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
Post-COVID-19 Syndrome Experiences Among University Students: A Qualitative Cross-Sectional Study
Introduction: Post-COVID-19 syndrome refers to persistent symptoms that continue after an individual has recovered from acute COVID-19 infection. Although these symptoms are often milder than during the acute phase, they can still disrupt daily activities and impair quality of life. University students, as a productive age group with dense academic and social responsibilities, are at risk of COVID-19 exposure and long-term symptoms. This study aimed to explore the experiences of students living with post-COVID-19 syndrome. Objective: To explore and describe the lived experiences of university students experiencing post-COVID-19 syndrome, particularly focusing on the impact of persistent anosmia and ageusia on appetite, eating patterns, and daily quality of life. Methods: A descriptive qualitative approach with a cross-sectional design was used. Data were collected through in-depth interviews in June 2025. Three participants were selected using purposive sampling. Interviews lasted 30–45 minutes, were audio-recorded, transcribed verbatim, and analyzed thematically. Results: The most frequently reported symptoms were anosmia and ageusia. These symptoms led to reduced appetite and altered eating patterns. Participants also reported feelings of frustration, a loss of enjoyment in food, and disruptions in daily social activities. Conclusion: Post-COVID-19 anosmia and ageusia significantly affect appetite and dietary patterns among students, ultimately influencing their quality of life. These findings highlight the need for psychosocial support and long-term health monitoring for students experiencing persistent symptoms following COVID-19 infection.
Copyright (c) 2026 Putri Ayu Wulansari (Author) https://creativecommons.org/licenses/by/4.0
Effects of Traditional Engklek Game on Static and Dynamic Balance in Preschool Children: A Quasi-Experimental Study
Background: Static and dynamic balance are essential components of motor development in preschool children, yet insufficient physical stimulation may impair balance acquisition during early childhood. Objective: To evaluate the effect of the traditional engklek game on static and dynamic balance in preschool children aged 4–6 years. Methods: A quasi-experimental pre-test–post-test control group study was conducted involving 36 preschool children (intervention n=18; control n=18). The intervention group participated in a modified engklek game three times per week for four weeks, while the control group followed routine school activities. Static balance was assessed using the One-Leg Stand Test (OLS) and dynamic balance using the 10-Meter Walk Test (10MWT). Data were analyzed using Wilcoxon Signed Rank and Mann–Whitney U tests (α=0.05), with effect sizes reported as r. Results: The intervention group showed significant improvements in static balance (median OLS: 6.2 s to 11.4 s; p<0.001; r=0.62) and dynamic balance (median 10MWT: 9.1 s to 7.4 s; p<0.001; r=0.58), while no significant changes were observed in the control group. Between-group comparisons demonstrated significant differences in both outcomes (p<0.01). Conclusion: The traditional engklek game significantly improves static and dynamic balance in preschool children aged 4–6 years and may serve as a feasible play-based intervention in pediatric physiotherapy.
Copyright (c) 2026 Rahadyani Ridha Mahdiyah, Mahendra Wahyu Dewangga, Rinna Ainul Maghfiroh (Author) https://creativecommons.org/licenses/by/4.0
Physical Activity and Concentration in Children: A Cross-Sectional Study in Denpasar
Background: This study investigated the relationship between physical activity and concentration among primary school children in Denpasar, Bali. Objective: This study aimed to examine the association between physical activity levels and concentration ability among primary school children aged 7–12 years in Denpasar, Bali. Methods: A quantitative, cross-sectional study was conducted at SDN 14 Dauh Puri involving 69 students aged 7–12 years, selected via simple random sampling from a population of 158. Physical activity was assessed using the Physical Activity Questionnaire for Children (PAQ-C), and concentration was measured using the Grid Concentration Test. Anthropometric measurements were also recorded. Data were analyzed using Spearman’s rho correlation test with a significance threshold of p < 0.05. Results: A statistically significant weak positive correlation was found between physical activity and concentration (r = 0.373, p = 0.002), indicating that higher physical activity levels were associated with better concentration among children in this age group. Conclusion: Physical activity is positively associated with concentration in children aged 7–12 years. Promoting appropriate physical activity in primary school settings may enhance concentration and support cognitive function.
