Majalah Ilmiah Fisioterapi Indonesia (MIFI) — Indonesian Scientific Journal of Physiotherapy is a peer-reviewed scientific journal published by the Undergraduate and Professional Physiotherapy Study Program, Faculty of Medicine, Udayana University, in collaboration with the Indonesian Physiotherapy Association (IFI). The journal publishes original research articles, literature reviews, case reports, and systematic reviews in the fields of physiotherapy, rehabilitation, public health, and related health sciences. MIFI aims to serve as a platform for disseminating scientific knowledge, fostering the development of physiotherapy science, and strengthening collaboration among practitioners, academics, and researchers at both national and international levels.
Program Studi Sarjana Fisioterapi dan Profesi Fisioterapi, Fakultas Kedokteran, Universitas Udayana bersama Ikatan Fisioterapi Indonesia
Physiotherapy Outcomes in Chronic Femoral Osteomyelitis Following Reconstructive ORIF: A Case Report
Background: Chronic femoral osteomyelitis following Open Reduction and Internal Fixation (ORIF) is associated with prolonged immobilisation and persistent functional impairment. Evidence regarding physiotherapy during periods of active chronic infection remains limited. Objective: To describe the effects of a structured physiotherapy program on joint mobility, muscle strength, and lower extremity function in a patient with chronic femoral osteomyelitis after reconstructive ORIF. Methods: This CARE-compliant case report involved a 26-year-old female with chronic left femoral osteomyelitis. The patient received a three-week physiotherapy program consisting of Transcutaneous Electrical Nerve Stimulation, knee range-of-motion exercises, resistance-band strengthening, and stretching. Outcomes included knee range of motion, Manual Muscle Testing, and the Lower Extremity Functional Scale (LEFS). Data were analysed descriptively. Results: Active and passive knee flexion increased by 7° each. Quadriceps and hamstring muscle strength improved from grades 3+ and 3− to grade 4−. The LEFS score increased from 60 to 67. No adverse events were observed. Conclusion: Structured physiotherapy may be safely implemented and contribute to functional improvement in patients with chronic femoral osteomyelitis following reconstructive ORIF.
Copyright (c) 2026 Arum Cahyaningsih, Arif Pristianto, Prihantoro Larasati (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of DNS and SI Sensorimotor Exercises in a Child with Down Syndrome: A Case Study
Introduction: Sitting and crawling are essential milestones in gross motor development. Children with Down syndrome frequently experience delays due to hypotonia and impaired sensory integration, leading to difficulties in coordination and postural control. Dynamic Neuromuscular Stabilization (DNS) and Sensory Integration (SI) approaches aim to stimulate neuromuscular and sensory systems to enhance motor development. Objective: This study aimed to describe the effects of a combined Dynamic Neuromuscular Stabilization and Sensory Integration intervention on gross motor function, primitive reflex maturation, and sensory responses in a child with Down syndrome. Methods: This descriptive case study involved a 2-year-old male with delayed sitting and crawling abilities. The intervention consisted of four sessions over one month, including gym ball activities, quadruped and squat positions (DNS), and structured sensory activities (SI). Assessments included the Gross Motor Function Measure (GMFM) for Dimensions A and B, primitive reflex testing, and sensory response observation. Results: GMFM Dimension A scores improved from 68.8% to 91.2%, and Dimension B from 43.3% to 76.7%. Primitive reflexes, including the Asymmetrical Tonic Neck Reflex (ATNR) and palmar grasp reflex, decreased from positive to negative. Sensory responses showed notable improvement, particularly in vestibular, tactile, and auditory systems. Conclusion: Combining DNS and SI approaches demonstrated positive effects on gross motor function, reflex maturation, and sensory integration in a child with Down syndrome. These findings highlight the potential of integrated sensorimotor interventions in addressing developmental delays associated with Down syndrome.
Copyright (c) 2026 Nova Ayu Aisyah, Dimas Arya Nugraha, Diah Rosyida Maulidina (Author) https://creativecommons.org/licenses/by/4.0
Association of body mass index and body fat with agility and power: A cross-sectional study
Introduction: Body composition is a key determinant of athletic performance, particularly in soccer, where it influences strength, agility, and overall physical capacity. Body composition can be assessed through body mass index (BMI), body fat percentage, and muscle mass. Objective: This study aimed to examine the association of BMI and body fat percentage with agility and lower-limb explosive power in university soccer players. Methods: This cross-sectional analytical study employed purposive sampling and was conducted in March 2024 at the Hasanuddin University Soccer Student Activity Unit. BMI and body fat percentage were assessed using the Karada Scan, agility was measured with the Illinois Agility Test, and lower-limb explosive power was evaluated using the Vertical Jump Test. Results: A total of 45 respondents participated in the study. The mean BMI was 20.65 kg/m² (within the normal range), mean body fat percentage was 12.70% (normal), mean agility score was 18.24 seconds (moderate), and mean vertical jump height was 50.20 cm (fair). Correlation analysis using Somers’ D revealed no statistically significant associations between BMI and body fat percentage with either agility or lower-limb explosive power (p = 0.412). Conclusion: No significant associations were found between BMI and body fat percentage with agility or lower-limb explosive power in university soccer players. These findings suggest that factors beyond body composition may play a greater role in determining agility and explosive performance in soccer athletes.
