Indonesian Journal of Physical Medicine and Rehabilitation
Indonesia Journal of Physical Medicine and Rehabilitation
All articles published in the Indonesian Journal of Physical Medicine and Rehabilitation (IJPMR) are licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows others to share, copy, distribute, adapt, and build upon the work for any purpose, including commercial use, as long as proper attribution is given to the original authors. Indonesian Journal of Physical Medicine and Rehabilitation is Full license terms: https://creativecommons.org/licenses/by/4.0/
Validity of KineFeet for Assessing Medial Longitudinal Arch Deformation During Gait in Individuals with Flat and Non–Flat Feet
Background: Accurate assessment of medial longitudinal arch (MLA) deformation during gait is essential for diagnosing and managing foot-related musculoskeletal disorders. KineFeet is a novel, depth-camera–based web application developed for real-time foot kinematic analysis. This study aimed to evaluate the validity of KineFeet in measuring MLA angles during the stance phase of walking. Methods: A total of 89 healthy adults (74.2% female; mean age: 30.9 Â± 2.5 years) were recruited and classified into flat-footed and non-flat-footed groups based on the navicular drop test. Each participant walked on a treadmill while MLA angles were recorded using KineFeet and manually measured using Kinovea software as a reference. Measurements were taken across seven subphases of the stance phase. Statistical agreement and correlation with static foot posture were analyzed. Results: In non-flat-footed individuals, MLA angles obtained from KineFeet showed no significant differences compared to Kinovea across all stance subphases (p > 0.05), indicating good validity. However, in flat-footed participants, significant discrepancies were observed in the initial contact, loading response, and midstance phases (p < 0.05). Weak positive correlations were found between navicular drop test scores and dynamic MLA angles, particularly during initial contact, hallux extension, and initial swing (r = 0.23–0.29). Conclusion: KineFeet demonstrated acceptable validity for assessing medial longitudinal arch (MLA) dynamics in individuals with normal foot posture and showed potential for clinical use in detecting flexible flatfoot deformities during walking. Further algorithm refinement is recommended to enhance its accuracy, particularly for early stance phases in individuals with flat feet.
KineFeet; medial longitudinal arch; gait analysis; flat feet; navicular drop test; depth camera.
Copyright (c) 2025 Indonesian Journal of Physical Medicine and Rehabilitation
Acceptability & Tolerability of Virtual Reality Sessions in Acute Geriatric Ward
Introduction: Virtual Reality (VR) could improve mental and physical condition. However, limited studies have been conducted on VR utilization for the elderly in acute wards. This study aimed to evaluate the acceptability and tolerability of a VR Prototype called VRAGMENT in the acute geriatric ward, as well as the acceptance correlation with cognitive function. Methods: In this cross-sectional study, thirty-two subjects were recruited consecutively. Their satisfaction and complaints during and after a single VRAGMENT session were recorded using a questionnaire that elaborates the Technology Acceptance Model. VRAGMENT is a VR game programmed based on Instrumental Activities of Daily Living, designed by Universitas Indonesia. Result: No falls or near falls were reported. No subject reported nausea, boredom, sleepiness, or oculomotor impairments such as dry or red eye, eye strain, blur, or difficulty focusing. Few subjects complained of general discomfort (19%), fatigue (6%), headache (9%), and dizziness (16%). All subjects declared that they were satisfied, enjoyed, and impressed. Most of them (97%) stated that VRAGMENT met their expectations and needs, and would like to recommend it to others. The overall acceptance and perceived ease of learning were significantly correlated with cognitive function. Conclusion: This study proved that despite their age, cognitive impairment, and acute clinical condition, most subjects could accept and tolerate VRAGMENT sessions. This could be achieved through since VRAGMENT specifically designed for the elderly with cognitive impairment, as well as game protocol adaptation. Following study about the effect on patient outcomes needs to be conducted.
Virtual Reality, VRAGMENT, Geriatric, Cognitive, Acute Ward
The Transition from Delayed Physiotherapy to Early Physiotherapy in Intensive Care Patients: A Bibliometric Analysis
Introduction: Critically ill patients in the Intensive Care Unit (ICU) require timely and comprehensive interventions to ensure safety and optimize recovery. Early physiotherapy serves as a vital component of critical care, contributing to patients’ physical, psychological, and long-term functional recovery. Methods: The study employed a bibliometric and systematic literature review to analyze research trends in early physiotherapy. Relevant articles were retrieved from SCOPUS-indexed journals, screened based on relevance, keywords, and abstracts, and analyzed using Mendeley for reference management and VOSviewer for bibliometric visualization. Results: The analysis delineated six thematic clusters: (1) pathological classification and therapeutic modalities, (2) patient compliance, (3) therapeutic approaches, (4) physiotherapy in critical care settings, (5) condition-specific therapeutic methods, and (6) safety procedures. These clusters encapsulate the predominant research trajectories and focal domain within the corpus of early physiotherapy literature. Conclusion: Early physiotherapy in critical care substantially enhances patients’ psychological well-being, physical functioning, and overall quality of life, while mitigating complications and reducing hospitalization costs. The findings highlight the importance of integrating early physiotherapy as an integral component of standardize ICU patient management. Keywords: Patient, disease critical care, intensive care unit, early physiotherapy, bibliometric analysis
Patient, disease critical care, intensive care unit, early physiotherapy, bibliometric analysis
The Effect Of 6 Minutes Of Walking Exercise On Reducing Blood Pressure In The Elderly
