Current Articles

PJAHS- the Philippine Journal of Allied Health Sciences is a peer-reviewed Open Access journal publishing original research, systematic reviews and meta-synthesis, short reports, and letters to the editor.

Article 1 | Preface

Preface PJAHS Volume 5 Issue 2

Article 2 | Five Commonly Overlooked Aspects of Manuscript Submission

Ivan Neil Gomez

Editorial

Article 3 | Telerehabilitation for Speech-Language Pathology in Community- Based Rehabilitation in the Philippines: A Feasibility Study

Joyce Anne Ponciano-Villafania, Ellary Grace Odtuhan, Carmela Tria, Jowillyn Capacite, Mykel Francesco Dequiña, Jelynna Noreen Alano, Beatrice Colleen Cajucom

Background: Filipino speech-language pathologists (SLPs) can reach more persons with disabilities across 7,107 Philippine islands through telerehabilitation (also known as teletherapy, telepractice). This study described the feasibility of telerehabilitation for speech-language pathology in community-based rehabilitation in terms of appropriate information and communication technologies (ICT), stakeholder perspectives, and facilitators and barriers. Methods: A qualitative descriptive design was employed. Participants were purposely selected as telerehabilitation stakeholders. One metropolitan-based SLP conducted remote and synchronous therapy sessions to two persons with voice disorders (52 and 65 years old) in their homes, assisted by one primary caregiver each and one community-based rehabilitation worker (CBRW). ICT observations were logged as field notes. Stakeholder perspectives were obtained through participant journals and interviews, thematically analyzed using NVIVO, and validated by participants. Facilitators and barriers were derived from data triangulation of field notes, journals, and interviews. Results: The best ICT comprised of fastest wireless internet available (7.2 Mbps), MacBookTM laptop, and FaceTimeTM videoconferencing application. Stakeholders had varied yet positive perspectives. The SLP focused on ICT requirements and intervention conduct. The families saw telerehabilitation benefits of cost-effectiveness and intervention effectiveness. Both SLP and the families were satisfied as telerehabilitation providers and consumers. CBRW appreciated intervention effectivity. The only barrier to telerehabilitation was low internet bandwidth. Facilitators to telerehabilitation were stronger CBR policies and SLP capacity development. Conclusion: Telerehabilitation is feasible in speech-language pathology within community-based rehabilitation in the Philippines, given community-appropriate ICT and positive experiences of stakeholders. It can flourish with faster internet, stronger community health policies, and empowering stakeholders.

Article 4 | Occupational Therapy Dysphagia Management in Selected Philippine Hospitals During the Time of the COVID-19 Pandemic

Consuelo Gonzalez-Suarez, Ivan Neil Gomez

Due to the nature of dysphagia management, the continuation of its delivery by occupational therapists (OTs) during the COVID-19 pandemic is challenging. The high risk of infection and transmission associated with dysphagia management calls for innovative, safe, and effective strategies. The purpose of this report is to describe the current practices in dysphagia management by OTs in selected Philippine hospitals. Current practices include integrated infection control, telehealth, indirect service delivery, use of acrylic barriers, and exercise videos. The effects of the COVID-19 pandemic are shaping the practice of occupational therapy in dysphagia management in the current time and beyond.

Article 5 | Evaluation of an Arnis-based Exercise Program for Community- Dwelling Older Adults in the Philippines: An Exploratory Study Protocol

Donald Lipardo, Diane Ernabel Añonuevo, Jason Barlis, Eimee Jealyne Chang, Sophia Anne Ferrer, Juean Joloue Lama, Danielle Koleen Rivera, Kristopher Saludo, Marie Therese Turiano, Jerome Porto, Robinson Laxa

Background: Arnis is the national martial art of the Philippines. Similar to Tai Chi, a martial art with established therapeutic effects, it can improve the balance control of older adults. However, no study has been conducted to prove this. Objective: This study aims to design and evaluate an Arnis-based exercise program to improve the static and dynamic balance control of community-dwelling Filipino older adults. Methodology: A qualitative exploratory study will be conducted. An Arnis-based exercise program for older adults will be age-appropriately designed and video-recorded by the researchers. A heterogeneous group of resource persons composed of a Physical Therapist, Geriatrician, Sports Scientist, Arnis Expert, and Senior Citizen will be invited to watch the videos and evaluate the exercise program. Using the Delphi method and semi-structured interviews via the different online meeting platforms, they will provide feedback and comments about the exercise program based on their unique professional background, experience, and perspective. Thematic analysis will be employed in examining the gathered information. The modification of the exercise program and additional rounds of validation and feedback from the resource persons will be conducted as necessary until consensus is achieved. Expected Results: This will produce an alternative and culturally relevant exercise program that can be implemented by physical therapists and other health professionals caring for older adults in improving their balance control to reduce their risk of falling.

