The prevalence, characteristics, and impact of work-related musculoskeletal disorders among physical therapists in the Kingdom of Saudi Arabia – a cross-sectional study

BackgroundPhysical therapists are known to be susceptible to work-related musculoskeletal disorders (WMSDs), but the prevalence of WMSDs in Saudi Arabia has not been documented. This study aimed to establish the prevalence, characteristics, and risk factors of WMSDs among physical therapists in Saudi Arabia.Material and MethodsA cross-sectional study was conducted among 113 physical therapists in Saudi Arabia using a 6-component questionnaire. Descriptive statistics, incidence, percentages, and χ2 test were used for data analysis.ResultsThe response rate was 68.8%. The reported 12-month incidence of WMSDs was 83.8%. The low back (63.7%) was the most common site of these disorders, followed by the neck (59.2%), while the hip/thigh (4.4%) was the least involved body part. Incidence was related to gender: females were more affected than males (neck, shoulders, low back); age: younger therapists were more affected than older ones (shoulders, low back); working sector: government sector workers were more affected than those employed in other sectors (neck); and specialty: orthopedic specialists were the most frequently affected, followed by those specializing in neurology (thumbs, upper back, knees, ankle/foot). Most of the physical therapists had >5 periods of neck, shoulder, and low-back WMSDs. The most important risk factor for WMSDs was treating more patients in a day (47.7%). The most frequently adopted handling strategy identified to combat WMSDS was modifying the patient’s position (62.8%).ConclusionsOverall, WMSDs among physical therapists in Saudi Arabia are common, with the low back and the neck constituting the most frequently affected body regions. Professional experience and the awareness of ergonomics principles can help prevent the early development of WMSDs among physical therapists. Med Pr. 2021;72(4):363–7

Association of age on cervical joint position error

This study quantitatively assesses the association between age and cervical joint position error (JPE) and compares JPE between young and older asymptomatic subjects. Subjects (n = 230) ranging in age from 17 to 70 years volunteered to participate in the study. Cervical JPE was measured for all subjects with the active movement angle reproduction test in degrees using a digital inclinometer; testing was done in all cervical movement directions (flexion, extension, side-bending right and left, rotation right and left). Subjects were divided into two groups: young (n = 169, mean age: 32.4 years; range 17–49 years) and older (n = 61, mean age: 61.9 years; range 50–70 years) and JPE was compared. Pearson’s product-moment correlation coefficients were significant and positive for the association of age on cervical JPE in flexion (r = 0.71), extension (r = 0.81), side-bending right (r = 0.77), side-bending left (r = 0.84), rotation right (r = 0.84), and rotation left (r = 0.84). JPE was significantly larger (for all movement directions) in the older subject group (P < 0.001). Advancing age was significantly associated with the increasing cervical JPE and older subjects showed greater errors when compared to younger subjects

Effectiveness of Low-Frequency Stimulation in Proprioceptive Neuromuscular Facilitation Techniques for Post Ankle Sprain Balance and Proprioception in Adults: A Randomized Controlled Trial

Stretching is an important part of post ankle sprain rehabilitation, as well as an effective exercise for improving general ankle-joint performance. But the combination of stretching alongside low-frequency stimulation has not yet been extensively studied. Therefore, the purpose of the present randomized controlled trial was to compare the combined effects of low-frequency transcutaneous electrical nerve stimulation (TENS) with proprioceptive neuromuscular facilitation (PNF) on strength, balance, and proprioception among individuals with post ankle sprain. Sixty male subjects with lateral ankle sprain were selected and randomly allocated to three groups: group 1, group 2, and the control group (CG). Subjects in group 1 received the PNF stretching technique combined with TENS. TENS stimulation was provided using two electrodes placed 5 cm apart directly on the triceps sural muscle of the affected leg and a biphasic current with a symmetrical waveform at 50 Hz for 15 seconds, tuned for a 3-second ramp up time and a 30-second rest time with a 250-microsecond pulse duration was given with PNF stretching. Subjects in group 2 received the PNF stretching technique alone. Both group 1 and group 2 received these treatments for 4 weeks (4 days/week); follow-up assessments were administered in the third and fifth weeks. CG received no treatment; outcome measures alone were assessed. Outcome measures comprised pain, balance, flexibility, proprioception, range of motion, muscle strength, and functional limitation. A mixed-model ANOVA showed significant interaction (time and group) and the time effect for all the outcome measures (p≤0.05). Group 1 (PNF-TENS) showed significant improvement for all the outcome variables compared to the other groups. The present study showed PNF stretching combined with TENS for the triceps sural muscle to trigger muscle contraction during the muscle contraction phase of the PNF stretch, compared against PNF stretching alone, produced significant improvements in ankle function for post ankle sprain subjects

