our research

MAXIMUM OXYGEN UPTAKE PREDICTION RESULT OF SIX MINUTE WALKING TEST AS A FUNCTIONAL CAPACITY PARAMETER OF A HEALTHY ADULT IN INDONESIA

2012-01-02T00:18:00.000-08:00

MAXIMUM OXYGEN UPTAKE PREDICTION RESULT OF SIX MINUTE WALKING TEST AS A FUNCTIONAL CAPACITY PARAMETER OF A HEALTHY ADULT IN INDONESIA

NuryNusdwinuringtyas*, WidjajaLaksmi*, AdangBachtiar**

*Medical Rehabilitation Department, FKUI-RSCM

**Public Health Department

ABSTRACT

This study use 123 Indonesian healthy adult subjects (58 males and 65 females) with sedentary lifestyle, aimed to produce maximum VO₂as a measurement tool of an Indonesian healthy adult functional capacity. Designed by using the followings: distance, height, body weight, sex, age, maximum heart rate of six minute walking test and lung capacity (FEV and FVC), resulted a good correlation except body weight (p > 0.05) with maximum VO₂. A new protocol of the six minute walking test used in this study gives a non significant difference result of distance compared to the golden standard value using Biodex^®gait trainer (p<0.05). Post hoc test of the new formula gave result of maximum VO₂that is relevant to the golden standard maximum VO₂using Cosmed^®C-P ex and has significant difference compared to Cahalin’s formula (p<0.05). Increase of serum lactic acid level after the six minute walking test proves the presence of muscle cellular metabolism. The increase of lactic acid less than 4mM which is an indicator of aerobic zone proves that the new protocol of the six minute walking test is a submaximum test.

Key words: maximum VO₂, Nury’s formula, Cahalin’s formula, Nury’s protocol, six miute walking test

ABSTRAK

Penelitian ini menggunakan 123 subjek (58 laki-lakidan 65 perempuan) dewasa sehat Indonesia dengan sikap hidup sedentary ,bertujuan memperoleh rumus prediksiVO₂maksimal sebagai alat ukur kapasitas fungsi dewasa sehat Indonesia. Dirancang dengan memasukkan jarak tempuh disertai berturut-turut tinggi badan, berat badan, jenis kelamin, umur, denyut jantung tertinggi yang didapat dari ujijalan di lintasan dan kapasitas paru (VEP₁dan KVP) setelah didapati berkorelasi baik kecuali berat badan (p > 0,05) dengan VO₂maksimal. Protokol baru uji jalan enam menit yang digunakan pada penelitian memberikan hasil jarak tempuh yang tidak berbeda bermakna dengan nilai baku emas jarak tempuh menggunakan Biodex^®gait trainer (p<0,05). Padaujipost hocmenggunakanrumusbarudidapatihasilVO₂maksimal yang sesuai dengan baku emas VO₂maksimal menggunakan Cosmed^®C-P ex, dan jika dibandingkan antara rumus baru dengan rumus Cahalin terdapat perbedaan yang bermakna (p<0,05). Peningkatan kadar laktat sesudah uji jalan enam menit, membuktikan terjadi peristiwa metabolisme selular pada otot. Kadar laktat yang tidak melebihi 4 mM, menunjukkan masih pada zona aerobik, memberikan bukti bahwa uji jalan enam menit menggunakan protokol baru merupakan uji submaksimal.

Kata kunci : VO₂maksimal, Rumus Nury, Rumus Cahalin, Protokol Nury, Uji jalan enam menit

2010-12-31T21:46:00.000-08:00

THE EFFECT OF LOW LEVEL LASER THERAPY IN THE PROCESS OF WOUND HEALING IN DIABETIC FOOT ULCER

2010-10-29T18:41:00.000-07:00

THE EFFECT OF LOW LEVEL LASER THERAPY

IN THE PROCESS OF WOUND HEALING IN DIABETIC FOOT ULCER

Ray Indra Wibowo, Nury Nusdwinuringtyas, Elida Ilyas, Em Yunir, Surjanto Hartono

Departement of Physical Medical and Rehabilitation , Faculty of Medicine University of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Abstract : The objective of this research is to enhance alternative of wound healing of diabetic foot ulcer using Low Level Laser Therapy, by evaluating the effect of Low Level Laser Therapy in the process of wound healing in diabetic foot ulcer. Research design using experimental clinical trial at Department of Physical Medicine & Rehabilitation, Metabolic & Endocrine clinic Department of Internal Medicine and inpatient ward of Dr Cipto Mangunkusumo Hospital, Jakarta. Subject of the research are 34 patients with diabetic foot ulcer, 17 in the intervention group and 17 in the control group. Both groups are homogen in terms of age distribution, BMI, duration of Diabetic Mellitus, level of HbA1C, duration of ulceration and initial ulcer size. Intervention group had standard wound dressing with NaCl 0.9% combined with Low Level Laser stimulation of 5 Joule/cm², twice weekly. The control group had standard wound dressing with NaCl 0.9% twice weekly. Ulcer size was evaluated weekly for the duration of 5 weeks. The outcome parameter determined by changes in ulcer size and the result is the rate of wound healing in the intervention group was significantly higher than in the control group. It was found that wound dressing combined with Low Level Laser stimulation, can accelerate wound healing.