Copyright (c) 2026 Ni Made Diwi Sudyawati, Daryono, Ni Luh Made Reny Wahyu Sari, I Made Yoga Parwata (Author) https://creativecommons.org/licenses/by/4.0
McKenzie Exercise Improves Physiological Response and Fitness: A Quasi-Experimental Study
Introduction: Prolonged standing during packing work can lead to increased physiological load and decreased physical fitness, particularly affecting spinal flexibility and cardiovascular response. These factors can reduce work productivity and increase the risk of musculoskeletal disorders. Exercise interventions such as the McKenzie method may offer benefits in reducing physical strain and improving functional fitness among industrial workers. Objective: This study aimed to determine the effect of McKenzie exercise on physiological workload, as indicated by the percentage of cardiovascular load (%CVL), and physical fitness, assessed through spinal flexibility using the Modified Schober Test, among packing workers exposed to prolonged standing postures. Methods: This quasi-experimental study used a one-group pretest–posttest design involving 10 packing workers at CV. Cahaya Baru, aged 29–56 years, with an average work duration of 16.4 ± 14.1 years. Physiological response was measured using the percentage of cardiovascular load (%CVL), while physical fitness was assessed through the Modified Schober Test. Participants underwent McKenzie exercise sessions twice weekly for four weeks, totaling eight sessions. Results: The intervention resulted in a mean reduction of 10.4% in %CVL, indicating improved physiological efficiency. Additionally, physical fitness, as measured by the Modified Schober Test, increased by 25.1%. Paired sample t-test analysis revealed statistically significant improvements in both parameters (p = 0.000; p < 0.05). Discussion: These findings demonstrate that McKenzie exercises effectively reduce physiological workload and enhance spinal mobility, contributing to improved physical fitness in workers exposed to prolonged static standing postures.
Copyright (c) 2026 Putu Paramitha Candra Dewi, I Gede Arya Sena, Ni Luh Made Reny Wahyu Sari, Daryono (Author) https://creativecommons.org/licenses/by/4.0
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
Physiotherapy Management of Muscle Imbalance due to Lateral Epicondylitis: A Case Report
Background: Lateral epicondylitis (LE), commonly known as tennis elbow, is an overuse-related tendinopathy frequently associated with repetitive wrist extension activities. Although LE is widely reported, muscle imbalance as a contributing factor remains underrecognized and rarely discussed in clinical case reports. Objective: This case report aimed to evaluate the effects of an integrated physiotherapy intervention on muscle imbalance secondary to lateral epicondylitis. Methods: A case report was conducted involving a 27-year-old right-hand–dominant male presenting with pain and functional limitation of the right elbow. The patient underwent four physiotherapy sessions over a two-week period. The intervention program consisted of progressive strengthening exercises, muscle release techniques, stretching, and electrotherapy. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, Manual Muscle Testing (MMT) for muscle strength, goniometric measurement for range of motion, and clinical provocation tests. Results: Pain intensity decreased substantially from VAS 7 at baseline to VAS 1 after the final session, representing an 85.7% reduction. Wrist extensor muscle strength improved from MMT grade 4 to grade 5, while wrist range of motion increased. Mill’s and Maudsley’s tests changed from positive to negative. Functional performance improved, allowing the patient to resume daily activities and recreational sports without pain. No adverse effects were reported. Conclusion: An integrated physiotherapy approach combining strengthening exercises, muscle release, stretching, and electrotherapy was effective in reducing pain, correcting muscle imbalance, and restoring functional performance in a patient with lateral epicondylitis. This case highlights the importance of comprehensive neuromuscular assessment and targeted physiotherapy management in LE.
