Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : YC07 - YC10 Full Version

Correlation between Age and Modified Star Excursion Balance Test in Healthcare Workers: A Cross-sectional Study


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52776.15885
Ahmad Dhahawi Alanazi

1. Physical Therapist, Department of Physical Therapy, Rabigh General Hospital, Rabigh, Saudi Arabia.

Correspondence Address :
Dr. Ahmad Dhahawi Alanazi,
Majmaah University, Majmaah, Saudi Arabia.
E-mail: aalanazi@mu.edu.sa

Abstract

Introduction: With advancing age, the ability to maintain postural stability may decline. Healthcare workers might be prone to musculoskeletal symptoms which may lead to greater decline in postural stability with advancing age. However, the relationship between age and balance in healthy hospital staff has not been elucidated.

Aim: To identify the correlations between age and balance measured by the modified Star Excursion Balance Test (mSEBT) performance and determine if age predicts mSEBT performance in healthy male hospital staff.

Materials and Methods: A cross-sectional observational study was conducted at Rabigh General Hospital, Rabigh, Saudi Arabia, from December 2020 to June 2021. Fifteen male hospital staff were included in this study. Participants were instructed to perform three trials of mSEBT. Normalised composite scores and reach distances in each direction for both legs were calculated. Pearson correlation was conducted to identify the correlations between age and mSEBT performance. Also, simple linear regression was performed to determine if age predicts mSEBT performance.

Results: Significant moderate negative correlations were observed between age and non dominant Posteromedial (PM) direction (r=-0.44, p=0.04) and non dominant composite score (r=-0.48, p=0.03). Also, there was a significant strong negative correlation between age and dominant PM direction (r=-0.52, p=0.02) and a significant moderate negative correlation between age and dominant composite score (r=-0.44, p=0.04). The regression analysis showed that age significantly (p=0.046) predicted 27.3% of the variation in the dominant PM reach direction distance (B=-1.35).

Conclusion: The results showed, that age was negatively correlated with PM direction and composite scores for both limbs. Also, age was a predictor of the mSEBT performance only in the dominant PM reach direction.

Keywords

Balance, Dynamic activities, Postural stability

Postural control is maintained by sensory information provided by somatosensory, vestibular, and visual systems (1),(2). Constant sensory input is required from these systems to maintain postural stability during dynamic activities (2). Among the acclaimed tools to clinically evaluate dynamic balance of the lower extremity are the SEBT and the Y-Balance Test (YBT) (3),(4),(5),(6). The mSEBT is a modified version of the eight-reach direction SEBT which requires participants to reach only in three directions: anterior (ANT), PM, and Posterolateral (PL) while standing on one foot (7),(8),(9).

The mSEBT has been reported as a valid and reliable tool to measure balance during dynamic activities in various populations (10),(11). A significant amount of postural control, strength, range of motion, and proprioceptive abilities are required to maintain balance while performing this test. With advancing age, however, the ability to maintain balance might be diminished due to age related changes (2).

Ageing is an inevitable process that may impair several physiological functions, leading to a reduced quality of life (12). Previous researchers have reported that ageing may impact physical performance due to age related deterioration of organ systems such as the musculoskeletal system (13),(14). The function of skeletal muscle is governed by four distinct characteristics including architecture, excitement contraction coupling, and energy release and production of power and force (15). Previous study has found a decline in all four characteristics of skeletal muscle with advancing age (16). These changes may impair individuals’ abilities to maintain postural stability, placing an individual at greater risk of fall.

In addition to the age related deterioration affecting postural control, the nature of work may affect physical performance due to musculoskeletal symptoms creating another challenge to maintain postural control. Specifically, healthcare workers might be prone to musculoskeletal symptoms due to their job that may require long shifts, standing for a long time, and lifting and transferring patients. Previous investigators have reported a high prevalence of musculoskeletal symptoms among health-care workers in Saudi Arabia particularly among nurses (17), dentists (18), physicians (19), emergency care service (20), and physical and occupational therapists (21). Literature has indicated that musculoskeletal symptoms are strongly associated with poor postural control and balance (22),(23),(24). For instance, reduced dynamic balance has been reported in individuals with low back pain (25),(26),(27).