Copyright (c) 2026 Kezia Febryanti Mustamu, Irianto2 (Author) https://creativecommons.org/licenses/by/4.0
Neuromuscular Physiotherapy Management for Paraplegia due to Non-traumatic Spinal Cord Injury: A Case Report
Introduction: Non-traumatic spinal cord injury (SCI) refers to damage of the spinal cord without direct trauma, commonly caused by infection, tumor, vascular disorders, or degenerative conditions. Lesions at the thoracolumbar junction (Th12–L1) may result in paraplegia characterized by motor and sensory impairment below the level of injury, including lower limb weakness, impaired bladder and bowel control, reduced balance, and functional limitations. Patients are also at risk of secondary complications such as muscle weakness, spasms, restricted range of motion, contractures, and pressure ulcers. Physiotherapy plays a central role in rehabilitation through interventions aimed at preserving and improving body function, preventing complications, and promoting independence. Multimodal interventions may include infrared radiation (IRR), neuromuscular electrical stimulation (NMES), manual therapy, exercise therapy, and breathing exercises. Objective: To describe the early clinical response to a multimodal neuromuscular physiotherapy program in a patient with paraplegia due to non-traumatic spinal cord injury at the Th12–L1 level. Methods: This case report describes a 45-year-old female patient diagnosed with paraplegia due to non-traumatic SCI at the Th12–L1 vertebrae, treated at the Physio Sakti Clinic, Makassar. Results: After two physiotherapy sessions, pain intensity decreased substantially, anxiety levels improved, and initial lower-limb muscle activation was observed (MMT: 0→1 in selected muscle groups). These findings highlight the early positive effects of multimodal physiotherapy on pain control and functional recovery. Conclusion: Early neuromuscular physiotherapy using a multimodal approach can provide meaningful benefits in restoring initial function and enhancing mobility in patients with paraplegia caused by non-traumatic SCI.
Copyright (c) 2026 Annisa’ Rezky Ramadhina (Author) https://creativecommons.org/licenses/by/4.0
Comparative Effects of Balance and Otago Exercises on Fall Risk in Older Adults: A Quasi-Experimental Study
Background: Falls are a major public health problem among older adults, leading to injury, functional decline, and reduced quality of life. Balance Exercise and the Otago Exercise Programme are commonly used exercise-based interventions to reduce fall risk, yet direct comparative evidence remains limited. Objective: To compare the effects of Balance Exercise and the Otago Exercise Programme on fall risk among older adults. Methods: This quasi-experimental pre-test–post-test two-group study included 20 community-dwelling older adults aged 60–75 years with Timed Up and Go (TUG) Test scores >12 seconds. Participants were allocated to a Balance Exercise group (n = 10) or an Otago Exercise Programme group (n = 10). Both interventions were performed three times weekly for four weeks. Fall risk was assessed using the TUG Test. Paired and independent sample t-tests were applied (p < 0.05). Results: Both groups showed significant reductions in TUG scores after the intervention (Balance Exercise: mean reduction = 3.00 seconds, p < 0.001; Otago Exercise Programme: mean reduction = 2.40 seconds, p < 0.001). No significant between-group difference was found in post-intervention TUG scores (mean difference = 0.90 seconds, p = 0.316). Conclusion: Balance Exercise and the Otago Exercise Programme were similarly associated with improved functional mobility in older adults. Given the quasi-experimental design, results should be interpreted as comparative associations rather than causal effects. Both interventions may be considered feasible options for fall risk reduction in community settings.
Copyright (c) 2026 Deasy Virka Sari, Virginia Eka Putri A. Baharudin, Ragil Aidil Fitriasari Addini (Author) https://creativecommons.org/licenses/by/4.0
Quasi-Experimental Comparison of Resistance Band Exercise and Tandem Walking on Dynamic Balance in Community-Dwelling Older Adults
Background: Age-related decline in dynamic balance is a major contributor to falls and functional limitations among older adults. Exercise-based physiotherapy interventions, including resistance band exercise and tandem walking, are frequently implemented in community settings; however, evidence directly comparing their effectiveness remains limited. Objective: To compare the effects of resistance band exercise and tandem walking on dynamic balance in community-dwelling older adults. Methods: A quasi-experimental non-randomized comparative study was conducted among 30 community-dwelling older adults aged 60–75 years with impaired dynamic balance, defined as a Timed Up and Go Test (TUGT) score greater than 10 seconds. Participants were allocated to a resistance band exercise group (n = 15) and a tandem walking group (n = 15). Both interventions were administered twice weekly for six weeks under supervised conditions. Dynamic balance was assessed using the TUGT. Within-group changes were analyzed using paired t-tests, and between-group differences were examined using independent t-tests. Effect sizes were calculated using Cohen’s d. Results: Both intervention groups demonstrated significant improvements in dynamic balance after six weeks (p < 0.001). The resistance band exercise group showed a greater reduction in TUGT completion time compared with the tandem walking group, with a statistically significant between-group difference (p = 0.045; Cohen’s d = 0.62). Conclusion: Both resistance band exercise and tandem walking may be beneficial for improving dynamic balance in community-dwelling older adults. Resistance band exercise demonstrated a greater magnitude of improvement; however, findings should be interpreted cautiously due to the non-randomized design.
Copyright (c) 2026 Yessa Kristia Dhikta, ⁠Ragil Aidil FA, Mianti Nurrizky Sutejo, Laksmita Dewi Adzillina (Author) https://creativecommons.org/licenses/by/4.0
Psychological Stress, Sleep Quality, and Blood Pressure in Young Adults: Cross-Sectional Study
Background: Blood pressure regulation is influenced not only by biological and lifestyle factors but also by psychological and behavioral determinants, including psychological stress and sleep quality. Chronic stress and sleep disturbances may activate the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis, contributing to elevated blood pressure even in young adulthood. Objective: To examine the association between psychological stress, sleep quality, and blood pressure among young adults aged 20–40 years. Methods: This observational cross-sectional study was conducted in Pandanan Village, Klaten Regency, Central Java, Indonesia, from March to May 2025. A total of 100 adults aged 20–40 years were recruited using purposive sampling. Psychological stress was assessed using the Perceived Stress Scale (PSS), sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), and blood pressure was measured using a calibrated digital sphygmomanometer. Blood pressure categories were defined according to international standards. Associations were analyzed using the chi-square test with a significance level of 0.05. Results: Psychological stress was significantly associated with blood pressure status (p = 0.004), with a higher prevalence of elevated blood pressure observed among participants reporting severe to very severe stress levels. Sleep quality was also significantly associated with blood pressure (p < 0.001), with poor sleep quality predominating among participants with elevated blood pressure. Conclusion: Higher psychological stress levels and poor sleep quality are significantly associated with elevated blood pressure among young adults. These findings highlight the importance of stress management and sleep quality improvement as components of early, non-pharmacological strategies for blood pressure control.
