Philippine Journal of Allied Health Sciences Vol 3 Iss 1

PJAHS • Volume 3 Issue 1 2019 • Question 17 Carbohydrate food sources 0 Question 18 Protein food sources 0 Question 19 Protein consumption 0 Question 20 Iron food sources and absorption 0 Question 21 0 Question 22 Protein and fat function 0 Question 23 0 Question 24 Fiber sources 0 Question 25 Vitamin intake 0 Question 26 Dehydration 0 Question 27 0 Question 28 0 Question 29 0 Overall Score 0 40

(doi:10.36413/pjahs.0301.006) 0.68 (< 0.00) Good 0.68 Good 0.59 (0.0006) Fair 0.59 Fair 0.60 (0.0005) Good 0.56 Fair 0.66 (< 0.00) Good 0.60 Good 0.56 (0.0011) Fair 0.50 Fair 0.22 (0.25) Poor 0.11 Poor 0.13 (0.48) Poor 0.13 Poor 0.57 (0.0011) Fair 0.57 Fair 0.42 (0.0222) Fair 0.42 Fair 0.62 (0.0003) Good 0.61 Good 0.49 (0.0059) Fair 0.48 Fair 0.64 (0.00) Good 0.59 Fair 0.51 (0.004) Fair 0.51 Fair 0.60 (0.0005) Good 0.60 Good 0

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.006) in a scale reliability α score of 0.81 (95% lower some were modified to be more understood and confidence limit = 0.72), earning an overall adaptable to the local participants. ‘Good’ rating. Only two questions (Questions 9 and 26) received a lower rating of ‘Acceptable’, The Food Guide Pyramid used in the original with a Cronbach’s α of 0.79. Only a few items questionnaire was the US version19. In this study, were noted to have fair scores in terms of test- however, a modified version of the Food Guide retest reliability. The Dietary Habits section Pyramid which was adapted for the Filipino resulted in positive outputs, with an overall population was used. For the purpose of this score 0.79 rated as ‘Excellent’ while some items study, this modified version will be referred to as such as questions 6, 7, 15 and 17 were rated as the ‘Filipino Food Guide Pyramid’. Adding ‘Fair’, with an ICC score between 0.40 to 0.55. No phrases like “sa isang araw” at the end of each questions were rated ‘Poor’ (see Table 6). question about food consumption based on the Filipino Food Pyramid Guide were emphasized. In this section, hydration and recording of food In the Filipino Food Guide Pyramid, the intake, frequency of junk food and fast food population was classified into two; Filipinos aged consumption were items that would have the 18-19 years old and 20-25 years old. As there are greatest possibility of change over a one-week two different age groups involved in the target period. This could also be particularly true for population being tested, two versions of the the Nutrition Knowledge Section where questionnaire were made for each age group, participants would have guessed their answers one modified to the Food Guide Pyramid directly in terms of nutritional information, as recommendation for 18-19 years old20 and opposed to misunderstanding the concepts another for 20-25 years old21. This rationale for grammatically. In this section, test-retest the creation of two different versions of the reliability resulted in an overall score of 0.60 questionnaire was to highlight the differences in interpreted as ‘Good’. Items were mostly rated the dietary recommendations between the two ‘Fair’ and ‘Poor’, with an ICC score ranging from age groups. 0.10 to 0.59. Only seven items were recorded to be ‘Good’ or ‘Excellent’. Internal consistency is defined as how well the item being tested measures what it is supposed DISCUSSION to measure. Reliability test results of “Questionable” for dietary habits section could The DHNKQ-Fil was created using a variety of be attributed to the selection of participants translation and validation guidelines to ensure coming from different sports. Different sports cultural adaptability and statistical reliability. In exhibit different dietary habits as they have to the expert committee review, items that did not meet the requirements of their sport22. Judo, for meet the score of Item-Content Validity Index (I- example, a sport which categorizes athletes by CVI) score of 0.78 were modified due to its their weight classes, cannot be compared to a grammatical difficulties as its chosen translation team sport like basketball because dietary habits may be difficult to comprehend. With the would be given more emphasis by players whose modern age Filipino athlete, more relevant weight will be greatly affected by it. Dietary terminologies allow for better conceptualization habits practiced by these kinds of athletes will of the subject being referred to in the question differ from non-weight category sports because stated. Items were simplified enough to better nutrition habits will have a much greater impact adapt to modern Filipino culture applicable to on their target performance and classification in the practices and lifestyles of these athletes18. the sport. An example of this would be the habit Food terminologies such as junk food, of dieting, food recording, eating fast food, or the carbonated drinks, and dairy were modified to habit of eating food high in sugar. Considering correspond to the typical Filipino food terms the varying concepts behind dietary habits per such as meryenda, softdrinks and gatas. Samples sport, scores in its Filipino translated version of Filipino food items were also provided, and may as well be affected. 41

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.006) Internal consistency is defined as how well the obtained, it does not necessarily construe as item being tested measures what it is supposed unreliable but the information on these to measure. Reliability test results of questions may change due to habit formation as “Questionable” for dietary habits section could recalled from the previous questionnaire rather be attributed to the selection of participants than grammatical or linguistic inconsistency. coming from different sports. Different sports exhibit different dietary habits as they have to The Bilingual Education Policy existing in the meet the requirements of their sport22. Judo, for Philippines advocates the use of Filipino in example, a sport which categorizes athletes by primary level and English during the secondary their weight classes, cannot be compared to a and tertiary levels, but it also advocated those team sport like basketball because dietary habits who reside in the National Capital Region’s would be given more emphasis by players whose (NCR) private and public schools. As the sample weight will be greatly affected by it. Dietary size is also limited, the study would have habits practiced by these kinds of athletes will produced different results and distribution of differ from non-weight category sports because responses for each statistical tool. Also, athlete nutrition habits will have a much greater impact participants in the study, although randomized, on their target performance and classification in were not fully representative of their sport, the sport. An example of this would be the habit thereby affecting items such as dietary habits of dieting, food recording, eating fast food, or the which could have been validated better should habit of eating food high in sugar. Considering the comparisons be made within their sporting the varying concepts behind dietary habits per teams only. Lastly, changes in the school system sport, scores in its Filipino translated version have not yet been implemented during the time may as well be affected. of the study; thus, age differences in the collegiate level may vary in the future. The Nutrition Knowledge Section, however, has an overall scale reliability rated as ‘Good’. In a Although the questionnaire was successfully study by Folasire et al2, nutrition knowledge is a translated, validated and tested for its reliability, foundation for any individual who would some considerations should be taken note of in consider nutrition as an essential part of life future studies to further reinforce findings regardless of what sport an athlete is engaged in. gathered in this study. These considerations Although the specified recommended dietary include increasing sample size to 300 – 500 intakes for Filipinos varied from the original participants as stated in guidelines set by Sousa English questionnaire, the concept and and Rojjanasrirat12. Validating the questionnaire information behind each question still provided to a single sport to eliminate the effects of one and the same meaning after translation. The anthropometric and nutritional characteristics understanding of eating the three fundamental from the psychometric analysis is highly meals a day, vitamins and minerals, macro and recommended, as the responses of the micronutrients, for example, would be the same participants in this study are extremely varied across any sport with only its amounts varying due to the assortment of sports with different with each sport. This is a common nutritional dietary needs. This is apparent in weight control information among participants that is why sports that have weight classes, such as Judo and scores would be high. Boxing. Lastly, considering the different dialects being used in the Philippines, it would also be Test-retest reliability is defined as how recommended to revalidate and translate to consistent an item is over time when tested on a these dialects for future use among collegiate set on the same set of participants. Intraclass athletes outside the National Capital Region. Correlation Coefficient (ICC) was used to Ultimately, this questionnaire could be used in measure this aspect. The results of both Dietary sports nutrition for performance enhancement Habits and Nutrition Knowledge sections through proper nutritional recommendations. produced overall acceptable ratings which indicate the consistency of the understanding towards the questionnaire. In the outputs 42

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.006) CONCLUSION of Rehabilitation Sciences, University of Santo Tomas. The Dietary Habits and Nutrition Knowledge Questionnaire is a tool that can aid health Authors Contributions experts in assessing collegiate athletes’ nutrition Mrs. Karen Leslie L. Pineda conceived of the practice and knowledge. The cultural adaptation presented idea. Together with Ms. Stephanie of the instrument was carried out in accordance Claire L. Pagarigan, verified the analytical with various international guidelines. The methods and lead all investigators in the DHNKQ-FIL was shown to have acceptable levels structure of the translation process. Mr. of validity and reliability. It can be suitable for Alessandro B. Cardenas, Ms. Rayesha Azzedine use in determining sports nutrition knowledge Ma. G. Quilala and Ms. Niccol V. Servañez and dietary habits that may affect athletic developed the theory and framework of related performance and health of Filipino athletes. translation studies. Mr. Ronell Angelo P. Esteban Moreover, this questionnaire can be used to and Mr. Johnmer Paul M. Se processed almost all investigate the relationship of nutrition the experimental data, verified results and knowledge and dietary habits according to drafted the manuscript. All authors took part in sports. Lastly, due to its reliability, this can serve organizing and facilitating the focus group as a valuable assessment tool in planning discussions, data gathering, results analysis and nutrition education program. discussion and writing of the final manuscript. Acknowledgment Disclosure Statement The authors of the publication declare no We acknowledge the following individuals, relevant or material financial interests that consultants and professors for their valuable relate to the research described in this paper. contribution for the expert committee review and translation processes: Sarah Paugh Weaver, Conflict of Interest MS, ATC, PES, CKTP for allowing us to use her No potential conflict of interest was reported by original English DHNKQ questionnaire for the authors. translation, Alexander P. Villa for the contributions to the development of the paper, Supplementary File Grace Bengco and Benjamin M. Mendillo Jr., Ph.D. SI_ DHNKQ-FIL. Copy of the Dietary Habits and for forward translation from Komisyon sa Nutrition Knowledge Questionnaire- Filipino Wikang Filipino, Raquel Jimenez and Doc Andres (DHNKQ-FIL). Julio V. Santiago, Jr., Ph.D. from Language Center of University of Santo Tomas for backward References translation, the 3 registered Nutritionists Glenna Grace Bernabe, RND, Jane Serrapion, RND, and 1. American College of Sports Medicine, American Dietetic Kimberly Hung, RND for being a nutrition Association, Dietitians of Canada. Joint position consultant, two Sports Scientist from the UST statement: nutrition and athletic performance. Med sci Sports Science Department Saul Sibayan, MSS, sports exerc 200; 32(12):2130-45. TSAC-F and Josephine Joy G. Reyes, MPE, Coach Cyrus Alcantara head coach of the UST UAAP 2. Folasire OF, Akomolafe AA, Sanusi RA. Does nutrition Seniors Men’s Swimming Team, Aljon Salonga knowledge and practice of athletes translate to Water Polo Athlete of the Philippine National enhanced athletic performance? Cross-sectional study Team, Anthropologist Jesus T. Peralta, Ph.D., our amongst nigerian undergraduate athletes. Global statisticians Jose Ronilo G. Juangco, MPH, MD, journal of health science. 2015 Sep;7(5):215. Chair of the Ethics Review Committee Panel of the Research Institute for Health Sciences from the UERMMMCI (University of the East Ramon Magsaysay Memorial Medical Center Institute) and Catherine Joy Escuarda, faculty of the College 43