Background : Hypertension is a condition in which blood pressure increases, causing symptoms that affect specific target organs in the body and can lead to damage, such as stroke, left ventricular hypertrophy, kidney failure, and other diseases. This condition affects the elderly and even younger people due to unhealthy lifestyles and stress. Lack of physical activity can increase the risk of hypertension. Objective : The purpose of this study is to determine the effect of a 6-minute walk on reducing blood pressure. Methods : Fourteen elderly respondents aged 60-85 years were selected through purposive sampling. The study involved performing a 6-minute walking exercise three times daily at 6:00 AM, 11:00 AM, and 6:00 PM for three sessions over two weeks. Blood pressure data was measured on the first day (pre-test), on the 7th day (middle test), and on the 14th day (post-test), with all measurements taken before and after the walking exercise and then processed using SPSS version 25.0. Result : The study results showed that the pre-test systolic blood pressure was 151.78 ± 11.926, and the post-test systolic blood pressure was 151.74 ± 11.926, with a p-value of 0.901. Since the p-value is greater than 0.05, it was concluded that there was no significant difference in the average systolic blood pressure before and after the intervention. However, systolic blood pressure experienced a slight reduction after performing the six-minute walking exercise. The mean pre-test diastolic blood pressure in the intervention group was 92.43 ± 3.283, while the post-test diastolic pressure was 94.00 ± 3.283. With a p-value greater than 0.05, it was similarly concluded that there was no significant difference in the average diastolic blood pressure before and after the intervention. Conclusion : Based on the research conducted, it can be concluded that systolic blood pressure decreased after the 6-minute walking exercise, while diastolic blood pressure increased after the same exercise. Keywords : Hypertension , Elderly, Physical Activity
Hypertension , Elderly, Physical Activity
The Association of Severity of Scoliosis Curvature And Quality of Life in Adolescent Idiopathic Scoliosis Patients
Background: In 2018 in Surakarta, Central Java, a team from the Orthopedic Hospital Prof. Dr. Soeharso Surakarta examined one thousand one hundred junior high school students throughout Surakarta city and found that 1% of students had scoliosis. Common symptoms include pain, leg length discrepancy, posture disturbance, and psychological problems, resulting in poor health-related quality of life. Physical and Rehabilitation Medicine section of the European Union of Medical Specialists (UEMS), which recommends regular monitoring of patients with scoliosis including quality of life measurements. Objective: To determine the association between scoliosis curve severity and quality of life in adolescent idiopathic scoliosis patients. Methods: This study employed an observational analytic approach with a cross-sectional design and utilized purposive sampling over a one-month period. Secondary data were collected by assessing the severity of scoliosis curves based on patients' X-ray results, while primary data on the quality of life of adolescent scoliosis patients were gathered through questionnaires developed by the researcher. Results: Spearman test was used to analyze the association of scoliosis curve severity and quality of life. Significant results were obtained with a p value of p = 0.008. Conclusion: The results of this study support the theory and previous research which states that the greater the degree of scoliosis curve, there will be a decrease in the quality of life in patients. Keywords: adolescent idiopathic scoliosis, Quality of life, The SJ-27 Questionnaire
Evaluating the Efficacy of Breathing Exercises Among Healthy Adult Smokers
Introduction: Smoking contributes significantly to preventable diseases such as chronic obstructive pulmonary disease. Breathing exercises have emerged as potential complementary therapies aimed at improving lung function among smokers. This study aims to evaluate the efficacy of breathing exercises in improving lung function among adult smokers. Methods: A comprehensive search of peer-reviewed literature from PubMed, Semantic Scholar, and Google Scholar from the past ten years. Eligible studies included randomized controlled trials (RCTs), quasi-experimental studies, and pilot studies on the impact of breathing exercises on lung function in adult smokers. Narrative data synthesis was conducted. Results: Nine studies met the inclusion criteria. Diaphragmatic breathing, balloon blowing, and feedback breathing exercises significantly improved pulmonary parameters, including the FEV1/FVC ratio, tidal volume, inspiratory reserve volume, inspiratory capacity, vital capacity, and respiratory muscle activity. One study shows that FVC (3.77 ± 0.30) and FEV1 (3.13 ± 0.54) significantly improved after exercise (p < 0.05). Conclusions: Breathing techniques can be a beneficial complementary treatment for improving lung function, particularly in terms of vagus nerve control and the balance between sympathetic and parasympathetic systems, as well as the kinesiology and physiology of the lung’s dynamics. The findings are limited by study design, sample size, and intervention protocols. Future research should focus on high-quality randomized controlled trials (RCTs) with long-term follow-ups to evaluate the long-term effects. Keyword: Breathing exercise, lung function, adult smokers, respiratory muscle training, pulmonary rehabilitation
The Rehabilitative Management of Adult Scoliosis with Radicular Neuropathy and Lateral Spondylolisthesis of Lumbar Vertebrae: A Case Report
Introduction: Adult scoliosis is a progressive spinal deformity that can be further complicated by neurological symptoms and structural instability due to the asymmetric degenerative changes in the vertebral column. Radicular neuropathy and lateral rotational listhesis caused by curve progression may lead to significant functional impairment, chronic pain, and reduced quality of life. Case presentation: A 53-year-old female patient presenting with severe scoliosis complained of 6-months continuous radicular pain to our spine rehabilitation clinic. Scoliogram showed right thoracic curve (T4-T11) Cobb’s angle 70o, left lumbar curve (T11-L4) Cobb’s angle 65o, rotational lateral listhesis of L2-L3 grade I. Patient was prescribed with scoliosis-specific therapeutic exercise and physical modalities for 3 months. A rigid 3D adult scoliosis brace was custom-made and used part-time (4-5 hours daily) for 6 months. Our data demonstrated immediate and continuous improvement of pain and spinal stability. Discussion: Implementing individualized rehabilitative strategies targeting both mechanical and neurogenic disorders were able to help maintain symptoms and progression of adult scoliosis, as recommended by literature. Conclusion: Comprehensive rehabilitative approach to adult scoliosis patient with spondylolisthesis and radiculopathy is important to reduce symptoms and enhance function by emphasizing the integration of physical therapy, pain management, and bracing.