Copyright (c) 2026 Indah Mutiara Barokah, Wahyu Tri Sudaryanto (Author) https://creativecommons.org/licenses/by/4.0
Association Between Anxiety and Hypertension in Working-Age Adults: A Cross-Sectional Study
Background: Anxiety is a prevalent psychological condition that activates neuroendocrine stress pathways and may contribute to blood pressure dysregulation. Hypertension remains a major global public health concern and is frequently undiagnosed among working-age adults, who are commonly exposed to substantial psychosocial stressors. Objective: To examine the association between anxiety levels and hypertension among working-age adults in Kartasura District, Sukoharjo Regency, Indonesia. Methods: This community-based cross-sectional study included 219 adults aged 22–59 years, recruited using consecutive non-random sampling. Anxiety levels were assessed using the Zung Self-Rating Anxiety Scale, while blood pressure was measured with a calibrated digital sphygmomanometer. Hypertension was categorized according to national clinical guidelines. Data were analyzed using Kendall’s tau-b correlation test with a significance level of 0.05. Results: Most participants reported mild to moderate anxiety, and more than 40% were classified as hypertensive. A statistically significant and strong positive correlation was observed between anxiety level and hypertension severity (r = 0.626; 95% CI 0.55–0.70; p < 0.001), indicating that higher anxiety scores were consistently associated with higher blood pressure categories. Conclusion: Anxiety levels are strongly associated with hypertension among working-age adults. These findings highlight the importance of integrating psychological assessment and stress management into hypertension prevention and control strategies, particularly within primary care and physiotherapy-based services.
Copyright (c) 2026 Puspita Salwa Septa Wina, Wahyu Tri Sudaryanto (Author) https://creativecommons.org/licenses/by/4.0
Association of Primary Dysmenorrhea with Stress and Sleep Quality Among Adolescent Girls: A Cross-Sectional Study
Background: Primary dysmenorrhea is a highly prevalent reproductive health problem among adolescent girls and may affect not only physical well-being but also psychological stress and sleep quality. Persistent menstrual pain may trigger stress responses and sleep disturbances through neuroendocrine and behavioral mechanisms. Objective: This study aimed to examine the association between primary dysmenorrhea severity, perceived stress, and sleep quality among adolescent girls. Methods: An observational cross-sectional study was conducted among 222 adolescent girls residing in an Islamic boarding school in Surakarta, Indonesia. Primary dysmenorrhea severity was assessed using the Numeric Rating Scale (NRS), stress levels were measured using the Perceived Stress Scale–10 (PSS-10), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using Spearman’s rank correlation test with a significance level of 0.05. Results: Most participants reported severe primary dysmenorrhea (64.4%), high stress levels (54.5%), and poor sleep quality (84.2%). Primary dysmenorrhea severity showed a significant positive correlation with stress level (r = 0.571; p < 0.001), indicating a moderate-to-strong association. A significant moderate association was also observed between primary dysmenorrhea severity and sleep quality (r = 0.440; p < 0.001). Conclusion: Primary dysmenorrhea is significantly associated with increased stress levels and poorer sleep quality among adolescent girls. These findings underscore the importance of incorporating psychological stress management and sleep-related strategies into holistic, non-pharmacological approaches for managing primary dysmenorrhea in adolescents.
Copyright (c) 2026 Lintang Cahya Ningrum, Wahyu Tri Sudaryanto (Author) https://creativecommons.org/licenses/by/4.0
Transcutaneous Electrical Nerve Stimulation for Pain and Function in Knee Osteoarthritis: A Narrative Review
Background: Knee osteoarthritis (OA) is a common degenerative joint condition associated with chronic pain and functional limitations, particularly among adults and older populations. Transcutaneous Electrical Nerve Stimulation (TENS) is widely used in physiotherapy as a non-pharmacological intervention, yet its clinical effectiveness in mild to moderate knee OA remains inconsistent. Objective: This narrative review aimed to summarize and critically discuss recent clinical evidence on the effects of TENS on pain and physical function in individuals with mild to moderate knee osteoarthritis. Methods: A narrative literature review was conducted using targeted searches of PubMed and ScienceDirect. Clinical studies published between 2020 and 2025 that investigated TENS interventions and reported pain and/or physical function outcomes were included. Evidence was synthesized descriptively without systematic selection or quantitative pooling. Results: Recent randomized controlled trials suggest that TENS may provide short-term pain relief and support functional performance in knee osteoarthritis. Treatment effects varied according to individual characteristics, stimulation parameters, and rehabilitation context, with more consistent functional benefits observed when TENS was combined with exercise. Conclusion: TENS appears to be a safe adjunctive modality for pain management and functional support in mild to moderate knee osteoarthritis. However, heterogeneity across studies limits definitive conclusions, and further research is needed to optimize clinical application.
Transcutaneous Electrical Nerve Stimulation
Copyright (c) 2026 I Gede Putu Wahyu Mahendra, Sayu Aryantari Putri Thanaya (Author) https://creativecommons.org/licenses/by/4.0
Effect of the 4-7-8 Breathing Technique on Sleep Quality in University Students: A Quasi-Experimental Controlled Study
Background: University students are at high risk of poor sleep quality due to academic demands, psychological stress, and irregular sleep schedules. Non-pharmacological relaxation strategies, such as the 4-7-8 breathing technique, have been proposed to improve sleep quality by promoting autonomic regulation and relaxation. Objective: This study aimed to examine the effect of the 4-7-8 breathing technique on sleep quality among university students. Methods: A quasi-experimental pretest–posttest controlled study was conducted involving 110 undergraduate physiotherapy students. Participants were allocated into an intervention group (n = 55) and a control group (n = 55). The intervention group performed the 4-7-8 breathing technique twice daily for 14 consecutive days, while the control group received no intervention. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Within-group changes were analyzed using paired t-tests, and between-group differences were evaluated using independent t-tests, with a significance level of α = 0.05. Results: The intervention group demonstrated a significant reduction in PSQI scores from 9.5 ± 3.5 at baseline to 5.7 ± 2.9 post-intervention (t = 7.108, p < 0.001; 95% CI: 4.9–6.5), with a large effect size (Cohen’s d = 0.95). No significant change was observed in the control group. Post-intervention comparisons showed significantly better sleep quality in the intervention group compared with the control group (t = 3.910, p < 0.001; Cohen’s d = 0.75). Conclusion: The 4-7-8 breathing technique significantly improves sleep quality among university students and may serve as an effective, safe, and accessible non-pharmacological intervention.