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.006) 3. Hornstrom GR, Friesen CA, Ellery JE, et al. Nutrition 16. Anthoine E, Moret L, Regnault A, et al. Sample size used knowledge, practices, attitudes, and information to validate a scale: a review of publications on newly- sources of mid-American conference college softball developed patient reported outcomes measures. Health players. Food and Nutrition Sciences. 2011 Apr and quality of life outcomes. 2014 Dec;12(1):2. 26;2(02):109. 17. Swaine‐Verdier A, Doward LC, Hagell P, et al. Adapting 4. Alaunyte I, Perry J, Aubrey T. Nutritional knowledge quality of life instruments. Value in health. 2004 and eating habits of professional rugby players: does Sep;7:S27-30. knowledge translate into practice? Journal of the Intl Society of Sports Nut. 2015, 12:18. 18. Bolarinwa OA. Principles and methods of validity and https://doi.org/10.1186/s12970-015-0082-y. reliability testing of questionnaires used in social and health science researches. Nigerian Postgraduate 5. Montecalbo RC, Cardenas RC. Nutritional knowledge Medical Journal. 2015 Oct 1;22(4):195. and dietary habits of Philippine collegiate athletes. International Journal of Sports Science. 2015;5(2):45- 19. United States Department of Agriculture Center for 50. Nutrition Policy and Promotion. Food guide pyramid. 1992 6. Zinn C, Schofield G, Wall C. Development of a psychometrically valid and reliable sports nutrition 20. Republic of the Philippines Food and Nutrition knowledge questionnaire. Journal of science and Research Institute Department of Science and medicine in sport. 2005 Aug 1;8(3):346-51. Technology. Daily nutritional guide pyramid for Filipino children (13-19 years old). 2000 7. Calella P, Iacullo VM, Valerio G. Validation of a general and sport nutrition knowledge questionnaire in 21. Republic of the Philippines Food and Nutrition adolescents and young adults: GeSNK. Nutrients. 2017 Research Institute Department of Science and Apr 29;9(5):439. Technology. Daily nutritional guide pyramid for Filipino adults (20-39 years old). 2000 8. Halliday MAK, Gibbons J, Nicholas H. Learning, keeping and using language. John Benjamins Publishing 22. Galanti G, Stefani L, Scacciati I, et al. Eating and Company. Philadephia. 1990; 2:153-161. nutrition habits in young competitive athletes: a comparison between soccer players and cyclists. 9. Bernardo AB. McKinley's questionable bequest: Over Translational Medicine@ UniSa. 2015 Jan;11:44. 100 years of English in Philippine education. World Englishes. 2004 Feb;23(1):17-31. 10. Beaton DE, Bombardier C, Guillemin F, et al. Guidelines for the process of cross-cultural adaptation of self- report measures. Spine. 2000 Dec 15;25(24):3186-91. 11. World Health Organization. Process of translation and adaptation of instruments. 2007 12. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross‐ cultural health care research: a clear and user‐friendly guideline. Journal of evaluation in clinical practice. 2011 Apr;17(2):268-74. 13. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee‐Lorenz A, et al. Principles of good practice for the translation and cultural adaptation process for patient‐reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in health. 2005 Mar;8(2):94-104. 14. Artino Jr AR, La Rochelle JS, Dezee KJ, et al. Developing questionnaires for educational research: AMEE Guide No. 87. Medical teacher. 2014 Jun 1;36(6):463-74. 15. Paugh SL. Dietary habits and nutritional knowledge of college athletes. Bachelor's Thesis, Faculty of the School of Graduate Studies and Research, California University of Pennsylvania. 2005. 44

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) Original Article Association of Lateral Epicondylalgia and Shoulder Rotatory Motion: A Cross-sectional Case Control Study Lyle Patrick Tangcuangcoa,b, Valentin Donesa,b,c aGraduate School, University of Santo Tomas, Manila, Philippines; bCenter for Health Research and Movement Sciences - College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines; cCollege of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines Correspondence should be addressed to: Lyle Patrick Tangcuangcoa,c; [email protected] Article Received: 25 March 2019 Article Accepted: 8 July 2019 Article Published: 19 July 2019 (Online) Copyright © 2019 Tangcuangco and Dones. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Lateral epicondylalgia (LE) is a cumulative strain injury affecting the common extensor origin of the elbow, manifesting as lateral elbow pain. Tightness of the fascia connecting the lateral elbow area with the shoulder area was assumed as potential source of LE. Limitation in shoulder rotatory motions may be associated with painful LE elbows. Aim: To determine the difference on shoulder rotatory motions between sides of symptomatic and asymptomatic elbows. Methods: Eligible participants had at least one elbow that tested positive for Cozen, Mill, or Maudsley’s test. Using a universal goniometer, a blinded assessor measured the participants’ active and followed by passive shoulder internal and external rotation. The primary investigator tested the external rotation followed by internal rotation of the right upper extremity, then subsequently the left upper extremity of healthy participants both passively and actively. Results: The assessor showed excellent intra-tester reliability in measuring active and passive shoulder rotatory motions of 20 asymptomatic right upper extremities (ICC=0.98). Twenty-seven (27) participants (3 males, 24 females) with a mean (95%CI) age of 54 (49-58) years old were enrolled in the study. The mean visual analogue scale of the patients was 6.53 (5.91- 7.13), with mean (95%CI) duration of 96 (50-142) weeks. Based on hand dominance and side of LE, significant difference was found in active and passive shoulder internal rotation (p>0.05). Conclusion: Shoulder active and passive internal rotations were significantly associated with hand dominance in patients with LE. Tightness of the fascia and muscle in the shoulder and painful LE elbow may underpin the decreased shoulder rotatory motions. Keywords: lateral epicondylalgia, tennis elbow, shoulder, fascia Introduction test5.Cozen, Mill and Maudsley tests have sensitivities of 91%, 76%, and 66% Lateral epicondylalgia (LE) is a musculoskeletal respectively6. injury characterized by lateral elbow pain and painful grip affecting daily functions.1 LE is most The forearm wrist extensor muscles and the prevalent in jobs or activities requiring lateral intermuscular septum were reported to repetitive manual tasks commonly seen in tennis be associated with lateral elbow pain in LE players, cooks, washers, painters, plumbers, elbows7;8;9;10. The lateral intermuscular septum butchers and carpenters2. LE is commonly found is connected to the forearm wrist extensor between 45-54 years old with prevalence of 1- muscles through the lateral epicondyle9;10;11;12. 3% with no apparent gender bias1; 3; 4. The lateral intermuscular septum is proximally connected to the triceps brachii, middle deltoid Lateral epicondylalgia (LE) is clinically and posterior deltoid6;12;13. diagnosed by reproducing patient’s lateral elbow pain using the Cozen, Mill or Maudsley’s 45

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) The forearm wrist extensor-lateral A_File). Participants’ responses to replication intermuscular septum-shoulder muscles fascia tests (i.e. Cozen, Mill and Maudsley tests) were link could have underpinned the reported noted. The control participants were matched association between shoulder and elbow with case participants based on gender, age, and movements in LE patients by Abott (2001). The occupation. Based on sample size calculation, a limitation in the shoulder range of motion of 23 1:1 case: control matching was performed. participants with LE elbow was due to due to increased muscle activity in the shoulder14. The Criteria of Eligible Participants assumed shoulder and elbow limitation in the range of motion remains to be under- Participants were LE were selected based on the investigated in the current literature. following inclusion criteria: This study aimed to associate shoulder rotatory  Characteristic lateral elbow pain replicated motion with presence or absence of LE. We by any one or combination of the Cozen, Mill aimed to find association between hand or Maudsley test; dominance, age, gender, activities, and chronicity of LE symptoms with shoulder rotatory motions.  Engaged in forceful and repetitive upper extremity activities such as laundry washing, carpentry, car mechanics, tennis playing, and golfing; Materials and Methods Participants with orthopedic conditions in the Ethics Approval elbow that may mimic LE (i.e. fractures in the elbow, arthritic conditions, medial epicondylalgia, nerve impingement at the elbow, This study obtained ethics approval from the elbow pain from cervical radiculopathy, Ethics Review Committee of the College of paresthesia occurring along the elbow region) Rehabilitation Sciences of the University of Santo were excluded from the study. Tomas (UST-CRS), Manila, Philippines (Ethics Protocol Number SE-2014-033-R1). The non-symptomatic elbows of healthy Study Design participants were tested negative to all Cozen, Mill and Maudsley tests. The healthy This was an observational cross-sectional case- participants had no lateral elbow pain in the past control study. Active and passive shoulder six months prior to inclusion in the study and rotatory motions of participants with unilateral were involved in repetitive and forceful handgrip LE and healthy participants without LE were activities (i.e. laundry, sewing, typing). measured. Non-LE elbows were the non-painful elbows of participants with unilateral LE. Non- Status of Elbows Used in the Study symptomatic elbows were the bilateral Elbows, whose sides of shoulder range of asymptomatic elbows of healthy participants. movement were measured, were referred to in Recruitment Protocol and Sample Size the study as: From January 2015 to March 2015, potential 1. LE elbows i.e. symptomatic elbows of participants were recruited from the following participants with unilateral LE places: 2. Non-LE elbows i.e., asymptomatic elbows of 1. University of Santo Tomas-College of participants with unilateral LE Rehabilitation Sciences affiliated centers, 3. Non-symptomatic elbows i.e., elbows of 2. health centers surrounding the vicinity of healthy participants University of Santo Tomas Setting 3. Tennis/golf clubs in Metro Manila identified The study was conducted at Lingap Karunungan, through yellow pages. Rehabilitation and Empowerment of Adults and The participants were evaluated by a licensed Children with Handicap (REACH) Foundation, physiotherapist other than the Assessor at the Mandaluyong City serving 44 barangays in Physiotherapy Skills Laboratory of UST-CRS Mandaluyong City. REACH is a non-profit using an initial screening checklist (Supplement organization providing physical therapy, 46

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) occupational therapy, speech therapy, and participants both actively first followed by special education classes. passive movement. Equipment Used Outcome Measures A mechanical contraption was used in this study Measurements on shoulder active and passive (Fig. 1). The mechanical contraption held the external and internal rotatory motions were head and neck in a neutral position, and shoulder used to determine differences in shoulder at 90 degrees of abduction of a supine-lying rotatory motions between LE and non-LE elbows patient. The mechanical contraption prevented of participants with unilateral LE. Shoulder unnecessary neck (lateral and rotatory) and rotatory motions were compared between shoulder (elevation) motions. shoulders of case and control participants. The following section described in detail the components of Phases 1 and 2. Steps used in measuring shoulder rotatory movements. A series of three trial measurements were performed by the primary investigator. The second and third trials were performed after the 20 non-symptomatic upper extremities had been measured, to minimize recall bias of the primary investigator. The junior investigator noted the readings of the primary investigator. Figure 1. Statistical analysis used. MedCalc Version 15.2.2 software (MedCalc Software, Ostend, A universal goniometer was used to measure the Belgium) was used for data analysis. The intra- active and passive shoulder internal rotation and class correlation coefficient (ICC) of the same external rotation. The universal goniometer has raters and absolute agreement was used to moderate to good reliability, with Intraclass determine the intra-tester reliability of the Correlation Coefficients of ≥ 0.9415. primary investigator in measuring the shoulder rotatory motions of healthy participants. Assessor Absolute agreement considered systematic differences involved in the process of quantifying The Assessor had 10 years of clinical practice in shoulder rotatory movement of included musculoskeletal physiotherapy. Using the participants. The ICC was interpreted as follows: standard universal goniometer, the Assessor was blinded to the side of LE during measurements of  0-0.2: poor agreement shoulder rotatory motions.  0.3-0.4: fair agreement  0.5-0.6: moderate agreement Study Protocol  0.7-0.8: strong agreement  >0.8: almost perfect agreement The Standard Error of Measurement (SEM) was used to estimate the error of the primary investigator in reading the shoulder rotatory movement measurements using the formula: Participants lay supine on mechanical SEM = SD* [square root of (1-ICC)] contraption (Fig. 1). The primary investigator Key: SD, Standard deviation; ICC, Intraclass tested the external rotation followed by internal Correlation Coefficient rotation of the right upper extremity, then An a-priori level of significance was set at α=0.05 subsequently the left upper extremity of healthy to indicate a significant difference between 47