The immediate and short-term effects of dynamic taping on pain, endurance, disability, mobility and kinesiophobia in individuals with chronic non-specific low back pain: A randomized controlled trial.

Evidence suggests that the application of Kinesio Tape (KT) on patients with chronic non-specific low back pain (CNLBP) is inconclusive. Dynamic tape (DT) is a relatively new treatment technique, which is increasingly being used as an adjunctive method to treat musculoskeletal problems. To our knowledge, no study has investigated the application of DT in individuals with CNLBP. To compare the immediate and short-term effects of DT versus KT and no tape among patients with CNLBP on pain, endurance, disability, mobility, and kinesiophobia. Forty-five patients with CNLBP were randomly assigned to 1 of 3 groups. Outcomes were measured at baseline, immediately, and on the third day post-application of tapes. The primary outcomes of pain, endurance, and disability were measured through the visual analog scale (VAS), Biering-Sorensen test, and Oswestry disability index (ODI), respectively. Secondary outcome measures of mobility and kinesiophobia were measured using the modified-modified Schober test and the Tampa Scale of Kinesiophobia, respectively. No significant immediate and short-term differences were found between DT and KT in pain, disability, mobility, and kinesiophobia. Improved back extensor endurance was observed for the DT group than KT (p = 0.023) and control group (p = 0.006). The application of DT may result in improvements only in back extensor endurance among individuals with CNLBP. This finding suggests that DT controls the processes that lead to back muscle fatigue

Cardiorespiratory Fitness as a Correlate of Cardiovascular, Anthropometric, and Physical Risk Factors: Using the Ruffier Test as a Template

BACKGROUND. Assessment of cardiorespiratory fitness (CRF) is a standard procedure in routine clinical practices. Early identification of risk factors through screening is vital in the fight against chronic diseases. Evaluation of CRF can impose cost implications in the clinical setting; thus, a simple and easy-to-use test is to be advocated. The Ruffier test is a simple test that can assess CRF, and it is necessary to find whether the test reflects the effects of compounding factors in CRF. OBJECTIVE. This study aims to determine the association between CRF (estimated VO2max) with cardiovascular, anthropometric, and physical risk factors using the Ruffier test. Methods. A cross-sectional study with a sample of 52 male participants was conducted. Before the Ruffier test, each participant’s body weight, height, waist circumference, skinfold thickness, thigh length, lower-limb length, thigh circumference, physical activity, blood pressure, smoking, diabetes, and pulmonary functions were recorded, and these factors correlated with CRF. RESULTS. There was a significant inverse relationship found between the estimated VO2max and age, height, body weight, body mass index, waist circumference, a sum of skinfold, fat percentage, thigh length, lower-limb length, thigh circumference, smoking, blood pressure, heart rates, and diabetes . A significant positive correlation was found between the estimated VO2max with physical activity and respiratory functions . In the multivariable model, body weight and resting heart rate were significantly inversely associated with the estimated VO2max. CONCLUSION. Using the Ruffier test, various risk factors of CRF are correlated with the estimated VO2max. This test reflects the effects of different compounding factors on CRF; therefore, it can be used in routine clinical practices to identify the risk factors early