Keywords : Diabetic foot, ulcer, Low Level Laser therapy

Average Six-Minute-Walk Test Score in Children Aged 9-10 Years

2009-12-27T22:36:00.000-08:00

Munadia*, NuryNusdwinuringtyas*, Amendi Nasution*, Suryanto**

*Physical Medicine and Rehabilitation Department, Faculty of Medicine,University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta

**Medical Research Unit, Faculty of Medicine, University of Indonesia, Jakarta

Abstract:The aim of this study is to get standard value of six-minute-walk test for children aged 9-10 years as well as exploring the correlation of sex, body weight, and height with walking distances. The standard value could later be used to measure functional capacity, monitor progress of disease, and response to treatment of disabled children. The subjects consist of 194 boys and 198 girls aged 9-10 years in Central Jakarta’s public elementary school. Baseline examination comprised of body weight, body height, vital signs, standard physical examination, and nutritional state with Epi Info. Walking instructions were given prior to the test. Vital signs were re-measured afterward. No significant difference found in the subject’s anthropometric characteristics. Consecutively, boys’ and girls’ walking distances were 500.08 meter and 481,82 meter. There was significant difference in walking distance between both sexes. There was weak and no significant correlation between body height, body weight, body mass index, and walking distance in boys and girls, except for girls’ body height. Vital signs had significant difference before and after test. Performing a six-minute-walk test is feasible, easy, and practical in children, but very dependant upon the child’s motivation and coordination.

Keywords: children, six-minute-walk test, exercise testing

The Effect of Electrical Stimulation (ES) on Strength of Quadriceps Femoris Muscles in Acute Exacerbation and Post Acute Exacerbation COPD Patients

2009-12-27T22:33:00.000-08:00

The Effect of Electrical Stimulation (ES) on Strength of Quadriceps Femoris Muscles in Acute Exacerbation and Post Acute Exacerbation COPD Patients

Abner Penalemen Barus*, Nury Nusdwinuringtyas*, Anita Ratnawati**, Indah Suci Widyahening***

*Department of Physical Medical and Rehabilitation, Faculty of Medicine, University of Indonesia / dr. Cipto Mangunkusumo Hospital, Jakarta

* Persahabatan Hospital, Jakarta

*** Department of Community Health, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta

Abstract : The purpose of this study is to compare the effect of electrical stimulation (ES) on strength of quadriceps femoris muscles in acute exacerbation and post acute exacerbation Chronic Obstructive Pulmonary Disease (COPD) patients. This is a pre and post test study without a control group. The ES was applied for 30 minutes on both sides of quadriceps muscles with duration of treatment in 4 weeks for all subjects. Muscle strength measurement was performed before and after intervention period. Muscle strength improved significantly on right side (by 154,60 ± 34,77 to 206,36 ± 32,47, p<0,05)>

Key Words: COPD, quadriceps femoris strength, electrical stimulation

Low Laser Power for Wound Healing of Diabetic Foot

2009-08-28T14:34:00.000-07:00

Ray Wibowo, Nury Nusdwinuringtyas, Elida Ilyas, Em Yunir, Suryanto

ABSTRACT

Objective :

To enhance alternative of wound healing of diabetic foot ulcer using Low Level Laser Therapy, by evaluating the effect of Low Level Laser Therapy in the process of wound healing in diabetic foot ulcer

Design :

Experimental clinical trial

Setting :

Department of Physical Medicine & Rehabilitation, Metabolic & Endocrine clinic Department of Internal Medicine Dr Cipto Mangunkusumo Hospital, Jakarta and inpatient ward of Dr Cipto Mangunkusumo Hospital, Jakarta

Subject :

34 patient with diabetic foot ulcer, 17 in the intervention group and 17 in the control group. Both group are homogen in terms of age distribution, BMI, duration of Diabetic Mellitus, level of HbA1C, duration of ulcearation and initial ulcer size.

Intervention :

Intervention group had standard wound dressing with NaCl 0.9% combined with Low Level Laser stimulation of 5 Joule/cm², twice weekly. The control group had standard wound dressing with NaCl 0.9% twice weekly. Ulcer size was evaluated weekly for the duration of 5 weeks

Main outcome measure :

Ulcer healing, determined by changes in ulcer size

Result :

Rate of wound healing in the intervention group was significantly higher than in the control group

Conclusion :

Wound dressing combined with Low Level Laser stimulation, can accelerate wound healing, determined by higher wound healing rate

Keywords : Diabetic foot, ulcer, Low Level Laser therapy

The Effect of Relaxation with EMG Biofeedback Monitor on the Achievement of Asthma Control and Quality of Life Improvement in Adult Asthmatic Patients

2008-10-05T06:35:00.000-07:00

The Effect of Relaxation with EMG Biofeedback Monitor on the Achievement of Asthma Control and Quality of Life Improvement in Adult Asthmatic Patients

Dwi Lelandari, Nury Nusdwinuringtyas, Heru Sundaru Suryanto Hartono

Background: The prevalence of asthma has been constantly increasing over the past three decade. Apart from its increasing prevalence, asthma also causes various level of functional restriction in daily life which is nonetheless important and therefore asthma has to be well controlled. This study is to find out the effect of relaxation with EMG Biofeedback on the achievement of asthma control and quality of life improvement in adult asthmatic patients.