Comprehensive Rehabilitation in Systemic Sclerosis with Complex Neurological Involvement: A Case Report Short running title: Complex Systemic Sclerosis Rehabilitation
Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by fibrosis and vascular dysfunction affecting multiple organ systems. Neurological and pulmonary complications, though less common, can markedly worsen disability and impair quality of life. Multidisciplinary rehabilitation plays a crucial role in optimizing function, yet evidence in complex SSc cases remains limited. Case Presentation: A 65-year-old woman with known SSc developed progressive rigidity, mixed axonal–demyelinating polyneuropathy confirmed by electrodiagnostic studies, interstitial lung disease with an NSIP pattern on HRCT, and significant nutritional decline. She presented with bedridden status, marked balance impairment, stocking–glove sensory loss, digital ischemia, poor exercise tolerance, and complete dependence in mobility and self-care. An individualized inpatient rehabilitation program was initiated, including gradual mobility and strengthening exercises, adaptive self-care training, pulmonary rehabilitation, nutritional optimization, and psychological support. Over several weeks, she demonstrated measurable improvements in supervised ambulation with a walker, independence in daily activities, reduction of neuropathic symptoms, enhanced nutritional intake, and improved sleep. Discussion: This case illustrates the compounded functional burden imposed by the coexistence of neurological and pulmonary manifestations in SSc. Polyneuropathy further limits mobility, while interstitial lung disease contributes to fatigue, dyspnea, and exercise intolerance. The patient’s meaningful gains highlight the importance of early, coordinated rehabilitation approaches tailored to multisystem impairment. Strengthening, balance retraining, pulmonary conditioning, and nutritional support can produce synergistic benefits, even in severe disease stages. Conclusion: Comprehensive, individualized multidisciplinary rehabilitation can substantially enhance functional outcomes and quality of life in patients with systemic sclerosis complicated by neurological and pulmonary involvement. Early referral and integrated management are essential to mitigate disability and optimize recovery. Keywords: systemic sclerosis; polyneuropathy; interstitial lung disease; rehabilitation; functional recovery
systemic sclerosis; polyneuropathy; interstitial lung disease; rehabilitation; functional recovery
Effectiveness of Elastic Taping Compared to Sham Taping on Upper Trapezius Muscle Elasticity in Patients with Myofascial Pain Syndrome
Introduction: Elastic taping (ET) is believed to improve muscle elasticity in patients with myofascial pain syndrome (MPS); however, studies employing objective measurements of muscle elasticity remain scarce. This study aims to provide empirical evidence demonstrating that ET can objectively improve muscle elasticity. Methods: This double-blind randomized clinical trial investigated the efficacy of ET versus sham taping on upper trapezius muscle elasticity and pain pressure threshold (PPT) in patients with MPS. Participants were assigned to ET using the inhibition technique or sham taping without stretch. Shear wave elastography (SWE) and PPT were measured pre-intervention, 20 minutes, and 24 hours post-intervention. Results: The ET group demonstrated significant improvements in muscle elasticity (reduced SWE) and increased PPT at both 20 minutes and 24 hours (p<0.05). The sham group showed non-significant changes at 20 minutes (p=0,122) and partial improvement at 24 hours(p=0,019). Between-group comparisons revealed statistically significant differences at both post-intervention time points (p<0.05). Conclusion: ET proved effective as an adjunct to stretching, eliciting immediate and sustained benefits, and represents a non-invasive, easily applicable modality with potential for wide clinical use in upper trapezius MPS. Keywords: myofascial pain syndrome, upper trapezius, elastic taping, shear wave elastography, pain pressure threshold
myofascial pain syndrome, upper trapezius, elastic taping, shear wave elastography, pain pressure threshold
Exploring the Relationship Between Muscle Tone, Echotexture, and Walking Speed in Chronic Stroke Patients : A Pilot Analysis
Latar Belakang: Spastisitas dan perubahan struktur otot diketahui memengaruhi kemampuan berjalan pasca-stroke. Sementara Skala Ashworth yang Dimodifikasi (MAS) dan Skala Heckmatt yang Dimodifikasi (MHS) umumnya digunakan dalam praktik klinis, hubungannya dengan luaran fungsional seperti kecepatan berjalan masih belum jelas. Tujuan: Studi percontohan ini mengeksplorasi hubungan antara spastisitas, ekotekstur otot, dan kecepatan berjalan pada pasien dengan stroke kronis. Metode: Delapan pasien rawat jalan, 8 – 24 bulan pasca-stroke pertama, dinilai di klinik neurorehabilitasi. Tonus otot diukur menggunakan MAS, ekotekstur otot menggunakan MHS, dan kecepatan berjalan diperoleh dari tes berjalan 6 menit. Data dianalisis menggunakan korelasi peringkat Spearman. Hasil: Kecepatan berjalan rata-rata adalah 0,82 ± 0,21 m/s, skor MAS rata-rata adalah 2,1 ± 0,6, dan skor MHS rata-rata adalah 2,7 ± 0,5. MAS dan MHS menunjukkan korelasi lemah hingga sedang (? = 0,067–0,417), sementara MHS dan kecepatan berjalan menunjukkan hubungan negatif yang sangat lemah (? = –0,126 hingga –0,206). Tidak ada hubungan yang mencapai signifikansi statistik (p > 0,05). Kesimpulan: Meskipun tidak ditemukan korelasi yang signifikan, temuan ini memberikan wawasan awal yang berharga. Penelitian yang lebih besar dan lebih beragam, terutama yang melibatkan pasien stroke subakut dan stratifikasi berdasarkan stadium Brunnstrom, diperlukan untuk memperjelas bagaimana spastisitas dan kualitas otot berkontribusi terhadap luaran mobilitas dalam rehabilitasi stroke. Kata kunci stroke kronis, tonus otot, ekotekstur, kecepatan berjalan, ultrasonografi
Keywords chronic stroke, muscle tone, echotexture, walking speed, ultrasonography
Integrating Pain Assessment and Personalized Goals: A Preliminary Study on Rehabilitation Outcomes for Post-Stroke Hemiplegic Shoulder Pain
Introduction: Hemiplegic shoulder pain (HSP) is a frequent complication in stroke survivors, negatively impacting rehabilitation and overall quality of life. HSP can make it hard to do everyday things, which can make patient anxious, stressed, and depressed because of muscle pain, spasticity, and less ability to do things. This study aims to clarify the correlation between shoulder pain intensity and clinical variables, also to evaluate the efficacy of Goal Attainment Scaling (GAS) in facilitating patients' achievement of rehabilitation goals following intervention. Methods: This cross-sectional study collected data from post-stroke patients with HSP at the Neurorehabilitation Department of Hasan Sadikin Hospital over a one-year period. The demographics of the patients (age, sex), clinical measure such as Range of Motion (ROM), Motor Assessment Scale (MAS), Brunnstrom stage, Manual Muscle Test (MMT), Depression Anxiety Stress Scales (DASS), Scale of Pain Intensity (SPIN), and Goal Attainment Scaling (GAS), were carefully recorded. Results: Pain during movement was considerably greater than pain at rest (3.3±0.9 vs 3.0±1.3; p<0.05). GAS analysis indicated improvements following to the rehabilitation program (37.2±0.44 vs 52.6±0.4; p<0.05). A significant correlation was identified only in DASS Depression scores (r=0.55; p<0.05), when other variables shown no significant correlation. Conclusions: HSP demonstrate greater intensity during movement and a moderate correlation with depression; a significant enhancement in GAS scores following intervention confirms the crucial role of goal-oriented rehabilitation in improving functional outcomes for post-stroke HSP patients. It is recommended to continue future research with larger sample sizes to strengthen the statistical correlations among clinical variables. Keywords : GAS, Hemiplegic, Shoulder, Stroke, Pain