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) groups. Associations between shoulder rotatory shoulder external (0.98) and internal (0.99) motions, side of LE, hand dominance, gender, rotatory motion measurements. Supplement B activities, and visual analog scores were tested. shows the intra-tester reliability of primary investigator in measuring shoulder rotatory The paired-samples t-test was used to compare: movements of both shoulder of 10 healthy participants.  mean of the shoulder rotatory motions between LE and non-LE elbows of The primary investigator had less SEM for passive participants based on side of LE and hand shoulder internal rotation (SEM=0.40 degree) dominance; and and active shoulder internal rotation (SEM=0.70 degree). The SEM for shoulder passive and active  mean of shoulder rotatory movements external rotation was 1.41 and 1.69 degrees, between non-symptomatic elbows of healthy respectively. participants. Baseline Demographics All predictor variables (i.e. age, gender, activities, hand dominance, presence of LE) found Thirty-six (36) participants with lateral elbow significantly associated to shoulder rotatory pain were initially screened. Of the 36 movements were analyzed using multiple participants, nine (9) participants were excluded regression. Multiple regression was the method secondary to the following: used to examine the relationship between shoulder rotatory movements as the dependent  Negative to all provocation tests: 6 variable and their significantly associated  Past history of elbow fracture: 1 predictors as independent variables. The  Signfiicant shoulder pain: 2 backward method was used to minimize suppressor effects which occur when a predictor Twenty-seven eligible participants with had a significant effect only when another unilateral LE (male: female=3:24) had mean variable was constant. Backward method (95% CI) age of 54 (49-58) years. The mean minimized the risk of making a Type II error (i.e. (95% CI) visual analog scale pain score of the missing a predictor that does, in fact, predict the participants was 6.53 (5.91-7.13) with a mean outcome). A predictor variable with a p-value of (95%CI) pain duration of 96 (50-142) weeks. 24 less than 0.05 was entered into the model. A participants were right hand dominant and 3 predictor variable with p-value more than 0.10 participants were left hand dominant. was removed from the model. The coefficient of Meanwhile, 13 participants had LE elbows on the determination R2 was used to explain the dominant hand side. Laundry work (67%) was proportion of the variation in the dependent the most common activity engaged by variable by the regression model. In the participants with unilateral LE followed by regression equation, the beta coefficient typing (22%), vending (7%) and sewing (4%). (standard error) quantified the change in shoulder range of movement for every point Twenty-seven healthy participants without LE change in the predictor variable. The p-value was (male: female=3:24) had a mean (95% CI) age of the probability that one had found the current 53 (49-57). Considering that the controls were result if the coefficient were equal to 0 (null matched with the cases, no significant hypothesis). Additionally, a two-way analysis of differences on gender, hand dominance and variance was used to determine interaction activities were found between unilateral LE effects between significantly associated participants and healthy participants. predictor variables. Shoulder Rotatory Range of Motion Results Side of Lateral Epicondylalgia (LE). Based on Reliability and Standard Error of Measurement side of LE, no significant differences in active and passive shoulder rotatory motions were found The primary investigator demonstrated almost between shoulders of LE elbows and non-LE perfect agreement in both active and passive elbows (p>0.05). Table 1 reports the mean (SD) of active and passive shoulder external and 48

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) internal rotation based on the presence or absence of LE. Table 1. Shoulder range of movement based on the presence or absence of LE (n=27) Shoulder LE Non-LE Difference p-value movement Mean (SD) Mean (SD) Mean (SD) in degrees in degrees in degrees 0.50 0.33 Active ER 79 (12) 78 (8) -1.21 0.56 Active IR 60 (7) 58 (8) -1.65 0.89 Passive ER 86 (10) 86 (8) -0.77 Passive IR 66 (4) 66 (6) -0.20 Key: ER, external rotation; IR, internal rotation; LE, lateral epicondylalgia; SD, standard deviation Hand Dominance of the Case and Control and passive shoulder external and internal rotation based on hand dominance. Participants. Based on hand dominance, only right active and passive shoulder rotatory Based on findings on right hand dominant motions were included in the analysis participants (n=24), no significant differences in considering the sufficient number of participants active and passive shoulder rotatory motions who were right hand dominant (n=24). Active between dominant and non-dominant hands and passive shoulder internal rotation were were noted (p>0.05). Table 2 reports the mean significantly smaller on the side of dominant (SD) of active and passive shoulder external and elbow compared to non-dominant elbow internal rotation in right hand dominant (p<0.05). Table 2 reports the mean (SD) of active participants. Table 2. Shoulder range of movement in right hand dominant participants (n=24) CASE PARTICPANTS Dominant Non-dominant Difference p-value Mean (SD) Mean (SD) Mean (SD) Shoulder in degrees in degrees in degrees 0.41 movement 79 (10) 0.003* 78 (11) 61 (7) 1.61 0.82 Active ER 56 (7) 87 (9) 4.78 0.03* Active IR 86 (10) 68 (5) 0.33 Passive ER 65 (6) 3.17 p-value Passive IR Non-dominant CONTROL PARTICIPANTS Dominant Mean (SD) Difference 0.15 Mean (SD) in degrees Mean (SD) 0.09 Shoulder in degrees in degrees 0.96 movement 82 (6) 0.39 81 (5) 63 (5) 1.11 Active ER 62 (5) 87 (3) 1.25 Active IR 87 (3) 68 (3) -0.03 Passive ER 68 (3) 0.58 Passive IR *significant finding Hand dominance and presence of LE. Of the 24 hand non-dominant side with non-LE elbow right hand dominant participants, 12 (p<0.05). Table 3 reports the mean (SD) of active participants had LE on the right-hand dominant and passive shoulder external and internal side. Active and passive shoulder internal rotation based on hand dominance and presence rotation were significantly smaller in the right of LE. hand dominant side with LE compared to the left 49

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) Table 3. Shoulder range of movement in right hand dominant with LE elbows (n=12) Shoulder Dominant Non-dominant Difference p-value movement Mean (SD) Mean (SD) Mean (SD) in degrees in degrees in degrees 0.70 0.04* Active ER 79 (14) 80 (10) 1.06 0.93 Active IR 59 (6) 63 (6) 4.17 0.04* Passive ER 88 (13) 87 (11) 0.17 Passive IR 66 (5) 69 (5) 3.56 *significant finding Key: ER, external rotation; IR, internal rotation; LE, lateral epicondylalgia; SD, standard deviation No significant associations were found between case (n=54 shoulders) and control (n=48 shoulder rotatory motions, gender activities and shoulders) participants: visual analogue scale scores (p>0.05).  Dependent variables: Shoulder passive and Case and Control Participants: Multiple active internal rotation range of movement regression. Considering that shoulder active  Predictor variables: Hand dominance and and passive internal rotation range of movements were significantly lesser compared presence of LE to shoulder external rotation based on hand dominance and presence of LE in shoulder of Both predictor variables explained variations in case participants, the following classifications shoulder active internal rotation (R2=16%) and were entered in the multiple regression analysis passive internal rotation (R2=11%) of case and using both shoulder range of movements from control participants. Table 4 shows the results of the regression equation. Table 4. Regression equation for shoulder internal rotation (n=102) Dependent variable Independent variables Beta coefficient (SE) p-value Active IR Hand dominance -2.95 (1.23) 0.01* 0.02* LE 2.55 (0.74) 0.01* Passive IR Hand dominance -2.13 (0.83) 0.02* LE 1.14 (0.50) *significant finding Key: IR, internal rotation; LE, lateral epicondylalgia; N, number of shoulders; SE, standard error Significant interaction effects between hand (p<0.05); b. Shoulder internal rotation was dominance and status of elbows (LE, non-LE, significantly smaller in right dominant hand with non-symptomatic) on shoulder active (p=0.001) LE compared to left non-dominant hand with and passive (p=0.003) internal rotation were non-LE elbow (p<0.05); c. Status of elbow and found. Supplement C reports on the interaction hand dominance accounted for variations in effects between hand dominance and status of shoulder active internal rotation (R2=16%) and elbows. passive internal rotation (R2=11%); and d. No associations between shoulder rotatory motions, Discussion gender, activities and visual analog scale were found (p>0.05). In healthy participants and This study investigated the association between regardless of hand dominance, no significant shoulder rotatory motions, LE status, hand differences in active and passive shoulder range dominance, gender, activities, and visual analog of motions were found (p>0.05). scale score of participants with unilateral LE. We found that: a. Shoulder internal rotation was The contrasting association of hand dominance significantly smaller at dominant hand side and shoulder rotatory motions between compared to the non-dominant hand side participants with LE and healthy participants were underpinned by the interaction effects 50

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) between hand dominance and LE (p<0.05). We The participants were engaged in repetitive and hypothesized that the restriction on the use of forceful activities that were commonly suggested the dominant painful extremity could have to be the cause of LE. The mean (95% CI) age of altered the flexibility of the upper extremity 54 (50-59) years of participants with LE muscles. This alteration on the flexibility of reflected the common age range for individuals upper extremity muscles in the dominant painful with LE as reported in the literature. side may likely explain the decreased active shoulder internal rotation (by 2.95 degrees) and Only one left elbow with LE was reported in this passive shoulder internal rotation (by 2.13 study. This reflected the scarcity of left elbows degrees). with LE as reported in the current literature14. The strength of the reported association of LE Hand dominance and status of elbow and dominant hand side should only be claimed significantly affects shoulder internal rotation for the right had dominant side participants. (p<0.01). The decrease in shoulder ranges of motion may be secondary to tightness in the Implications to Practice upper extremity muscles, suggested to be associated with LE16. In LE, decreased tightness We are aware that the influence of hand suggests a lower capacity of the elbow to oppose dominance and LE on shoulder internal rotation rapidly changing forces of handgrip activities16. constituted only 11-16% of the variation found Although, we recommend having a bigger and in shoulder range of movement in this study. more diverse population to have a better However small, we recommend the inclusion of representation of the effect of hand dominance shoulder active and passive internal rotation in and LE on shoulder internal rotation. the evaluation of upper extremities of Considering that the SEM of the primary participants with LE. This evaluation underpins investigator is less in shoulder internal rotation the importance of the deep fascia specifically the (SEM=0.4-0.7), the measurements taken for lateral intermuscular septum in transmitting shoulder internal rotation truly reflected the stresses from elbow to shoulder. The treatment changes brought by hand dominance and LE in directed towards the lateral intermuscular the shoulder. septum may mitigate the lateral elbow pain and restriction in shoulder movement of participants The interplay between the elbow and shoulder with LE. This, however, should be investigated may be explained by the musculofascial system both in clinics and research. in the lateral elbow area. In the current literature, authors had reported the connection Implications to Research of the forearm extensor muscles with the upper arm muscles9;12;13;17;18. The lateral intermuscular A prospective randomized controlled study septum connects the forearm extensor muscles investigating the effects of physiotherapy with the middle deltoid, on its posterior aspect17. treatment directed to LE elbows, on shoulder We assume that a shortened lateral range of movement is recommended. This will intermuscular septum promotes shoulder strengthen the association between LE, hand external rotation. This was reflected in our study dominance and shoulder internal rotation by the decreased shoulder internal rotation on reported in this study. the dominant hand side and status of the elbow (p<0.05). Considering that the lateral Acknowledgments intermuscular septum is a deep fascia that transmits tensile forces18, it may potentially The authors would like to thank the following transmit stress forces from the elbow (lateral people, Lou Erika Rubion, Geronimo Orlino epicondyle) to the shoulder (deltoid). Kamus III, Angelito Esteban, Jr. Alyanna Miko Mercado, Rani Gayle Rivera, Aimee Cara Vergara, The participants with LE in this study truly Rufino Francisco III, Lea Mai De Ocampo, and represented those individuals diagnosed with Patrick John De Jesus. LE. The painful elbows were tested positive to either one of the Cozen, Mill or Maudsley test. 51