Objective: The objective of this study is to find out the benefit of relaxation with EMG Biofeedback monitor on the achievement of asthma control and the quality of life improvement in adult asthmatic patients.

Method: Fourteen uncontrolled asthmatic patients participated in relaxation exercise with/without EMG Biofeedback for 20 minutes duration per exercise, 3 times a week for 6 weeks. Pre and post study after this treatment were done under parallel experimental clinical trial.

Result: Positive correlation was found between asthma control and quality of life (activity domain, symptoms and emotion). Correlation test with relatively high value was found between TKA with activity domain result r = 0.529 with p = 0.029; TKA with symptoms domain r = 0.731 with p = 0.001; and TKA with emotion domain r = 0.649 with p = 0.005; while TKA correlation test with non significant environment domain r = 0.73 with p <>2 saturation in the intervention group of 1.35 % while in control group 1.05 %. The 6 minutes distance test in the intervention group was improved by 76.02 m while in control group was 47.8 m.

Conclusion: There was an increase of TKA from uncontrolled to well controlled. There was a significant difference in AQLQ(s) test (Activity, Symptoms and Quality of Life domain) between the intervention group and uncontrolled group, whilst environment domain was not significant. Relaxation exercise helps to speed asthma control achievement. There were improvement in the 6 minutes distance test and decreased of degree of dispnea in the intervened group.

Key Words: Asthma, relaxation, asthma control test, quality of life, rehabilitation

THE EFFECT OF WALK EXERCISE ON LAP AND ST GEOGE RESPITARORY QUESTIONNAIRE IN PATIENT WITH MODERATE COPD

2008-08-09T17:37:00.000-07:00

The First Winner in the Investigator Award;

The 10th International Meeting on Respiratory Care Indonesia (RESPINA) 2008

FULL PAPER

THE EFFECT OF WALK EXERCISE ON LAP AND

ST. GEORGE QUESTIONNAIRE IN PATIENTS WITH MODERATE CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Sari Dewi Saraswati; Nury Nusdwinuringtyas; Tri Damiati Panji; Hadyana Sukandar

INTRODUCTION : Chronic obstructive pulmonary disease (COPD) is incurable disease and in most patients it is progressive.⁽¹⁾In COPD patients, a condition of progressive disability and handicap are characterized with the decrease of exercise capacity.

One of rehabilitation programme for COPD is reconditioning exercise, which aims to enhance the physical capacity and the ability of daily living activities. The types of exercise include cardiopulmonary endurance.⁽²⁾ The exercise is usually related to the exercise using large muscle group, that is, the muscles of lower extremities.

In resulting appropriate reconditioning to the purpose of the exercise, the walk exercise should be a specific programme due to the patients have limited lung functions.

Problem Identification: Could the program of walk exercise in patients with moderate COPD increase the lap and reduce SGRQ score?

Study Objective: To assess the effect of walk exercise on the change of lap and SGRQ score in patients with moderate COPD.

In exercise of endurance, programme was made measurable and directed, as well as monitored in order to obtain the expected results. In this programming of endurance exercise, four aspects should be noticed, i.e., intensity, duration, frequency, and type of exercise.

The effect of Exercise on COPD: In COPD, there is an abnormality in mechanism of respiratory system, that is, the ability to increase ventilation in agreement to the demand of oxygen supply for exercise due to breathless as the main complaint. Beside the presence of limited respiratory capacity, the peripheral muscular disfunction and muscular fatigue also limit the exercise capacity leading to reduced exercise tolerance. In the fact, the training programme applied to the patients is able to increase exercise tolerance.

The important principles should be applied the progamme: ^(3,21)

1. The specification of the training. Endurance exercise increases the number of capillary blood vessels.

2. Frequency, intensity, duration, and length of training. Threshold training effect is achieved at several 20‑ to 30-minute exercises in a week leading to increased endurance. The effect of 8-week training is able to show the increased cardiopulmonary endurance.^{(13,14,15,16)}

3. Detraining effect. When the training is withdrawn, the results of training achievement will fade away. This indicates the importance of continuous exercise.⁽²⁴⁾

It assumed that the more efficient peripheral oxygen utility resulted from the muscle agility and endurance will give an increase in cardiovascular and respiratory functions; resulting an increased cardiopulmonary endurance of patients with COPD. Besides, improved respitory muscle endurance, heightened motivation, reduced sensitivity against shortness of breath, and improved exercise capacity.⁽²⁰⁾

Walk exercise for COPD patients:

Intensity: In training programme according to the American College of Sport Medicine, the training intensity for walk endurance is adjusted to each individual capacity. Walk exercise can be carried out by measuring intensity using Borg’s subjective work scale.^(25,31) It refers to the subjective scale at which the magnitude of body capability to exert exercise work at a given time (Borg 1998). The values of work score have a range from 1 to 12 Borg scale ^{(14,15,25,31)} denoting a work exerted.