A Preliminary Analysis of Fatigue and Depressive Symptoms in Relation to Physical Activity Among Chronic Stroke Survivors
ABSTRACT Introduction: Depression and fatigue are common sequelae among chronic stroke survivors and may influence their physical activity levels. This preliminary study analyzed associations between depressive symptoms, physical fatigue, and physical activity in chronic stroke patients. Methods: A preliminary cross-sectional study was conducted from January to May 2025 involving chronic stroke outpatients (?6 months) with Brunnstrom stage IV–V and MoCA-Ina ?24. Depression was assessed using the Indonesian-validated DASS-21, fatigue using the Fatigue Severity Scale (FSS), and physical activity using the Global Physical Activity Questionnaire (GPAQ). Mann–Whitney U tests compared low versus moderate activity groups, and Spearman’s rho evaluated correlations (?=0.05). Results: Fatigue scores were higher in the low-activity group (34.8 ± 13.10) compared with the moderate-activity group (20.2 ± 6.64), showing a trend toward significance (p = 0.057). Depres sion scores did not differ between groups (p = 0.532). Spearman’s analysis showed a moderate negative trend between fatigue and activity (rho = -0.592, p = 0.071), while depression demonstrated a weak non-significant association (rho=-0.073, p=0.841). Conclusions: Physical fatigue showed a stronger trend toward lower activity levels than depressive symptoms, although associations were not statistically significant. Larger, adequately powered studies are needed to clarify these relationships. Keywords : Brunnstorm, Chronic, Depression, Fatigue, GPAQ, Physical, Rehabilitation, Stroke
Brunnstorm, Chronic, Depression, Fatigue, GPAQ, Physical, Rehabilitation, Stroke
Reliability Measurement of TongueFit for Tongue Strength Measurement in Children
Introduction: TongueFit is a newly available and lower cost orofacial manometer. This device is specifically developed for children to measure and improve tongue strength and endurance which includes a complementary application. This study evaluates the reliability of TongueFit as a measurement device. Methods: This is a cross-sectional study which recruited 74 subjects. Each subject was screened for clinical symptoms of dysphagia, only healthy subjects included in this study. Children who use visual or hearing aids were excluded. Tongue measurement will be repeated twice, with a 5-minute rest period. This study was analysed using SPSS version 27. The reliability of TongueFit is assessed using intraclass correlation (ICC) with single measurements, absolute agreement, and a two-way mixed-effects model. Result: 54 subjects were analyzed in the reliability analysis of TongueFit. There was excellent reliability with ICC 0.993 (0.988-0.996). Conclusion: This study showed an excellent reliability for TongueFit with high ICC. These results confirmed that the device is suitable for objective and precise tongue measurements.
Analysis of the Quality of Life Domain in Knee Injury an Osteoarthritis Outcome Score as an Expansion of Western Ontario and McMaster Universities Osteoarthritis Index for Evaluating Knee Osteoarthritis Therapy Outcomes
Introduction : Knee osteoarthritis is a degenerative joint disease causing pain and functional limitation, with rising prevalence globally and in Indonesia. Outcomes are commonly assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which evaluates pain, stiffness, and function, but excludes quality of life (QOL). Rehabilitation medicine emphasizes not only symptom relief but also recovery and life quality. The Knee Injury and Osteoarthritis Outcome Score (KOOS) adds a QOL domain for more comprehensive evaluation. Method: A pre-post observational study was conducted on 24 knee osteoarthritis patients receiving ultrasound diathermy and transcutaneous electrical nerve stimulation (USD TENS). KOOS scores for pain, activities of daily living (ADL), and QOL were recorded before and after intervention. Paired t-tests or Wilcoxon tests analyzed score changes, while Pearson or Spearman tests assessed correlations between ?QOL and ?pain, ?ADL, and ?WOMAC. Result: KOOS scores improved significantly after therapy (pre = 58.96; post = 33.29; p < 0.001), including QOL (p = 0.002), pain (pre = 52.50; post = 30.63; p = 0.000), and ADL (pre = 58.13; post = 37.92; p = 0.000). However, QOL changes were not significantly correlated with ?pain (r = 0.399; p = 0.053), ?ADL (? = 0.306; p = 0.146), or ?WOMAC (? = 0.356; p = 0.088). Conclusion: The QOL domain in KOOS reflects a distinct dimension not captured by WOMAC. KOOS thus offers a more holistic and patient-centered evaluation of therapeutic outcomes, highlighting the importance of including QOL in rehabilitation medicine. Keywords: knee osteoarthritis, KOOS, WOMAC, quality of life, USD TENS
knee osteoarthritis, KOOS, WOMAC, quality of life, USD TENS
Diagnostic Study of Indonesian Version of Dysphagia Handicap Index in Oropharyngeal Dysphagia Patient
Introduction: Dysphagia significantly affects patients’ quality of life, and its early detection is crucial. The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is limited to referral hospitals. Accordingly, the Indonesian version of the Dysphagia Handicap Index (DHI-INA) was investigated as a potential screening instrument for identifying dysphagia among patients in community-based settings with restricted access to advanced diagnostic modalities. Methods: A cross-sectional study was conducted involving patients with oropharyngeal dysphagia. Each participant completed the DHI-INA questionnaire, and FEES was conducted to assess swallowing function using the Penetration-Aspiration Scale (PAS). Data were analyzed using ROC curve analysis to determine the Area Under the Curve (AUC), sensitivity, specificity, and optimal cut-off values. Results: A total of 100 patients were enrolled in the study, with a mean age of 52.62 ± 9.61 years; with 58% male and 42% female. The primary etiologies included neurological disorders, head and neck pathologies, reflux disease, and other medical conditions. The optimal DHI-INA cut-off score of 21 yielded a sensitivity of 90.24% and specificity of 84.74%, with an AUC of 86.30%, indicating good diagnostic accuracy. A significant correlation was found between DHI-INA domain scores and PAS results (p < 0.001). Conclusion: The DHI-INA demonstrated strong diagnostic performance and a significant correlation with FEES outcomes. It represents a valid and practical screening instrument for identifying patients at risk of penetration or aspiration, particularly in community settings with limited access to advanced swallowing diagnostics.