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.005) Contribution, Disclosure, and Conflict of 7. Albrecht, S., Cordis, R., Kleihues, H., Noack, W. (1997). Interest Statement Pathoanatomic findings in radiohumeral epicondylopathy. A combined anatomic and The two authors contributed equally to electromyographic study. Arch Orthop Trauma Surg, conceptualization, implementation, data 116, 157–163 collection and analysis and writing of the research manuscript. They have no conflict of 8. Bunata RE, Brown DS, Capelo R (2007). Anatomic interest. factors related to the cause of tennis elbow. J Bone Joint Surg Am. Available from: Supplementary Files http://dx.doi.org/10.2106/JBJS.F.00727. Supplement A. Initial Screening Checklist. 9. Van Der Wal, J. (2009). The architecture of the connective tissue in the musculoskeletal system: an Supplement B. Intra-tester reliability of primary often overlooked functional parameter as to investigator in measuring shoulder rotatory proprioception in the locomotor apparatus. Int J Ther movements of both shoulder of 10 healthy Massage Bodywork, 2, 9-23. participants. 10. Wilhelm, A. (1996). Tennis elbow: treatment of Supplement C. Interaction effects between hand resistant cases by denervation. British Journal of Hand dominance and status of elbows Surgery, 21, 523-533. References 11. Fairbank, S.M. & Corlett, R.J. (2002). The role of the extensor digitorum communis muscle in lateral 1. Herd, C. & Meserve, B., (2007). A Systematic Review of epicondylitis. American Journal of Hand Surgery, 27, the Effectiveness of Manipulative Therapy in Treating 405–409 Lateral Epicondylalgia. The Journal of Manual & Manipulative Therapy. 16, 225-237. 12. Paoletti, S. (2006). The Fasciae - Anatomy, Dysfunction, & Treatment, 1st edition. United Kingdom: Eastland 2. American Academy of Orthopedic Surgeon. (2009). Press Tennis Elbow (Lateral Epicondylitis). Retrieved September 2014, from 13. Stecco, L. & Stecco, C. (2009). 1st edition. Mf sequence http://orthoinfo.aaos.org/topic.cfm?topic=a00068 of lateromotion. Fascial manipulation: Practical Part. Padua, Italy: Piccin, 119-45 3. Chard, M.D. & Hazlema, B.L. (1989). Tennis elbow--a reappraisal. Br J Rhematol, 28, 187-90. 14. Abbott, J.H. (2001). Mobilization with movement applied to the elbow affects shoulder range of 4. Nordander C, Ohlsson K, Akesson I, Arvidsson I, Balogh movement in subjects with lateral epicondylalgia. Man I, Hansson G A, et al (2009). Risk of musculoskeletal Ther, 6(3), 170-7 disorders among females and males in repetitive/constrained work. Ergonomics. 52(10): 15. Kolber, M. & Hanney, W. (2012). The reliability and 1226-39. concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: a technical 5. Saroja, G., Aseer, A.L. & Venkata, S. (2014). Diagnostic report. International Journal of Sports Physical Accuracy of Provocative Tests in Lateral Epicondylitis. Therapy 7(3), 306-313 Int J Physiother Res, 2(6), 815-823. 16. Chourasia, A., Buhr, K., Rabago, D., Kijowski, R. & Sesto, 6. Dones, V.CIII., Grimmer-Somers, K., Milanese, S. & M. (2012) The Effect of Lateral Epicondylosis on Upper Kumar, S., (2014). The Sensitivity of the Provocation Limb Mechanical Parameters. Clin Biomech, 2, 124- Tests in Replicating Pain on the Lateral Elbow Area of 130. Participants with Lateral Epicondylalgia. http://arrow.unisa.edu.au:8081/1959.8/161722 17. Dones, V.CIII., Milanese, S., Worth, D. & Grimmer- Somers, K. (2013). The anatomy of the forearm extensor muscles and the fascia in the lateral aspect of the elbow joint complex. Anatom Physiol, 3, 117 18. Myers, T. (2009). Anatomy Trains, 2nd edition. Churchill Livingstone Elsevier. 52

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) Original Article Test-retest reliability, internal consistency, and discriminant validity of the Filipino version of Knee injury and Osteoarthritis Outcome Score among community-dwellers with knee osteoarthritis Donald Manlapaz,a,b Catherine Joy Escuadra,a,b John Kenneth Ceazar Averia,a Andrea Blancaflor,a Rachel Ann Enriquez,a Angela Mariz Ladeza,a Angelica Marie Mandario,a Jose Javier Mendoza,a Thad Nuel Natividada aDepartment of Physical Therapy, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines; bCenter for Health Research and Movement Sciences, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines Correspondence should be addressed to Donald Manlapaza,b; [email protected] Article Received: 1 April 2019 Article Accepted: 2 July 2019 Article Published: 6 August 2019 (Online) Copyright © 2019 Manlapaz et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objective: This study aimed to determine the test-retest reliability, internal consistency, and discriminant validity of the Filipino Knee injury and Osteoarthritis Outcome Score (F-KOOS) among community-dwellers with knee osteoarthritis (OA). The study also examined the suitability of the F-KOOS in terms of relevance and ease of understanding. Methods: This psychometric study utilized a cross-sectional design. Participants (>50 years old) with knee pain and soreness were recruited from the community and were medically diagnosed with knee OA according to the American College of Rheumatology clinical criteria. Participants were instructed to report for two sessions approximately two weeks apart. Descriptive statistics were used to describe the characteristics of participants and suitability in answering F-KOOS. Test-retest reliability and internal consistency were determined through intraclass correlation coefficients (ICCs) and Cronbach alpha, respectively. Discriminant validity was examined by comparing those with and without knee OA using independent t-test (p<0.05) per F-KOOS subscale. Results and Discussion: A total of 53 participants (35 females, 18 males) with a mean age of 69.67+5.83 years old were included in the study. The domains of the KOOS in the pre- test and re-test range from 0.30 to 0.78 (p<0.05), indicating good test-retest reliability between two assessment points. All domains of the F-KOOS had high internal consistency (Cronbach alpha of > 0.7) ranging from 0.87 to 0.96. Discriminant validity of all domains of F-KOOS between participants diagnosed with and without knee OA showed p-values <0.01 which indicate a significant difference between both groups. In terms of preference, out of 40 participants who answered the survey, 55-85% expressed ease and satisfaction in answering F-KOOS. Conclusion: The study demonstrated that the F-KOOS has an acceptable test-retest reliability, good internal consistency, and discriminant validity in individuals with knee OA. The study further determined that the use of the F-KOOS is appropriate, relevant, and easy to understand in the community setting. Keywords: KOOS, psychometric properties, knee osteoarthritis, outcome measures INTRODUCTION Metro Manila reported that out of 859 patients diagnosed with OA, 62.5% had knee OA while Osteoarthritis (OA) is the most prevalent chronic 1.6% had hip OA.4 With the evidence of elevated joint disease and one of the most leading forms prevalence and burden of knee OA, focus on of pain and disability worldwide.1 Between the proper screening and assessment of the two types of lower extremity OA, knee OA condition are essential in order to create an continues to be more prevalent than hip OA effective treatment and prevention management. across the globe and in the Asian region.2 In the Philippines, 11% of the population aged 60 and Clinicians and researchers in health care above have OA which is expected to double professionals tend to use patient-oriented within the next 25 years.3 A cross-sectional study outcome measures or disease-specific outcome conducted in two different arthritis clinics in measures to determine the rehabilitation 53

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) success.5 The utilization of standardized Physical symptoms worsen due to financial constraints.11 Therapy (PT) outcome measures is In a developing country like the Philippines, recommended to objectively evaluate the signs various communities do not have access to and symptoms of a given condition.6 Moreover, immediate medical evaluation and treatment. valid and reliable outcomes to measure a specific The KOOS could be used as a convenient and impairment, functional limitations, and quality of accessible tool in assessing pain, ADLs, and life (QoL) of the patient are critical at any stage function of individuals with OA of the knee. of rehabilitation.7 Although the F-KOOS was already translated and International groups and societies for OA culturally adapted, the identified psychometric recommend set of outcome measures to properties such as test-retest reliability, internal accurately classify and diagnose individuals with consistency, and discriminant validity have not knee OA. Two of the most commonly used been explored. As per researchers’ knowledge, outcome measures are Knee injury and only one validity study for F- KOOS is available in Osteoarthritis Outcome Score (KOOS) and the country.10 Despite the availability of the F- Western Ontario and McMaster Universities KOOS, there is a paucity in examining the (WOMAC). These outcome measures have been applicability and usage of these tools in the extensively used both in the clinical and research community setting. Therefore, the primary aim application. of the study was to determine the test-retest reliability, internal consistency, and discriminant The original KOOS was developed using WOMAC, validity of the F-KOOS among the community- which is intended to be used for knee injury that dwellers with knee OA. The secondary aim was can subsequently result in posttraumatic OA. It is to examine the suitability of the F-KOOS in terms also widely used among individuals clinically and of relevance and ease of understanding the tool. medically diagnosed with knee OA.8 It is composed of 42 questions divided into five METHODS separate subscales addressing knee symptoms, pain, function in activities of daily living (ADLs), Study Design function in sport and recreation, and knee- related QoL. It uses a five-point Likert scale A cross-sectional quantitative psychometric scoring system ranging from 0 (least severe) to 4 research design was utilized in this study. The (most severe)9 in order to answer each question. participants were asked to attend two screening sessions, that were two weeks apart, in order to KOOS has been extensively adapted in multiple determine the test-retest reliability of F-KOOS. languages and tested for validity and reliability, This study was reported in accordance with the including a Filipino version10 making it a widely Guidelines for Reporting Reliability and accepted outcome measure tool in assessing Agreement Studies (GRRAS) statement from the knee OA.4 The Filipino version of KOOS (F-KOOS) Enhancing the QUAlity and Transparency Of has well accepted cross-cultural adaptation and health Research (EQUATOR) network.12 demonstrated acceptable psychometric properties such as Cronbach’s alpha, ICCs, item- The study complied with the principles of the to-domain correlations and validity in Filipino Declaration of Helsinki and Good Clinical patients with knee OA.10 However, the Practice Guidelines of the Philippine Health psychometric properties such as test-retest Research Ethics Board. The ethical approval was reliability, internal consistency, and discriminant obtained from the University of Santo Tomas- validity have not yet been investigated. College of Rehabilitation Sciences Ethical Review Interestingly, the F-KOOS has only been used Committee (Protocol Number: SI 2017-005). among patients in hospitals and has yet been studied as a part of screening tools or outcome Sample size measures in the community setting (rural areas). This is important in the context of the The sample size was based on COnsensus-based community setting since most people who have Standards for the selection of health knee OA do not seek medical care until the Measurement Instrument (COSMIN) which is an appraisal tool used in evaluating the 54