Exercise duration : Exercise was performed within 10 minutes per session and 3-5 minute resting period was applied every 2-3 exercise sessions.⁽³⁾Exercise conducted with 30-minute duration for 5 sessions can enhance adaptation to training tolerance. ⁽¹⁾

The optimal frequency of exercise is 3 to 4 times per week. This is certainly individual.^(1,21)The average exercise period is 6-8 week.

6-Minute Walk Test (6-MWT): 6-MWT is a measuring instrument by walking reciprocally along a 30-m lap without cheer within 6 minutes. The outcome of this test is lap time. Lap distance is estimated from body weight and height adjusted to gender. Walk test is easily carried out, well tolerated by patients with COPD, and its safety and reliability have been assessed.

SGRQ is a specific questionnaire for assessing the quality of life of patients with chronic airway disease; it has been developed by PW Jones et al.⁽³⁰⁾The questionnaire consists of 76 items which are divided into three components: the symptoms of the disease, activity, and implication.

Research Design

Experimental study with complete randomized design was conducted on pre- and post-treatment repetitive observation. This study was divided into two groups, a walk exercise group and control group.

Settings: Medical Rehabilitation, dr. Hasan Sadikin Hospital, Bandung. It was conducted from December 2006 to March 2007.

Reachable Population: Patients with moderate Chronic Obstructive Pulmonary Disease admitted to Sub-Department of Pulmonology, Department of Internal Medicine, dr. Hasan Sadikin Hospital, Bandung.

Inclusion Criteria:

1. The out-patient had been diagnosed moderate COPD at Clinic of Pulmonology, Department of Internal Medicine, dr. Hasan Sadikin Hospital, without acute exacerbation.

2. Male or female of 55-75 years old.

3. Walk able without support device.

4. Cooperative and agreed to participate in the study and ready to conduct walk exercise; all were stated in informed consent.

5. Had no regular sport activity.

Exclusion criteria:

1. Suffering neuromusculoskeletal disorder, particularly in lower extremity.

2. The patient refused to participate in the study.

Drop-out criteria:

When the patient did not perform exercise 4 times consecutively, he or she is considered to be drop-out.

Variables

a. Independent variables: Walk exercise

b. Dependent variables : SGRQ score and Lap

Research Management

1. All subjects who met the inclusion criteria were examined after diagnosis moderate COPD at Clinic of Pulmonology, Department of Internal Medicine, dr. Hasan Sadikin Hospital, Bandung

2. Every subject who met the inclusion criteria received:

a. Anamnesis

b. Physical Examination

c. Signing the informed consent to participate in the reseach

d. 6-MWT (the procedure enclosed in Appendix)

e. Filling-out the SGRQ questionnaire form

3. Subjects were divided into two groups, a training group and a control group.

4. All subject got education on:

a. The purpose and objectives of walk test and how to do it clearly untill they can do it well.

b. How to use Borg scale during exercise.

5. The training programme for group was held at the Hospital under supervision of the researcher. That for control group was not under supervision.

6. The implementation of the procedure was:

a. The general condition of the subjects examined at sitting position was: blood pressure, pulse, and respiratory rate within one minute.

b. Borg scale was used to measure : work, breathless, and muscular fatigue.

c. The subjects were instructed to do stretching exercise.

d. Subjects were asked to do walk with intensity at Borg scale 12 (work more than mild). Stopwatch started.

e. After the first 10-minute walk, the subjects were asked to take 3-minute by sitting.

f. Then, the subjects were asked to restart walk with the similar intensity for the second 10-minutes.

g. Next, they were asked to stop walk and do second 3-minute rest by sitting.

h. In the same way, subsequently, the subjects were asked to restart walk with the similar intensity for the third 10-minutes.

i. Next, they should stop walking.

j. They did stretching exercise.

k. They finished their exercise.

Finally, they were examined at sitting position for their blood pressure, pulse, and respiratory rate within one minute, and Borg scale.

Drop-out from exercise when appear :

· left chest pain (angina-like symptom).

· Fatigue or “heavy”sensation in chest.

· Sign of reduced blood perfusion, such as dark-sight, parlour, nausea.

7. At the end of 4^th and 8^th weeks, the subjects in each group got 6-MWT; and at the end of the study, SGRQ assessment was conducted.

