Background: The Kujala score is a useful diagnostic tool to evaluate patellofemoral pain syndrome (PFPS). However, no validated Indonesian version of the Kujala score has been available. Purpose: To develop and validate an Indonesian version of the Kujala score. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: This was a cross-sectional study to develop an Indonesian version of the Kujala score by using a forward-backward translation protocol. The resulting questionnaire was given to 51 patients diagnosed with PFPS. The validity of the questionnaire was evaluated by correlating the final score with the Indonesian version of the 36-Item Short Form Health Survey (SF-36). Reliability was measured by evaluating the internal consistency (Cronbach alpha) and test-retest reliability (intraclass correlation coefficient [ICC]). Results: The Indonesian version of the Kujala score had a positive correlation with the physical components of the SF-36. The internal consistency was fairly high (α = .74), and the test-retest reliability was excellent (ICC, 0.996). Conclusion: The Indonesian version of the Kujala score was proven to be a valid and reliable tool to diagnose PFPS. Future epidemiological studies could implement this score to find the prevalence of PFPS in Indonesia. Further, ensuing studies could explore the application of this scoring system in posttreatment and postoperative settings.

Background: Determination of stunting and wasting always uses the WHO growth standard in Indonesia. However, it is believed that Indonesian children are “below” the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the prevalence and determinants of stunting and underweight using WHO growth standard and national Indonesian growth reference. Methods: This was a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO standard and national Indonesian reference. Univariate and multivariate binomial logistic regression were used for statistical analysis. Results: The prevalence of stunting and underweight were higher for the WHO standard than the national reference (53.9% vs 10.7% and 29.17% vs 17.7%; all p < 0.001). After adjusted for confounding factors, when the WHO standard was used, determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm; determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities. When the national reference was used, no determinants was found for stunting; the determinants of underweight were intrauterine growth restriction and maternal education. Conclusions: The WHO standard is not suitable for representing child growth in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the national Indonesian reference.

AIM: Low back pain (LBP) is a widespread complaint of all age groups. The economic burden of LBP is high, and physiotherapy has proven to reduce this. Unfortunately, physiotherapy or exercise regimen is rarely prescribed to LBP patients by doctors. Until now, there was no study regarding the application of physiotherapy exercise in Indonesia. This study aims to evaluate the effect of Williams flexion exercise (WFE) toward people with LBP. METHODS: This was a pretest-posttest experimental study design of PROLANIS participants with LBP complaints in one of the primary health-care centers in Jombang, East Java, Indonesia, on June 2018–July 2018. The total sampling method was used in this study. Participants’ basic clinical data and Oswestry Disability Index (ODI) were obtained through a self-administered questionnaire. WFE was taught to the participants through a presentation, video, and live demonstration. After 1 month, ODI of the participants was reassessed. RESULTS: There were 42 participants included in this study. There was a significant ODI difference between pre- and post-WFE implementation (31.05 ± 17.40 vs. 14.10 ± 11.78, p = 0.019). Higher exercise frequency (>1 times/day) was associated with further reduction in ODI compared to lower exercise frequency group (1 time/day) (22.09 ± 19.09 vs. 7.38 ± 12.58, p = 0.017). There was no significant difference in ODI reduction between geriatric and non-geriatric participants (p = 0.24). CONCLUSION: WFE improves functional symptoms of LBP regardless of age. This exercise could be implemented in a primary health-care setting in future to reduce the cost for LBP treatment.

Background<br />Elbow deformity in children due to neglected proper fracture management is a devastating condition. The stiffness and pain complicated the function in daily activity. Successful management of neglected elbow dislocation is a challenging problem for orthopedic surgeons. In this study, we aimed to evaluate results of open reduction for neglected elbow dislocation in children.<br /><br />Case Description<br />This is a case series of 13-14 years old neglected elbow dislocations, for up to 15 months. Open reduction after external distractor and followed by intensive rehabilitation was implemented. Clinical and functional outcome were evaluated within 4-7 years. Initial average elbow flexion was 53,3°, extension was 0°, arc of flexion was 53,3°, arc of pronation-supination was 150° and Mayo Elbow Performance Index (MEPI) was 80. Clinical and functional outcome were evaluated within 4-7 years. At follow-up after open reduction, the improvement in whole range of movement was significant. Average elbow flexion was 118,3°, extension was 36,67°, arc of flexion was 81,67°, arc of pronation-supination was 133°. The average improvement of flexion was 65°, arc of flexion was 31,67°, and arc of pronation-supination was 8,3°. The average loss of flexion was 15,5%, arc of flexion was 44,2%, and arc of pronation-supination was 10,7% compared with uninjured side. The average Mayo Elbow Performance Index (MEPI) was 96,67; all with excellent results.<br /><br />Conclusion<br />Planned and well execution open reduction in pediatric neglected elbow dislocation may bring back the painless movement within normal daily function.

Background: Determination of stunting and wasting always uses the WHO growth standard in Indonesia. However, it is believed that Indonesian children are “below” the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the prevalence and determinants of stunting and underweight using WHO growth standard and national Indonesian growth reference. Methods: This was a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO standard and national Indonesian reference. Univariate and multivariate binomial logistic regression were used for statistical analysis. Results: The prevalence of stunting and underweight were higher for the WHO standard than the national reference (53.9% vs 10.7% and 29.17% vs 17.7%; all p < 0.001). After adjusted for confounding factors, when the WHO standard was used, determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm; determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities. When the national reference was used, no determinants was found for stunting; the determinants of underweight were intrauterine growth restriction and maternal education. Conclusions: The WHO standard is not suitable for representing child growth in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the national Indonesian reference.