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) methodological quality.13 According to the araw-araw na gawain (17 items), Gampanin, COSMIN tool, excellent (adequate sample size) is Isports at Libangan (5 items), and Kalidad ng given greater than or equal to 100 recruited buhay (4 items)15. After rating each item, the participants while poor for less than 30.13 scores of each subscale are then individually converted to a 0-100 scale (0 = extreme knee Participants problems, 100 = no knee problems) wherein the lower score would mean a more severe condition Community-dwellers aged 50 years old and of knee OA.15 The F-KOOS was translated by a above with knee pain or soreness were recruited qualified instructor from the University of the for this study. Two licensed medical doctors Philippines, and another independent translator were present during the assessment and data who is knowledgeable of the KOOS.10 collection to identify participants with knee OA. The American College of Rheumatology (ACR) To determine if the questions of the F-KOOS are clinical criteria using history and physical suitable and relevant to the condition of the examination for classification of knee OA was participants, a survey was distributed after the used as the basis for the inclusion of administration of the F-KOOS. According to a participants.14 Participants who understood study by Caudle and colleagues, the satisfaction Filipino/Tagalog written and verbal instructions can be determined by the following domains: were recruited since the F-KOOS is a self- appropriateness, convenience (easy to apply), administered outcome measure. Participants and comprehension (perception).16 The with health conditions that affected the level of questions of the survey revolved around the independence in ADLs were excluded from the aforementioned domains.16 This survey was done study. Since the tool assesses pain, function, and in the form of a Likert scale. There is no gold QOL, the study excluded any conditions (e.g. standard as to how to assess the satisfaction of Acute neurologic conditions, fracture, sprain, instrument or an outcome measure, but previous etc.) that influence these factors other than knee studies have focused on its relevance to OA. evidence-based practice in terms of developing better health outcomes.17 Recruitment and study setting Participants were recruited from Binangonan, Procedure Rizal through community advertising. Prior to advertising, several consultations were made During the data collection, the researcher with the Community-Based Rehabilitation (CBR) explained the purpose and procedures of the head, Barangay Officials and, Health City study to the participant. The assessor Administrators. The permission and assistance administered the consent process and answered were sought from the City Mayor’s office through any queries the participants had. An assessment the CBR head. The study was supported by tool kit, which contained the F-KOOS and a self- government health officials of Binangonan, Rizal administered participants’ satisfaction and commenced upon receiving an approval. questionnaire was prepared and given to participants. Communication to respective barangay officials was done to identify the time and location of the The participants answered the questionnaire for data gathering. approximately 10-15 minutes. The participants were instructed to drop the accomplished Recruitment took place from November 2017 to questionnaires in a secured ballot box. The ballot December 2017. Potential participants from the box was accessed and kept by one (1) researcher communities were invited to the city’s Municipal until the period of data analysis. After two weeks, Hospital and Convention Hall where they were the F-KOOS was re-administered by the assessed. researcher to assess the test re-test reliability. Instrument Data Analysis The F-KOOS is a 42-item self-administered Stata 15 (Serial Number: 401506343769) was outcome measure consisting of five subscales: used for data analyses. Descriptive statistics (i.e. Pagkirot (9 items), Sintomas (7 items), Pang- mean and standard deviation) were used to 55

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) determine baseline characteristics of pain diagnoses with knee OA versus participants without knee OA. Between-group analyses were participants with and without knee OA and F- done by using independent t-test per F-KOOS KOOS subscale scores. Frequencies and subscale. P-values less than 0.05 were percentages were used to determine the considered significant in the analyses. preferred questionnaire by the participants, the answers were reported through descriptive RESULTS statics. To evaluate the variability of the responses of the participant’s floor and ceiling Participants effects were computed. The test-retest reliability and discriminant validity were both analyzed A total of 53 participants with the age of 69.67 + through inferential statistics. The test-retest 5.83 years old (35 female, 18 males) were reliability was tested using the Intraclass included in the study. 41 participants were correlation Coefficient (ICC). It reflects both diagnosed by medical doctors to have knee OA systematic and random differences in the test according to ACR clinical criteria without other scores of the first and second questionnaire comorbidities. Figure 1 shows the F-KOOS administered and thus, values of ICC may vary subscale scores of the participants for the 1st from 0 (unreliable) to 1 (perfectly reliable).18 assessment (baseline) and 2nd assessment (re- The ICC was chosen in preference to the Pearson test). Table 1 shows the results of F-KOOS scores correlation, which may overestimate reliability.19 showing the mean, median, range scores of each The standard error of measurement (S.E.M.) and F-KOOS subscale and their corresponding floor minimal detectable change (MDC) was and ceiling effect. computed. Discriminant validity was assessed by comparing the results of participants with knee Figure 1: Results of F-KOOS of participants with knee OA at baseline and re-test (n=41) Note: ADL- Activity of daily living; QoL- Quality of life 56

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) Table 1: Summary of F-KOOS responses of participants with knee OA at baseline assessment (n=41) Subscale Items Mean (SD) Median Range Floor (n,%) Ceiling (n,%) Pain 9 59.71 (22.13) 63.89 25.00-97.22 - - Symptoms 7 57.19 (21.32) 53.57 17.86-96.43 - - ADL 17 61.39 (20.85) 63.24 29.41-95.59 - - Sports/ Recreation 5 51.19 (26.45) 55.00 0-95.00 2 (4.88) QOL 4 50.46 (23.28) 43.75 18.75-100.00 - 1 (2.44) Note: SD- standard deviation; n- count; %- percentage, ADL- Activity of daily living; QoL- Quality of life Test-retest reliability the domains of the F-KOOS in the pre-test and re- test range from 0.30 - 0.78 indicating no Table 2 shows the result of the test-retest significant difference between two assessment analysis. With the alpha set at 0.05, p-values of points . Table 2: Comparison of F-KOOS responses across time of participants with knee OA (n=41) F-KOOS subscale Items Pre-test Re-test p-value Mean (SD) Mean (SD) 0.78 Pain 9 57.02 (3.19) 55.77 (3.15) 0.30 Symptoms 0.31 7 59.82 (3.30) 54.91 (3.37) 0.69 0.60 ADL 17 61.88 (3.12) 58.46 (3.00) Sports/Recreation 5 51.83 (3.98) 49.49 (4.17) QOL 4 50.58 (3.50) 48.03 (3.33) Note: SD- standard deviation; n- count; ADL- Activity of daily living; QoL- Quality of life Table 3 which shows the ICC, 95% CI, standard ICC showed slightly good level of agreement error of the mean, minimal detectable change, from 0.64-69. and Cronbach alpha for F-KOOS subscales. The Table 3: Test-retest reliability and internal consistency of F-KOOS among participants with knee OA (n=41) Subscales Items Cronbach’s ICC (95% CI) SEM MDC alpha Pain 9 0.92 0.69 (.40-0.84) 2.36 6.52 Symptoms 7 0.84 0.69 (0.40-0.84) 2.23 6.16 ADL 17 0.96 0.69 (0.40-0.84) 2.17 6.00 Sports/Rec 5 0.89 0.64 (0.30-0.81) 2.86 7.90 QOL 4 0.87 0.64 (0.30-0.82) 2.42 6.69 Note: ICC- intraclass correlation; CI- confidence interval; SEM- standard error of mean; MDC- minimal detectable change; ADL- Activity of daily living; QoL- Quality of life Internal consistency Discriminant validity Table 3 shows the result of internal consistency. To determine discriminant validity, Table 4 All domains of the F- KOOS have a Cronbach reports differences in F-KOOS subscale scores alpha >0.70 which indicates high internal between participants with and without knee OA . consistency within all domains ranging from 0.87 to 0.96. 57

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) Table 4: Discriminant validity of F-KOOS among participants with and without knee OA With knee osteoarthritis Without knee osteoarthritis (n=41) (n=12) t value p-value d-value Mean SD Mean SD 3.67 <0.01* 1.21 3.04 <0.01* 1.00 Pain 85.42 18.12 59.71 22.13 3.29 0.02* 1.08 57.19 21.32 3.43 <0.01* 1.12 Symptoms 77.68 17.50 61.39 20.85 4.29 <0.01* 1.41 ADL 83.59 19.48 51.19 26.45 50.46 23.28 Sports/Rec 80.42 24.26 QOL 83.33 23.59 Note: *significant at p<0.05; SD- standard deviation Suitability of F-KOOS participants strongly agreed that the outcome measure was appropriate. Forty-five percent of In terms of suitability, only 40 participants the participants agreed and 55% of participants answered the survey. Most participants who strongly agreed that the outcome measure was answered the suitability questionnaire agreed easy to understand and answer. Figure 2 (strongly agreed 65% and agreed 30%) that the summarizes the response rate regarding the outcome measure was relevant. Five percent suitability of F-KOOS. disagreed, 55% agreed, and 45% of the Figure 2: Summary of perceptions of participants regarding use of F-KOOS (n=40) DISCUSSION majority of the participants agreed that the F- KOOS was easy to answer and understand. This study demonstrated that the F-KOOS has Participants agreed that the F-KOOS was acceptable test re-test reliability, good internal relevant to their experience and condition. consistency, and discriminant validity in individuals with knee OA. Suitability of F-KOOS 58 for community-dwelling patients showed that

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) Psychometric properties of F-KOOS condition. All participants either agreed or strongly agreed that the KOOS was easy to Test-retest reliability refers to the extent to understand and answer. These results which test results are consistent over time.20 corroborate with a study by Caudle and Findings in this study have established that the colleagues where the preference of outcome F-KOOS has an acceptable test-retest reliability measures was established.16 In this current coefficient for all subscales in the present study study, the F-KOOS was well-received as an particularly in pain and ADL with an ICCs outcome measure that can be applicable to their ranging from 0.64 to 0.69. This suggests condition. The participants also did not have any satisfactory stability of F-KOOS scores over time difficulty in answering the F-KOOS and making the version of the tool reliable for understanding its contents in the Filipino obtaining results among knee OA community community setting. dwellers. The result is also comparable with the findings in studies done in other languages with Psychometric tests can be administered to a similar conditions including the original KOOS large group of people at a time, without having to with ICC of 0.75 to 0.93.9 tailor each one to different individuals. It should be noted that this increases the speed and ease of The Internal consistency, described by administration of the outcome measure; computing Cronbach alpha of F-KOOS, was although, much of the value of any test depends acceptable in all domains (pain, other symptoms, on the administrators. Tests can be poorly function in sports and recreation, function in presented or explained, which can cause the daily living, and knee-related QoL) ranging from results to not be accurate. Moreover, because the 0.87 to 0.96, which exceeded the normative value emphasis is often placed on the results of these of 0.70, and reflective of the original version of psychometric tests, it can be potentially KOOS9. This indicated a high correlation of items damaging to the study, especially to those who in contrast to Persian KOOS with a low Cronbach hail from different language and cultural Alpha of 0.25 in Symptoms domain and 0.65 in backgrounds. QoL domain.21 Singapore Chinese version also has a below-average results in Symptom domain Limitations of the study which is 0.65 and Pain domain which is 0.64.15 The disparity in results may be attributed to The findings of this study have several several factors such as characteristics of methodological limitations. Although our sample participants, and logistics in the administration size is moderate to high, the sample was of the tool Korean KOOS, on the other hand, composed of those with knee pain and with knee presents a good Cronbach alpha in all domains OA diagnosis. Aside from this, the study utilized ranging from 0.7 to 0.9522 as well as the Italian self-reported data only making results possibly KOOS with 0.7 to 0.95.23 prone to certain biases. Further studies are needed to clearly ascertain differences between The study also included assessment discriminant the group with and without knee OA using other validity among the other variables to be external or criterion-related validity of the evaluated and by obtaining the p values (p<0.05), objective tests and clinical tests. it can be determined that there is a significant difference between the participants with and The group encountered some limitations during without knee OA. Thus, the F-KOOS can the course of the study: scheduling of the data effectively distinguish between those adults with gathering. Nevertheless, the researchers were knee OA and without knee OA and can be used in able to address these problems and gather & the Filipino community setting. analyze the data needed. In terms of scheduling, those who did not come back during the second Suitability of F-KOOS in the community-dwelling phase were asked to answer in a more knee OA convenient time; their respective assessment tools were given to the barangay coordinator and Majority of the participants (95%) of our study was administered by local health workers. either agreed or strongly agreed that the KOOS is During the administration of the test, the group indeed relevant and appropriate to their present encountered some of the participants that had 59