8. The results of 6-MWT laps and SGRQ scores at the end of study were compared to those of the beginning of the training.

Data Analysis

The method of data analysis used in this study for the enhancement of laps, pre-treatment and post-treatment SGRQ was paired t-test or Wilcoxon ZW-test (Wilcoxon test) and t-test for unpaired or Mann-Whitney test if the distribution is not normal. The significance was determined at p level<0.05.>

All data were processed using SPSS program for Windows version 13.0.

STUDY RESULTS

The percentage of different lap distance 6-MWT I and III in training group increased by 30,8%, whereas in control group reduced by 12,6% significantly (p<>

The subject characteristics: Subject ages ranged 55 to 70 years in training group with the mean age was 66.8 years (SD=4.4); while in control group the mean age was 63.2 years (SD=7.3). it implies statistically non-significant. Calculated BMI indicated the mean BMI of the training group was 22.5 (SD=4.0) and in control group it was 22.0 (SD=2.7), implying nonsignificant. Mean FEV₁ percentage in training group was 71.5 (SD=7.9) and in control group was 73.3 (SD=2.6), implying nonsignificance.

The different percentage of laps at 6-MWT I and III in training group increased by 30.8%, whereas in control group reduced by 12.6% very significantly (p<0.05).>

Figure 1. Chart of The Change in Distance on 6 Minute Walking Exercise (6-MWT) I (Week 0), II ( Week 4th), dan III ( Week 8th).

The total score of SGRQ percentage in training group reduced by 17.9%, while in control group it increased by 10.1%.

Figure 2. Chart of Change in Total Score SGRQ I dan II.

The overall SGRQ of symptoms, activity and implication, only implication in training group revealed significant score.

Figure 3. Chart of Score Change in Impact Component SGRQ I dan II.

DISCUSSION

The mean lap distances at 6-MWT I, II and III in training group were 276.9 m (SD=72.2), 329.6 m (SD=54.1), and 352.2 m (SD 58.8), respectively. The significantly increased lap distance indicated the presence of implication of training against functional capacity of 6-minute walk since the fourth week.

The difference of mean lap distance at 6-MWT II and III increased nonsignificantly because the greatest effect of training occurred at the first four weeks in untrained subjects; while in the following four weeks, the increase occurred but nonsignificatly.

In obtaining the more sigificant lap distance, it is enabled by increasing of intensity or duration.

Total SGRQ score values of training group indicated very significantly reduction; whereas those of control group indicated nonsignificant reduction with p>0.05.

Among SGRQ components of symptoms, activity, and implication in training group, the only significantly reduced score was the implication as shown at Table 5.9. Thus, the effect of training only implicated on social and psycological aspects.

Training implication did not reduce the breathless symptom in both groups.

Factor of respiratory problems within one year, listed in part Symptoms in the questionnaire whose answers in the sum of first and final scores, did not implicate on reducing the scores.

Activity component indicated nonsignificantly reduced scores in training group. In this training group, there was a possible reduction in breathless symptoms against activity (from 50.6 [SD=20.4] to 42.9 [SD=24.6]), although nonsignificantly. Meanwhile, in the control group, there was a increase in breathless symptoms against activity (from 44.7 [SD=20.6] to 49.0 [SD=26.6]).

In training group, when the increased lap distance was associated to SGRQ components up to week-8, there was a significant increase in implication; indicating that the magnitude of differences in lap distance at 6-MWT were associated to the improvement of implication component based on SGRQ score.

The implication of walk exercise against work in Borg scale was unclear due to the different score was non significant when compared to control group.

At week-8 pre 6-MWT, there was a compromised breathless symptom in control group, however, that of each group was reduced nonsignificantly.

Fatigue of Borg scale at week-8 pre and post 6-MWT were significantly different between training group and control group. The implication of training against fatigue reduced after 8 weeks.

There was an significant association between implication component on SGRQ and lap distance I-III and II-III. It can be concluded that training effect can enhance lap distance and reduce SGRQ score of implication component. .

Conclusion

1. There was an increased lap distance at 6-MWT in patient with moderate COPD in training group compared to that of control group.

2. The greatest increment of lap distance 6-MWT was at week-4.

3. There was a reduced SGRQ score in training group of patients with moderate COPD compared to that in control group. Of the SGRQ components, implication provides significant improvement.

4. Implication component have an association with lap distance 6-MWT.

The Impact of Walking Exercise on Moderate Chronic Obstructive Pulmonary Disease Patients Towards Walking Distance and St. George’s Respiratory Questi

2007-08-26T05:39:00.000-07:00

ABSTRACT

The Impact of Walking Exercise on Moderate Chronic Obstructive Pulmonary Disease Patients Towards Walking Distance and St. George’s Respiratory Questionnaire

Sari Dewi Saraswati, Nury Nusdwinuringtyas,

Tri Damiati Pandji, Hadyana Sukandar

Objective: The aim of this study was to assess the effect of walking exercise on the change of lapse distance and SGRQ in patients with moderate COPD

Subjects: Twenty-six subjects that met inclusion criteria were the patients with COPD from the Pulmonology Clinic of dr. Hasan Sadikin Hospital, and assigned into an exercise group of 13 patients and a control group of 13 subjects. During the study period, 3 subjects of the exercise group were lost to attend the exercise, consequently, 23 subjects completed the study.