DETERMINING THE STRENGTH OF HAND GRIP FOR HEALTHY ADULTS IN RELATION WITH HAND LENGTH, FOREARM CIRCUMFERENCE, BMI AND HAND DOMINANCE

Background: Hand-grip strength studies with healthy adults have shown correlation between anthropometric variables and hand grip strength. There is dearth in literature in population of Saudi Arabia. The objective of this study is to describe normative data to evaluate the relationship between handgrip strength and other anthropometric variables especially hand length, forearm circumference with regard to dominant hand, among healthy males in Abha, Saudi Arabia, using a Hand held dynamometer. Methods: A sample of 99 male adults from the population of Abha, Saudi Arabia, ages 20 to 72 years were tested using standardized positioning and instructions. A Hand–held dynamometer was used to measure grip strength in kilograms. Results: Low to medium correlation (significant) is found between all the variables and HGS. Age is negatively correlated. A stepwise regression predicts that hand length, age, forearm girth circumference are the three significant variables of hand grip strength. An ANOVA proves that hand grip strength is less for subjects above 60 years; hand grip strength is higher for subjects with extra-large forearm girth circumference. Conclusion: Normative values hand grip strength in population of Saudi Arabia is established through this study. The hand grip strength is influenced by hand length, hand girth circumference as well as age category of the subjects and these variables can be better predictors while clinically rehabilitating hand patients

The Aftermath of the COVID-19 Crisis in Saudi Arabia: Respiratory Rehabilitation Recommendations by Physical Therapists

Since late 2019, the number of COVID-19 patients has gradually increased in certain regions as consecutive waves of infections hit countries. Whenever this wave hits the corresponding areas, the entire healthcare system must respond quickly to curb the diseases, morbidities, and mortalities in intensive care settings. The healthcare team involved in COVID-19 patients&rsquo; care must work tirelessly without having breaks. Our understanding of COVID-19 is limited as new challenges emerge with new COVID-19 variants appearing in different world regions. Though medical therapies are finding solutions to deal with the disease, there are few recommendations for respiratory rehabilitation therapies. A group of respiratory rehabilitation care professionals in Saudi Arabia and international experts have agreed with the World Health bodies such as the World Health Organization (WHO) on the treatment and rehabilitation of patients with COVID-19. Professionals participating in COVID-19 patient treatment, rehabilitation, and recovery formulated respiratory rehabilitation guidelines based on the DELPHI Method, combining scientific research and personal practical experience. As a result, it is envisaged that the number of individuals in the region suffering from respiratory ailments due to post-COVID-19 will decrease. This narrative review and clinical expertise guidelines may give physiotherapists acceptable and standard clinical guideline protocols for treating COVID-19 patients

Foot Posture Index Reference Values among Young Adults in Saudi Arabia and Their Association with Anthropometric Determinants, Balance, Functional Mobility, and Hypermobility

Background. The foot posture index (FPI) is a valid, reliable, and multidimensional method for determining foot posture in a wide range of clinical settings. To date, no normative data of healthy young adults in Saudi Arabia have been available for comparison and reference. Hence, this study is aimed at establishing the FPI reference values, gender, and side differences of FPI and their association with anthropometric determinants, balance, functional mobility, and hypermobility. Methods. FPI was assessed in 581 (291 men and 290 women) healthy young adults aged 18–25 years. The FPI range was obtained for both feet as the sum of the scores (–2, –1, 0, 1, and 2) given to each criterion: (–1 to –12) supinated foot, (0 to +5) neutral foot, and (+6 to +12) pronated foot. The study furthermore assessed the balance using a near tandem balance test, functional mobility by stair ascent and descent test, and joint hypermobility via the Beighton scale. Results. The average FPI score was 2.76±5.23 for all subjects, 2.98±5.02 for men and 2.55±5.43 for women. Neutral foot posture was most frequent in this study (52.9%). A higher proportion of women had pronated (21.0%) and supinated (11.7%) feet than men which were 16.8% and 10.3%, respectively. This study also confirmed that side differences were found to be significant (p value < 0.001), whereas gender differences were significant only in the normal, pronated, and supinated foot groups. Conclusion. The most common foot posture in both genders was ranged from neutral to slight pronation. We also found a correlation between balance with FPI in the supinated and hypersupinated foot groups, functional mobility with FPI of pronated and supinated foot groups, and joint hypermobility with FPI of the hyperpronated foot group

