Papers by Boon Chong Kwok
Journal of mechanics in medicine and biology, May 31, 2024
Journal of mechanics in medicine and biology, May 31, 2024
International Journal of Productivity and Performance Management, Jul 10, 2023
PurposeThe project was undertaken to re-design the performance management system for allied healt... more PurposeThe project was undertaken to re-design the performance management system for allied health professionals (AHPs). The primary aim of the system is to protect healthcare workers from being assigned excessive responsibilities that often result in over-time work.Design/methodology/approachA project algorithm provided an overview of objectives (project scope) to achieve during the project period, October 2020 to August 2022. The project uses top-down and bottom-up approaches in re-design of the performance management system to ensure that the end-product is acceptable for the senior management and AHPs. Process evaluation was used throughout the project phases to reiterate and improve the system. User acceptance (outcome evaluation) was surveyed from senior management and AHPs separately to support finalization of the system.FindingsThe authors found acceptance in use of the revised system from senior management and AHPs, thus the system is validated. Based on qualitative feedbacks, participants are motivated by the new system. Therefore, the system designed is feasible for implementation to control for work task assignment.Originality/valueThis is the first paper that demonstrates the application of skills and tasks approach in performance management of AHPs. The use of entrustable professional activities framework is currently limited to undergraduate AHPs, but the authors have successfully translated and implemented the framework for practising AHPs.
Trials, Jun 18, 2011
Background: Falls are common in frail older adults and often result in injuries and hospitalisati... more Background: Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo ® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo ® Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline. Methods: This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and nonfallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments. Discussions: The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme.
Age and Ageing, Jun 24, 2016
Background: the study compares the effects of a Nintendo Wii exercise programme and a standard Gy... more Background: the study compares the effects of a Nintendo Wii exercise programme and a standard Gym-based exercise intervention on fear of falling, knee strength, physical function and falls rate in older adults. Methods: eighty community-dwelling adults aged 60 years and above with short physical performance battery score of 5-9 points and modified falls efficacy scale (MFES) score of ≤9 points participated in the parallel-group randomised trial. Each intervention arm involved an hour of intervention per week, totalling 12 sessions over 12 weeks. Besides 1-year fall incidence, the participants were evaluated on MFES, knee extensor strength (KES), timed-up-and-go test, gait speed, 6-minute walk test and narrow corridor walk test at weeks 13 and 24. Results: at week 13, between interventions, the effect of MFES changes did not reach statistical significance (difference = −0.07 point, 95% CI −0.56 to 0.42, P = 0.78); at week 24, the Wii group showed statistically significant effects over the Gym group (difference = 0.8 point, 95% CI 0.27 to 1.29, P < 0.01). For KES, the two groups did not differ statistically at week 13 (difference = −2.0%, 95% CI −5.6 to −1.7, P = 0.29); at week 24, the Gym group had greater strength gains than the Wii group (difference = −5.1%, 95% CI −8.7 to −1.5, P < 0.01). No between-group differences were observed for other outcome measures. Conclusion: on completion of a 12-week Nintendo Wii exercise programme, there was no significant benefit seen on fear of falling when compared to a standard Gym-based exercise intervention; however, post-intervention there was an apparent reduction in fear of falling in the group allocated to Wii training, despite knee strength apparently improving more in those allocated to the Gym. It is possible that long-term gains after using the Wii might be due to a carry-over effect. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12610000576022.
BMC Geriatrics, Mar 6, 2013
Background: Rehabilitation interventions promote functional recovery among frail older adults and... more Background: Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Methods: Data from the "Evaluation of the Frails' Fall Efficacy by Comparing Treatments" study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cutoff values of 6MWD (in meters) for GROC rating of "a little bit better" (+2), based on feedback from participants. Results: The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC ≥ 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. Conclusion: The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population.
Biology, Oct 25, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Bodywork and Movement Therapies
International Journal of Productivity and Performance Management
PurposeThe project was undertaken to re-design the performance management system for allied healt... more PurposeThe project was undertaken to re-design the performance management system for allied health professionals (AHPs). The primary aim of the system is to protect healthcare workers from being assigned excessive responsibilities that often result in over-time work.Design/methodology/approachA project algorithm provided an overview of objectives (project scope) to achieve during the project period, October 2020 to August 2022. The project uses top-down and bottom-up approaches in re-design of the performance management system to ensure that the end-product is acceptable for the senior management and AHPs. Process evaluation was used throughout the project phases to reiterate and improve the system. User acceptance (outcome evaluation) was surveyed from senior management and AHPs separately to support finalization of the system.FindingsThe authors found acceptance in use of the revised system from senior management and AHPs, thus the system is validated. Based on qualitative feedbac...