Article 6 | Cross-cultural Adaptation and Reliability of the Multidimensional Outcome Expectations for Exercise Scale (MOEES) in Filipino Older Adults: A Study Protocol

Donald Lipardo, Eunice Jessica Aquino, Fiona Cruz, Robert Joshua De Leon, Andrei Rafael Herras, Marrianne Natividad Llantino, Christine Mae Tibigar, Christian Joi Tupaz

Background: Older adults have varying outcome expectations on why they exercise. The Multidimensional Outcomes Expectation for Exercise Scale (MOEES) is a tool used to measure this; however, it has not been cross-culturally adapted yet in the Filipino setting. Objectives: This study aims to translate and cross-culturally adapt the MOEES into Filipino and establish its preliminary psychometric properties in terms of internal consistency and test-retest reliability in community-dwelling Filipino older adults. Methods: This psychometric study is divided into two phases. Phase 1 will be on the MOEES translation and cross-cultural adaptation in accordance with the guidelines set by the Beaton Protocol. Phase 2 will be on the establishment of preliminary psychometric properties based on the internal consistency and test-retest reliability of the adapted MOEES from at least 30 conveniently sampled community-dwelling Filipino older adults, aged 60 years old or above, with a Mini-Mental State Examination score of at least 24 and classified as active based on the Telephone Assessment of Physical Activity. Internal consistency will be assessed using Cronbach’s alpha coefficient and item-total correlations. Intraclass correlation/ ICC (3, K) will be utilized to establish the tool’s test-retest reliability. Expected Results: This will develop a translated and cross-culturally adapted MOEES in Filipino with good internal consistency, item-total correlation, and test-retest reliability that can be used by health professionals as a guide in designing, implementing, and assessing exercise programs for older persons to ensure achievement of their treatment outcome expectations.

Article 7 | Commonly Used Outcome Measurement Tools in Pediatric Physical Therapy Telerehabilitation in the Philippines: A Quantitative Cross- Sectional Descriptive Study Protocol

Arlene Chiong Maya, Christian Rey Rimando, Maria Eliza DelaCruz, Daniel Stephen Banting, Alliana Cielo Equipaje, Noel Antonio Ipo, Therese Daniela Manaloto, Jana Mae Mosi Ramos, Marc Jefferson Rillas, Jaycelle Anne Tajan

Background: With the COVID-19 pandemic, the need for social distancing presents an apparent barrier to in-clinic consultation. Therefore, the adoption of telerehabilitation has rapidly increased to improve access and minimize cross-infection risk to patients. Nevertheless, Filipino pediatric physical therapists must ensure that they conduct evidence-based procedures for specific tests and measures to determine patient outcomes. The utilization of outcome measurement tools (OMTs) enhances the quality of assessment in clinical decision-making and provides a credible and reliable justification for treatment on an individual patient level. However, a lack of information on utilizing OMTs in telerehabilitation by pediatric physical therapists internationally and locally is evident. Objective: To determine the most common pediatric OMTs used in telerehabilitation by Filipino pediatric physical therapists catering to 0 to 21-year-olds in the Philippines. Methods: The study will use an adapted questionnaire to gather data on common OMTs used during pediatric telerehabilitation. Phase I will include the validation of the 15-item adapted questionnaire by determining the content validity index. In Phase II, participants will be recruited through email and social media. Descriptive statistics will be used to report participants’ responses. Expected results: In Phase I, the expected result is a valid and reliable questionnaire to investigate the common OMTs used in pediatric telerehabilitation for Phase II. The results will be synthesized to inform other researchers and clinicians and encourage non- users to utilize OMTs despite the challenge of the pandemic. The study can give insights to stakeholders on what OMTs optimize pediatric telerehabilitation.

