Feasibility of Rehub Web Application as an Exercise Prescription

Method for Office Workers with a Neck Muscle Spasm

Daniel Hadimartana

, Fitri Anestherita

Department of Physical Medicine and Rehabilitation, Dr Cipto Mangunkusumo Hopsital

University of Indinesia, Jakarta, Indonesia

Musculoskeletal Division, Department of Physical Medicine and Rehabilitation Department,

University of Indonesia, Jakarta, Indonesia

Keywords: Exercise Feasibility, Exercise Prescription, Physical Exercise, Printed Instruction, Web Application

Abstract: Background: Routine home exercise will provide better benefits than just training at the health center,

especially for chronic conditions. Exercise adherence and accuracy are important to achieve therapeutic

goals. This study is designed to evaluate the feasibility of Rehub, a web application for personalized

exercise prescription in Bahasa Indonesia. Methods: A questionnaire was asked to 10 doctors after using

Rehub and 10 office workers (OW) after getting a printed prescription to evaluate Rehub's feasibility. Result:

All doctors state that Rehub is easy to use and will use it. Eighty percent of doctors agree it will help them

to explain, save time, and help the patient. Eighty percent of doctors agree, it has a proper description and

will increase adherence. Ninety percent of doctors agree that they are satisfied and will increase health

service quality. All OW agree that Rehub printed exercise (RPE) will help them to remember. Sixty percent

of OW prefers to get RPE over-exercise demonstration. Eighty percent of OW agree that they are more

motivated after getting RPE and will ask to get RPE. Eighty percent of OW agree that RPE is easy to

understand. Conclusion: Rehub is feasible to be used as an exercise prescription option.

1 INTRODUCTION

Based on several studies, physical exercise is the

foundation in the management of musculoskeletal

medical conditions (Sihawong et al., 2011;

Hochberg et al., 2012; Mcalindon et al., 2014;

Nelson et al., 2014; Weber and Jevsevar, 2016).

Routine physical training programs and according to

medical instructions for some medical conditions are

considered to be an important component in

rehabilitation management programs, compared to a

supervised therapy session with limited time

(Fokkenrood et al., 2013; Jakobsen et al., 2015;

Williams et al., 2015; Gutiérrez-Espinoza et al.,

2017; Minetama et al., 2019).

Prescribing physical exercises is more common

using conventional methods for providing

instructions for home exercise programs. Patients

who need home exercise are given instructions by

exemplifying some of the movements directly as

well as for instructions on the frequency of exercise,

the number of repetitions, sets, and length of

detention adjusted to the medical condition of each

patient (Williams et al., 2015). With the

conventional method, it takes a long time to educate,

the movements are made incorrectly and the exercise

dose is not according to instructions because the

patient forgets the instructions, resulting in reduced

compliance.

In recent decades the use of computers has

increased sharply among office workers. Computer

users who spend more than 3 hours per day in front

of the computer are proven to have more neck

muscle spasm and develop pain (Kanchanomai et

al., 2012; Liyanage, Liyanage and Khan, 2014). This

is related to changes in the posture of computer and

mobile phone users during sitting and doing

activities in front of the computer (Kanchanomai et

al., 2012; Liyanage, Liyanage and Khan, 2014;

Nejati et al., 2015; Mingels et al., 2016). In-office

workers, the prevalence increases to 71% or about

two out of three people will experience this

complaint during life (Fejer, Kyvik, and Hartvigsen,

2006; Mehrseed Sinaki, 2016).

Hadimartana, D. and Anestherita, F.

Feasibility of Rehub Web Application as an Exercise Prescription Method for Ofﬁce Workers with a Neck Muscle Spasm.

DOI: 10.5220/0009089102590264

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 259-264

ISBN: 978-989-758-409-1

259

Various studies show that long sitting (more than

3 hours) in front of the computer adds neck flexion

and head tilt, reduced head movements, shortening

the distance of vision, and increasing posture

deviation, resulting in forward head posture (FHP)

(Kanchanomai et al., 2012; Liyanage, Liyanage and

Khan, 2014; Nejati et al., 2015; Mingels et al.,

2016). FHP is a common finding in patients with

migraines, tension-type headache, pain cervicogenic

head, neck pain, myofascial syndrome, and

temporomandibular dysfunction(Mingels et al.,

2016). This posture will increase the burden on the

musculoskeletal system due to increased dorsal

vertebral kyphosis so that the head is in front of the

center gravity. If this condition is not overcome,

remodeling of the structure will occur the neck and

continues to become permanent deformity, ie

shoulder protraction (Yoo, 2013). Combined from

this condition known as the upper crossed syndrome

(Bae et al., 2016).

The treatment for neck pain experienced by

computer users emphasizes on proper movement

control and head posture to prevent improvement

neck strain (Mingels et al., 2016). Posture correction

is done with therapeutic exercises, including

strengthening (strengthening) of the muscles that are

weak and stretching (stretching) tight muscles, and

posture training and education (Shih et al., 2017).

Currently, there are various methods of exercise for

the management of neck pain, both of which are

practiced isometric, dynamic, or a combination of

both (Somya, 2014).

For a chronic condition like neck problems in

office workers, the adherence to doing an exercise

has an important role to achieve the targeted goals.

There are available a lot of software applications

for physical exercise prescribing methods nowadays,

especially in English but no in Bahasa Indonesia.