Copyright (c) 2026 Wa Ode Adisty Nurul Syahrani, Salma Nur Madina, Nurul Fadhilah Haris, Winiy Mahdiyah Siradja, Sitti Nurafifah, Nur Ismi Sudarman, Harsely Trivos, Riswana (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
Physiotherapy Management After Posterior Stabilization in Thoracic Scoliosis: A Case Report
Introduction: Scoliosis is an abnormal curvature of the spine that may lead to back pain, restricted mobility, and respiratory impairment. In severe thoracic scoliosis, surgical correction with posterior vertebral stabilization is commonly performed; however, postoperative pain and functional limitations often require structured physiotherapy to optimize recovery. Objective: To describe the effects of multimodal physiotherapy on pain, trunk range of motion, dyspnea, and activities of daily living in a patient with thoracic scoliosis following posterior vertebral stabilization surgery. Methods: This case report was conducted at Dr. Wahidin Sudirohusodo Hospital, Makassar, in November 2024. The patient was a 23-year-old woman with thoracic scoliosis who underwent posterior vertebral stabilization surgery in August 2024. Postoperative assessment revealed pain (VAS 6/10), limited trunk range of motion, dyspnea, and impaired activities of daily living. The physiotherapy program consisted of cryotherapy, interferential current, muscle release techniques, and exercise therapy administered over three treatment sessions. Results: Following the intervention, pain decreased to 0/10 at rest, 3/10 on palpation, and 2/10 during movement. Trunk range of motion improved from S.15°–0°–40° to S.20°–0°–45°. Dyspnea grade improved from grade 3 to grade 1, and activities of daily living scores increased from 70 to 85. Conclusion: Multimodal physiotherapy was effective in accelerating postoperative functional recovery by reducing pain, improving trunk mobility, decreasing dyspnea, and enhancing activities of daily living in a patient with thoracic scoliosis following posterior vertebral stabilization.
Copyright (c) 2026 Firza Alisa Salsabilah, Irianto, Bustaman Wahab (Author) https://creativecommons.org/licenses/by/4.0
Physiotherapy Management of Shoulder Osteoarthritis with Functional Limitation: A Case Report
Introduction: Shoulder osteoarthritis (OA) can significantly impair daily functional activities in older adults, leading to reduced quality of life and independence. Population-based studies report that 16.1%–20.1% of adults over 65 years show radiographic evidence of glenohumeral OA. Physiotherapy plays an important role in reducing pain and improving joint function. Objective: This case report aimed to describe the effects of a short course of physiotherapy on pain, muscle strength, and functional ability in an elderly patient with long-standing shoulder OA. Methods: This case report used quantitative and qualitative approaches. Quantitative assessments included Manual Muscle Testing (MMT), the Shoulder Pain and Disability Index (SPADI), the Visual Analog Scale (VAS), and the Human Rating Scale for Activities (HRS-A). Qualitative data were obtained through clinical observation and patient interviews. Results: An 87-year-old woman with a five-year history of shoulder OA presented with chronic pain, limited range of motion, and muscle weakness (MMT 3/5). Physiotherapy interventions included Transcutaneous Electrical Nerve Stimulation (TENS) and exercise therapy consisting of strengthening exercises, roll-gliding and traction-translation mobilization, and proprioceptive neuromuscular facilitation (PNF). After intervention, VAS scores decreased from 4 to 2 for palpation pain and from 8 to 5 for movement pain. Muscle strength improved to MMT grade 4, and SPADI scores decreased from 68 to 59. Conclusion: A short course of physiotherapy combining TENS and targeted exercise therapy effectively reduced pain and improved functional capacity in a very elderly patient with long-standing shoulder OA.