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) difficulty in reading the outcome measure; the Conflict of Interest The authors declare no conflict of interest researchers opted to help them by reading the questions and choices to them for better understanding and appreciation of the outcome measure tool. Implication to practice and research References The F-KOOS can be used easily as an assessment 1. Fransen M, McConnell S, Harmer AR, Van der Esch M, tool in the community setting as it is convenient Simic M, Bennell KL. Exercise for osteoarthritis of the to administer and would not require additional knee: a Cochrane systematic review. Br J Sports Med. materials and training. Outcome questionnaires 2015 Dec 1;49(24):1554-7. are important in assessment to objectively evaluate the signs, symptoms, and function of 2. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen patients. It is also used to evaluate the progress M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett of patients during the course of treatment. LL. The global burden of hip and knee osteoarthritis: Through the results of this study, PT can be estimates from the global burden of disease 2010 confident to use the F-KOOS in screening study. Annals of the rheumatic diseases. 2014 Jul individuals with knee OA in the community 1;73(7):1323-30. setting. 3. Philippine Rheumatology Association. 2010. Clinical The KOOS has been extensively adapted into Practice Guidelines for the Medical Management of other languages with its psychometric properties Knee Osteoarthritis (OA). Retrieved from evaluated. There is only one existing study done http://www.thefilipinodoctor.com/cpm_pdf/CPM12th in the Philippines regarding the F-KOOS. With %20Osteoarthritis.pdf this study, the F-KOOS has now been tested to have acceptable test-retest reliability, good 4. Racaza GZ, Salido EO, Penserga EG. Clinical profile of internal consistency, and discriminant validity. Filipino patients with osteoarthritis seen at two The suitability of the F-KOOS demonstrated very arthritis clinics (for the osteoarthritis network of the high in the majority of the participants who Philippine general hospital). Osteoarthritis and answered the survey. Thus, contributing to the Cartilage. 2012 Apr 1;20:S193. body of literature in assessing individuals with knee OA using F-KOOS. Future researches about 5. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. the tool may focus on other psychometric Measures of knee function: International Knee properties of the tool such as criterion validity Documentation Committee (IKDC) Subjective Knee (when compared with clinical tools), construct Evaluation Form, Knee Injury and Osteoarthritis validity, sensitivity, and specificity. Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS‐ CONCLUSION PS), Knee Outcome Survey Activities of Daily Living Scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford This study demonstrated that the F-KOOS has Knee Score (OKS), Western Ontario and McMaster acceptable test-retest reliability, good internal Universities Osteoarthritis Index (WOMAC), Activity consistency, and discriminant validity in Rating Scale (ARS), and Tegner Activity Score (TAS). individuals with knee OA. The study further Arthritis care & research. 2011 Nov;63(S11):S208-28. determined that the use of the F-KOOS is appropriate, relevant, and easy to understand. 6. Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of Health care providers including PT can be standardized outcome measures in physical therapist assured that they are evaluating individuals with practice: perceptions and applications. Physical knee OA using valid and reliable tool which can therapy. 2009 Feb 1;89(2):125-35. lead to creating an effective treatment and prevention strategies. 7. Hand C. Measuring health-related quality of life in adults with chronic conditions in primary care settings: Critical review of concepts and 3 tools. Canadian Family Physician. 2016 Jul 1;62(7):e375-83. 8. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health and quality of life outcomes. 2003 Dec;1(1):64. 9. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome 60

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.001) measure. Journal of Orthopaedic & Sports Physical 22. Seo SS, Chung KC, Kim YB. Assessment of validity, Therapy. 1998 Aug;28(2):88-96. reliability and responsiveness of Korean Knee injury and Osteoarthritis Outcome Score (KOOS) for the knee 10. Villanueva-Misa A, Penserga, E. (n.d.). Cross-cultural injury (In Korean). J Korean Orthop Assoc adaptation and validation of the Filipino translation of 2006;41(3):441-53. the knee injury and osteoarthritis outcome score (KOOS) in Filipinos with knee osteoarthritis at the 23. Monticone M, Ferrante S, Salvaderi S, Rocca B, Totti V, University of the Philippines‐ Philippine General Foti C, et al. Development of the Italian version of the Hospital (UP-PGH) knee injury and osteoarthritis outcome score for patients with knee injuries: cross-cultural adaptation, 11. Litwic A, Edwards MH, Dennison EM, Cooper C. dimensionality, reliability, and validity. Osteoarthritis Epidemiology and burden of osteoarthritis. British Cartilage 2012;20:330-5. medical bulletin. 2013 Jan 20;105(1):185-99. 12. Altman DG, Simera I, Hoey J, Moher D, Schulz K. EQUATOR: reporting guidelines for health research. Open Med. 2008;2(2):e49–e50. 13. Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Quality of Life Research. 2012 May 1;21(4):651-7. 14. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1986 Aug;29(8):1039-49. 15. Xie F, Li SC, Roos EM, Fong KY, Lo NN, Yeo SJ, Yang KY, Yeo W, Chong HC, Thumboo J. Cross-cultural adaptation and validation of Singapore English and Chinese versions of the Knee injury and Osteoarthritis Outcome Score (KOOS) in Asians with knee osteoarthritis in Singapore. Osteoarthritis and cartilage. 2006 Nov 1;14(11):1098-103. 16. Caudle AS, Yang WT, Mittendorf EA, Kuerer HM.Assessment of Preferences for Treatment: Validation of a Measure. 2016;150(2):137-143. doi:10.1001/jamasurg.2014.1086.Feasibility 17. Bridges JFP, Hopkins J. Patient Preference Methods - A Patient Centered Evaluation Paradigm. 2007:1-4. 18. Peterson RA. A meta-analysis of Cronbach's coefficient alpha. Journal of consumer research. 1994 Sep 1;21(2):381-91. 19. Steiner GL, Norman DR. Health Measurement Scales: A Practical Guide to their Development and Use, 2nd edn. Oxford: Oxford University Press 1996. 20. Salaffi F, Leardini G, Canesi B, et al. Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthr Cartil. 2003;11(8):551-560. doi:10.1016/S1063- 4584(03)00089-X. 21. Salavati M, Mazaheri M, Negahban H, Sohani SM, Ebrahimian MR, Ebrahimi I, et al. Validation of a Persian version of Knee injury and Osteoarthritis Outcome Score (KOOS) in Iranians with knee injuries. Osteoarthritis Cartilage 2008;16:1178-82. 61

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.007) Short Report The birth of a national network for interprofessional education and collaboration: results from an inter-university partnership Michael Sya,b, Catherine Joy Escuadrac, Reeva Ann Sumulongd aAngeles University Foundation, Pampanga, Philippines; bTokyo Metropolitan University, Tokyo, Japan; cUniversity of Santo Tomas, Manila, Philippines; eDe La Salle Medical and Health Sciences Institute, Cavite, Philippines Correspondence should be addressed to: Catherine Joy Escuadra2; [email protected] Article Received: 1 April 2019 Article Accepted: 2 July 2019 Article Published: 18 July 2019 (Online) Copyright © 2019 Sy et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The Philippine Interprofessional Education and Collaboration (PhIPEC) Conference is the first-ever national program held in the Philippines on interprofessional education and collaboration (IPEC). This project, initiated through an inter-university partnership between University of Santo Tomas and Angeles University Foundation, aimed to facilitate uniform understanding of IPEC across higher education institutions and health facilities as well as to instigate IPEC related researches in the country. The two-day conference was able to gather over 80 participants from more than 10 health and social care professions and 15 speakers who shared their expertise in health education and practice. Aside from these, the initiative has also gathered more than 500 followings in Facebook Page and 161 members in the mailing list. With the turn-out of this initiative, there was a move to rename the group into PhIPEC Network. The network has been agreed upon to serve as an informal entity that represents a collective of Filipino health and social care professionals towards advocating collaborative learning and health care services. Future directions were also determined focused on considering IPEC initiatives in education, practice, research, and policies. Keywords: Interprofessional Education and Collaboration, IPE, IPC BACKGROUND global efforts in promoting IPEC in other developed and developing countries.3 However, Interprofessional Education and Collaboration IPEC has yet to be practiced deliberately by (IPEC) is a global strategy mandated by the health and social care workers worldwide.4 World Health Organization (WHO) and its partners since 2010 where individuals from While national governing bodies in the different health and social care professions learn Philippines such as the Commission on Higher and work together towards achieving same Education (CHEd) and Department of Health outcomes. This strategy was developed to have already recognized the importance of IPEC, address inappropriate supply, mix, and the documentation of official IPEC initiatives and distribution of the health care workforce who activities is still limited.5 Locally, published will provide holistic care to patients with works on IPEC started with the pilot complex health needs.1 IPEC has also shown to implementation of IPE in a community-academe improve job satisfaction among health workers partnership towards community health resulting in better quality and safety of development,5 followed by an interprofessional healthcare delivery, and overall public approach used for infection control in hospitals satisfaction.2 In response to this WHO mandate, in Manila,6 and the survey studies on IPEC countries like Australia, Canada, the United among Filipino occupational therapists, physical Kingdom, and the United States, have on-going therapists, and speech-language pathologists7 62

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.007) and Filipino mental health professionals.8 While the intended purpose of creating a national IPEC researches and activities are continually network for IPEC in the Philippines. The being explored in the Philippines, studies and following section outlines the specific steps programs are conducted independently by conducted by the organizers to demonstrate how universities and organizations without parallel the conference led to the creation of the local discussions and sustainable long-term plans network composed of Filipino IPEC champions. related to the National Unified Health Research Agenda by Department of Science and Step 1: Identifying local IPEC champions. Technology and the National Higher Education Research Agenda by CHED. One way of As advocated by WHO (2013), a radical addressing this is to gather people from higher transformation in any complex system requires education institutions, professional champions who have strong leadership organizations, and communities to conduct competencies, e.g. ability to plan and decide on formal IPEC training, improve practice guidelines rules and processes, implement regulation and in health and social care, and streamline research accountability mechanisms, and enact proposed and policy initiatives. Accordingly, the University changes in accordance to goals.9 In anticipation of Santo Tomas (UST) and Angeles University of prospective structural barriers and Foundation (AUF) organized an inter-university bureaucratic barriers, IPEC champions were partnership that yielded a two-day conference identified from the partnering universities (UST entitled “1st Philippine Interprofessional and AUF) who served as members of the steering Education and Collaboration Conference 2018” committee of the PhIPEC 2018 Conference. The (PhIPEC 2018) with the theme “Revisiting the members also happened to be the first, second, Bayanihan Spirit in the Philippine Health and and third authors of this article. The steering Social Care Systems” last 10 to 11 August 2018. committee initially planned the aims of the Accredited by the Professional Regulation conference which resulted to initiate a formal Commission (PRC) of the Philippines, the PhIPEC meeting between UST and AUF. 2018 aimed to: 1) disseminate basic principles of interprofessional education and collaborative Step 2: Securing institutional support and practice (IPECP); 2) discuss IPECP concepts in assistance. terms of teaching, discovery, integration, and application; 3) gather health and social care To formalize this initiative a Memorandum of professions educators, practitioners, and Understanding (MOU) between UST and AUF students; 4) establish partnerships among was created and signed by the deans from the professional associations, higher education College of Rehabilitation Sciences (UST) and institutions, and health and social facilities; and College of Allied Medical Professions (AUF) to 5) create a roadmap for future research and seal the inter-university initiative. This step was applications on IPECP within the health/social found to be significant as numerous IPEC studies professions education and healthcare delivery. have highlighted how administrative support To the authors’ recollection, the PhIPEC was the remains to be a major facilitator for successful first national conference focused on IPEC. This IPEC programs worldwide.6–10 The MOU specified short article aims to document the approaches the obligations of each university which included and strategies employed and outcomes from the the technical, logistical, and financial concerns PhIPEC Conference 2018 to serve as a model or for the conference. Moreover, the steering basis for future collaboration of different committee had an open dialogue with the institutions and/or organizations. administrators from the host university (UST) to further discuss and clarify matters concerning APPROACH the PhIPEC 2018 conference. The mutual agreement that resulted from the dialogue The educator and curricular mechanisms between the two universities led to the proposed by the WHO (2010)9 were utilized and formulation of the official organizing committees modified by the PhIPEC 2018 organizers to befit including a total of 10 more volunteers (four from UST, 10 from AUF) for the conference. Administrators from both universities also provided assistance in applying to ensure the 63