Article 8 | The Effects of Active Range of Motion with Overpressure on the Fascia Displacement of the Upper Trapezius Muscle among Individuals With and Without Myofascial Pain Syndrome: A Retrospective Case-Control Study Protocol

Valentin Dones III, Lyle Patrick Tangcuangco, Chrizelle Joy Del Rosario, Andrea Janelle Co, Sean Jerimiah Agbayani, Patricia Denise Cabrera, Edrin Isabel Dellosa, Daniel Rey Ibo, Ivy Sophia Pagente, Angelika Camille Sua, Clarence Pryce Joshua Almazan, Marie Arallu Capistrano, Kimberly-Anne Enriquez, Jorell Angelo Inarda, Maria Hellena Quebral, John Aldee Rigor, Angelica Supangan

Background: Myofascial Pain Syndrome (MPS) is a persistent pain on the shoulders and cervical spine-related to limitation of motion (LOM), muscle weakness, and loss of function. It is a cumulative, repetitive injury causing disability among the middle-aged working population. This study will determine the differences in upper trapezius’ superficial and deep fascia displacements among participants with and without MPS based on the effects of cervical active range of motion (AROM). Methods: This is a retrospective records review study with two interlinked parts. In the reliability study, the Tracker will determine the physiotherapy interns’ intertester and intratester reliability in assessing the musculoskeletal ultrasound videos. Using MedCalc Software and the Bland-Altman plot, the single measures ICC will determine the reliability. In determining clinically acceptable use of the Tracker, a <0.40 cut-off reliability will be used. In the case-control study, physiotherapy interns will assess 2,904 musculoskeletal ultrasound videos. The difference between the superficial and deep fascia displacements will be determined using paired t-test and the mean differences using an independent t-test. A significant difference between groups will be determined using a p-value of <0.05. Expected Results: This study expects that cervical AROM with overpressure will displace the superficial and deep fascia of the upper trapezius, particularly among patients with MPS. Proving the correlation between LOM and altered fascia displacement will help rehabilitation professionals create new manual therapy techniques and emphasize the use of existing fascia-related treatments.

Article 9 | The Short-Term Effects of Biomechanical Taping on Upper Extremity Muscles in Unilateral Lateral Epicondylalgia: A Pre-and Post-Experimental Study Protocol

Valentin Dones III, Christian Rimando, Andrea Janelle Co, Clarence Almazan, Marie Capistrano, Kimberly-Anne Enriquez, Jorell Inarda, Maria Quebral, John Aldee Rigor, Angelica Supangan

Background: Lateral epicondylalgia (LE) causes ineffective handgrip due to microtrauma on the elbow's common extensor origin. Objectives: This study will determine the differences in the Extensor Digitorum Communis' (EDC) fascia slide, percentage maximum voluntary contraction (%MVC), static maximum handgrip strength (SMHGT), muscle activation onset time (MAOT) in LE and non-LE elbows, with and without Biomechanical Tape (BMT). The study will determine differences in Visual Analogue Scales (VAS) and Patient Rated Tennis Elbow Evaluation (PRTEE) scores of patients with and without BMT. Methods: Nineteen participants' elbows with unilateral LE with and without BMT will be evaluated using musculoskeletal ultrasound (MSK) and electromyography (EMG) on Days 1, 3, and 5. A Physiotherapist-Sonographer, a Physiotherapist-EMG user, and a Research Assistant using Jamar hydraulic dynamometer will evaluate the participants. The participants will perform Mill's test during MSK and SMHGT using the dynamometer during EMG. A Chi-squared test will evaluate the relationship between BMT and fascia slide. Two-way repeated-measures ANOVA will compare the fascia slide, %MVC, SMHGT, and MAOT between elbows with and without BMT. It will be blocked according to elbow status (i.e., LE, no LE). Dunnett post hoc test will determine the groups whose results differed significantly. Differences in PRTEE scores at Days 1 and 5 will be determined. A p-value <0.05 indicates a significant difference in scores. Expected Results: We expect decreased fascial slide measurements on EDC, VAS, PRTEE scores, and increased %MVC, MAOT, and SMHGT on taped elbows. Results will determine the underpinning mechanism behind the short-term effects of BMT.