Copyright (c) 2026 Dewi Masitoh, Dea Angreni Mustamin, Putri Rezkina Aris, Rindy Diani Woretma, Nurliya Dwi Ichsanti Prawito, Siti Ummu Jamilah, Winiy Mahdiyah Siradja, Salma Nur Madina, Aulia Masita (Author) https://creativecommons.org/licenses/by/4.0
Association Between Stress Levels and Primary Dysmenorrhea Pain Intensity: A Cross-Sectional Study
Introduction: Primary dysmenorrhea is a common complaint among female university students and may interfere with daily activities. Stress is considered one of the factors that can exacerbate menstrual pain. Objective: This study aimed to examine the association between stress levels and the intensity of primary dysmenorrhea pain among female students at Dhyana Pura University. Methods: This cross-sectional quantitative study was conducted at Dhyana Pura University from April to May 2025. A total of 40 female students who met the inclusion criteria were recruited. Stress levels were assessed using the Kessler Psychological Distress Scale (K10), while pain intensity was measured using the Numeric Rating Scale (NRS). Data analysis included descriptive statistics, normality testing, linearity testing, and hypothesis testing. Normality tests showed that both stress levels and pain intensity were not normally distributed (p=0.001 for both; p<0.05); therefore, Spearman’s Rho correlation test was applied. Results: The analysis demonstrated a strong positive correlation between stress levels and primary dysmenorrhea pain intensity (r=0.757; p<0.01), indicating that higher stress levels were associated with greater menstrual pain intensity. Conclusion: Stress levels are significantly and positively associated with the intensity of primary dysmenorrhea pain among female university students.
Copyright (c) 2026 Agusta Klaudia Wea, Luh Putu Ayu Vitalisyawati, Ni Made Rininta Adi Putri, Ni Luh Made Reny Wahyu Sari (Author) https://creativecommons.org/licenses/by/4.0
Effectiveness of Electrical Stimulation and Passive Exercise in Incomplete Paraplegia: A Case Report
Introduction: Paraplegia is paralysis of both lower extremities caused by spinal cord disorders, including compression by spinal meningioma, which disrupts motor, sensory, and functional abilities. Objective: This case report aimed to evaluate the effectiveness of combined electrical stimulation and passive exercise in improving sensory function and reducing spasticity in a patient with incomplete paraplegia following thoracic meningioma surgery. Methods: A 41-year-old female with incomplete paraplegia Frankel B due to thoracic (T10–T11) meningioma underwent four physiotherapy sessions over four weeks, each lasting approximately 30 minutes. Assessments included sensory function (key point dermatome), spasticity (Modified Ashworth Scale), muscle strength (Manual Muscle Testing), range of motion (goniometry), and functional independence (Spinal Cord Independence Measure III). Results: Post-intervention evaluation showed improved sensory function and reduced spasticity, indicating a positive response to the combined intervention. Conclusion: Electrical stimulation combined with passive exercise was effective in improving sensory function and reducing spasticity in incomplete paraplegia following thoracic meningioma surgery.
Copyright (c) 2026 Adiba Hanim Fairuzza, Diah Rosyida Maulidina, Yeni Tri Nur Hayati (Author) https://creativecommons.org/licenses/by/4.0
Case Report: Combined Chain Exercises for Functional Recovery After Total Hip Replacement
Introduction: The hip joint is a major weight-bearing joint that is vulnerable to degeneration and injury. Severe hip pathology may cause pain, restricted mobility, and limitations in daily activities. Total Hip Replacement (THR) aims to relieve pain and restore function; however, postoperative pain, muscle spasm, limited range of motion (ROM), and muscle weakness may delay recovery. Combined open kinetic chain (OKC) and closed kinetic chain (CKC) exercises may enhance functional outcomes during post-THR rehabilitation. Objective: This case report aimed to evaluate the effectiveness of combined OKC and CKC exercises in reducing pain and improving ROM, muscle strength, and functional ability following THR. Methods: A post-THR patient underwent a physiotherapy program consisting of combined OKC and CKC exercises for six treatment sessions. Outcome measures included pain intensity using the Numeric Rating Scale (NRS), ROM, muscle strength assessed by Manual Muscle Testing (MMT), and functional ability evaluated using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: After six sessions, pain decreased from 5/10 to 2/10 on palpation and from 7/10 to 3/10 during movement. Improvements were observed in hip flexion, adduction, and endorotation ROM. Muscle strength of the hip and knee increased. Functional outcomes improved, with HHS increasing from 43.9% to 70.75% and WOMAC decreasing from 44.7% to 23.95%. Conclusion: Combined OKC and CKC exercises were effective in reducing pain, improving ROM, enhancing muscle strength, and restoring functional ability in a post-THR patient. This approach may serve as an adjunct to standard postoperative rehabilitation.