Introduction: In the literature of physiotherapy management of shoulder adhesive capsulitis, it i... more Introduction: In the literature of physiotherapy management of shoulder adhesive capsulitis, it is recommended that patients attend twice a week of physiotherapy intervention, but such a recommendation is difficult to translate into clinical practice and the feasibility is a concern. This study investigated the change in shoulder active range of motion (AROM) between patients receiving regular follow-up interval (2-week) and patients with irregular/prolonged follow-up interval (>2 week).
Methods: 46 subjects with shoulder adhesive capsulitis were prospectively recruited from the National Healthcare Group Polyclinics physiotherapy centres to attend up to 6 treatment sessions. The groups were a 2-week follow-up interval group (n=22) and a prolonged follow-up interval group (n=24). The main study outcome measures were pain score and the affected shoulder AROM. The between and within group differences were analysed using the t-test. ANCOVA was performed for each outcome measure with adjustment of its baseline and the number of sessions attended, followed by bootstrapping.
Results: The bootstrapped ANCOVA showed a statistically significant difference between the 2 groups in shoulder flexion AROM, 2-week interval group was superior, 11.9 degrees difference, 95% CI (1.8 to 20.9), p=0.03. The superiority of 2-week interval group in shoulder abduction AROM was clinically important but not statistically significant, 10.8 degrees difference, 95% CI (-2.9 to 21.7), p=0.12. There was no statistically or clinically significant difference between the 2 groups on other outcome measures.
Conclusion: The study found that a regular 2-week physiotherapy follow-up interval in managing shoulder adhesive capsulitis could improve shoulder flexion AROM more than irregular prolonged follow-up interval.
Introduction: Clinical education involves mentorship and experience building. The judgement in su... more Introduction: Clinical education involves mentorship and experience building. The judgement in summative assessment among mentors varies and can be subjected to bias. The use of a direct patient feedback form could help to address potential bias within a mentor and also to provide immediate feedback for both the student trainee and the mentor. In clinical education, a trainee may be challenging for a mentor to facilitate learning. Trainees who are challenging to manage can have very different characteristics from each other. They have strengths that might be inhibited by their weaknesses, which could result in perceived poor performance by a mentor. As such, in addition to the mentor's feedback, this study explored the use of the patient feedback form to provide insights on the trainee from the patient's perspective, drawing similarities and differences in perspectives of the patients and clinical mentor.
Physiotherapy (PT) appointment default rate was relatively high (Figure ) and hence a Kaizen team... more Physiotherapy (PT) appointment default rate was relatively high (Figure ) and hence a Kaizen team workshop was formed to understand the root cause (Figure ). The study aimed to improve Bukit Batok (BBK) Polyclinic PT Centre default rate (Phase I) and subsequently to apply to other centres (Phase II).
Clinical documentation (CD) is important in the patient care process and is also a medico-legal d... more Clinical documentation (CD) is important in the patient care process and is also a medico-legal document if disputes arise between a patient and the healthcare provider. Because no guideline exist in CD, it is vital to explore and investigate the difference in perceived value and expectation of CD between clinicians; of interest, the physiotherapy documentation is studied.
Clinical biomechanics (Bristol, Avon), Jan 11, 2015
The Wii Balance Board has received increasing attention as a balance measurement tool; however it... more The Wii Balance Board has received increasing attention as a balance measurement tool; however its ability to prospectively predict falls is unknown. This exploratory study investigated the use of the Wii Balance Board and other clinical-based measures for prospectively predicting falls among community-dwelling older adults. Seventy-three community-dwelling men and women, aged 60-85years were followed-up over a year for falls. Standing balance was indexed by sway velocities measured using the Wii Balance Board interfaced with a laptop. Clinical-based measures included Short Physical Performance Battery, gait speed and Timed-Up-and-Go test. Multivariable regression analyses were used to assess the ability of the Wii Balance Board measure to complement the TUG test in fall screening. Individually, the study found Wii Balance Board anteroposterior (odds ratio 1.98, 95% CI 1.16 to 3.40, P=0.01) and mediolateral (odds ratio 2.80, 95% CI 1.10 to 7.13, p=0.03) sway velocity measures predic...
BMC Geriatrics, 2013
Background: Rehabilitation interventions promote functional recovery among frail older adults and... more Background: Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Methods: Data from the "Evaluation of the Frails' Fall Efficacy by Comparing Treatments" study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cutoff values of 6MWD (in meters) for GROC rating of "a little bit better" (+2), based on feedback from participants. Results: The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC ≥ 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. Conclusion: The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population.