Article 10 | Translation, Cross-Cultural Adaptation of the Lower Extremity Functional Scale into Filipino, and Analysis of its Psychometric Properties: A Study Protocol

Ken Erbvin Sosa, Fe Therese Chavez, Leila Janina Bagsic, Ma. Sophia Louise Dato, Luis Miguel Dela Cruz, Wenna Mitchelle Manongsong, Aaron Nuñez, Jhellina Rojano, Paul Jimson Sy, Sophia Joy Velante

Background: Impairment and functional limitations from musculoskeletal conditions are evaluated using outcome measure tools. The Lower Extremity Functional Scale (LEFS) is one of the outcome measure tools (OMT) that assess the functional capacity of patients who have lower extremity conditions. It was originally developed in English and translated later into other languages; however, no Filipino version is available. Objective: This study aims to translate, cross-culturally adapt the LEFS into Filipino, and evaluate its psychometric properties. Methods: Using a psychometric study design, the LEFS will be translated and cross-culturally adapted into Filipino following the guidelines set by Beaton et al. and Sousa and Rojjanasrirat. These include six stages: (1) forward translation into Filipino, (2) synthesis, (3) backward translation, (4) expert committee review, (5) pilot testing/cognitive interview, and (6) psychometric testing. Filipinos with lower extremity conditions will be recruited for the pilot (n= 10) and psychometric testing (n= 200). Validity will be evaluated using face validity index, content validity index, independent t-test (knowngroup validity), and Spearman rho (concurrent validity). Reliability will be assessed using Cronbach alpha for the internal consistency and intraclass correlation coefficient for the stability. Floor and ceiling effects will also be computed. Expected results: The LEFS will be successfully translated and cross-culturally adapted into Filipino. It will be a valid and reliable outcome measure tool that physical therapists and other healthcare professionals can use for the functional assessment of patients. This study can also serve as a reference for future translation studies.

Article 11 | Occupational Therapy Models and Practice on Telehealth and Beyond

Abelardo Apollo David, Jr., Rod Charlie Delos Reyes

Special Collection: Letter to the Editor

Article 12 | Occupational Tree of Life (OTL) Model: Addressing Adherence to Home Instruction Programs in Occupational Therapy

Elaine Caday, Kristine Anne Candelaria, Christianne Grace Lopez, Queenie Nicole Masajo, Coleen Perez, Rod Charlie Delos Reyes

Home programs are part of occupational therapy services that improve outcomes and further increase their benefits. However, adherence to home programs can be challenging, and adherence rates range from 40-70%.1 In the Filipino Occupational Therapy practice, this problem is also evident. This model aims to enable practitioners to view the occupational therapy process, specifically the factors involving adherence to home programs, and to effectively consider and address barriers and support the achievement of intended therapeutic goals. The coconut tree depicts the occupational therapy process in relation to home-based rehabilitation programs. Each part of the image corresponds to a vital element. The conceptual framework can also aid Occupational Therapists in determining the rehabilitation potential and prognosis of the client based on the factors seen

Article 13 | The Family Therapy Engagement Model (FTEM)

Crissa Nicole Alonso, Genell Lagare, Czyrhen Veanne Chua, Madjoriel Alaan, Selina Jane Escandor, and Abelardo Apollo David, Jr.

Among pediatric Occupational Therapists’ goals is to provide a holistic approach towards intervention planning which includes preparing the child’s social environment, especially in facilitating the carry-over of tasks in the child’s daily contexts. This model explores the factors contributing to the limited opportunities for family/caregiver participation during actual therapy sessions. It also discusses and integrates some of the best practice principles for family engagement that are based on the Phoenix Theory of Parent Attendance, Adlerian Play Therapy, and Discrimination model. This model was conceptualized in response to the growing need to increase family engagement during therapy in the Philippine setting, which could help them overcome barriers and strengthen their therapeutic skills and relationship with the child. Techniques and intervention processes that aim to engage the family during occupational therapy need to be further developed and studied. To fulfill this, this paper introduces a conceptual framework that maps out (1) five core elements, (2) five phases of family therapy engagement, and (3) a process checklist during the intervention process. The five core elements that affect family engagement are client, therapist, family, therapy-related, and environmental factors. This model explains how good collaboration between the family and therapists can be achieved if they undergo the preparation, consultation, planning, experiential activities, and re-education phase. The researchers suggest using this conceptual framework as a guide to understand and provide a systematic family engagement process during therapy sessions

Article 14 | Building Occupational Alliance for Therapy (BOAT) Model

Abigail Racho, Julianne Choa, Ma. Alexandra Barrera, Monica Andrea Bañez, Don Tongol, Abelardo Apollo David, Jr.