Keywords: diagnostic, dysphagia, dysphagia handicap index, DHI, Indonesia version
Implementation of Super-circuit Training Protocol to Improve Functional Capacity in A Patient with Coronary Artery Disease: A Case Report
Introduction: Phase II cardiac rehabilitation (CR) was the primary intervention used to improve functional capacity (FC) and facilitate patients with coronary artery disease (CAD) in returning to their pre-illness functional activities. This case report described the implementation of super-circuit training (SCT) as a novel exercise modality to assess its efficacy and safety. Case Description: A 37-year-old man underwent phase II CR eight weeks after percutaneous coronary intervention with an FC of 5.4 metabolic equivalents, which limited his activities. Fear of recurrent heart attacks further contributed to these limitations. The patient participated in a six-week SCT program aimed at improving FC as the primary cause of functional impairment. After completing the program, improvements in FC, muscular fitness, and psychological well-being were observed, leading to enhanced daily, vocational, and sexual activities. No adverse events occurred during the CR program. Discussion: The SCT protocol was a novel form of circuit training combining high-intensity aerobic exercise (AE) and resistance training (RT), specifically designed for CAD and heart failure patients with reduced ejection fraction. In this case, the protocol was adapted with modified RT intensity and type. AE was performed at 75%-85% of heart rate reserve, while RT included calisthenic exercises at 50% of repetition to failure. Physiologically, this regimen effectively increased metabolic and hemodynamic demand, improving muscular endurance, strength, and cardiorespiratory fitness. SCT was found to be safe and beneficial, consistent with previous studies. Conclusion: The implementation of SCT in a CAD patient undergoing phase II CR resulted in significant FC improvement and was considered safe.
Effect of Umbilical Cord-Mesenchymal Stem Cells (UC-MSCs) Derived Secretome Combined with UC-MSCs in Anterior Cruciate Ligament Tear: A Case Report
Introduction: Anterior cruciate ligament (ACL) tears are common in athletes and active individuals, often requiring surgical reconstruction in grade 3 (complete) cases. Emerging regenerative approaches using mesenchymal stem cells (MSCs) and their secretome offer potential alternatives to surgery. Case: A male amateur futsal player in his 30s sustained a complete ACL tear with associated meniscal injury. He reported knee instability and severe pain (Numeric Pain Rating Scale [NPRS] score of 7). MRI confirmed a grade 3 ACL tear. The patient declined surgical intervention. Intervention: Treatment included periarticular trigger-point injection of 1.5?mL UC-MSC-derived secretome, followed later by intra-articular injection of 1×10? UC-MSCs suspended in 3?mL saline and 1.5?mL secretome. A structured home-based rehabilitation program and biomechanical correction using insoles were provided. Results: Pain improved from an NPRS score of 7 to 0 within six months. The patient returned to sport, reporting minimal residual instability. Follow-up MRI showed restored ACL continuity. No adverse events occurred. Conclusion: This case highlights the potential of UC-MSCs and secretome combination therapy as a non-invasive alternative for ACL repair. Further research is needed to validate its clinical efficacy and long-term safety.
ACL tear; UC-MSCs; secretome; pain; ligament
Bronchoscopy Balloon Dilatation and Pulmonary Rehabilitation To Prevent Recurrent Dyspnea In Post-Tuberculosis Lung Disease: A Case Report
Background: Post-tuberculosis lung disease (PTLD) frequently results in chronic airway complications, including cicatricial bronchial stenosis, which can cause recurrent dyspnea and impaired quality of life. Therapeutic bronchoscopy with balloon dilation and comprehensive pulmonary rehabilitation are emerging modalities for restoring airway patency and improving functional capacity. Case Description: A 23-year-old female with treated pulmonary tuberculosis in 2020 presented with worsening dyspnea and productive cough. Bronchoscopy revealed near-total cicatricial stenosis of the right main bronchus. Sequential electrocautery via the Mercedes-Benz technique and balloon dilations with 8 mm and 9 mm balloons achieved airway patency, confirmed by passage of a 5.4 mm bronchoscope beyond the stenotic segment. Discussion: Bronchoscopic balloon dilation has demonstrated safety and minimal invasiveness for tuberculosis-related bronchial stenosis, with low morbidity and manageable restenosis rates. Pulmonary rehabilitation, including Active Cycle Breathing Technique, diaphragmatic and deep-breathing exercises, mobilization, and energy conservation, aligns with WHO recommendations and significantly enhances lung function (FEV?, FVC, DLCO), exercise capacity, and quality of life. The combination of interventional and rehabilitative strategies offers a comprehensive approach, optimizing functional recovery and reducing dyspnea. Conclusions: Combining bronchoscopic balloon dilation with structured pulmonary rehabilitation effectively reduces airway obstruction and improves respiratory function in PTLD. Early intervention and ongoing rehabilitation are essential to sustain long-term benefits and prevent functional decline.