Methods: The study was an experimental study with complete randomized design using repeated observation, i.e., before and after treatment. In this study, there were two types of treatment, that is, one group of walking in the hospital and the other was a control group. In week 0, 6MWD I and SGRQ I were conducted. In the exercise group, the exercise was walking in the hospital with effort intensity scale Borg12 (milder), duration of 30 minutes, and 3 times per week, for 8 weeks. In week 4 and week 8 6MWD II and III were done, respectively;while SGRQ II was done in week 8.

Settings: This study was performed at Department of Physical Medicine and Rehabilitation of dr. Hasan Sadikin Hospital, Bandung

Results: Exercise group was found increased in lapse distance of 6MWD with value of (329.6 ± 72.2 m) in week 4;whereas the increased lapse distance of 6MWD with value of (352.2 ± 58.8 m) in week 8 at p<0.05.>

Conclusion: Walking exercise has effect on increased lapse distance and decreased SGRQ score.

Key words: COPD, Walking Distance, SGRQ value, Aerobic Exercise

The effect of low level LASER therapy decrease pain on Carpal Tunnel Syndrome (CTS)

2007-07-15T12:48:00.000-07:00

Abstract

Topic : The effect of low level LASER therapy decrease pain on Carpal Tunnel Syndrome (CTS)
Fadil, Hamidah. Nusdwinuringtyas ,Nury

Design : Experimental parallel study to compare decrease pain and to know the additional theurapetic effect,between grou using neutral wrist splint and low level LASER therapy (theurapeutic group) and group using neutral wrist splint ( control group)

Subject : Forty six sample with CTS come from Department Physical Medicine and Rehabilitation and referred from Neurology Depatment RSCM Hospital Jakarta

Method : Subjects were randomized into two groups : the theurapetic group compared with control group the treatment for two weeks.The pain was scored using Visual Analoque Scale (VAS) on the beginning of the study and everyday evaluation of the pain for both group

Result : Samples were analyzed with paired t test and Mann Whitney U there was significant decrease of VAS and the response was seen on the tenth day after treatment on both group ( p<>

Efficacy Hairmyers Exercise to Six Minute Walking Time and St George’s Respiratory Questionare on Chronik Obstructive Pulmonary Disease

2007-05-20T14:28:00.000-07:00

Abstract:

Efficacy Hairmyers Exercise to Six Minute Walking Time and St George’s Respiratory Questionare on Chronik Obstructive Pulmonary Disease

Johan Talesu, Nury Nusdwinuringtyas, Anita Ratnawati, Sabarinah B. Prasetyo

Objective : To evaluate the efficacy of low intensity hairmyers exercises on the functional capacity using six minutes walking test (6MWT) and quality of life according to st George’s Respiratory Questionare (SGRQ) on Cronic Pulmonary disease (COPD) patients.

Methods : pre- experimental intervention, before and after on one subject group. Samples use hairmyers exercise for eight weeks, five times a week, of which two are done of the researcher. 6MWT is taken pre, on week four, and post exercise periods. SGRQ is taken pre and post eexercise periods.

Location : Dr Cipto Mangunkusumo Hospital and Persahabatan Hospatal

Subject : 17 moderate to severe COPD patients participated in the study. Three drop out laing 14 patients out of eight minimum samples.

Results : mean differeance of 6 MWT between pre and post intervention, and between fourth week and post intervention shows highly significant result on Activity, Impact and total component (p<0.05).>

Conclusion : The functional capacity based on 6MWT and quality of life according to SGRQ on COPD patients significantly increases after doing hairmyers exercises.

Keywords: COPD, low-intensity exercise, 6MWT, SGRQ

Effect of Diaphragmat breathing and static cycle in moderate persisten asthma

2007-05-02T06:27:00.000-07:00

Effect of Diaphragmat breathing and static cycle in moderate persisten asthma

Ahmad Alamsyah”, Nury Nusdwinuringtyas*, Iris Rengganis**, Suryanto Hartono***

*Physical Medicine and Rehabilitation Departemen. Medical faculty –University of Indonesia, Cipto Mangunkusumo Hospital Jakarta

**Allegy- Immunology division, Internal Medicine Departemen Medical Faculty –University of Indonesia, Cipto Mangunkusumo Hospital Jakarta

ABSTRACT

Objective : To know the influence diaphragm breathing exercise or without static cycle exercise toward level of physical fitness of moderate asthma persistent patien.

Design : Paralel clinical test compare two interventions. Case group is given diaphragm breathing exercise only.