Copyright (c) 2026 Dinda Mualifah, Isnaini Herawati (Author) https://creativecommons.org/licenses/by/4.0
Clinical Effects of Active Cycle of Breathing Technique in COPD: A Case Report
Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation, dyspnea, and reduced physical capacity. The Active Cycle of Breathing Technique (ACBT) is a physiotherapy intervention aimed at improving ventilation, airway clearance, and functional capacity. Objective: To describe the clinical effects of ACBT on cardiorespiratory fitness and dyspnea severity in patients with COPD. Methods: This case report followed the CARE Guidelines and involved two patients with COPD treated at a primary healthcare center in Surakarta, Indonesia. ACBT, consisting of breathing control, thoracic expansion, and huffing, was administered twice daily for two weeks. Outcomes assessed before and after the intervention included blood pressure, oxygen saturation, the Six-Minute Walk Test (6MWT), and dyspnea severity using the modified Medical Research Council (mMRC) Dyspnea Scale. Results: Both patients demonstrated improvements in walking distance on the 6MWT, exceeding the minimal clinically important difference (25–33 m). Oxygen saturation remained stable in both patients. Patient 1 achieved a 6MWT distance of 300 m, while Patient 2 achieved 210 m. Changes in blood pressure reflected individual physiological responses. Conclusion: ACBT was associated with improved functional exercise capacity and stable oxygen saturation in two patients with COPD. Further studies with larger samples are needed to confirm these findings.
Copyright (c) 2026 Andini Sukma Ayu, Isnaini Herawati (Author) https://creativecommons.org/licenses/by/4.0
Correlation Between Lipid Profiles and Chronic Low Back Pain: A Systematic Review
Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide. Emerging evidence suggests that metabolic factors, particularly lipid profile abnormalities, may contribute to the pathogenesis of CLBP through vascular, inflammatory, and degenerative mechanisms. Objective: To systematically review the association between lipid profiles and chronic low back pain. Methods: A systematic review was conducted in six electronic databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar) following PRISMA 2020 guidelines. Observational and genetic epidemiological studies published between 2020 and 2025 examining lipid parameters (total cholesterol, LDL-C, HDL-C, triglycerides, and lipid subclasses) in adults with CLBP were included. Study quality was appraised using a STROBE-based checklist. Results: Ten studies met the inclusion criteria. Large population-based studies demonstrated that low HDL-C levels and elevated LDL-C/HDL-C ratios were associated with an increased risk of CLBP (odds ratios ranging from approximately 1.15 to 1.34). Mendelian randomization analyses consistently indicated a protective causal effect of genetically higher HDL-C on low back pain risk (OR ≈ 0.92). Lipidomic studies further revealed increased monoacylglycerol and diacylglycerol levels, alongside reduced triacylglycerol levels, suggesting altered lipid metabolism and low-grade inflammation in CLBP. Conclusion: Dyslipidemia, particularly low HDL-C and atherogenic lipid patterns, is consistently associated with chronic low back pain. Lipid profiles may serve as complementary risk markers in CLBP assessment and support a multidisciplinary management approach integrating metabolic, biomechanical, and lifestyle interventions.
Copyright (c) 2026 Sulista Putri (Author) https://creativecommons.org/licenses/by/4.0
Balance Training and Aerobic Exercise in Diabetic Peripheral Neuropathy: A Systematic Review
Background: Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus in older adults and is associated with impairments in balance, mobility, and functional capacity that negatively affect quality of life. Objective: To evaluate the effectiveness of balance training and aerobic exercise on quality of life and related functional outcomes in older adults with diabetic peripheral neuropathy. Methods: This systematic review followed the PRISMA 2020 guidelines. Literature searches were conducted in PubMed, Google Scholar, SAGE, and ScienceDirect for randomized controlled trials published between 2020 and 2025. Studies involving balance training and/or aerobic exercise in older adults or patients with DPN were included. Methodological quality was assessed using the PEDro scale. Due to heterogeneity across studies, a narrative synthesis was performed. Results: Seven randomized controlled trials involving 382 participants were included from 993 identified records. Balance training consistently improved postural control, balance stability, and functional mobility, while aerobic exercise demonstrated beneficial effects on glycemic control, cardiovascular capacity, and walking performance. Multimodal interventions combining balance and aerobic exercise produced broader improvements in functional outcomes and quality-of-life domains than single interventions. Conclusion: Balance training and aerobic exercise are effective in improving functional performance and quality of life in older adults with diabetic peripheral neuropathy and should be considered integral components of rehabilitation programs.
Copyright (c) 2026 Farita Adhynda Amithya, Dwi Rosella Komalasari, Safari Wahyu Jatmiko (Author) https://creativecommons.org/licenses/by/4.0
Effect of Traditional Hopscotch Game on Lower Limb Muscle Power in Early Childhood: A Quasi-Experimental Study
Background: Lower limb muscle power is a key component of gross motor development in early childhood, particularly for jumping-related activities. Although the traditional hopscotch game has been shown to enhance motor performance, evidence in early childhood populations remains limited. Objective: To determine the effect of the traditional hopscotch game on lower limb muscle power in children aged 4–6 years. Methods: A quasi-experimental non-randomized two-group pretest–posttest study was conducted involving 36 children aged 4–6 years. Participants were allocated into an intervention group (n = 18) and a control group (n = 18). The intervention group performed hopscotch play twice weekly for four weeks, while the control group continued routine school activities. Lower limb muscle power was assessed using the vertical jump test. Data were analyzed using paired and independent sample t-tests with a significance level of 0.05, and effect sizes were calculated using Cohen’s d. Results: The intervention group showed a significant improvement in vertical jump performance (p < 0.001; Cohen’s d = 1.00), whereas no significant change was observed in the control group (p = 0.245; Cohen’s d = 0.28). Post-intervention comparison revealed a significant difference between groups favoring the intervention (p < 0.001; Cohen’s d = 1.91). Conclusion: The traditional hopscotch game significantly improves lower limb muscle power in children aged 4–6 years and can be recommended as a simple, safe, and play-based physical activity in kindergarten settings.