Occupational Therapy (OT) is a profession that is not easily understood, leading to limited appreciation and misunderstanding of its therapeutic scope and areas of concern. The BOAT Model was created to guide therapists in establishing a therapeutic alliance with clients for the purpose of eliciting mutual concern, perception, and understanding of the client’s unique occupational performance issues (OPI). The model also aims to help enhance the appreciation for OT services. Two specific steps were provided as a process in achieving the outcomes stated, namely Establish and Converse. The use of appropriate therapeutic interactive styles and modes outlined in the IRM were incorporated into the model. At the end of the process, the identified OPI using the COPM will be used to advise the creation of an occupation-based evaluation and intervention that is more relevant and meaningful for the client.

Article 15 | The Tele-Evaluation Facilitators Model

Alyssa Albarillo, Stefannie Balinas, Korinne Bea Castaño, Cyrille Inah Pabustan, Abelardo Apollo David, Jr.

Telehealth has become an alternative service delivery of different healthcare professionals, including occupational therapists, upon the onset of the COVID-19 pandemic. Occupational therapists have adapted to this platform to deliver service in response to the global crisis. This conceptual framework explores the facilitators of occupational therapy evaluation provided via telehealth. It aims to provide insights to clinicians and clients in engaging tele-evaluation. It also aims to establish primary considerations to ensure a thorough evaluation process. The Tele-Evaluation Facilitators Model (TFM) describes the occupational therapy evaluation in the therapy setting. It outlines the OT evaluation process, adapting it to the telehealth setting. The process emphasizes the importance of client-caregiver interaction in creating and achieving occupational therapy goals. Moreover, surrounding the tele-evaluation process, the model highlights the facilitators of tele-evaluation, enabling a comprehensive evaluation process despite the challenges and barriers of this alternative service delivery. Across practice settings, the COVID-19 pandemic necessitated a shift in service delivery to telehealth, and occupational therapists adapted accordingly. Evaluation frameworks exist for telehealth services, but none are unique to occupational therapy evaluation. As a result, an occupational therapy framework that highlights the facilitators of telehealth evaluation will benefit occupational therapy. TFM consists of three domain areas: (1) Family Involvement, (2) Accessibility, (3) Professional Development. This framework promotes telehealth evaluation to clinicians and clients who have hesitations and difficulties in this service delivery model.

Article 16 | Elements of Realistic Goal-Setting Model

Michaela Denice Buenaventura, Jaclyn Margaret Fajatin, Andrea Marie Samaniego, Carl Jason Villagracia, Rod Charlie Delos Reyes

Goal setting leads to improved clinical outcomes, a more client-centered approach, enhanced motivation and psychological adaptation, and enhanced collaboration between client and clinician. However, goal setting remains problematic for both clients and clinicians. The purpose of this conceptual framework is to provide elements to consider when facilitating a collaborative goal-setting as supported by several theoretical concepts. Using the Goal-Setting Theory, Person-Environment-Occupational-Performance Model, Dekker’s tool in setting meaningful goals in rehabilitation, and Canadian Model of Client-Centered Enablement, the authors have identified eleven (11) essential elements, which are the following: external factors, global meaning, collaborate, coordinate, consult, design, clarity, challenge, self-efficacy, commitment, and overall occupation-centered goal. By considering the various elements presented, occupational therapists can avoid having unrealistic expectations from clients during the process of goal setting.

Article 17 | Systematic and Collaborative Review of E-health Ecological Networks (SCREEN) Model

Mark André Blanco, Janessa Bulanadi-Mamaril, Joshua Jocson, Vince Mercado, John Paul Sevilla, Rod Charlie Delos Reyes

Due to the Covid-19 pandemic, occupational therapy services in the Philippines experienced a shift in service delivery. As face-to-face services were halted, E-health became the key solution for rendering rehabilitation services. Practitioners relied on their clinical judgment in accepting clients for this type of service delivery. The Systematic and Collaborative Review of E-health Ecological Networks or SCREEN is a model that may aid occupational therapists practicing in the pediatric setting and providing services through E-health. The SCREEN model will assist practitioners in deciding what type of service delivery would be beneficial for the client and if the therapist is equipped to provide E-health as a service. SCREEN model includes the framework and a decision tree for its usability and application to OT practice, particularly in E-health.

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The Philippine Journal of Allied health Sciences [ISSN: 1908-5044] is an Open Access, peer reviewed journal published by the University of Santo Tomas-College of Rehabilitation Sciences, Manila, Philippines.

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