Knee pain and functional disability of knee osteoarthritis patients seen at Malaysian government hospitals

Introduction: Osteoarthritis (OA) is the main cause of knee pain. It also affects individual’s physical functioning. Anti- inflammatory drugs and knee replacement are the mainstay methods in the management of knee OA in Malaysia. However, patients with knee OA often suffer pain. The general objective of the study is to evaluate the effectiveness of a cognitive behavioural intervention module on knee pain, functional disability and psychological outcomes among knee OA patients attending Orthopedics Clinics in Hospital Putrajaya and Hospital Serdang, Malaysia. This study aims to determine the baseline level of knee pain and functional disability among knee OA patients. Methods: Baseline results on the knee pain and functional disability were obtained from a two arm parallel- group randomized controlled study. Three hundred patients aged 35 to 75 years diagnosed with knee OA were recruited. A set of pre tested and validated Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used in this study. Results: Mean baseline of KOOS pain was 56.09 (SD=21.75) and 52.26 (SD=22.08) for the intervention and control groups respectively. Participants in the intervention and control groups had a mean KOOS function in daily living of 61.11 (SD=21.20) and 56.72 (SD=22.13) respectively. Overall mean baseline of KOOS function in sport and recreation was 35.30 (SD=27.38). Conclusions: Majority of participants had moderate level of knee pain and functional disability in daily living. However, participants had more extreme symptoms of functional disability in sport and recreation. Therefore, interventions to reduce knee pain and functional disability symptoms in knee OA are needed

Factors Influencing COVID-19 Vaccination Intention among University Students : A Cross-Sectional Study in Malaysia

Vaccination is crucial in controlling the spread of the coronavirus disease 2019 (COVID-19) that triggered the pandemic, but herd immunity can only work with high vaccination coverage in the population. This study aims to measure the COVID-19 knowledge level and determine the factors influencing COVID-19 vaccination intention among university students in Malaysia. A cross-sectional online survey was carried out with 1,274 Malaysian university students in July 2021. Univariate and multivariate analyses were employed to examine the relationships between the study variables. Results showed that the majority of university students had an acceptable level of knowledge of COVID-19. The knowledge, risk perception of COVID-19, social norms, and perceived benefit of COVID-19 vaccination were positively associated with vaccination intention. However, perceived trust in information sources of COVID-19 vaccination and the government's response to COVID-19 did not affect the university students’ desire to receive the vaccination. These findings are essential for health policymakers and healthcare providers to implement evidence-based interventions to increase COVID-19 vaccination uptake among university students

Effectiveness of group cognitive behavioral-based therapy on pain, functional disability and psychological outcomes among knee osteoarthritis patients in Malaysian government hospitals

Background: Knee osteoarthritis (OA) mainly causes pain, stiffness and muscle weakness. It also affects individual’s physical functioning. It has great impact on individual’s quality of life and wellbeing. Anti -inflammatory drugs and knee replacement are the mainstay methods in the management of knee OA in Malaysia. It is still noted that individuals with knee OA suffer from low quality of life. Non-pharmacological interventions are still a driving force in managing knee OA pain. Cognitive behavioral-based therapy is a first line psychosocial treatment which is more applied in chronic pain conditions. Evidence of effectiveness of cognitive behavioral-based therapy in treating OA knee pain is lacking. Objective: This study aimed to develop, implement, and evaluate the effectiveness of a cognitive behavioral-based therapy module in treating knee pain, functional disability and psychological outcomes for patients with knee OA. Methodology: A two arm parallel-group unblinded randomized controlled study design was used in this study. Three hundred patients aged 35 to 75 years diagnosed with knee OA (Kellgren grade ≥2 and visual analogue scale (VAS) score 40 or more) were recruited from Orthopaedics clinic of Hospital Putrajaya and Hospital Serdang, Malaysia. A cognitive behavioral-based therapy module was developed based on the cognitive-behavioral model. Eligible patients were randomized by applying independently operated computer- generated random sequence system with the block randomization of six (http://random-allocation-software.software.informer.com/2.0/).Participants in intervention group (n=150) received a three sessions of a group cognitive behavioral intervention (two and a half hour for each session) in addition to standard routine care and participants in control group (n=150) received standard routine care. A set of self-administered validated and reliable structured questionnaire was used for data collection. Data was collected at baseline, immediate, one month and six months post treatment. Primary outcome measure was knee pain intensity. Secondary outcome measures included functional disability (daily living and sport), depression, anxiety, stress, fear-avoidance beliefs (physical activity and work), pain catastrophising and pain self-efficacy. Data collected was analyzed using SPSS software with the application of mixed design repeated measured analysis of variance. Results: One hundred and nineteen (79%) participants in the intervention group and 111 (74%) participants in the control group were included in the analysis at six months. The Knee injury and Osteoarthritis Outcome Score (KOOS) knee pain scores improved substantially in the intervention group, but not in the control group. The mean change in the KOOS knee pain score was 8.9 points (95% CI -11.23 to -6.62, p=0.0001) higher (less knee pain intensity) in the intervention group. Functional disability in daily living, depression, anxiety, pain catastrophising, and pain self-efficacy level improved significantly in the intervention group (p0.05). Conclusion: The cognitive behavioral-based therapy module is effective in reducing knee pain intensity, functional disability in daily living, depression, anxiety, pain catastrophising, and improving pain self-efficacy level in this knee OA population