Copyright (c) 2026 Salma Fadila Nisa, Mahendra Wahyu Dewangga, Rinna Ainul Maghfiroh (Author) https://creativecommons.org/licenses/by/4.0
Craniovertebral Angle and Postural Control in Forward Head Posture: A Narrative Review
Background: Forward head posture (FHP) is a common postural disorder characterized by altered cervical alignment that may impair neuromuscular function and postural control. Craniovertebral angle (CVA) is widely used as an objective indicator to quantify FHP severity. Objective: To analyze the relationship between CVA and postural control and to identify patterns and research gaps in the literature. Methods: A narrative literature review was conducted using PubMed and ScienceDirect to identify studies published between 2015 and 2025. Eligible articles were original human studies involving individuals with FHP that reported CVA measurements and postural control outcomes. Included study designs comprised randomized controlled trials, cross-sectional studies, and case–control studies. Data were synthesized descriptively. Results: Nine studies were included (five randomized controlled trials, two cross-sectional studies, and two case control studies), involving 26–160 participants. Individuals with FHP consistently demonstrated smaller CVA values (approximately 41°- 46°) compared with controls (approximately 53°-55°). Smaller CVA values were associated with increased postural sway, higher overall stability index, and greater cervical proprioceptive error. Intervention studies showed that improvements in cervical alignment were accompanied by increases in CVA and clinically meaningful improvements in balance, trunk control, and proprioception. In addition, one case-control EEG/EMG study reported increased corticomuscular coherence during challenging balance conditions, indicating compensatory neural strategies in individuals with FHP. Conclusion: Reduced CVA is consistently associated with impaired postural control. Improving cervical alignment may enhance balance and neuromuscular function, supporting the relevance of CVA in postural assessment and rehabilitation
Copyright (c) 2026 Anida Azkia Fitri, Umi Budi Rahayu, Wahyuni (Author) https://creativecommons.org/licenses/by/4.0
Physical Activity and Musculoskeletal Complaints in Older Adults: A Cross-Sectional Study
Background: Musculoskeletal complaints are common among older adults and may interfere with daily functioning. Physical activity is widely promoted to maintain health in older populations; however, inappropriate intensity may be associated with musculoskeletal complaints, particularly in community-dwelling older adults. Objective: To examine the association between physical activity level and musculoskeletal complaints among older adults in Badung, Bali. Methods: This observational study employed a cross-sectional design and involved 50 community-dwelling older adults aged ≥60 years, recruited using total sampling in February 2025. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), while musculoskeletal complaints were measured using the Nordic Body Map (NBM). Data were analyzed using the chi-square test, and the magnitude of association was expressed as a prevalence ratio (PR) with a 95% confidence interval (CI). Results: A significant association was observed between physical activity level and musculoskeletal complaints (p = 0.001). Older adults with higher levels of physical activity showed a higher prevalence of musculoskeletal complaints compared to those with moderate physical activity. Conclusion: Physical activity level was significantly associated with musculoskeletal complaints among older adults. These findings indicate the importance of appropriate physical activity regulation and monitoring in older populations to minimize musculoskeletal complaints.
Copyright (c) 2026 Luh Putu Wulan Aristina Dewi, I Putu Astrawan, I Gusti Ngurah Mayun, Ida Ayu Astiti Suadnyana (Author) https://creativecommons.org/licenses/by/4.0
Walking Exercise in Phase II Cardiac Rehabilitation After PCI: A Case Report
Background: Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality. Despite successful revascularization with percutaneous coronary intervention (PCI), many patients experience reduced functional capacity, underscoring the importance of structured cardiac rehabilitation. Objective: To describe the implementation of walking exercise in phase II cardiac rehabilitation and its effects on functional capacity in a patient following PCI. Methods: This case report involved a 61-year-old woman diagnosed with CAD two-vessel disease after PCI. The patient participated in a phase II cardiac rehabilitation program consisting of supervised walking exercise performed 3–5 times per week for 30–60 minutes at moderate intensity (40–60% heart rate reserve or rating of perceived exertion 11–13), combined with a home-based program. Outcome measures included vital signs, the 6-Minute Walking Test (6MWT), estimated maximal oxygen uptake (VO₂max), and metabolic equivalents (METs). Results: After six supervised rehabilitation sessions, the 6MWT distance increased from 396 m to 510 m. Estimated VO₂max improved from 22.4 to 27.3 mL·kg⁻¹·min⁻¹, and METs increased from 6.4 to 7.8. No adverse events or cardiovascular complications were observed during the intervention period. Conclusion: Walking exercise as part of phase II cardiac rehabilitation was safe and associated with clinically meaningful improvements in aerobic capacity and functional tolerance in a patient after PCI.
Copyright (c) 2026 Fitri Aulia Naufal, Farid Rahman, Ridwan Andi Susilo (Author) https://creativecommons.org/licenses/by/4.0
Effect of 4-7-8 Breathing Exercise on Anxiety in University Students: A Quasi-Experimental Controlled Study
Background: Anxiety is common among university students and may negatively affect academic performance and psychological well-being. Simple, safe, and self-administered non-pharmacological interventions are therefore needed, one of which is the 4-7-8 breathing exercise. Objective: To examine the effect of the 4-7-8 breathing exercise on anxiety levels among undergraduate physiotherapy students. Methods: This quasi-experimental pretest–posttest study with a non-randomized control group was conducted in October 2025 at a physiotherapy undergraduate program. A total of 110 students were recruited using purposive sampling and allocated into an experimental group (n=55) and a control group (n=55). The experimental group performed the 4-7-8 breathing exercise for 14 days with a duration of 2 minutes per session, while the control group received no intervention. Anxiety levels were assessed using the Zung Self-Rating Anxiety Scale. Data were analyzed using Wilcoxon signed-rank and Mann–Whitney U tests with a significance level of p<0.05. Results: The experimental group showed a significant reduction in anxiety scores, with the median decreasing from 47 (IQR 45–51) at baseline to 30 (IQR 22–45) post-intervention (Z=−6.230; p<0.001; r=0.84). No significant change was observed in the control group (p=0.108). Post-intervention anxiety scores were significantly lower in the experimental group than in the control group (Z=−6.846; p<0.001; r=0.65). Conclusion: The 4-7-8 breathing exercise is effective in reducing anxiety among university students and may serve as a practical non-pharmacological strategy for anxiety management in academic settings.