Setting : Physical Medicine and Rehabilitation Departemen. Medical Faculty –University of Indonesia, Cipto Mangunkusumo Hospital Jakarta

Subject : 57 patient of moderate asthma persistent from Allegy- Immunology division, Internal Medicine Departemen Medical Faculty –University of Indonesia, Cipto Mangunkusumo Hospital Jakarta

.Intervention : between January 2005 up to March 2005. 42 moderate asthma persistent patients which fufill the condition are divided inti two groups (case and control). Perform diaphragm breathing exercise whit or without static cycle exercise with supervision for six weeks. The result of VO₂max increment is compare at the end of the research.

Result : We find VO₂max significant increment (p<0,01)>2max significant (p<0,0218)>

Conclusion : Diaphragm breathing exercise with static cycle exercise increase the level of physical of fitness moderate asthma persistent patient is better than diaphragm breathing exercise only.

Key word : Moderate persistent asthma- VO₂max - diaphragm breathing exercise - static cycle.

Effect Aerobic Exercise in Chronic Obstructive Pulmonary Disease to Quality of life using St George’s Respiratory Questionnaire

2007-04-20T16:28:00.000-07:00

Pengaruh latihan erobik pada penyakit paru obstruksi kronik terhadap kualitas hidup dengan menggunakan St George’s Respiratory Questionnaire

Satryo Waspodo*, Tri Damiati Panji*, Nury Nusdwinuringtyas**, Hadyana Sukandar*

ABSTRACT

Objectives : The aim of this study was to find out an aerobic exercise program and its influence for the improvement of a quality of life and a maximum capacity of this exercise for COPD patients

Subjects : There were 60 COPD patients from the Pulmonology Department Hasan Sadikin Hospital who were eligible for this study. They were divided into two groups. The first group, called the exercised group, consisted of 30 people and the second group, called the controlled group, consisted of 30 people. During randomization process, they were only 55 people who joint the study because 5 people from the controlled group absent. Then, during the aerobic exercise, they were 3 people from the exercised group drop out. Therefore, they were only 25 people from the controlled group and 27 people from the exercised group who could accomplish until the final study (total 52 people)

Methods : This study was quasi experiment with pre and post intervention to the exercised and controlled groups. The study consist of preliminary examination for subject selection, subjects who were eligible for this study was divided into exercised and controlled groups. For the exercised group, there was SGRQ assessment with exercised test in order to assess an aerobic maximum capacity. Then, there was aerobic exercise program 3 times a week, 24 minutes duration, intensity 50-80% an aerobic maximum capacity for core exercise during 6 weeks. After 6 weeks, there was a SGRQ re-assessment and an aerobic maximum capacity. For the controlled group, there was a SGRQ re-assessment without treatment and after 6 weeks, there was a SGRA re-assessment

Setting : This study was carried out at Physical Medicine and Rehabilitation Medical Department Hasan Sadikin Hospital.

Results : For the exercised group; there was a significant decrease of SGRQ value at all components (symptoms, activity, impacts and total, P<0,001), p="0,648" p="0,055)," p="0,038)" p="0,022)." r="0,032" p ="0,873," style=""> r=-0,260 ; p =0,191, impacts r=-0,353 p =0,071 and total r=-0,303; p =0,124)

Conclusion : Aerobic exercise had an influence on the improvement of quality of life (a significant decrease of SGRQ value ) and aerobic maximum capacity for COPD patients. There was no significant correlation among the changes of quality of life (the changes of SGRQ value) with the improvement of aerobic maximum capacity

Key words : COPD, SGRQ value, Quality of Life, Aerobic Exercise.

*Dept. Physical medicine and Rehabilitation, Hasan Sadikin Hospital, Bandung - Indonesia

**Dept. Physical Medicine and Rehabilitation, Cipto Mangunkusumo Hospital, Jakarta –Indonesia

Correlation between St George’s Respiratory Questionnaire (SGRQ) and Six Minutes Walk Test (6- MWD) in COPD

2007-04-14T04:56:00.000-07:00

Correlation between Quality Of Life in Chronic Obstructive Pulmonary Disease (COPD) Patients using St George’s Respiratory Questionnaire (SGRQ) and Functional Capacity using Six Minutes Walk Test (6- MWD)

Gunawan Kurniadi*, Nury Nusdwinuringtas*, Anita Ratnawati**

*Cipto Mangunkusumo Hospital, Jakarta- Indonesia

** Persahabatna Hospital, Jakarta-Indonesia

Abstract

Objective: This study was to assess whether Indonesian version of St George’s Respiratory Questionnaire (SGRQ) could serve as a practical outcome measure for medical rehabilitation of chronic obstructive pulmonary disease (COPD) .

Method: This was designed as correlation study . Spearmen’s rank correlation test, test-retest reliability, internal consistency Cronbach α were used for analysis.

Setting: This study was conducted at RSUPN-CM and RSUP Persahabatan.

Participated: 22 subjects suffering from COPD identified as stated in inclusion criteria.