Copyright (c) 2025 Rizanah Agustina, Yeni Tri Nur Hayati, Dimas Arya Nugraha (Author) https://creativecommons.org/licenses/by/4.0
Neurodevelopmental Treatment for Sitting Balance in Microcephaly: A Case Report
Introduction: Microcephaly often leads to delayed gross motor development, including poor head control, low trunk stability, and unintegrated primitive reflexes. Objective: This case report aimed to describe the effects of Neurodevelopmental Treatment (NDT) on sitting balance and gross motor function in a child with microcephaly. Methods: A 12-month-old male patient was treated at the Medical Rehabilitation Clinic, Muhammadiyah Hospital Lamongan. NDT sessions were conducted once weekly for four weeks, each lasting 30–45 minutes, focusing on head control, trunk stability, and sitting balance using a gym ball. Techniques included visual stimulation, handling at key points of control, and transitional position training. Outcome measures included the Gross Motor Function Measure (GMFM), head circumference, and Spinal Galant reflex assessment. Results: GMFM dimension A scores increased from 25.4% to 86%, and dimension B from 30% to 61%. The Spinal Galant reflex, initially positive, became negative after therapy. Head circumference remained unchanged at 41 cm. Clinically, the patient showed improved head-lifting ability, the capacity to sit with minimal assistance, and greater trunk stability. Conclusion: NDT improved gross motor function in a child with microcephaly, particularly head control, trunk stability, and sitting balance. Active family involvement in home exercises supported therapy success, suggesting that collaborative management between physiotherapists and families should be encouraged for similar cases.
Copyright (c) 2026 Mira Virdiana Azhahroh, Yeni Tri Nurhayati, Rizka Asna Rahmawati (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
Exploring Perceived Effects of Foi Doa Exercise in Older Adults with Hypertension: A Descriptive Qualitative Study
Background: Hypertension is highly prevalent among older adults and remains a major contributor to cardiovascular morbidity. In addition to pharmacological treatment, culturally grounded physical activities are increasingly considered as complementary non-pharmacological approaches to enhance acceptability in community settings. Foi Doa exercise combines gentle body movements with traditional bamboo instrumental music from East Nusa Tenggara and is perceived to promote relaxation among older adults. Objective: This study explored older adults’ experiences and perceived effects of Foi Doa exercise as a complementary non-pharmacological approach to hypertension management. Methods: A descriptive qualitative study with thematic content analysis was conducted. Older adults diagnosed with hypertension participated in Foi Doa exercise sessions once daily for three consecutive days. Data were collected through observation, semi-structured in-depth interviews, and descriptive-supportive blood pressure monitoring. Blood pressure data were used solely to contextualize participants’ experiences, not to assess clinical effectiveness. Results: Two community-dwelling older adults (n = 2) participated. Participants reported physical relaxation, emotional calmness, improved body comfort, and high acceptance of the exercise. Traditional music and slow, gentle movements enhanced enjoyment, motivation, and cultural familiarity. Blood pressure values remained stable throughout the intervention period. Conclusion: Foi Doa exercise was perceived as a calming, culturally meaningful, and acceptable complementary activity among older adults with hypertension, supporting its potential role in community-based health promotion rather than as a primary therapeutic intervention.
Copyright (c) 2026 I Made Wahyu Palguna (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
Observed Changes in Skin Integrity Risk Following 30° Lateral Positioning and Virgin Coconut Oil Massage: A Case Report
Background: Impaired skin integrity is a common complication among immobilized stroke patients, particularly in home-care settings with limited professional supervision. Combined preventive strategies such as repositioning and topical skin care are frequently recommended, yet evidence describing their application in community-based practice remains limited. Objective: To describe observed changes in skin integrity risk following the combined use of 30° lateral positioning and effleurage massage with Virgin Coconut Oil (VCO) in a home-care stroke patient. Methods: This descriptive exploratory case report involved a 58-year-old female patient with non-hemorrhagic stroke and prolonged immobilization. The intervention consisted of 30° lateral repositioning and VCO effleurage massage, administered twice daily for four consecutive days. Skin integrity risk was assessed daily using the Braden Scale. Results: The Braden Scale score improved from 12 (high risk) at baseline to 17 (low risk) after four days (Δ = +5). Improvements were mainly observed in the moisture, mobility, and friction/shear domains, while sensory perception and activity remained unchanged. Conclusion: This case report describes a short-term improvement in skin integrity risk following combined 30° lateral positioning and VCO massage. Due to the single-case design and short follow-up, the findings should be interpreted cautiously. However, the intervention appears feasible for home-care settings and merits further investigation.