Case Report Functional Outcomes of Task-Oriented Circuit Training in a Middle-Aged Male with Vascular Parkinsonism and Recurrent Stroke: A Case Report
Introduction: Vascular parkinsonism (VP) due to small-vessel disease markedly impairs mobility and quality of life. As VP patients respond poorly to dopaminergic therapy, structured exercise rehabilitation is essential. This case report examines the functional outcomes of a six-week task-oriented circuit training (TOCT) program in a 59-year-old man with chronic VP (>6 months, four prior events). Presentation/Case Description: A 59-year-old male with VP from recurrent ischemic infarcts presented with gait unsteadiness, bradykinesia, and limited community ambulation. A six-week rehabilitation program centered on TOCT, integrating balance, gait, and functional task practice, was implemented. This was supplemented with aerobic conditioning and stretching. Post-intervention assessment revealed improvements in balance, walking endurance, pain reduction, and functional independence. Discussion: The structured TOCT protocol, emphasizing high repetition of task-specific movements and progressive challenges, effectively addressed the postural instability and endurance deficits characteristic of VP. The combination of TOCT with aerobic exercise provided a comprehensive approach to improve motor performance and patient-reported outcomes. Conclusions: An individualized six-week multidisciplinary rehabilitation program improved balance, endurance, pain, and QoL in a patient with VP; however, these findings are limited by the descriptive single-case design and require confirmation in larger, randomized, and blinded studies. Keywords : quality of life, rehabilitation, small vessel disease, stroke, TOCT, vascular parkinsonism.
Functional Seating to Enhance Mobility and Activity in a Child with Spastic Quadriplegic Cerebral Palsy
Introduction: Cerebral palsy is a permanent disorder of movement and posture caused by non-progressive disturbances in the developing brain. Spastic quadriplegia is the most severe subtype, affecting all four limbs and the trunk, and is often associated with significant limitations in mobility, posture, and functional independence. Children with this condition frequently require specialized postural support to enhance stability and improve participation in daily activities. This case report describes the use of functional seating to address postural instability in a 7-year-old girl with spastic quadriplegia following perinatal hypoxic–ischemic injury. Case Presentation: A multidisciplinary rehabilitation program was implemented using a customized functional seating system equipped with lateral trunk supports and contoured cushions to stabilize the pelvis, trunk, and neck. The child presented with global developmental delay and difficulty sitting, walking, and speaking. The intervention focused on optimizing postural alignment, reducing abnormal movement patterns, and facilitating safer mobility and daily participation. Challenges during positioning included markedly increased muscle tone, strong extension patterns, and involuntary movement, which required continuous adjustment of the seating configuration. Discussion: Despite these challenges, the functional seating provided improved postural stability, enabling the child to maintain sitting for longer periods with better alignment. Enhanced stability supported improved motor control and increased participation in daily routines. The intervention also reduced caregiver burden by facilitating easier and safer handling during daily activities. Conclusion: Functional seating is an effective adjunct to rehabilitation for children with spastic quadriplegia. When integrated into a tailored, multidisciplinary program, it enhances posture, supports mobility, and improves participation in daily activities, contributing to better overall quality of life. Keyword: cerebral palsy, spastic quadriplegic, functional seating
Introduction: The World Health Organization (WHO) defines an elderly individual as someone aged 65 years or older. With aging, the respiratory system undergoes structural and functional changes, leading to reduced pulmonary function, diminished exercise capacity, and increased susceptibility to respiratory diseases due to anatomical, physiological, and immunological alterations. Inspiratory muscle training (IMT) has been proposed as an intervention to counteract these age-related declines. Evidence suggests that IMT enhances inspiratory muscle strength, improves lung function, increases exercise tolerance and mobility, and promotes diaphragmatic hypertrophy in older adults. Thus, IMT may serve as a viable strategy to mitigate respiratory deterioration associated with aging. Method: A literature search was conducted using PubMed, Google Scholar, and the Cochrane Library to identify original research articles on inspiratory muscle training in the elderly. Results: IMT has been demonstrated to counteract physiological changes associated with aging, leading to improved respiratory function and overall physical performance. Conclusion: Given its documented benefits, IMT represents a promising adjunctive or alternative training modality for older adults. This literature review further explores the implementation and effectiveness of IMT in the elderly population. Keywords: Inspiratory muscle training, aging, respiratory function, diaphragm
Celebrating International Disability Days: Improving Concern for People with Disabilities in Indonesia.
Disability is defined as a person's interaction with the limitations they have in their ability to participate in their environment and society. Consequently, Disability can also be defined as a functional limitation to activity daily living. These limitations for people with disabilities often resulted in difficulties in adapting, which making them difficult to fully participate in their daily life. These limitations further supported by the number of people with disabilities in Indonesia that is keep increasing over the years. Statistics Indonesia (BPS) data from 2023 shows that there are approximately 22.97 million people with disabilities, or about 8.5% of the Indonesian population. This increase in numbers resulted in an increased obligation for the state to provide educational and health facilities, as well as employment opportunities that are accessible to these people with disabilities. The main problems faced by people with disabilities in Indonesia, especially for children, are including physical disabilities, cognitive impairments, and emotional regulation. Firstly, physical disabilities are including hearing impairment, low vision to blindness, and mobility issues that on most cases would needs a walking aid, whilst high prevalence of undetected hearing and vision problems might hinder children's learning ability and disrupt growth and development. Secondly, cognitive and emotional regulation is followed by these issues, such as intellectual disabilities, autism, and language disorders that are all quite prevalent, further complicating learning problems during the developmental period. Another crucial issue is the lack of literacy among parents and caregivers of people with disabilities regarding their children's growth and development, including their acceptance of children with special needs. In many cases, parents would, intentionally or unintentionally, mistreat their children with special needs with inequality. This phenomenon is particularly evident in school opportunities. Furthermore, with the growing stigma in society about having a child with a disability is often associated to a curse and punishment from God. Thereby, this kind of believes often leads many to feel ashamed and disregarded, pushing through the phenomenon of inequality for many households with disabled children. As an act to reduce discrimination for people with disabilities, the Indonesian government has enacted laws and regulations to increase their participation in education, employment, and social settings. Government Law No. 8 of 2016 establishes the government's obligation to provide the widest possible access for people with disabilities to school and pursue equal education. However, this is not enough; it requires collaboration from all levels of society with social media plays a crucial role in educating people about the equality of people with disabilities and promoting activities for people with disabilities, thereby reducing societal stigma. In conclusion, let us work together to raise awareness of people with disabilities so that no one in Indonesia, especially those with disabilities, feels left behind. Together, we can make Indonesia Golden 2050 a success.