Copyright (c) 2026 Vivin Dwi Febriyanti, Isnaini Herawati (Author) https://creativecommons.org/licenses/by/4.0
Flexible Tubing Modification of Jet Nebulizers in Supine Patients: A Crossover Pilot Trial
Background: Jet nebulizers are widely used in patients with respiratory disorders such as chronic obstructive pulmonary disease, asthma, and pneumonia. Their effectiveness depends on maintaining the medication cup in an upright position, which limits use in supine patients or those unable to sit upright. This limitation often reduces comfort and treatment efficiency, indicating the need for a more flexible device design. Objective: To develop a flexible tubing modification for a jet nebulizer and to evaluate its feasibility and preliminary effectiveness through expert judgment and an in vivo pilot crossover trial. Methods: This study employed a Research and Development approach using the MANTAP model, followed by a randomized crossover pilot trial. Product feasibility was assessed through expert judgment involving pulmonologists, physiotherapists, and academic experts. Six hospitalized patients received both standard and modified jet nebulizer interventions in randomized order with a 48-hour washout period. Patient satisfaction was measured using the Patient Satisfaction and Preference Questionnaire, and nebulization duration was recorded. Data were analyzed using the Wilcoxon signed-rank test. Results: Expert evaluation confirmed that the modified nebulizer was feasible for clinical use. Patient satisfaction was significantly higher with the modified device than with the standard nebulizer (Z = −2.232; p = 0.026). Nebulization duration was also significantly shorter with the modified design (Z = −1.992; p = 0.046). Conclusion: The flexible tubing modification of a jet nebulizer improved patient satisfaction and reduced treatment duration compared with the standard design, demonstrating potential benefits for nebulization therapy in supine patients.
Copyright (c) 2026 Zahrina Alyani Firdaus, Isnaini Herawati (Author) https://creativecommons.org/licenses/by/4.0
Effect of Inspiratory Muscle Training on Peak Expiratory Flow After Thoracic Surgery: A Case Report
Background: Post-thoracic surgery patients commonly experience respiratory muscle dysfunction, reduced lung volumes, impaired cough effectiveness, and decreased peak expiratory flow. Inspiratory muscle training using incentive spirometry is widely applied in pulmonary rehabilitation to facilitate postoperative recovery. However, evidence describing its short-term effects on peak expiratory flow with daily monitoring remains limited. Objective: To evaluate the effect of inspiratory muscle training using incentive spirometry on peak expiratory flow in a post-thoracic surgery patient. Methods: This case report involved a 40-year-old male patient who underwent thoracic surgery for spontaneous pneumothorax and lung cancer. The patient presented with dyspnea, postoperative pain, and altered breathing patterns. Inspiratory muscle training using incentive spirometry was administered twice daily for 10 consecutive days. Peak expiratory flow was measured before and after the intervention using a peak flow meter. Pain and dyspnea were assessed using the Wong–Baker Faces Pain Rating Scale and the Borg Scale. Results: Peak expiratory flow increased from 100 L/min to 350 L/min after 10 days of intervention. Pain scores decreased from 5/10 to 2/10, and dyspnea scores improved from 7 (very severe) to 2 (mild). The average daily improvement in peak expiratory flow was 25 L/min. Conclusion: Inspiratory muscle training using incentive spirometry improved peak expiratory flow and alleviated pain and dyspnea in a post-thoracic surgery patient, supporting its role in early postoperative pulmonary rehabilitation.
Copyright (c) 2026 Astrid Risma Priyanka, Isnaini Herawati (Author) https://creativecommons.org/licenses/by/4.0
Phase II Cardiac Rehabilitation Using Treadmill and Cycle Ergometer: A Case Report
Background: Congestive heart failure (CHF) is characterized by impaired cardiac output, leading to reduced aerobic capacity and functional limitation. Phase II cardiac rehabilitation is recommended to improve cardiopulmonary function after coronary artery bypass grafting (CABG). Objective: To evaluate the effects of a Phase II cardiac rehabilitation program using treadmill and cycle ergometer exercise on aerobic capacity in a patient with CHF due to three-vessel coronary artery disease (CAD) after CABG. Methods: This case report involved a 52-year-old male with CHF et causa CAD three-vessel disease following CABG. The patient participated in a supervised Phase II cardiac rehabilitation program consisting of treadmill walking and cycle ergometer training, performed 3–5 sessions per week over five sessions, with each session lasting 20–60 minutes. Aerobic capacity was assessed using the 6-Minute Walk Test (6MWT), metabolic equivalents (METs), Borg Rating of Perceived Exertion, and vital signs measured before and after the intervention. Results: Aerobic capacity improved, with METs increasing from 4.13 to 4.90 (+18.6%) and 6MWT distance increasing from 350 m to 441 m (+26.0%). Hemodynamic parameters remained stable throughout the intervention, and no adverse events or exercise intolerance were observed. Conclusion: Phase II cardiac rehabilitation using treadmill and cycle ergometer exercise was safe and effective in improving aerobic capacity and functional tolerance in a patient with CHF after CABG.
Copyright (c) 2026 Fauzia Alya Putri, Farid Rahman, Kadek Agustini Aryani (Author) https://creativecommons.org/licenses/by/4.0
Effects of balance-strength training on balance and quality of life in type 2 diabetes: a quasi-experimental study
Background: Individuals with type 2 diabetes mellitus (T2DM) frequently experience balance impairment, which adversely affects mobility and quality of life (QoL). Objective: To evaluate the effects of a combined balance and lower-extremity strength training program on balance performance and quality of life in individuals with T2DM. Methods: This non-randomized quasi-experimental pre–post control group study was conducted in community health centers and included 34 individuals with T2DM (intervention n = 17; control n = 17). Balance performance, assessed using the Timed Up and Go (TUG) test, was the primary outcome, while quality of life was measured using the WHOQOL-BREF questionnaire. The intervention group performed structured static–dynamic balance and lower-extremity strengthening exercises three times per week for six weeks, whereas the control group exercised once weekly. Data were analyzed using paired and independent t-tests or non-parametric equivalents, with effect sizes reported. Results: The intervention group demonstrated a significant reduction in TUG time (mean change = −2.76 ± 1.10 s; d = 2.51; p < 0.001). Significant improvements were observed in the physical (d = 0.81; p = 0.004) and environmental domains (r = 0.74; p = 0.002), as well as in the total WHOQOL-BREF score (r = 0.69; p = 0.005). Between-group analyses showed greater improvements in TUG (d = 1.40; p < 0.001), environmental domain (d = 0.63; p < 0.001), and total WHOQOL-BREF score (p = 0.032). Conclusion: A six-week balance and lower-extremity strength training program effectively improved balance and selected QoL domains in individuals with T2DM.