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.007) accreditation for the continuing professional Deficiency Syndrome (HIV/AIDS) care, substance development (CPD) of the conference by PRC. addiction and rehabilitation, community health, curriculum evaluation, communication Step 3: Employing effective communication competencies, and team-based learning strategies. strategies. Each day in the conference concluded with a workshop that reinforced Since communication was found to be one of the interprofessional and interactive learning among major challenges in any IPEC initiatives,11 the participants. The workshops promoted members from the organizing committees translational research and evidence-based explored using various communication strategies teachings such as the use of technology and the during the preparation phase for the PhIPEC T-E-A-M Protocol in facilitating IPEC within 2018 conference. Since the organizers came from universities, clinical teaching, and actual practice. different professions with different schedules A total of 15 speakers coming from various and concerns, face-to-face meetings were health and social care professions were invited deliberately scheduled to orient everyone about to ensure that IPEC was discussed from different the aims, program flow, logistics, and other practice areas and perspectives. matters concerning the conference. These meetings also became an opportunity for the Participants organizing committee members to learn about each other’s professional concerns and resolve The PhIPEC conference was attended by a total conflicts about differences pertaining to of 80 participants (local and foreign) from more credentialing and accreditation. After the than 10 health and social care professions i.e., synchronous face-to-face meetings, occupational therapy, physical therapy, speech- teleconferencing and asynchronous language pathology, nursing, medicine, social communication strategies through the use of work, psychology, dentistry, pharmacy, public online applications (e.g., Google, Skype, health, health professions education. Facebook, etc.) were utilized by the organizing Furthermore, the conference also gathered members in preparation for the conference. approximately 600 members in the network’s official Facebook Page OUTCOMES (www.facebook.com/phipecnet/) and 161 subscribers in the network’s mailing list. Structure IMPACT AND FUTURE DIRECTIONS To provide a holistic learning experience in introducing and understanding IPEC principles, A post-conference workshop was organized the scientific committee members managed to where a total of 20 prospective IPEC champions plot various learning sessions within the from different local universities and institutions program which included a total of five keynote discussed the possibility of having a local presentations, five plenary sessions, three network for IPEC and the future plans that the symposia, and two workshops. Keynote network could potentially work on including 1) presentations aimed to impart a uniform set of formalizing IPEC training and education for knowledge on IPEC among the participants faculty, students, and graduate students across based on WHO guidelines contextualized in medical and health science programs; 2) globalized and local healthcare systems. On the reinforcing the involvement of more other hand, plenary sessions focused on sharing practitioners to learn about and implement IPEC; of experiences and works of IPEC advocated 3) highlighting conflict resolution and effective based on the core tenets of health professions communication competencies within the medical education namely teaching, applying, integrating, and health sciences curricula; 4) exploring and discovering. Symposia provided the various research designs and methods in opportunity for participants to discuss special conducting IPEC-related research i.e., qualitative, topics relative to IPEC including Human mixed methods, longitudinal, experimental; 5) Immunodeficiency Virus/Acquired Immune publishing a reference book highlighting local 64

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.007) best practices in IPEC within the areas of higher Individual Author’s Contributions education, governance, and clinical practice; 6) discovering potentials for more inter-university M.S., C.J.E, R.A.S; conceptualized paper, gathered collaborations to espouse IPEC-related activities; and organized data, co-wrote the paper. and 7) establishing of an organic network for Filipino IPEC champions. Among all these future Disclosure Statement plans, the last stated plan was the first to be realized. Without the need to make a formal This paper has not been funded by any Funding organization or legal entity, the organizing Agency. members decided to come up with the “Philippine Interprofessional Education and Conflicts of Interest Collaboration Network” (PHIPEC Network) that constitutes all the participants of the first The authors of this paper declare no conflicting conference. The PHIPEC Network is envisioned interest. to be a partner of the Asia Pacific Interprofessional Education and Collaboration References (APIPEC) group, a member of Interprofessional Global (formerly known as the World 1. Barr, H. (2015). Interprofessional education: the Coordinating Council for IPEC). Upon the genesis of a global movement. London: Centre for conclusion of the 1st PhIPEC 2018 Conference, Advancement of Interprofessional Education. the event was featured in the UST and AUF newsletters and official websites, two local 2. Reeves S. Community‐based interprofessional newspapers, and in the Centre for the education for medical, nursing and dental Advancement of Interprofessional Education students. Health & social care in the community. (CAIPE) newsletter. 2000 Jul 1;8(4):269-76. As a summary, this inter-university partnership 3. Oandasan I, D’Amour D, Zwarenstein M, Barker K, resulting from mutual identification for a need Purden M, Beaulieu MD, Reeves S, Nasmith L, for a venue and network for IPEC has led to the Bosco C, Ginsburg L, Tregunno D. Interdisciplinary effective utilization of the various IPEC educator education for collaborative, patient-centered and curricular mechanisms from WHO. The practice research and findings report. Ottawa: reported effective practices in this initiative can Health Canada. 2004:41-99. serve as a reference for creating future activities locally and internationally that will either focus 4. Sunguya BF, Hinthong W, Jimba M, Yasuoka J. on IPEC or involve interprofessional team Interprofessional education for whom?— members. challenges and lessons learned from its implementation in developed countries and their Acknowledgments application to developing countries: a systematic review. PloS one. 2014 May 8;9(5):e96724. The authors would like to express their gratitude to Dean Anne Marie Aseron (UST) and Dean 5. Opina-Tan LA. A pilot implementation of Annalyn Navarro (AUF) for their guidance and interprofessional education in a community- support from the conceptualization until the academe partnership in the Philippines. Education conclusion of the first PhIPEC 2018 Conference. for Health. 2013 Sep 1;26(3):164. We would also like to thank all the people who made this national event possible, especially, the 6. Mitchell, K. F., Barker, A. K., Abad, C. L., & Safdar, N. members of the organizing committees, resource (2017). Infection control at an urban hospital in speakers, partner organizations, and conference Manila, Philippines: a systems engineering participants. assessment of barriers and facilitators. Antimicrobial resistance and infection control, 6, 90. doi:10.1186/s13756-017-0248-2 7. Sy MP. Filipino therapists’ experiences and attitudes of interprofessional education and collaboration: A cross-sectional survey. Journal of interprofessional care. 2017 Nov 2;31(6):761-70. 8. Sy MP, Martinez PG, Labung FF, Medina MA, Mesina AS, Vicencio MR, Tulabut HD. Baseline assessment on the quality of interprofessional collaboration among Filipino Mental Health 65

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.007) Professionals. Journal of Interprofessional Education & Practice. 2019 Mar 1;14:58-66. 9. World Health Organization. (2013b). Transforming and scaling up health professionals’ education and training. Geneva, Switzerland, WHO Press. 10. Bridges D, Davidson RA, Soule Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Medical education online. 2011 Jan 1;16(1):6035. 11. Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. Journal of Public Health. 2015 Dec 1;37(4):716-27. 1Barr, H. (2015). Interprofessional education: the genesis of a global movement. London: Centre for 6. Sy MP. Filipino therapists’ experiences and attitudes of interprofessional education and Advancement of Interprofessional Education. collaboration: A cross-sectional survey. Journal of interprofessional care. 2017 Nov 2;31(6):761-70. 1. Reeves S. Community‐based interprofessional education for medical, nursing and dental students. Health & social care in the community. 2000 Jul 1;8(4):269-76. 7. Sy MP, Martinez PG, Labung FF, Medina MA, Mesina AS, Vicencio MR, Tulabut HD. Baseline 2. Oandasan I, D’Amour D, Zwarenstein M, Barker K, Purden M, Beaulieu MD, Reeves S, Nasmith L, assessment on the quality of interprofessional collaboration among Filipino Mental Health Bosco C, Ginsburg L, Tregunno D. Interdisciplinary education for collaborative, patient-centered Professionals. Journal of Interprofessional Education & Practice. 2019 Mar 1;14:58-66. practice research and findings report. Ottawa: Health Canada. 2004:41-99. 3. Sunguya BF, Hinthong W, Jimba M, Yasuoka J. Interprofessional education for whom?—challenges 8. World Health Organization. (2013b). Transforming and scaling up health professionals’ education and lessons learned from its implementation in developed countries and their application to and training. Geneva, Switzerland, WHO Press. developing countries: a systematic review. PloS one. 2014 May 8;9(5):e96724. 4. Opina-Tan LA. A pilot implementation of interprofessional education in a community-academe 9. Bridges D, Davidson RA, Soule Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: partnership in the Philippines. Education for Health. 2013 Sep 1;26(3):164. three best practice models of interprofessional education. Medical education online. 2011 Jan 5. Mitchell, K. F., Barker, A. K., Abad, C. L., & Safdar, N. (2017). Infection control at an urban hospital in 1;16(1):6035. Manila, Philippines: a systems engineering assessment of barriers and facilitators. Antimicrobial resistance and infection control, 6, 90. doi:10.1186/s13756-017-0248-2 10. Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. Journal of Public Health. 2015 Dec 1;37(4):716-27. 66

PJAHS • Volume 3 Issue 1 2019 • (doi:10.36413/pjahs.0301.003) Special Research Article In gratitude for the PJAHS 2019 editorial board and reviewers Ivan Neil Gomeza,b, Anne Marie Aseronb aCenter for Health Research and Movement Sciences, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines; College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines Correspondence should be addressed to: Ivan Neil Gomeza,b; [email protected] Article Received: 10 June 2019 Article Published: 22 July 2019 (Online) Copyright © 2019 Gomez and Aseron. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Philippine Journal of Allied Health Sciences Supplementary Material (PJAHS) and our publisher, the College of S1_PJAHS_List. Alphabetical List of PJAHS Rehabilitation Sciences of the University of Santo Editorial Board Members and Staff Tomas, extends our deepest gratitude to our editorial board and academic editors who have graciously contributed to the journal’s peer- review process for the years 2018-2019. We recognize your selfless contribution in support of our aim to further research in the field of allied health science through the democratization of knowledge evidence by way of Open Access journals such as PJAHS. We are back and here to stay because of your unwavering support and dedication. The names of the individual editorial board members, staff and academic editors who performed excellent peer-review on the submitted manuscripts, some of which appear in this edition, appear in the supplementary File S1_PJAHS_List. Your participation in the review process is duly recognized and appreciated. Thank you for embarking with us in this journey of informing and influencing allied health science clinical and research practice. We hope that our partnership continues to flourish and prosper in the coming editions of PJAHS. Maraming Salamat po! 67

PJAHS Guidelines for Submission Guidelines for Authors In submitting to the Philippine Journal of Allied Health All authors must comply with the requirements set by Sciences, all authors are advised to take note of the the journal in submitting their manuscripts. Inability following guidelines. Inability to comply with these to follow these guidelines may result to rejection of the guidelines may result to rejection of submissions. submission.  All submission should not have been Manuscripts accepted in this journal must be in previously published, nor currently being English and conforms to the standard rules of considered for publication, in any other American English. Authors whose native language is journal. Manuscripts currently being peer- not English are strongly encouraged to have their reviewed cannot be submitted to another manuscripts checked by professional language editing journal without informing the editor. services, or by an independent colleague whose mother-tongue is English prior to submission.  The submission file should be in MS Word (.doc, .docx) or Rich Text Format (RTF). Cover Letter  The journal is strict with plagiarism and will Each submission must be accompanied with a cover check all manuscripts considered for letter address to the Editor-in-Chief of PJAHS. A 1-page publication to plagiarism and similarity limit to the .doc/.docx/.pdf file submitted is imposed. software. In the letter, the author must include the following:  The text and style of the manuscript and  Short and succinct overview of the manuscript bibliographic references strictly adheres to to be submitted; the requirements outlined in the Author Guidelines.  The specific type of journal article being submitted for; General Author Guidelines  The reason why the manuscript should be To submit a new manuscript: accepted in the journal;  All submissions must be done through the  Summary of the research’s contribution to the journal website submission link. body of scientific evidence;  All fields must be filled in.  Optional items may include suggestion(s) for  All necessary files must be uploaded in one appropriate peer-reviewers and/or opposed list of reviewers; submission.  Authors are encouraged to provide a message  The letter must be signed by the corresponding author. to the editor about concerns they may have about the submission. Manuscript preparation:  Only the information about the submitting author should be used in the online The first page should contain the following: submission system. Information about the other authors should be placed in the 1. Title, name and surname of author(s) (i.e. Dr. manuscript document. John Doe or J Doe); To submit a revised version of the manuscript: 2. Institutional affiliations of each author; 3. A corresponding author (only one  All submission of revised manuscripts will be done through the journal’s official email: corresponding author is permitted) with [email protected] detailed contact details (institutional address, e-mail address, work phone number and/or  Guidelines for re-submission will be emailed fax number. to the corresponding author in a separate document. The second page should contain the following: The authors are given a maximum of four weeks (28 1. Individual author’s contributions; days) to respond and revise their manuscripts. 2. Disclosure Statement (which includes funding 68 agencies/bodies); 3. Conflicts of interest.