Preliminary efficacy of aerobic training among university students with migraine symptoms: Study protocol for a pilot randomized controlled trial.

BackgroundMigraine is a primary neurological headache. Treatment of this condition includes medications; however, these medications, when given for a longer duration, can have side effects. If migraine is left untreated or undiagnosed, it is reported that around 2.5% of individuals with migraine may develop to have a chronic condition. This study aims to analyse the preliminary effectiveness of aerobic training on migraine pain level, sleep quality, quality of life, and resting-state brain waves among university students with migraine symptoms.Methodology88 university students with migraine symptoms are the target participants. 4 of 5 on the Migraine Screen Questionnaire, 5 of 7 on the International Classification of Headache Disorders 3rd edition (ICHD-3), and both genders aged 18-40 years will be included. The participants with a score of more than or equal to 5 on the visual aura rating scale, diagnosed with a secondary headache, pregnancy, medication for neurological and cardiorespiratory conditions, and unwilling to participate will be excluded. Based on the disability questionnaire, the participants will be randomly assigned to either of the three groups. The primary outcome is resting-state electroencephalography (EEG) brain, and the secondary outcomes are sleep quality, quality of life, and migraine pain level. The post-test assessments will be performed at week 6.ResultAfter the primary EEG analysis using MATLAB, the amplitude, frequency, frequency band ratio, and power spectrum density will be analysed. Mixed design analysis and intention-to-treat analysis will be used to assess the efficacy of aerobic training.DiscussionMigraines can be unpredictable, sometimes occurring without symptoms. If underdiagnosed or over-looked, it encompasses a serious of long-term effects. Hence with appropriate intervention, the symptoms can be prevented from worsening. But there is an unmet need for evidence-based non-pharmacological approaches to complement pharmacotherapy in migraine prevention. Moreover, an exercise intervention may be more suitable for people with migraine considering their tendency toward inactivity. Although some studies developed exercise programs for untrained patients with migraine, the outcome was primarily in terms of exercise capacity rather than the primary characteristics and secondary brain wave/ sleep quality changes, indicating the need for this study

Urinary incontinence and its association with pelvic floor muscle exercise among pregnant women attending a primary care clinic in Selangor, Malaysia.

BackgroundUrinary Incontinence (UI) is when a person is unable to hold his/her urine effectively. This is a common problem which can develop and worsen during pregnancy. An effective way to manage UI is to educate patients on the Pelvic Floor Muscle Exercise (PFME) regularly. The present study aimed to ascertain the pregnant women's knowledge, attitudes, and practices (KAP) related to PFME.MethodsThis was a cross-sectional study done in a one primary care clinic located in a semi-urban area in Selangor, Malaysia. Simple random sampling was conducted among pregnant women aged 18 years old and above at any gestation. The validated study instruments used consisted of questions on socio-demography, KAP on UI, and also the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form to determine UI among the respondents.ResultsThe response rate for this study was 72.1%, where 440 pregnant women consented to take part in the study. The median age of study respondents was 30 years old and majority of the study respondents was from the Malay ethnicity (80.9%). The prevalence of UI was 40.9%. The proportion of pregnant women with good knowledge, attitude and practice scores were 58.0%, 46.6% and 45.2% respectively. There was a significant association between UI and age (p = .03), body mass index (p = .03), ethnicity (p = .04), gravida. (p = .001), knowledge on PFME (p = .007) and attitude towards PFME (p = .006).ConclusionsFindings from this study fill a gap in the prevalence and KAP concerning PFME at the primary care level. The foundation areas for future education and health promotion on UI should address the importance of correct PFME. This education can be delivered through a pragmatic way to ensure its effectiveness and sustainability of the health promotion program

