle strength (p = 0.006) and back muscle strength (p = 0.07). In the LBP group, significant correlations were found between back and abdominal muscle strength and hand grip strength (r = 0.377 and r = 0.396, resp.), multifidus control and lower limb function (r = 0.363) in females, and back muscle strength and lower limb function (r = 0.393) in males (all p < 0.05). Regression analysis showed that abdominal and back muscle strengths were significant predictors of hand grip strength (p = 0.041 and p = 0.049, resp.), and multifidus control was a significant predictor of lower limb function in females (p = 0.047). This study demonstrates that older women with LBP exhibit poorer muscle functions compared to older women without LBP.
Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: A scoping review

Mustapa A, Justine M, Manaf H

Malays Fam Physician, 2022 Nov 30;17(3):22-32.
PMID: 36606173 DOI: 10.51866/rv.208

INTRODUCTION: Patient education is an integral component of diabetes mellitus care. The emergence of different methods and characteristics of patient education has led to varying outcomes of quality of life (QoL). Herein, we systematically searched for published studies reporting patient education and its methods and characteristics for improving the QoL of patients with type 2 diabetes mellitus (T2DM).
METHOD: In this scoping review, eligible studies from six databases (PubMed, Scopus, Cochrane Library, Springer Link, Science Direct and Google Scholar) were identified. The keywords used in the search strategies were as follows: health education, health promotion, patient education, diabetes care, QoL, diabetes mellitus and type 2 diabetes mellitus. Two reviewers independently screened all references and full-text articles retrieved to identify articles eligible for inclusion.
RESULTS: A total of 203 articles were identified in the initial search. Of them, 166 were excluded after screening the titles and abstracts. Further full-text screening led to the subsequent removal of 22 articles, leaving 15 articles eligible for data extraction.
CONCLUSION: There is a broad array of methods of patient education for improving the QoL of patients with T2DM. Self-management education with supplementary supervision and monitoring effectively improves QoL. Future studies must emphasise the application of holistic education covering psychological distress, diet plan, and physical health.
The association of fatigue severity with pain level, obesity indices and functional performances in women with knee osteoarthritis

Che Mood A, Justine M, Bukry SA, Mohan V

Med J Malaysia, 2024 Mar;79(Suppl 1):1-7.
PMID: 38555878

INTRODUCTION: Knee osteoarthritis is most common among women with obesity. It may lead to physical inactivity that, in turn, causes fatigue or lack of physical enthusiasm to perform meaningful daily activities. Hence, this study aimed to examine whether pain level, obesity indices and functional performances are associated with fatigue severity in women with knee osteoarthritis (KOA).
MATERIALS AND METHODS: This cross-sectional study recruited women referred to physiotherapy to manage OA. The measurements included fatigue severity (fatigue severity scale); pain level (numerical rating scale); obesity indices (body mass index, fat %, waist circumference); functional performances (upper limb strength, lower limb strength, mobility, exercise capacity and quality of life). A simple linear regression analysis was used to determine which independent variable may be associated with fatigue severity.
RESULTS: Ninety-six women with unilateral KOA participated in this study (Mean age, 55.70, Standard Deviation, SD 6.90) years; Mean fatigue severity, 34.51, SD 14.03). The simple linear regression analysis showed that pain level (β=4.089, p<0.001), fat % (β=0.825, p<0.001) and QoL (β=0.304, p<0.001) were significantly associated with fatigue. After controlling for pain level, only fat % was significantly associated with fatigue (β=0.581, p=0.005).
CONCLUSION: Pain level, fat %, and QoL appear to be associated with fatigue severity in women with KOA. In addition, pain symptoms may interact with factors associated with fatigue severity.
Fulltext Gait alteration during turning while walking in older adults with benign paroxysmal positioning vertigo

Nasruddin H, Justine M, Alghwiri A, Manaf H

Ann Med, 2024 Dec;56(1):2402952.
PMID: 39550347 DOI: 10.1080/07853890.2024.2402952

BACKGROUND: Older adults with Benign Paroxysmal Positioning Vertigo (BPPV) may present with unsteadiness that affects gait patterns.
OBJECTIVE: This study investigated the spatiotemporal gait parameters and indicators of turning difficulty during the Timed Up and Go (TUG) test in older adults with BPPV.
METHODS: This case-controlled study collected data from older adults aged 65 and above with BPPV, young adults with BPPV and older adults without BPPV. Postural stability and self-perception of stability were measured using the Functional Gait Analysis and the Malay version of the Dizziness Handicap Inventory, respectively. The spatiotemporal gait parameters were recorded using a camera. The one-way ANOVA test was used for statistical analysis.
RESULTS: Older adults with BPPV presented with alteration in gait parameters (time and number of steps) compared to older adults without BPPV and adults with BPPV during the TUG test (p
Preliminary study of the patterns and physical risk factors of work-related musculoskeletal disorders among academicians in a higher learning institute

