Effects of Modified Diaphragmatic Training on Gastroesophageal Reflux Disease Questionnaire Score, Diaphragmatic Excursion, and Maximum Inspiratory Pressure in Adults with Gastroesophageal Reflux Disease After COVID-19: A Single-Blinded Randomized Control.

BACKGROUND: Although diaphragmatic training has been shown to improve gastroesophageal reflux disease (GERD) symptoms, its effectiveness in adults with GERD after COVID-19 has not been evaluated. This study examined the effectiveness of modified diaphragmatic training (MDT) on GERD questionnaire (GERDQ) score, diaphragmatic excursion, and maximum inspiratory pressure (MIP) in adults with GERD after COVID-19. METHODS: This single-blinded randomized control trial was conducted at Persahabatan Hospital from February to April 2023. The medical records of 364 patients with persistent gastrointestinal symptoms were evaluated; among these potential participants, 302 had symptoms before, and 62 after, COVID-19 infection. Fifty of these patients fulfilled the study inclusion and exclusion criteria and were randomly assigned to the intervention (n = 25) or control (n = 25) groups. Four weeks of diaphragmatic training were followed by MDT or standard diaphragmatic training. A follow-up assessment was conducted 30 days after the beginning of the training. RESULTS: The GERDQ score was significantly decreased in the pre-post-intervention group (10.44 ± 2.00 vs 1.84 ± 2.17) and the control group (8.64 ± 0.57 vs 3.32 ± 1.49), with p < 0.001. The intervention group showed significant improvements in the right diaphragmatic excursion (RDE) (44% vs 11.87%), left diaphragmatic excursion (LDE) (46.61% vs 13.62%), and MIP (75.26% vs 23.97%) compared with the control group. CONCLUSION: MDT in adults after COVID-19 with GERD enhanced diaphragmatic excursion and MIP and decreased symptoms of gastroesophageal reflux by 8.60 points of GERDQ. Respiratory symptoms and other side effects were comparable between the groups.

Reference equation for prediction of a total distance during six-minute walk test using Indonesian anthropometrics.

AIM: to develop a reference equation for prediction of the total distance walk using Indonesian anthropometrics of sedentary healthy subjects. Subsequently, the prediction obtained was compared to those calculated by the Caucasian-based Enright prediction equation. METHODS: the cross-sectional study was conducted among 123 healthy Indonesian adults with sedentary life style (58 male and 65 female subjects in an age range between 18 and 50 years). Heart rate was recorded using Polar with expectation in the sub-maximal zone (120-170 beats per minute). The subjects performed two six-minute walk tests, the first one on a 15-meter track according to the protocol developed by the investigator. The second walk was carried out on Biodex®gait trainer as gold standard. RESULTS: an average total distance of 547±54.24 m was found, not significantly different from the gold standard of 544.72±54.11 m (p>0.05). Multiple regression analysis was performed to develop the new equation. CONCLUSION: the reference equation for prediction of the total distance using Indonesian anthropometrics is more applicable in Indonesia.

The Delphi Method: Developing a Telerehabilitation Practice Guideline for Patients in Indonesia with Long COVID.

Telerehabilitation has the potential to help expand the reach of rehabilitation intervention. An online questionnaire-based Delphi method set out to develop a telerehabilitation guideline for patients in Indonesia with Long COVID. A Delphi panel comprised of 24 experts was selected from all relevant disciplines. Over two rounds of Delphi testing, panelists gave opinions and indicated their level of agreement with each recommendation. Key elements of consensus for a telerehabilitation guideline for patients with Long COVID includes: the benefit of telerehabilitation, types of rehabilitation intervention needed, methods of intervention, criteria for home-based self-exercise training, set-up of rehabilitation prescription, exercise monitoring, evaluation of rehabilitation intervention and duration of rehabilitation intervention. Further research is needed to determine the feasibility and effectiveness of this guideline.

The correlation between six-minute walking distance and maximum phonation time in healthy adults.

Objectives: This study aimed to determine the association between six-minute walking distance (6MWD) and maximum phonation time (MPT) in healthy adults. Patients and methods: The cross-sectional study was conducted with 50 sedentary nonsingers (32 females, 18 males; mean age: 33.5±8.3 years; range, 18 to 50 years) between February 2021 and April 2021. Subjects with a history of smoking, respiratory symptoms in the last two weeks, and heart, lung, musculoskeletal, and balance problems were excluded. The measurements of MPT and 6MWD were carried out by two different assessors blinded to each other. Results: The mean MPT was higher in male subjects (27.4±7.4 sec vs. 20.6±5.1 sec, p<0.001). In the bivariate analysis, there was a significant correlation between MPT and 6MWD (r=0.621, p<0.001), as well as body height (r=0.421, p=0.002) and the mean fundamental frequency (r=-0.429, p=0.002); however, no association was found with age, body weight, and the mean sound pressure level. After multiple regression, 6MWD was the only factor associated with MPT (p=0.002). Conclusion: There is a significant association between 6MWD and MPT in healthy adults, and the results suggest that aerobic capacity might have a role in improving the ability to sustain phonation.

Validity and Reliability of the Indonesian Version of the Brief Fatigue Inventory in Cancer Patients.

CONTEXT: Cancer-related fatigue is one of the most commonly reported symptoms in cancer patients. Short but good assessment is essential to detect and manage this symptom. Brief Fatigue Inventory (BFI) is a valid and reliable short instrument to assess cancer-related fatigue. OBJECTIVE: To examine the validity and reliability of the Indonesian BFI. METHODS: Forward and backward translation approach, followed by cognitive debriefing process, was done to develop Indonesian BFI. One hundred twenty-one consecutive adult outpatients with cancer who are willing to participate in this study filled in Indonesian BFI along with the Medical Outcome Study Quality of Life Short Form 36 (MOS SF-36). Demographic and health data were collected. RESULTS: The Indonesian BFI had an overall Cronbach's alpha for the nine items of 0.956. The results of the factor analysis suggested a one-factor solution, supporting the hypothesis of unidimensionality of the Indonesian BFI. The Indonesian BFI score was compared with MOS SF-36 subscale to evaluate convergent validity. An expected inverse correlation between Indonesian BFI and all domains of MOS SF-36 was observed (r = -0.388 to -0.676; P < 0.0000). Discriminant validity analysis showed that the Indonesian BFI mean score significantly increased with increasing Eastern Cooperative Oncology Group Performance Status values (P = 0.000). CONCLUSION: Indonesian BFI is a reliable and valid instrument for Indonesian cancer patients.