Results : There are strong correlation between SGRQ subcales with 6 minutes walking distance test (r = - 0.49 for activity, r= - 0.58 for impacts, r= - 0.58 for total ); and moderately strong correlation with FEV 1 % prediction (r = - 0.46 for activity , r = - 0.43 for impacts, r = - 0.52 for total ). Strong correlation is also found in repeated test of SGRQ ( r= 0.76 for symptoms, r= 0.58 for activity , r= 0.51 for impacts, r= 0.58 for total). There is no significant difference among subscales except for total scores p= 0.049 in Wilcoxon test . internal consistency using Cronbach α ranged from 0.73 to o.83.

Conclusion : Activity and impacts subscales of SGRQ are proved to be valid of functional capacity and severity of lung obstruction . SGRQ is also repeatable and has high internal consistency.

Keywords : St George’s Respiratory Questionnaire (SGRQ), chronic obstructive pulmonary disease (COPD), quality of life, functional capacity

Physical Medicine and Rehabilitation , Fakulty Medicine – University of Indonesia, Jakarta – Indonesia; 2002

Effects of respiratory muscle training on Chronic Obstructive Pulmonary Disease (COPD) at the Instalation of Rehabilitation Medicine ,

2007-04-09T05:07:00.000-07:00

xxv + 133 pages + 44 tables + 8 pictures , 1 appendices

Abstract

The purpose of this study was to examine the efficacy of targeted respiratory muscle training in patient with Chronic Obstructive Pulmonary Disease (COPD) . The study was conducted using descriptive-analytic method. The descriptive method would result in information related to any dependent and independent variable. The analytical method of randomized clinical trial based the study of the effect of respiratory muscle training. A random allocation was done resulted in eight patients with COPD belonged the breathing exercise group, eight patients received general exercises reconditioning. The other seven patients with COPD belonged to a control group with no intervention and without random allocation.

The respiration group underwent diaphragmatic breathing exercise + pursed lip breathing (PLB) . Breathing exercise were done daily at home an three times a week, under supervision at the Installation of Rehabilitation Medicine, dr Cipto Mangunkusumo hospital. The reconditioning group received exercises with ergocycle, three times a week which lasted for eight weeks under supervision at the institution.

The method analysis was done as follows : Univariat analysis was conducted to study the frequency characteristic of groups. Bivariat analysis ( paired-t test, Wilcoxon tesr) was conducted to study the effect of intervention.

Result of the study were as follows: The respiration group showed increased expiration muscle strength (MEP) significantly (p<> 0.05) and walking ability increased significantly (p <> 0.05) , physical fitness (VO ₂ max) increased (p> 0/05) . in the control group decrease of respiratory muscle strength was observed almost significantly (p > 0.05). The inspiratory muscle strength did not show result as expected, but decreased insignificantly in both groups with intervention and increased in the control group (p> 0.05).

The conclusion of the study were as follows. Breathing exercises and reconditioning resulted in better quality of life as shown by increase in walking ability . both successes derived of different approaches breathing exercise group by increases of expiratory muscle strength resulted in decrease of dyspnea and increase in quality of life. On the other side , reconditioning group resulted in better physical fitness and to better quality of life . respiratory muscle training was recommended when the exercises were intended to control dyspnea and reconditioning was done and reconditioning was done if physical fitness was intended.

We have to be aware of the increase of airway resistance in the diaphragmatic breathing exercises group + PLB . In the reconditioning group insspite of most decrease of residual air, there were decrease of inspiratory muscle strength.

Key words: Diaphragmatic breathing exercise; PLB (Pursed Lip Breathing)[ MEP (Maximal Expiratory Pressure); MIP (Maximal Inspiratory Pressure) ; dyspnea; VO₂ maximum; 12 minutes walk.

References : 67 (1962 - 1999)

The Benefit Of Diaphragmatic Breathing Exercise in Mild Asthma Persistent Done in Department Physical Medicine And Rehabilitation

2007-03-24T10:33:00.000-07:00

Abstract::

A study of application of deep diaphragmatic breathing exercise was done in twenty four asthamatic adults, using a quasy experiment pre and post treatment method. The study was conducted using Borg’s scale Dyspnea Index (BSDI) to evaluate dyspnea.

At the end of the eight weeks exercise, BSDI decreased significantly (p < style=""> coefficient correlation (r) was 0. 583.

Manfaat latihan pernafasan diafragma pada asma kronis derjat sedang di unit Rehabilitasi Medik Rumah Sakit dr Cipto Mangunkusumo Jakarta

Abstrak:

Suatu peneliian penerapan latihan pernafasan diafraga dalam dilakukan pada 24 kasus penderita asma dewasa, menggunakan metoda Quasy experiment pre and post treatment. Penelitian dilaksanakan melalui program latihan pernafasan dalam kurun waktu delapan minggu.

Pada akhir menggu ke delapan , sesak yang dinilai dengan Borg’s scale dyspne Index (BSDI) menurun bermakna (p <>