Mohan V, Justine M, Jagannathan M, Aminudin S, Johari SH

J Orthop Sci, 2015 Mar;20(2):410-7.
PMID: 25542222 DOI: 10.1007/s00776-014-0682-4

BACKGROUND: Research has been conducted on the prevalence and physical risk factors of work-related musculoskeletal disorders (WMSDs) among occupations such as agriculture workers, office workers, school teachers, and health care professionals. However, a paucity of research exists on the patterns and physical risk factors of WMSDs among the academicians in a higher learning institution. This study was conducted to determine the patterns and physical risk factors of WMSDs among the academicians.
METHODS: A cross-sectional study was conducted among 228 subjects with a mean age of participants of 32.3 ± 7.8 for a period of 1 year from December 2011 until December 2012. An extended neordic musculoskeletal questionnaire (NMQ-E) was used to assess the patterns of work-related musculoskeletal disorders. The short version of the Dutch musculoskeletal questionnaire (DMQ) was used to determine the physical risk factors of WMSDs among the academicians. Descriptive statistics and Pearson Chi square test were used for data analysis.
RESULTS: The 1-year pattern of WMSDs among the academicians were neck pain (44.7 %), followed by shoulder pain (40.4 %), upper and lower back pain (33.3 %), and the least common region was elbow pain (3.5 %). Among 20 common physical activities in DMQ, 15 physical activities performed by the academicians in their workplace were considered as a physical risk factors for neck, shoulder, and back pain at p < 0.05.
CONCLUSION: The preliminary study demonstrated that neck pain, shoulder pain, and back pain were the most common WMSDs among the academicians in a higher learning institution.
The mediating role of work-related musculoskeletal disorders on the link between psychosocial factors and absenteeism among administrative workers

Abdullah MZ, Othman AK, Ahmad MF, Justine M

Soc Work Public Health, 2015;30(1):64-74.
PMID: 25375935 DOI: 10.1080/19371918.2014.938393

This study aimed to investigate the association between psychosocial factors (i.e., job demand, decision latitude, social support, physical environment, and personal risk factors), work-related musculoskeletal disorders (WRMDs), and productivity as measured by workers' perceived absenteeism. Data were collected from the selected administrative workers (administrative assistant) and analyzed using cross tabulation. The results indicate that all psychological factors are not significantly associated with WRMDs, except for the association between personal risk factors and hip/thigh disorders. Subsequently, WRMDs do not significantly contribute to explaining absenteeism. The managerial and research implications of this study are deliberately discussed.
Fulltext Sharp turning and corner turning: comparison of energy expenditure, gait parameters, and level of fatigue among community-dwelling elderly

Justine M, Manaf H, Sulaiman A, Razi S, Alias HA

Biomed Res Int, 2014;2014:640321.
PMID: 24977154 DOI: 10.1155/2014/640321

This study compares energy expenditure (EE), gait parameters (GP), and level of fatigue (LOF) between 5-minute walking with sharp turning (ST) and corner turning (CT). Data were obtained from 29 community-dwelling elderly (mean age, 62.7 ± 3.54 years). For 5 minutes, in ST task, participants walked on a 3-meter pathway with 2 cones placed at each end (180° turning), while in CT task, participants walked on a 6-meter pathway with 4 cones placed at 4 corners (90° turning). The physiological cost index, pedometer, and 10-point Modified Borg Dyspnoea Scale were used to measure EE (beats/min), GP (no of steps), and LOF, respectively. Data were analyzed by using independent t-tests. EE during ST (0.62 ± 0.21 beats/min) was significantly higher than CT (0.48 ± 0.17 beats/min) (P < 0.05). GP (434 ± 92.93 steps) and LOF (1.40 ± 1.11) in ST were found to be lower compared to GP (463 ± 92.18 steps) and LOF (1.54 ± 1.34) in CT (All, P > 0.05). Higher EE in ST could be due to the difficulty in changing to a 180° direction, which may involve agility and different turning strategies (step-turn or pivot-turn) to adjust the posture carefully. In CT, participants could choose a step-turn strategy to change to a 90° direction, which was less challenging to postural control.

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