Authors are suggested to check the ICJME page for Meta-analyses and Systematic reviews which more details on these. provide a critical overview of the research on specific topics related to physical therapy, occupational Note: The main text should start on the third page therapy, sports science, speech-language pathology, which includes the abstract up to the reference section. nursing, psychology, biomedical engineering, pharmacy, nutrition, education and other allied health Journal Articles Accepted: sciences. High quality systematic reviews with definitive conclusions and clinical practice guidelines Original scholarly articles may be in the form of: are priority for publication. Original research article which include report Meta-analyses and/or Systematic reviews should research and studies in the fields of physical therapy, follow similar guidelines as that of original research occupational therapy, sports science, speech-language articles. However, authors are encouraged to follow pathology, nursing, psychology, biomedical the PRISMA guideline in reporting. If the systematic engineering, pharmacy, nutrition, education and other review has been registered in a protocol registry, allied health sciences. Randomized controlled trials, authors are encouraged to report in the main text of quasi-experimental studies, cross-sectional and their manuscript details of such. longitudinal studies are preferred studies. Nevertheless, PJAHS welcomes both quantitative and Meta-analyses and/or Systematic review manuscript qualitative research article submissions. submissions must have a structured abstract of not more than 250 words, 3-5 keywords, a main text with All original research articles should be divided into the a maximum 6000 words, 8 tables/figures and 50 following sections: abstract, introduction, methods, references. results, discussion, conclusion and references. The abstract should contain no more than 250 words Short reports which include clinical studies, case structured in the following sections: background, studies, review articles, abstracts of books and studies methods, results, conclusions. A maximum of 10 on reliability and/or validity of clinical measurement authors are permitted. For papers with more than 10 procedures. Short reports on early or initial findings of authors, it is suggested that a group name is used a research project must follow similar guidelines with and/or with specific names of the additional authors original research articles. Other types of short reports listed in an ad hoc appendix. may follow an unstructured format. An informative unstructured abstract of not more than 250 words is Authors are strongly encouraged to check their required. Short reports are limited to a maximum of submissions using relevant guidelines for reporting 2000 words, 3 tables/figures and 30 references. researches (i.e. CONSORT, STROBE, STARD, etc.) prior to submission. Author’s self-appraisal using these Letter to the editor may be any pertinent topic checklists can be attached as an appendix. Whenever related to allied health science. However, it is appropriate and/or available, authors are likewise recommended that these are about topics published in encouraged to indicate in their manuscript the PJAHS in previous articles. The authors of the paper(s) registration of the research project in appropriate cited in the letters to the editor will likewise be given registry databases (i.e. ClinicalTrials.gov, ICJME, WHO, an opportunity to respond in subsequent issues. etc). Submissions deemed as polemic, rude, vulgar, pedantic or pejorative will not be published. Submissions are All submitted original research articles are required of not peer-reviewed but published at the discretion of the following: a structured abstract of not more than the PJAHS editor. The opinions and conclusions 250 words; 3-5 keywords, text body of not more than expressed in the letters do necessarily reflect those of 5000 words; maximum of 5 tables/figures; not more PJAHS and its editor. Letter to the editor manuscript than 50 references. Individual tables and/or figures submissions have a maximum of 1000 words and 5 should be placed as a separate file submission. No references. tables/figures embedded in the main text will be permitted. A place holder text indicating which Word count restrictions do not include the first and table/figure should be inserted in specific parts of the second page. Research reports should not exceed 5000 manuscript is expected. words, reviews and meta-analyses 6000 words, short reports 2000 words, and letters to the editor 1000 words. These do not include the cover page, abstract, references, tables, or figure legends. 69

Manuscript format: journal article submitted. It should summarize the salient points of the manuscript submitted. Citations  Use Arial, 11-point font with 1.5 line spacing should not be included in the abstract. As much as set in a letter-sized document. possible, avoid abbreviations in this section. This section ends with 3-5 keywords.  Do not format text in multiple columns.  Left justified and one-inch margin on all sides. Introduction  ‘Normal’ style for text, ‘Heading’ styles for The introduction should clearly state the aims of the headings. Limit headings to 3 levels. study. Introduction need not be lengthy and only  Indents and tabs should be avoided when references necessary in understanding the objectives of the research should be included. formatting paragraphs and should use double carriage return between paragraphs. Methodology  The title/author page, author contribution page, abstract, text, acknowledgement and The study design, participants, and methods used for references should each begin on a new page. the study should be described in full detail to allow a  Tables and/or figures should be in individual knowledgeable reader to reproduce the separate submissions. A place holder text research. Where possible, a flow diagram depicting indicating which table/figure should be the major procedures involved in the research should inserted in specific parts of the manuscript is be included. expected.  Include continuous line numbers in the Diagrams, photos or drawings must be converted to manuscript file. JPEG or GIF and submitted as a separate file. A text  All pages of the manuscript should be marker must be added in the text for placement of continuously numbered and placed on the diagrams, e.g., “Insert Photo 1 here.” bottom right hand of the page.  Footnotes are not allowed. Consider moving Results them into the main text.  Define abbreviations as they first appear in Use text, tables and figures to present the results of the the text. Do not use non-traditional study. Restrict tables and figures to only those that are abbreviations unless they appear in the text necessary. There is no need to repeat information for more than three times. Limit the use of presented in tables and figures in the text, but all abbreviations. tables and figures should be referred to in the text.  Equations should follow the APA style of reporting results. Tables and figures should not be in the main text but  Use SI units of measurements. submitted as separate and individual submission. A  Manuscript should be in MS Word and saved text marker must be added in the text for placement of as document (.doc or .docx) or Rich Text tables/figures, e.g., “Insert Table 1 here.” Format (.rtf) files. MS Word documents should not be blocked, or password protected.  Submissions may be returned to the author if presented in the incorrect format. Manuscript Text: Discussion The organization for the text should follow the New and important findings should be emphasized in headings prescribed in this guideline. Clarity and the discussion, focusing on their implications, clinical conciseness in the arrangement of the text will be applications and limitations. Avoid repeating data highly appreciated. It is not necessary to start each previously presented in the Method and Results section of the text (introduction, methodology, results, sections. discussion, and conclusion) on a new page. Conclusions Abstract The conclusions should clearly address the objectives The abstract commences the main manuscript text and of the study. is seen at the third page of the submitted document. The maximum word count is specific to the type of Acknowledgements 70

Include here individuals and/or institutions that The authors are responsible for attaining relevant contributed to the research project but did not meet permission to reproduce and include images in their the criteria for authorship. Include a description of the articles. PJAHS may require submitting authors proof contribution. Do not acknowledge funders here; that such permission was sought, or whether the indicate them in the Disclosure Statement. Everyone images used are from the authors’ own work. named in the acknowledgments section must be previously informed by the author(s) that they are Supplementary Material named in the article. Supplementary materials are uploaded separately. References PJAHS will consider similar file types as with tables and figures for uploading as supplementary materials. References should be prepared and followed strictly They must be labeled appropriately in the following according to the Vancouver style. References should be format: “Supplement A”, Supplement B”, etc. and numbered according to the place in the text where it referred to in the manuscript text in the same manner. was first cited, not alphabetically. Text citations should Examples of supplementary materials include the be identified using a superscript number with no following: appraisal tool, sample of questionnaires, brackets or parenthesis. You may also refer to pre-prints, copy of protocol registrations, proof of http://www.nlm.nih.gov/bsd/uniform_requirements.h funding, etc. The maximum number of supplementary tml for more information. materials that will be accepted is shared with the maximum number of tables and/or figures. Tables and Figures Manuscript Acceptance Table and/or figures must be individually submitted. Each should be labelled accordingly as they appear in Manuscripts are accepted based on scientific interest the manuscript text. Provide a self-explanatory title for and relevance to Allied Health Science. Manuscripts each table and/or figure. PJAHS uses the APA style for are accepted based on the discrete opinion of the reporting table and figures. Editor supported by evaluations made by at least two anonymous peer-reviewers. Manuscripts requiring Tables must be submitted in separate files for revisions are returned to the corresponding author for submission. PJAHS will accept tables in the following response, modifications and improvement. The revised formats: doc, .docx or .pdf. Upload the highest quality manuscript should be submitted via email to PJAHS available for images. Include table numbers in the within 4 weeks upon receipt of decision. Submissions filenames of the files that will be submitted (i.e. Table made beyond this timeframe forfeits prior submission 1.docx). Do not embed tables in the manuscript text. and will be considered as a new submission. All tables should be cited in the manuscript text and have a title that is placed within the manuscript text. Peer-Review Policy Description of the table’s legends is optional, but if included must be placed within the manuscript text or Manuscripts submitted to PJAHS are critically as part of the table. Cite tables in the manuscript text appraised and evaluated by our Editorial Board as “Table 1”, “Table 2” etc. Reviewers and/or international Academic Editors in accordance with standards and principles of peer “Figure” refers to graphs, charts, drawings and review as outlined by ICJME. Each submission is first photographs. Use the original file format and image reviewed by the Editor-In-Chief on its suitability size whenever possible. Upload the highest quality before endorsing to the Managing Editor, who then available of images. File types that are acceptable for assigns it to peer-reviewers within the area of submission are .pdf, .jpeg and .png. Include figure expertise of the submitted manuscript. Submissions numbers in the filenames of the files that will be deemed out of the scope of PJAHS results to an submitted (i.e. Figure 1.jpeg). Do not embed figures in automatic desk rejection within 48-56 hours. the manuscript text. All figures should be cited in the Manuscript submission that surpasses the initial manuscript text and have a title that is placed within review process is assigned to at least two different the manuscript text. Description of the figure’s legends anonymous peer-reviewers. Authors will receive a is optional, but if included must be placed within the decision on the peer-review process within 4 weeks. manuscript text or as part of the figure. Cite figures in the manuscript text as “Figure 1”, “Figure 2” etc. 71

Copyright Notice PJAHS has opted to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published. This makes PJAHS an Open Access Publication. Authors who intend to submit to PJAHS grant all users free, irrevocable, worldwide, perpetual right of access to copy, use, distribute, transmit, and display their work worldwide, subject to proper citation and reference of authorship. The published article, including all supplementary items shall be deposited and archived in the PJAHS website database. Article Processing Charge At this time, PJAHS does not have any Article Processing Charges. Submission and acceptance to PJAHS is entirely free of charge. 72

CALL FOR PAPERS The Philippine Journal of Allied Health Sciences (PJAHS), the official academic journal of the College of Rehabilitation Sciences- University of Santo Tomas is now accepting manuscripts to be reviewed for its upcoming Volume 4 Issue 1. PJAHS is an online Open Access peer-reviewed scholarly journal which encourages authors to publish original scholarly articles in the fields of physical therapy, occupational therapy, sports science, speech-language pathology, nursing, psychology, biomedical engineering, pharmacy, nutrition, education and other allied health sciences. PJAHS will consider submissions on the following topics: human biomechanics, exercise physiology, physical activity in pediatrics and geriatrics, ergonomics, physiologic profiling of athletes, sports injury monitoring and clinical practice patterns in the allied health sciences. PJAHS publishes original research, systematic reviews and meta-synthesis, short reports, and letters to the editor. Authors who wish to submit manuscripts for review can view the relevant information by visiting our journal website at https://pjahs.ust.edu.ph/. The deadline for submission for the upcoming issue is on April 1, 2020. Accepted manuscripts will be published by August 2020. For any inquiries, email us at [email protected].