Literature Review: 6PBRT and UULEX as an Unsupported Upper Limb test in People with Respiratory and Musculoskeletal disability
Upper limb (UL) function is essential for daily activities, yet it is often overlooked in rehabilitation programs for individuals with respiratory and musculoskeletal disabilities. The six-minute pegboard and ring test (6PBRT) and the unsupported upper limb exercise test (UULEX) are two validated tools for assessing UL functional capacity. These tests simulate daily UL movements, measuring endurance, strength, and coordination, particularly in patients with chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, asthma, bronchiectasis, interstitial lung disease, and pulmonary hypertension. Research suggests that UL exercises improve dyspnea, endurance, and activities of daily living (ADLs), supporting their integration into rehabilitation programs. This review explores the methodology, clinical applications, and benefits of 6PBRT and UULEX, highlighting their role in comprehensive patient assessment and functional rehabilitation. Keyword: upper extremity function, pulmonary rehabilitation, exercise rehabilitation, exercise test, chronic obstructive pulmonary disease, activities of daily living.
upper extremity function, pulmonary rehabilitation, exercise rehabilitation, exercise test, chronic obstructive pulmonary disease, activities of daily living.
Abdominal Anterior Cutaneous Nerve Entrapment Syndrome: Case Report of An Overlooked Diagnosis
Introduction: Abdominal Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is a chronic abdominal pain condition caused by entrapment of thoracoabdominal nerve branches in the abdominal wall. It is often misdiagnosed due to nonspecific symptoms resembling gastrointestinal issues. Hydrodissection, a minimally invasive technique, involves injecting fluid to release entrapped nerves and alleviate pain. This case highlights successful pain relief in ACNES using ultrasound-guided hydrodissection. Methods: A case report of a 27-year-old male pilot presented with chronic lower abdominal pain for five months, worsened by sitting post varicocele operation. The patient reported having persistent abdominal pain with a Numeric Rating Scale (NRS) score of 5–6. Despite undergoing prolotherapy and radiofrequency targeting the left ilioinguinal nerve, the pain intensified to an NRS of 8–9. Examination revealed a positive Carnett’s sign, suggesting ACNES. Hydrodissection with lidocaine under ultrasound guidance was performed. Result: Post-hydrodissection, the patient reported significant pain relief, with his NRS score decreasing from 8–9 to 0–1. He experienced near-complete resolution of chronic abdominal pain without adverse effects, demonstrating hydrodissection's effectiveness. Conclusion: Recognizing ACNES as a potential cause of chronic abdominal pain is essential for targeted intervention.
Anterior Cutaneous Nerve Entrapment Syndrome; Hydrodissection; Ultrasound-guided; Interventional pain management; Carnett’s sign
Factor Associated with Improvement of VO2 Max after Cardiac Rehabilitation in Patients with Coronary Artery Disease Post Revascularization
Aims: This study aimed to assess the association of cardiovascular risk factors and the number of risk factors with improvement of VO2 Max in patients with coronary artery disease (CAD) post-revascularization by Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI) after completing phase II cardiac rehabilitation (CR). Methods: This was an analytic study with a cross-sectional design. Data were taken retrospectively using secondary data from medical records. The study population was post-revascularization CAD patients who underwent phase II CR at RSUP Dr. Hasan Sadikin Bandung in 2019-2020, and samples were taken by total sampling method. Data were processed with Microsoft Excel 2016 and Statistical Software R version 4.0.0, then presented analytically. The characteristics were described based on age, sex, body mass index, education, occupation, and the number of risk factors. Characteristic data were grouped based on the CABG and PCI interventions obtained. Correlation analysis was conducted to assess the association of age, family history, physical inactivity, smoking, obesity, hypertension, dyslipidemia, and diabetes mellitus risk factors and the number of risk factors with VO2 Max. Data were analyzed with appropriate statistical tests. Results: The median (range) of improvement of VO2 Max was 6.00 (1.20, 17.73) (ml/kg/min). Smoking was significantly associated with an improvement of VO2 Max (p-value 0.0197), while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. Patients with a total of seven risk factors had the highest improvement of VO2 Max with 12.88 (3.15, 12.90) (ml/kg/minute), followed by patients with a total of six risk factors with 9.84 (1.80, 16.44) (ml/kg/minute). However, the number of risk factors had no significant association with the improvement of VO2 Max. Conclusion: Smoking as a CVD risk factor was associated with improvement of VO2 Max, while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. The number of risk factors had no significant association with the improvement of VO2 Max.
Body Mass Index, Coronary Artery Disease, Cardiac Rehabilitation, Cardiovascular Diseases, Percutaneous Coronary Intervention, Sedentary Behavior
Correlation Between Physical Activity Level and Flatfoot’s Degree in Individual with Intellectual Disabilities and Obesity: Comparison Between Athletes and Non-Athletes
Abstract Background: Increasing incident of obesity was also in the population of intellectual disability (ID). Some of them are an athlete. The research aims to assess the relationship between level of physical activity and the degree of flatfoot on individual with intellectual disability and obesity. This research also provide data on the prevalence and degree of flatfoot. Method: This research was using analytic observational method in cross-sectional studies in groups of athletes and non-athletes with a total of 68 subjects. The data collected between July 2021 to October 2022. The data included subject characteristics, daily activities that converted to metabolic equivalent (MET) score of physical activity level (PAL), BMI, and footprints using the Harris Mat. The clinical outcomes were analysed using Spearman, Man Whitney, and Fisher’s exact test. Result: Flatfoot occurred in 97% of the samples based on Viladot criteria. All the non-athlete group had flatfoot and more severe degree of flatfoot, and there were 2 individuals with normal feet in the athlete group. There was relationship between the degree of flatfoot in special athlete - obesity groups and gender. No relationship between the degree of flatfoot in both groups with age, degree of intellectual disability, degree of obesity and PAL, type of sport or duration of active as an athlete. Conclusion: There is no relationship between the degree of flatfoot and the PAL in the athlete and non-athlete groups of intellectual disability and obesity. Keywords: flatfoot, physical activity level, intellectual disability, obesity, special athlete
flatfoot, physical activity level, intellectual disability, obesity, special athlete