Work requirements demand an efficient postural control for the accomplishment of activities in an ecological manner. Understanding age related postural deficits in healthcare professionals may help identify risk factors associated with work related musculoskeletal disorders causing alteration in trunk muscle activity. Furthermore, the periodic assessment and monitoring through postural assessment may help us to identify and develop approaches to rectify the impaired posture and alteration in trunk muscle activity. The mSEBT is an effective tool to identify dynamic measures of postural stability in normal and patient population (10),(11). Application of this tool in healthcare worker can provide reliable, sensitive and cost effective information about postural stability and could help monitor age related postural deficits in response to specific work requirements at hospital settings. Therefore, evaluating the correlation between age and balance using the mSEBT in healthcare workers may provide more insights regarding postural control. Hence, present study was conducted to elucidate the correlations between age and mSEBT performance and determine if age predicts mSEBT performance in healthy male hospital staff.

Material and Methods

This cross-sectional, observational study was conducted for approximately six months (started on December 24th 2020 and finished on June 20th 2021) at Rabigh General Hospital, Rabigh, Saudi Arabia. Institutional Review Board of the Ministry of Health (H-02-J-002) has approved this investigation and informed consents were obtained from participants before study enrollment.

Inclusion criteria: Male hospital staff (between the age of 20-40 years) who were able to perform the mSEBT were included.

Exclusion criteria: Participants were excluded if they had visual problems, vestibular diseases, neurological disorders, musculoskeletal conditions, or had undergone any surgery.

Study Procedure

The present study was a secondary analysis of a previous study (under review process). A group of 15 male hospital staff participated in this cross-sectional study. Anthropometric measures such as age, weight, height, and dominant side (preferred leg for kicking a ball) were taken and recorded after obtaining informed consent from each participant. While the participant was placed in supine on a table, Leg Length (LL) was measured from the inferior edge of the anterior superior iliac spine to the distal edge of the medial malleolus using a tape measure (5). Each participant was given a demonstration about the mSEBT according to the procedures previously described (5),(10). In addition, participants were instructed to perform four practice trials in each direction for both feet to reduce the learning effect (28). The practice trails were performed using the following standardised order: right anterior, left anterior, right PM, left PM, right PL, left PL. After the practice trails, participants were asked to execute formal testing attempts (3 trials) in each direction in the order similar to the practice trials.

In each formal attempt, participants were instructed to maintain balance and stand on one leg with their hands placed on the pelvis while moving the other leg as far as possible and returning back to the starting position (Table/Fig 1) (5). An investigator marked and measured the distance of the toe touch reach in each direction. Participants were allowed to rest for 30 seconds after each direction to minimise the effect of fatigue (29). All participants conducted practice and formal testing trials barefoot to prevent the potential effect of the shoes on stability and balance. The average reach distance was reported and normalised to LL for each participant by using the following formula: maximum distance obtained/LL×100 (10). Also, normalised composite score for each foot was calculated based on the formula: the sum of the 3 reach directions/3×LL×100 (10).

Statistical Analysis

All data were checked for the assumptions of normality and outliers using Shapiro test and box plots. The relationships between age and the mSEBT were determined by calculating Pearson correlation (r). The strength of the correlation was described using the following criteria: strong relationship (r ≥0.50), moderate relationship (≤0.30 r<0.50), and weak relationship (r<0.30) (30). A simple linear regression analysis was performed to determine if age predicts mSEBT performance. The level of significant (alpha level) was set at 0.05. All statistical analysis were performed using Statistical Package for the Social Sciences (SPSS) 25.0 (SPSS Inc, Chicago, IL).

Results

Fifteen participants (age: 33.86±3.68 years; height 1.72±0.05 m; weight 75.26±9.86 kg; BMI 25.48±3.52 kg/m2) were included in this study. Assumptions of normality and outlier were not violated. (Table/Fig 2) shows dominant and non dominant mean±SD values. Significant moderate negative correlations were observed between age and non dominant PM direction (r=-0.44, p=0.04) (Table/Fig 3) and non dominant composite score (r=-0.48, p=0.03) (Table/Fig 4). Also, there was a significant strong negative correlation between age and dominant PM direction (r=-0.52, p=0.02) (Table/Fig 5) and a significant moderate negative correlation between age and dominant composite score (r=-0.44, p=0.04) (Table/Fig 6),(Table/Fig 7). The regression analysis showed that age significantly (p=0.046) predicted 27.3% of the variation in the dominant PM reach direction distance (B=-1.35) (Table/Fig 8).