This exercise method is considered to help patients

to remember instructions that have been given

(Ortega-Martin et al., 2019). For this reason, we try

to build the first web application for personalized

exercise prescription in Bahasa Indonesia, Rehub.

This study is designed to evaluate the feasibility of

Rehub, to office workers with neck muscle spasm.

2 METHOD

This study of a web application physical exercise

Rehub that develop by Exinio is aimed to evaluate

the feasibility of the physical exercise prescription

method. The authors of this study proposed a

hypothesis that printed exercise prescription can

replace the conventional methods in indonesian

patients. They want to determine the doctor's

experience and the patient's acceptability while

using it. The progress of this study’s step is

illustrated in Figure 1.

We ask the doctors to prescribe neck muscle

stretching exercises using Rehub. Doctors were

asked to try it from the login page, patient data page,

patient diagnosis, choosing exercise type, and

exercise dosage (Appendix 1). After doctors exposed

in a trial and patients get the printed prescription

(Appendix 2). The prescription consists of static

photos of movement step, movement sequence

instruction, and individual notes. Doctors will

answer ten questions to describe their assumption in

Rehub's applicability during prescribing exercise,

doctor's expectation to patient's adherence to

exercise, and its impact on health service treatment

quality.

Patients will answer five questions to describe

their interpretation is the exercise prescription easy

to understand, their preference to get a printed

exercise prescription or live demonstration, their

expectation in the effect of exercise adherence, and

their eagerness to prescribed using Rehub. All of the

questions are arranged in 5 points Likert scale using

an online survey. The results are analyzed by

descriptive methods.

All of the subjects are not blinded and chosen

consecutively. Inclusion criteria for doctors are

general practitioners, Physical Medicine and

Rehabilitation (PMR) senior residents and PMR

attending that competent and regularly prescribing

physical exercise to patients using Bahasa Indonesia.

The patient's inclusion criteria are office workers

with neck muscle spasm without any prior neck

injury, deformities, or surgery and able to read in

Bahasa Indonesia. Subject’s demographics are

described in Table 1.

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

260

Table 1: Participant's characteristics.

Figure 1: Steps of data collection

until

data analysis.

Variables Doctors (n=10) Patiens (n=10)

Women, n 6 4

Level of education, n

High school 1

Diploma 2

Bachelor’s degree or above 7

Level of competency, n

PMR resident 9

PMR attending 1

Feasibility of Rehub Web Application as an Exercise Prescription Method for Ofﬁce Workers with a Neck Muscle Spasm

261

3 RESULTS

From the results of surveys and interpretations that

have been done, both doctors and patients give a

good impression for rehub application. Most doctors

and patients who use Rehub feel this method can

help in prescribing physical exercise and adherence.

All users state that Rehub is easy to use and they

will use it in their daily practice. Eighty percent of

users agree that it will help them in prescribing

exercise, save time during exercise explanation, and

will help the patient to understand the prescribed

exercise. Eighty percent of users agree that it has a

proper exercise description, and will increase

patient's adherence to exercise. Ninety percent of

users agree that they are satisfied with Rehub and it

will increase health service quality in their daily

practice. All patients agree that Rehub printed

exercise prescription will help them to remember the

prescribed exercise. Sixty percent of patients prefer

to get Rehub printed exercise prescriptions over-

exercise demonstration. Eighty percent of patients

agree that they are more motivated to do exercise

after getting Rehub printed exercise and will ask

their doctor to get Rehub printed exercise. Eighty

percent of patients agree that Rehub printed exercise

is easy to understand.

4 DISCUSSION

A printed document as an exercise prescription for

home program exercise is commonly used in several

countries. Printed or written instructions were good

reminders and improve patient’s adherence.

(Escolar-Reina et al., 2010; Smaerup et al., 2016;

Gutiérrez-Espinoza et al., 2017). Not so many

medical professionals choose this kind of

prescribing method because they don’t know a lot of

free home exercise programs and not so familiar

with it. There is still no study about written or

printed exercise prescription in Bahasa Indonesia.

Rehub is the first electronic, web-based

application for exercise prescription in Bahasa

Indonesia that used by medical professionals for

their patients. We build it in a web application

platform so that it can be accessed from a computer

or smartphone browser. One of the shortcomings of

using web applications is it needs the internet to be

used.

This study could serve as a prototype exercise

method for other conditions, such as muscle

strengthening, muscle endurance, and

cardiorespiratory rehabilitation in Bahasa Indonesia.

The Rehub web application is still in the

development stage, that is why in this study limited

in neck stretching exercise options and printed

prescription only.

Office workers as patients are included in this

study found that it is helpful to have prescribed

exercises in written form and guided with movement

sequence pictures. It is hoped that getting printed

instructions for home exercise can help improve

their adherence. From the hypothesis of this study

shows that not all of the patients want to get only

printed exercise prescription, but also want to be

given a direct example at the first time.

With this initial study, positive expectations were

obtained by both doctors and patients. Further

studies are needed that assess the effectiveness in

terms of accuracy of movement, exercise adherence

between patients who get conventional training

instructions, in printed form only, and a combination

of both.

5 CONCLUSION

Rehub is feasible to be used as an exercise

prescription option for neck muscle spasm. Further

study is needed to evaluate Rehub applicability and

effectiveness.

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APPENDIX

Rehub prescription flow

Rehub printed prescription

Feasibility of Rehub Web Application as an Exercise Prescription Method for Ofﬁce Workers with a Neck Muscle Spasm

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Medicine and Rehabilitation Association

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