Copyright (c) 2026 Larasati, Dwi Rosella Komala Sari (Author) https://creativecommons.org/licenses/by/4.0
Physical Activity and Sleep Quality in Relation to Blood Pressure Among Young Adults: A Cross-Sectional Study
Introduction: Blood pressure is a key indicator of cardiovascular health and is strongly influenced by lifestyle-related factors, particularly physical activity and sleep quality. Insufficient physical activity and poor sleep quality have been associated with impaired blood pressure regulation through neurohormonal and metabolic mechanisms; however, empirical evidence examining these relationships among young adults, especially university students, remains limited. Objective: This study aimed to examine the relationship between physical activity, sleep quality, and blood pressure among young adult students at the Faculty of Health Sciences, Universitas Muhammadiyah Surakarta. Methods: A quantitative observational study with a cross-sectional design was conducted involving 100 students aged 18–40 years. Physical activity was assessed using the International Physical Activity Questionnaire, sleep quality was measured using the Pittsburgh Sleep Quality Index, and blood pressure was measured using a digital sphygmomanometer. Data were analyzed using Spearman correlation, with systolic blood pressure as the primary outcome. Results: The findings demonstrated a significant negative correlation between physical activity and systolic blood pressure (r = –0.481; p < 0.001). Sleep quality also showed a significant negative correlation with systolic blood pressure (r = –0.257; p = 0.010). Conclusion: Higher levels of physical activity and better sleep quality were associated with lower and more controlled blood pressure among university students. These results highlight the importance of promoting active lifestyles and healthy sleep habits as early preventive strategies for cardiovascular risk in young adult populations.
Copyright (c) 2026 Farah Riskananda, Wahyu Tri Sudaryanto2 (Author) https://creativecommons.org/licenses/by/4.0
Sedentary Lifestyle and Well-Being Among University Students: A Cross-Sectional Correlational Study
Background: A sedentary lifestyle is an increasing public health concern among young adults, particularly university students. Prolonged sitting time has been associated with adverse physical and psychological outcomes that may compromise overall well-being. Objective: To determine the association between sedentary lifestyle and multidimensional well-being among university students. Methods: A cross-sectional correlational study was conducted involving 133 students randomly selected from the Faculty of Health Sciences, Universitas Muhammadiyah Surakarta. Data were collected in 2025 during regular classroom sessions. Sedentary behavior was assessed using the Sedentary Behaviour Questionnaire (SBQ), while well-being was measured using the Model for Healthy Questionnaire (MFH-Q). Descriptive statistics were calculated for sedentary time and well-being scores (mean sedentary time: 8.24 ± 5.26 hours/day). Data normality was evaluated using the Shapiro–Wilk test, and Pearson correlation analysis was performed to assess the relationship between variables. Results: Most participants reported high sedentary time, and nearly half demonstrated low well-being. Pearson correlation analysis showed no statistically significant association between sedentary lifestyle and well-being (r = –0.141; p = 0.105; 95% CI –0.30 to 0.03), indicating a weak and non-significant negative relationship. Conclusion: Sedentary time was not significantly associated with well-being among health sciences students. Well-being in young adults may be influenced by other factors such as sleep quality, academic stress, and social support. Further longitudinal and multivariate studies are recommended.
Copyright (c) 2026 Febri Dwi Kristanto, Farid Rahman (Author) https://creativecommons.org/licenses/by/4.0
Effect of Chair-Based Cloth-Assisted Exercise on Coordination and Grip Strength in Older Adults: A Quasi-Experimental Study
Background: Aging is associated with progressive declines in motor coordination and muscle strength, increasing the risk of falls and functional limitations. Chair-based exercise offers a safer alternative for older adults who are unable to perform standing exercises due to balance and mobility impairments. Objective: This study aimed to evaluate the effects of chair-based exercise using a non-elastic cloth on upper-extremity coordination and handgrip strength in older adults. Methods: A quasi-experimental one-group pretest–posttest study was conducted among 20 female older adults aged 60–85 years selected through purposive sampling. The intervention consisted of chair-based aerobic exercise using a 2-meter non-elastic cloth, performed once weekly for 10 weeks (60 minutes per session). Upper-extremity coordination was assessed using the Finger-to-Nose Test (completion time and errors), and muscle strength was measured using a handgrip dynamometer. Data were analyzed using the Shapiro–Wilk test and Wilcoxon signed-rank test (p < 0.05). Results: Significant improvements were observed in all outcomes. Finger-to-Nose completion time decreased from 20.0 to 9.5 seconds (p < 0.001; r = 0.62), and errors decreased from 2 to 1 (p < 0.001; r = 0.58). Right- and left-hand grip strength increased significantly (p < 0.001; r = 0.62). Conclusion: Chair-based exercise using a non-elastic cloth significantly improved coordination and handgrip strength, indicating a safe and effective approach to support functional capacity in older adults.