The minimal clinically important difference of six-minute walk in Asian older adults Boon Chong K... more The minimal clinically important difference of six-minute walk in Asian older adults Boon Chong Kwok 14/01/2013 The manuscript has been revised and the replies to the comments made by the reviewers are reported in this document.
Biology
Exercise plays an important role in rehabilitating people with chronic low back pain. Aerobic exe... more Exercise plays an important role in rehabilitating people with chronic low back pain. Aerobic exercise and resistance training are general exercise strategies to manage chronic low back pain, but these strategies require longer intervention period to achieve clinical outcomes in pain reduction and functional improvements. Directional preference is recognised as an important exercise strategy in managing low back pain. The Clinical Pilates exercise method leverages on the directional preference of an individual to achieve clinical outcomes faster. Clinical Pilates is a hybrid of two of the best exercise interventions for low back pain, which are general Pilates and the McKenzie method. Due to the scarcity of Clinical Pilates literature, a review of its theory and studies was undertaken to provide a structured guide to the technique in managing people with chronic low back pain. Hypothetical algorithms are developed to support translation into clinical practice and future research stu...
BMJ Open Quality
An emphasis on active ageing could help to delay the onset of frailty. In Singapore, Senior Activ... more An emphasis on active ageing could help to delay the onset of frailty. In Singapore, Senior Activity Centres provide free and guided group exercise sessions for older adults. However, one such centre had very low participation rates among community-dwelling older adults despite running standardised programmes. Based on a needs analysis from a prior project, this paper reports on strategies implemented to improve the daily centre-based group exercise participation rate among community-dwelling older adults. Using the behaviour change wheel model, participant motivation domains were identified as primary gaps, while the psychological capability and physical opportunity were categorised as secondary gaps. A logic model was used to design a project to respond to these identified gaps and guide the evaluation approach. Three strategies were implemented over a 4-week period and reviewed at 6 months: (1) promotion of the exercise classes, (2) delayed rewards for participation and (3) healt...
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Papers by Boon Chong Kwok
Methods: 46 subjects with shoulder adhesive capsulitis were prospectively recruited from the National Healthcare Group Polyclinics physiotherapy centres to attend up to 6 treatment sessions. The groups were a 2-week follow-up interval group (n=22) and a prolonged follow-up interval group (n=24). The main study outcome measures were pain score and the affected shoulder AROM. The between and within group differences were analysed using the t-test. ANCOVA was performed for each outcome measure with adjustment of its baseline and the number of sessions attended, followed by bootstrapping.
Results: The bootstrapped ANCOVA showed a statistically significant difference between the 2 groups in shoulder flexion AROM, 2-week interval group was superior, 11.9 degrees difference, 95% CI (1.8 to 20.9), p=0.03. The superiority of 2-week interval group in shoulder abduction AROM was clinically important but not statistically significant, 10.8 degrees difference, 95% CI (-2.9 to 21.7), p=0.12. There was no statistically or clinically significant difference between the 2 groups on other outcome measures.
Conclusion: The study found that a regular 2-week physiotherapy follow-up interval in managing shoulder adhesive capsulitis could improve shoulder flexion AROM more than irregular prolonged follow-up interval.
Methods: 46 subjects with shoulder adhesive capsulitis were prospectively recruited from the National Healthcare Group Polyclinics physiotherapy centres to attend up to 6 treatment sessions. The groups were a 2-week follow-up interval group (n=22) and a prolonged follow-up interval group (n=24). The main study outcome measures were pain score and the affected shoulder AROM. The between and within group differences were analysed using the t-test. ANCOVA was performed for each outcome measure with adjustment of its baseline and the number of sessions attended, followed by bootstrapping.
Results: The bootstrapped ANCOVA showed a statistically significant difference between the 2 groups in shoulder flexion AROM, 2-week interval group was superior, 11.9 degrees difference, 95% CI (1.8 to 20.9), p=0.03. The superiority of 2-week interval group in shoulder abduction AROM was clinically important but not statistically significant, 10.8 degrees difference, 95% CI (-2.9 to 21.7), p=0.12. There was no statistically or clinically significant difference between the 2 groups on other outcome measures.
Conclusion: The study found that a regular 2-week physiotherapy follow-up interval in managing shoulder adhesive capsulitis could improve shoulder flexion AROM more than irregular prolonged follow-up interval.