Self-management of osteoarthritis while waiting for total knee arthroplasty during the COVID-19 pandemic among older Malaysians.

BACKGROUND: The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty (TKA) procedure, as well as the associations between the length of waiting time, pain, and physical frailty and function. The study focused on individuals aged 50 years and above, as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation. This study hypothesizes that delayed TKR due to coronavirus disease 2019 (COVID-19) will bear negative effect in self-management, pain, and physical frailty and function in older adults. AIM: To investigate the effects of COVID-19 pandemic on self-management, pain, and physical function in older adults awaiting TKA in Malaysia. METHODS: This cross-sectional study has the data of participants, who matched the criteria and scheduled for TKA for the first time, extracted from the TKA registry in the Department of Orthopaedics and Traumatology, Hospital Canselor Tuanku Mukhriz. Data on pain status, and self-management, physical frailty, and instrumental activities daily living were also collected. Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance. RESULTS: Out of 180 had deferred TKA, 50% of them aged 50 years old and above, 80% were women with ethnic distribution Malay (66%), Chinese (22%), Indian (10%), and others (2%) respectively. Ninety-two percent of the participants took medication to manage their pain during the waiting time, while 10% used herbs and traditional supplements, and 68% did exercises as part of their osteoarthritis (OA) self-management. Thirty-six participants were found to have physical frailty (strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire score > 4) which accounted for 72%. Increased pain was associated with physical frailty with odds ratio, odds ratio (95% confidence interval): 1.46 (1.04-2.05). This association remained significant even after the adjustment according to age and self-management. CONCLUSION: While deferring TKA during a pandemic is unavoidable, patient monitoring for OA treatment during the waiting period is important in reducing physical frailty, ensuring the older patients' independence.

The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study.

Background: Mobile health presents a promising alternative in the digital era. Mobile health apps (mHealth), when combined with the concept of self-management, are considered one of the methods for incorporating technology-based interventions into the healthcare system. Objective: This study aimed to determine the effect of mHealth (specifically, the Diabetic Care App) on foot care behavior, dietary behavior, foot condition, and fasting blood glucose levels among patients with uncontrolled diabetes mellitus. Methods: A single randomized controlled trial was conducted at a government-run primary clinic in Northern Malaysia, involving 58 patients with uncontrolled diabetes who were assigned to two groups. The intervention group received the Diabetic Care App, attended a 2-hour face-to-face session, and was included in a WhatsApp group, while the control group received standard care. Relevant assessments were conducted for both groups in Week 1 and Week 5. The study was conducted from February 2020 to November 2020, and parametric and non-parametric statistics were used for data analysis. Results: Pretest-posttest comparisons in both groups revealed significant findings for foot care behavior (p <0.01), dietary behavior (p <0.01), and foot condition (p <0.01), except for fasting blood glucose levels. In inter-group comparisons, a significant difference was observed only in foot care behavior (p <0.01) and dietary behavior (p <0.01). Conclusion: The results indicate that technology-based interventions are beneficial for modifying behavior, specifically in terms of foot care and dietary behavior, in this study. The study highlights the applicability of mHealth for nurses in patient education and self-management of chronic conditions. Future research should explore app utilization among patients with chronic conditions. Clinical trial registration number: NCT04260100 (registered at https://clinicaltrials.gov/ct2/show/NCT04260100).

Pretravelling Health-Seeking Behavior, Knowledge of Vaccines, and Attitudes Toward Travel Health among Malaysian Travelers.

Background: Travelers are at higher risk of developing health-related problems, especially travel-related diseases, and this remains a major public health burden. Aims: To assess pretravel health behavior-seeking factors, knowledge of vaccine, and travel health attitudes. A cross-sectional design among Malaysian travelers. Methods: An online survey was conducted from December 2017 till March 2018 among 226 participants. Demographic data, pretraveling health behaviors, knowledge of vaccine-preventable diseases, and travel health were asked. Independent t-test and ANOVA were performed using SPSS version 20. Results: Among travelers, 51.3% and 63.7% used health-related information on their destination before departure and collected information on possible travel hazards at their destination. Participant age (P = 0.02), monthly income (P = 0.01), predeparture health information (P = 0.03), information on possible hazards (P = 0.04), and travel health advice from medical professionals (P = 0.03) have been reported as a major predictor of knowledge of vaccine-preventable disease. Travelers' gender (P = 0.01), household income (P = 0.01), and travel health advice from professionals (P = 0.002) were significantly associated with travel health attitude. Conclusions: Sociodemographic and pretravel health-seeking behavior influence knowledge of vaccine-preventable disease and attitudes towards travel health which requires a public health need for community outreach programs targeting this group.

Perspectives of ESCAPE-Pain Programme for Older People With Knee Osteoarthritis in the Community Setting.

Background: Functional limitationscommonly affect patients with knee osteoarthritis (OA) which reduces quality of life. The Enabling Self-management and Coping with Arthritic Pain using Exercise (ESCAPE-pain) is an evidence-based programme identified to be suitable for adaptation for the Malaysian health care system. It is important to understand the acceptance from a sociocultural context of the ESCAPE-pain programme from the perspectives of patients with knee OA and healthcare professionals. This qualitative study aims to explore the perspectives of stakeholders to inform the adaptation of the ESCAPE-pain programme into the Malaysian health care system. Method: Semi-structured interviews using interview guides were conducted with 18 patients with knee OA and 14 healthcare professionals including nurses, physiotherapists, occupational therapists, medical doctors, and orthopedic surgeons. The data were transcribed and analyzed using framework analysis. Results: The findings show that patients and healthcare professionals positively accept the programme into their daily living activities and recommend some modifications related to the Malaysian context. This study also highlights strategies to adopt when providing ESCAPE-pain to patients with knee OA. Conclusion: The findings reveal how sociocultural considerations could facilitate uptake and engagement with the ESCAPE-pain programme for home exercise among patients with knee osteoarthritis. These findings may benefit t patients with knee OA in the Malaysian healthcare system, although future research is recommended.

The need for first aid education for adolescents

Objective: The objective of this study is to identify the need for basic first aid knowledge and skills among adolescents. Method: A cross-sectional study using multistage sampling was conducted among 375 secondary school students in Kuantan, Pahang, Malaysia. The survey was adapted from a Hong Kong Red Cross survey. A back to back translation of this instrument was carried out by two bilingual medical experts with Cronbach's alpha 0.8. The data were analyzed using SPSS (Statistical Package for the Social Sciences) in terms of descriptive analysis, and an independent t-test and chi-square test were carried out. Results: There were 149 respondents from the lower form (grade level) and 226 respondents from the upper form. The majority of respondents (81.6%) were Malay. An independent t-test revealed a significant association between knowledge and attitude, as students who scored higher on first aid questions showed a more positive attitude towards first aid (1.475%). There were also significant associations between race and experience learning first aid. Conclusions: Adolescents receive minimal first aid education. Thus, there is an urgent need to educate adolescents more in first aid to promote a safer community and to prevent any further injuries

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