Comparative Effects of Mulligan’s Mobilization, Spinal Manipulation, and Conventional Massage Therapy in Cervicogenic Headache—A Prospective, Randomized, Controlled Trial

Background: There is ample evidence supporting the use of manual therapy techniques for the treatment of cervicogenic headache (CGH). Objective: The objective of this study was to find and compare the effects of different manual therapy approaches to cervicogenic headache. Methods: A randomized, controlled study was conducted on 84 CGH participants at the university hospital. The participants were divided into a Mulligan mobilization therapy group (MMT; n = 28), a spinal manipulation therapy group (SMT; n = 28), and a control group (Control; n = 28); they received the respective treatments for four weeks. The primary outcome (CGH frequency) and secondary outcomes (CGH pain intensity, CGH disability, neck pain frequency, pain intensity, pain threshold, flexion rotation (right and left), neck disability index, and quality of life scores) were measured at baseline, after 4 weeks, after 8 weeks, and at a 6-month follow-up. The one-way ANOVA test and repeated measures analysis of variance (rANOVA) test were performed to find the difference between the inter- and intra-treatment group effects. Results: Four weeks following training, the MMT group showed a statistically significant difference in the primary (CGH frequency) and secondary (CGH pain intensity, CGH disability, neck pain frequency, neck pain intensity, flexion rotation test, neck disability index, and quality of life) scores than those of the SMT and control groups (p p ≥ 0.05) but showed statistical difference at the 6-month follow-up. Conclusion: The study concluded that Mulligan’s mobilization therapy provided better outcomes in cervicogenic headache than those of spinal manipulation therapy and conventional massage therapy

Oblique, forward, and lateral directions reach test distances in young adults, and concurrent validity of these tests with the center of pressure excursion in assessing the limits of stability

Background: Limits of stability is required to perform functional activities and other advanced tasks of life without losing balance, and assessment of limits of stability is essential in clinical practice. Forward, Lateral, and Oblique direction reach tests are clinical balance tests that assess limits of stability, and these reach distances in various directions may be symmetrical or asymmetrical. The aim was to establish the symmetry between various reach distances on three reach tests and to establish the concurrent validity of oblique, forward, and lateral direction reach test distances with limits of stability measured by the Iso Free machine of TecnoBody company. Methods: The measurements of oblique, forward, and lateral reach tests and limits of stability excursions of center of pressure were taken in eight directions on Iso Free machine of Techno Body in fifty typical college-going young adults who were recruited through convenience sampling. Pearson correlation test was used to find the relationship between forward, lateral, and oblique direction reaches and limits of stability in forward, lateral, and oblique directions. Regression analysis was used to find the factors influencing the forward, lateral, and oblique reach tests. Results: The reach distances were symmetrical, and out of the three tests, the lateral and oblique direction reach tests have a moderate positive correlation with limits of stability test in lateral and oblique directions with an r-value of 0.569 (p < 0.001) and 0.50 (p < 0.001) respectively. A Significant standardized beta value of 0.49 (p < 0.05) for the oblique direction reach test with total stability limits. Conclusions: The oblique and lateral direction reach tests are correlated with their respective center of pressure excursion. However, the oblique direction reach test moderately correlated with the total limits of stability scores. Forward reach distances were more in number followed by oblique and lateral reach distances among young Saudi adults