Discussion

The investigation was conducted to identify the correlations between age and the mSEBT performance and to determine if age predicts mSEBT performance among healthy male hospital staff. The findings of this investigation support the hypothesis that there will be negative correlations between age and mSEBT performance. The results revealed that significant moderate negative correlations were observed between age and non dominant PM direction (r=-0.44, p=0.04) and non dominant composite score (r=-0.48, p=0.03). Additionally, there was a significant strong negative correlation between age and dominant PM direction (r=-0.52, p=0.02) and a significant moderate negative correlation between age and dominant composite score (r=-0.44, p=0.04).

The most important finding of this investigation was that age was a significant predictor (p=0.046) of the mSEBT performance only in the dominant PM reach direction. Decreased reach distance in PM direction has been linked to ankle instability in recreationally college students (31). In another study of 30 participants, a significant correlation between PM reach direction and hip abduction strength was reported (r=0.51, p=0.004) (32). Previous researchers have reported that increased hip abductors and extensors strength may help individuals to increase their reach distance in both PM and PL directions (32). In a study of 73 healthy participants, a linear regression analysis showed that hip abduction strength was significantly predictive of Y balance performance (33). Previous investigators have found a negative relationship between age and hip abduction strength in healthy subjects (34). Therefore, this finding suggests that the reduced reach distance in the PM direction may be attributed to hip abductors weakness.

Compared with other studies evaluating mSEBT performance (9),(10),(35), the reach distances observed in the current investigation were relatively small. Unlike other researchers who found that the PM reach distance scores were about 80% of the LL (8), the PM reach distance scores were less than 65% of the LL in the current investigation. This discrepancy in the PM reach distances could be related to differences in the sample age (33.86±3.68 years) in this investigation compared with the sample age in other studies. Additionally, averaging the scores of the three trials may lower the final scores in this investigation compared with a previous study in which the highest scores were utilised for data analysis (10).

The human body is composed of 40% skeletal muscles and ageing is associated with loss of muscle mass known as sarcopenia (36). Muscle mass reduction is mainly caused by a decline in the number of type II myosin heavy chain isoform (37). The magnetic resonance imaging technique of muscle fibre revealed a decline in the physiologic index of muscle quality due to a reduction in muscle density and increased intermuscular fat (38). Ageing is associated with reduced muscle strength, with a 1.0-1.5% decline annually and it is more noticeable in the lower extremities (39). With age, there is a significant reduction in type II than type I skeletal muscles fibres as well as the repair or recovery is reduced due to a reduced number of satellite cells in the skeletal muscles (40).

Clinical implications that can be drawn from the study’s findings should be discussed. Exploring the negative relationships between age and the PM and composite score for both legs may highlight the significant of implementing strengthening and coordination programs that aim to improve balance and potentially decrease risks of future injuries. Furthermore, knowing that age predicted mSEBT performance only in the dominant PM direction may emphasise the importance of designing training programs focusing on the PM direction as this direction has been linked to ankle instability.

Limitation(s)

Certain limitations to this investigation need to be addressed. The small sample size may limit the generalisability of the current investigation. Categorising participants into groups based on their age or profession was not performed due to the small sample size in the current investigation. Age related changes may not be pronounced due to the mean age of the sample (about 33.86 years). Also, the inclusion of only male participants may limit the generalisability of the study.

Conclusion

The findings of this investigation indicated that significant moderate negative correlations were found between age and non dominant PM direction and composite score. Additionally, age was strongly negatively correlated with the dominant PM direction and moderately negatively correlated with the dominant composite score. Also, age was a significant predictor of the mSEBT performance only in the dominant PM reach direction.

Acknowledgement

The author would like to thank Mr. Nawaf Almotairi for assistance with collecting data.

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DOI and Others

DOI: 10.7860/JCDR/2022/52776.15885

Date of Submission: Oct 08, 2021
Date of Peer Review: Oct 28, 2021
Date of Acceptance: Dec 21, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: Funded by Deanship of Scientific Research at Majmaah University. Project No. R-2022-7
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 11, 2021
• Manual Googling: Dec 18, 2021
• iThenticate Software: Dec 20, 2021 (6%)

ETYMOLOGY: Author Origin

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