Chair-Based Exercise, Senam lansia, koordinasi gerak, kekuatan otot
Copyright (c) 2026 Vikaenza Goldlian Brivilliany, Arin Supriyadin (Author) https://creativecommons.org/licenses/by/4.0
Effects of Core Stability Exercise and Lumbar Rotation Manipulation: A Quasi-Experimental Study
Background: Myogenic low back pain is a common occupational musculoskeletal condition associated with reduced lumbar flexibility and functional mobility. Exercise-based and manual therapy interventions are widely applied; however, comparative evidence in physically demanding work settings remains limited. Objective: To compare the effects of Core Stability Exercise (CSE) and Lumbar Rotation Manipulation (LRM) on lumbar flexibility and pain intensity in workers with myogenic low back pain. Methods: A quasi-experimental pre–post two-group study was conducted among 30 workers at the Fish Smoking Center in Bandarharjo, Semarang. Participants were allocated to either the CSE group (n = 15) or the LRM group (n = 15). Pain intensity was measured using the Visual Analogue Scale (VAS), and lumbar flexibility was assessed using the Schober Test. Paired t-tests were used for within-group analyses, and independent t-tests compared change scores (Δ = post–pre) between groups. Results: Both groups demonstrated significant improvements in lumbar flexibility (p < 0.001). The CSE group showed an increase in Schober scores from 3.45 ± 0.32 to 4.89 ± 0.45, while the LRM group improved from 3.42 ± 0.32 to 5.43 ± 0.42. No significant within-group reductions in pain intensity were observed in either group. Between-group comparisons revealed significant differences in change scores for lumbar flexibility and pain intensity (p < 0.001). Conclusion: CSE and LRM effectively improved lumbar flexibility but did not produce meaningful short-term pain reduction. Longer intervention durations or multimodal physiotherapy approaches may be required to achieve clinically relevant analgesic outcomes.
Copyright (c) 2026 Muhamad Haidar Ali , Deasy Virka Sari, Devina Puspa Wulandari (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Exercise Interventions for Diabetic Foot Ulcer Healing: A Systematic Review
Background: Diabetic foot ulcer is a serious complication of diabetes mellitus that is frequently associated with delayed wound healing, infection, and an increased risk of lower-limb amputation. Despite standard wound care and off-loading, outcomes often remain suboptimal, prompting interest in exercise as an adjunct therapy. Objective: This systematic review evaluated the effectiveness of exercise interventions on wound-healing outcomes in patients with diabetic foot ulcers. Methods: PubMed, Scopus, Google Scholar, and Semantic Scholar were searched for randomized controlled trials and controlled clinical trials of structured exercise in adults with diabetic foot ulcers. Two reviewers independently screened studies and extracted data. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Because of heterogeneity, results were synthesized narratively. Results: Five studies with intervention durations of 8–12 weeks were included. Non–weight-bearing aerobic exercise and structured foot exercises generally produced greater wound-area reduction and/or faster healing progression than standard care, with several trials reporting significant between-group differences (p < 0.05). Resistance training and passive lower-limb movement exercises yielded mixed results and were often non-significant for wound closure, although some studies reported improvements in metabolic or perfusion-related outcomes. Conclusion: Exercise may be a feasible adjunct to standard diabetic foot ulcer care, particularly non–weight-bearing aerobic and structured foot exercise programs; however, evidence is heterogeneous and of low-to-moderate methodological quality, supporting the need for well-designed trials with standardized outcome reporting.
Copyright (c) 2026 Nadiya Izzatul Jannah , Dwi Rosella Komalasari, Flora Ramona Sigit Prakoeswa (Author) https://creativecommons.org/licenses/by/4.0
Epidemiology of Cycling Injuries at a Provincial Championship: A Cross-Sectional Study
Background: Cycling is a sport in which participants use bicycles to complete a predetermined route in the shortest possible time. The categories contested include mountain biking and road racing. Objective: This study aims to determine the prevalence, types, and locations of injuries among cycling athletes participating in the 2024 South Kalimantan Provincial Cycling Championship (KEJURPROV). Methods: This study employed a cross-sectional quantitative observational design with a retrospective approach. It was conducted during the 2024 KEJURPROV and involved 66 athletes selected through total sampling. Data on injury types and locations were collected using validated questionnaires. The findings of this study are expected to provide useful evaluation material for coaches and athletes in designing more effective training programs. Results: The results showed that the most common type of injury experienced by cycling athletes was strain (80.3%), followed by contusion (53%) and open wounds (51.5%), The lower extremities were the most frequently affected injury location (86.4%), followed by the upper extremities (42.4%). Most athletes were younger than 18 years (56.1%), male (84.8%), and used mountain bikes (62.1%). Conclusion: Injuries sustained during the 2024 KEJURPROV were predominantly soft-tissue injuries affecting the lower extremities. Younger athletes, males, and mountain bike users showed higher injury prevalence, highlighting the need for targeted injury-prevention strategies.
Copyright (c) 2026 Nur Afrina Azra, Mahendra Wahyu Dewangga, Tiara Fatmarizka (Author) https://creativecommons.org/licenses/by/4.0
Correlation Between Shoulder Muscle Power and 50-m Freestyle Swimming Speed: A Cross-Sectional Study
Background: Shoulder muscle power plays a critical role in generating propulsive force during freestyle swimming, particularly over short-distance events in which maximal speed must be achieved within a limited time frame. Although previous studies have examined upper-limb strength in swimmers, evidence on the association between shoulder power and 50-m freestyle performance among swimmers in West Kalimantan remains limited. Objective: This study aimed to determine the correlation between shoulder muscle power and 50-m freestyle swimming speed among competitive swimmers in West Kalimantan. Methods: A cross-sectional design was used involving 20 swimmers recruited through purposive sampling from the Bintang Khatulistiwa Swimming Club. Shoulder muscle power was assessed using a 3-kg medicine ball throw test, and 50-m freestyle swimming speed was measured with a stopwatch. All measurements were conducted at Sultan Syarif Abdurrahman Stadium and Oevang Oeray Swimming Pool in February 2024. Spearman’s rho was employed to examine the relationship between shoulder muscle power and swimming speed. Results: A significant negative correlation was found between shoulder muscle power and 50-m freestyle swimming speed (r = –0.787, p < 0.001), indicating that greater throwing distance was associated with shorter swimming time. These findings suggest that swimmers with higher shoulder muscle power are more capable of producing effective propulsion, thereby achieving faster performance. Conclusion: Shoulder muscle power is significantly associated with 50-m freestyle swimming speed among competitive swimmers in West Kalimantan. Assessment and enhancement of shoulder power may be valuable for coaches and athletes seeking to optimize sprint freestyle performance.
Copyright (c) 2026 Myranti Puspitaningtsya Junaedi, Miftahul Nur ‘Amaliyah, Dini Afriani Khasanah, Tazkia Nabila, Joko Priono (Author) https://creativecommons.org/licenses/by/4.0