Effectiveness of Dry Needling on Reducing Pain, Increasing Range of Motion of the Neck, and Increasing Craniovertebral Angle in Obese Patients with Cervical Myofascial Pain Syndrome
Introduction: Obese patients often experience neck pain due to cervical myofascial pain syndrome.Dry needling is one of method to treat myofascial pain syndrome. Methods: This study was a single-blind randomized controlled trial. Participants aged 18- 59 year with neck pain > 3 months caused by myofascial pain syndrome in the neck region. Patients were randomized into the dry needling group (n=16 subjects) and the control group (n=16 subjects). The dry needling group received dry needling therapy once a week for 4 weeks and exercise therapy three times a week for 4 weeks. The control group received exercise therapy only three times a week for 4 weeks. Results: Participants had an average age of 41.4±11.2 years. Both groups experienced significant improvement in NRS, cervical ROM, and CVA between the pre-treatment assessment and the fourth week evaluation (p<0.05). The dry needling group experienced more significant improvements in NRS, cervical extension ROM, and CVA compared to the control group at the fourth week evaluation (p<0.05). Conclusion: Dry needling combined with exercise or exercise therapy alone is effective in improving NRS, cervical ROM, and CVA in obese patients with cervical myofascial pain syndrome. However, dry needling combine with exercise therapy is superior to exercise therapy alone. Keywords : Dry Needling, Obesity, Pain, Range of Motion in the Joint, Craniovertebral Angle, Myofascial Neck Pain Syndrome
Dry Needling, Obesity, Pain, Range of Motion in the Joint, Craniovertebral Angle, Myofascial Neck Pain Syndrome
The Effect of Intradialysis Resistance Training on Quality of Life and Physical Activity of End-Stage Chronic Renal Failure Patients Hemodialysis
Introduction: Patients with Chronic Kidney Failure have a decreased ability to excrete metabolic wastes. Metabolic wastes that accumulate in the musculoskeletal system are called uremic myopathy. Uremic myopathy is characterized by an increase in muscle protein catabolism which results in a decrease in contractility and muscle mass which causes the patient to tire easily and triggers sedentary behavior and reduces physical activity and quality of life. Objective: The purpose of this study was to determine the effect of intradialysis resistance exercise on quality of life and level of physical activity in end-stage chronic kidney disease patients undergoing hemodialysis 2 times per week. Methods: Thirty-nine subjects receive low-intensity resistance exercise for 2 sets of 15 repetitions. Progression of exercise is done by increasing the volume of exercise. Exercises are carried out twice a week for 24 training sessions under the supervision in the hospital. The examination was carried out before and after 24 training sessions including filling out the KDQOL (Kidney Disease and Quality of Life) and IPAQ (International Physical Activity Questionnaire) questionnaires. Statistical analysis using t-test and sign-test Results: The results showed significant changes in all the variables studied, KDQOL score (p=0.00) and the level of physical activity (p=0.00). The average KDQOL scores before and after exercise were 166.67 and 243.16. Twenty-five research subjects has increased in physical activity level, and fourteen research subjects did not increase in physical activity level Conclusion: Intradialysis resistance exercise improves quality of life and physical activity level of end-stage chronic kidney disease patients undergoing hemodialysis 2 times per week Keywords: Chronic kidney disease, hemodialysis, physical activity, quality of life, resistance training
Keywords: Chronic kidney disease, hemodialysis, physical activity, quality of life, resistance training
The "Exploring the Impact of Pain on Functional Capacity and Quality of Life in Elderly with Musculoskeletal Disorders"
ABSTRACT Introduction: Pain is a common health issue among the elderly, with chronic pain significantly impacting functional capacity and quality of life. This study analyzes the relationship between pain, functional capacity, and quality of life in elderly individuals using the Barthel Index and WHOQOL-BREF. Methods: This analytical observational study utilized a cross-sectional design involving 204 elderly individuals with musculoskeletal pain from 10 hospitals in Central Java. Pain levels were assessed using the Numerical Rating Scale (NRS), functional capacity was measured using the Barthel Index, and quality of life was evaluated using WHOQOL-BREF. Data were analyzed descriptively, and Spearman’s correlation test was used to determine relationships between variables. Results: The descriptive analysis revealed knee pain as the most commonly reported location (33.33%), followed by lower back pain (30.4%). Functional capacity assessment showed high independence in daily activities, with 99.0% eating and 96.6% bathing independently. However, only 74.0% could navigate stairs without assistance. Spearman's correlation analysis showed a significant negative correlation between pain and the Barthel Index (r = -0.174, p = 0.013), WHOQOL-BREF Domain 1 (r = -0.319, p < 0.001), and Domain 2 (r = -0.185, p = 0.008). No significant relationships were observed for Domains 3 and 4. Conclusion: Pain significantly impacts functional capacity and psychological well-being in elderly individuals, but its effect on social and environmental quality of life is less pronounced. Comprehensive pain assessment and targeted interventions are essential to improve their quality of life.
Keywords: Pain, functional capacity, quality of life, elderly, Barthel Index.
Differences in Sensitivity and Specificity of the Time Up and Go Test and Berg Balance Scale in Assessing the Risk of Falls in Chronic Heart Failure Patients with Systolic Dysfunction
Introduction: Chronic heart failure (HF) patients face increased fall risks due to muscle dysfunction and balance impairment. The Time Up and Go (TUG) and the Berg Balance Scale (BBS) are the tests that have been developed to assess the risk of falls in general population, but research specifically investigating their sensitivity and specificity in chronic HF patients remains scarce. Methods: This study was a cross-sectional study aimed at assessing the sensitivity and specificity of the TUG and BBS for risk of fall, performed using the Receiver Operating Characteristic (ROC) curve, involving patients from the Cardiology Department of Brawijaya University Hospital aged 21 to 60 years who were diagnosed with chronic HF with systolic dysfunction. Results: Analysis of 32 participants with average age of 56 years showed TUG’s area under the curve (AUC) was 0.85 (95% CI 0.5 – 1), with cut-off at 11.22 seconds, with 75.00% sensitivity, and 96.43% specificity. Meanwhile, BBS had an AUC of 0.72 (95% CI 0.4 - 1), with 71.43% sensitivity, and 75.00% specificity respectively with cutoff at 56. Conclusion: TUG demonstrated superior sensitivity and specificity compared to BBS, making it a preferred tool for identifying fall risk in chronic HF with systolic dysfunction.
Time Up and Go, Berg Balance Scale, heart failure, risk of falls