Copyright (c) 2026 Endah Sulistiyani (Author) https://creativecommons.org/licenses/by/4.0
Experiences of Rubber Ball Grip Therapy After Non-Hemorrhagic Stroke: A Descriptive Qualitative Study
Background: Hand muscle weakness commonly persists among older adults after non-hemorrhagic stroke and contributes to activity limitations. Rubber ball grip therapy is a simple home-based exercise frequently used in low-resource settings, yet qualitative evidence exploring patients’ perceived changes remains limited. Objective: This study aimed to explore older adults’ experiences and perceived changes in hand muscle strength following rubber ball grip therapy after non-hemorrhagic stroke. Methods: A descriptive qualitative study was conducted with two older adults living in a rural area of East Nusa Tenggara, Indonesia. Participants performed rubber ball gripping therapy at home for seven consecutive days. Data were collected through in-depth interviews and field notes. Manual Muscle Testing (MMT) was used as a supportive observational measure to contextualize participants’ narratives. Data were analyzed thematically. Results: Responses to therapy varied. One participant showed an observable improvement in hand muscle strength (MMT grade 3 to 4) accompanied by perceived ease of movement and increased functional confidence. The other participant demonstrated no change in muscle strength (MMT grade 2) and reported persistent fatigue and limitation. Baseline physical condition, daily activity level, motivation, and family support influenced perceived outcomes. Conclusion: Older adults experience rubber ball grip therapy differently after non-hemorrhagic stroke. Individual and contextual factors play a crucial role in shaping perceived benefits of simple home-based hand exercises.
Copyright (c) 2026 Dewa Agung Gina Andriani (Author) https://creativecommons.org/licenses/by/4.0
Standardized Acupressure to Improve Sleep Quality in Older Adults with Insomnia: A Qualitative Case Study
Background: Insomnia is prevalent among older adults and is associated with physical discomfort, emotional distress, and diminished quality of life. Although acupressure is commonly used as a complementary physiotherapy intervention to promote relaxation and sleep comfort, existing evidence has predominantly emphasized quantitative outcomes, with limited attention to older adults’ lived experiences. Objective: To explore the lived experiences of older adults with insomnia who underwent a standardized acupressure protocol in a community-based physiotherapy setting. Methods: A qualitative case study design was employed. Two older adults with insomnia received a standardized six-day acupressure intervention targeting HT7, PC6, SP6, and KI1. Data were collected through in-depth interviews, observations during therapy sessions, and sleep diaries. Reflexive thematic analysis, following Braun and Clarke’s approach, was conducted. Methodological rigor was enhanced through data triangulation, independent coding, member checking, and confirmation of data saturation. Results: Three themes emerged: (1) physical and emotional discomfort prior to therapy, (2) relaxation experienced during acupressure, and (3) improved subjective sleep experiences following therapy. Participants reported reduced sleep latency, fewer nocturnal awakenings, enhanced relaxation, and decreased pre-sleep anxiety. Observational findings corroborated these self-reported experiences. Conclusion: Standardized acupressure was perceived as a safe and acceptable physiotherapy intervention that promoted relaxation and improved the subjective sleep experience among older adults with insomnia. These findings support the integration of acupressure into holistic, community-based physiotherapy care.
Copyright (c) 2026 Kade Ngurah Dwi Putra Negara (Author) https://creativecommons.org/licenses/by/4.0