Traditional Chinese Medicine Body Constitutions as Predictors for Depression: A Systematic Review and Meta-Analysis

Traditional Chinese medicine body constitution (TCMBC) reflects a person’s vulnerability to diseases. Thus, identifying body constitutions prone to depression can help prevent and treat depression. The review aimed to assess and summarize the existing evidence that explores the relationship between TCMBC and depression. Psychology and Behavioral Sciences Collection, MEDLINE, PubMed, CNKI, Wanfang, SinoMed, Embase, VIP, CINAHL, and CMJ were searched from inception to April 2021. Observational studies assessing the association between TCMBC and depression were selected. The quality of the included studies were assessed using the Newcastle–Ottawa Scale (NOS). Eighteen studies were included in the systematic review and thirteen in the meta-analysis. The pooled odd ratios of developing depression for Qi-stagnation, Qi-deficiency, Yang-deficiency, Yin-deficiency, and Balanced constitutions were 3.12 (95% CI, 1.80–5.40; I2 = 94%), 2.15 (95% CI, 1.54–3.01; I2 = 89%), 1.89 (95% CI, 0.71–5.03; I2 = 81%), 1.41 (95% CI, 0.91–2.20; I2 = 57%), and 0.60 (95% CI, 0.40–0.90; I2 = 94%), respectively. The findings suggest that the evaluation of a person’s TCMBC could be useful the in prevention and treatment of depression. However, more case-control and cohort studies are required to further confirm the association between TCMBC and depression

Protocol of biofeedback training.

a- biofeedback training device, b- frontalis electrdode placement, c- training device display/feedback, d- trapezius electrode placement.</p

Protocol of aerobic training.

a- Neck exercise with resistance band, b- Static bicycle, c- Treadmill.</p

SPIRIT 2013 checklist: Recommended items to address in a clinical trial protocol and related documents*.

SPIRIT 2013 checklist: Recommended items to address in a clinical trial protocol and related documents*.</p

Warm up and cool down exercise.

BackgroundMigraine is a primary neurological headache. Treatment of this condition includes medications; however, these medications, when given for a longer duration, can have side effects. If migraine is left untreated or undiagnosed, it is reported that around 2.5% of individuals with migraine may develop to have a chronic condition. This study aims to analyse the preliminary effectiveness of aerobic training on migraine pain level, sleep quality, quality of life, and resting-state brain waves among university students with migraine symptoms.Methodology88 university students with migraine symptoms are the target participants. 4 of 5 on the Migraine Screen Questionnaire, 5 of 7 on the International Classification of Headache Disorders 3rd edition (ICHD-3), and both genders aged 18–40 years will be included. The participants with a score of more than or equal to 5 on the visual aura rating scale, diagnosed with a secondary headache, pregnancy, medication for neurological and cardiorespiratory conditions, and unwilling to participate will be excluded. Based on the disability questionnaire, the participants will be randomly assigned to either of the three groups. The primary outcome is resting-state electroencephalography (EEG) brain, and the secondary outcomes are sleep quality, quality of life, and migraine pain level. The post-test assessments will be performed at week 6.ResultAfter the primary EEG analysis using MATLAB, the amplitude, frequency, frequency band ratio, and power spectrum density will be analysed. Mixed design analysis and intention-to-treat analysis will be used to assess the efficacy of aerobic training.DiscussionMigraines can be unpredictable, sometimes occurring without symptoms. If underdiagnosed or over-looked, it encompasses a serious of long-term effects. Hence with appropriate intervention, the symptoms can be prevented from worsening. But there is an unmet need for evidence-based non-pharmacological approaches to complement pharmacotherapy in migraine prevention. Moreover, an exercise intervention may be more suitable for people with migraine considering their tendency toward inactivity. Although some studies developed exercise programs for untrained patients with migraine, the outcome was primarily in terms of exercise capacity rather than the primary characteristics and secondary brain wave/ sleep quality changes, indicating the need for this study.</div