Background: The validated Incremental Shuttle Walk Test (ISWT) is widely used for evaluating maximal exercise capacity, with the distance-walked (IWSD) as the primary outcome. However, there are no normative reference values (NRV) and reference equations to predict ISWD for the Singaporean population. Objectives: This study aims to establish the NRV and reference equations for ISWD in healthy Singaporeans aged 21 to 80 and investigate the determining variables during ISWT. Methods: This cross-sectional study recruited community-dwelling healthy subjects aged 21–80 from the community via convenience sampling. Each subject completed two trials of the ISWT according to the standard protocol. Variables measured during the trials included ISWD, pre-and post-test heart rate (HR), oxygen saturation, blood pressure (BP), modified Borg’s dyspnoea score and Borg’s rate of perceived exertion (RPE). Results: 199 healthy Singaporean (females = 114, males = 85) participated in the study. The overall median ISWD was 660.0 metres (m) [interquartile range (IQR):440.0–850.0]. The age-stratified mean ISWD ranged from 430.0 m (IQR:350.0–450.0) (aged 60–80) to 480.0 m (IQR:438.0–650.0) (aged 40–59) to 780.0 m (IQR:670.0–960.0) (aged 21–39). Gender, age, weight, height and HR change (highest post-test HR minus pre-test HR) were the most significant variables (p < 0.001). IWSD (m) = 651.4(Height, m) +89.7(Gender, male = 1; female = 0) –6.31(Age, years) –3.61(Weight, kilograms) +2.54(HR change, beats per minute); R² = 0.741. Previously published ISWT reference equations cannot accurately predict the ISWD in the Singaporean population. Conclusions: This study investigated the ISWD NRV and established reference equations for healthy Singaporeans aged 21–80. The information would be beneficial in setting performance benchmarks to guide physical assessment, intervention and rehabilitation.

Empathy is an essential antecedent in motivating healthcare professionals to treat and care for their patients with compassion – few studies had explored empathy on healthcare workers. Currently, no data reported empathy amongst physiotherapists and physiotherapy students in Singapore. This study aims to: 1) measure and explore within- and between-group differences in empathy scores amongst physiotherapists and physiotherapy students in Singapore, and 2) compare the results with similar studies locally and overseas. This cross-sectional survey recruited 187 participants (37 physiotherapists and 150 physiotherapy students) via convenience sampling. Participants completed the Jefferson Scale of Empathy (JSE) Health Professions (JSE-HP) and the JSE-Health Professions Students (JSE-HPS), correspondingly. The 20-item JSE-HP and JSE-HPS are validated self-reported questionnaires that measure clinical empathy using a 7-point Likert scale. Summed scores range from 20 to 140, with higher scores suggesting a higher level of empathy. Statistical analysis included descriptive statistics, independent-sample t-tests and one-way analyses of variance. The mean score of JSE-HP and JSE-HPS was 110.89±11.37 and 112.43±10.73, respectively. No statistically significant differences found between gender, physiotherapists and physiotherapy students, and years of study. However, physiotherapists scored significantly higher [5.08±1.24 (95% CI 4.67–5.49) vs 4.01±1.36 (95% CI 3.79–4.23), p < .001 ] in the JSE components ‘Walking in Patient's Shoes’. Physiotherapists and physiotherapy students in Singapore have similar empathy scores to their counterparts locally and internationally. No statistically significant differences in empathy scores were found. However, physiotherapy students were less able to understand patients' perspectives. This warrants further exploration in developing this vital attribute amongst students.

Background/Purpose: To date, there are no published validated Chinese versions of the incremental shuttle walk test (ISWT) instructions despite its wide clinical applications. Translation of the Chinese ISWT instruction is done in an ad-hoc manner within the Chinese-speaking populations, affecting the test’s reliability and validity since translation can differ significantly between individuals. This warrants the need for psychometric testing of such translation. Objectives: To develop a Chinese (Mandarin) version of the ISWT instructions (ISWT-CHN) that is conceptually equivalent to the original English version (ISWT-ENG) and establish its reliability and validity. Methods: Forward and backward translations from the ISWT-ENG were done to generate the ISWT-CHN. Face and content validity was determined during the translation process. Intra-rater and inter-rater reliability of the ISWT-CHN, construct and criterion validity were established by analysing the ISWT and the gold standard cardiopulmonary exercise test results. Results: The Item-Content validity index (I-CVI), Scale-level-Content validity index (S-CVI), and content validity ratio (CVR) of the ISWT-CHN were 1.0. Intra-class Correlation Coefficient (ICC) for inter-rater reliability between two raters were excellent ($\mathrm{\text{ICC}}=0.99$ , 95% CI 0.97–1.0, $p<0.001$ ; $\mathrm{\text{SEM}}=0.85$ $$ m, $\mathrm{\text{MDC}}=2.35$ $$ m). The intra-rater reliability of both Raters A ($\mathrm{\text{ICC}}=0.92$ , 95% CI 0.53–0.98, $p=0.003$ ; $\mathrm{\text{SEM}}=35$ $$ m, $\mathrm{\text{MDC}}=97$ $$ m) and B ($\mathrm{\text{ICC}}=0.90$ , 95% CI 0.76–0.96, $p<0.001$ ; $\mathrm{\text{SEM}}=32$ $$ m, $\mathrm{\text{MDC}}=88$ $$ m) were good. In a sample of 32 healthy participants, both ISWT-CHN and ISWT-ENG instruction results showed low-positive correlations with the VO${}_{2max}$ determined from the cardiopulmonary exercise test ($r$ = 0.439, $p<0.001$ ; $r=0.448$ , $p<0.001$ ). There is a very high correlation between ISWT-ENG and ISWT-CHN results with no statistically significant differences ($r=0.967$ , $p<0.001$ ). The construct and criterion validity of the ISWT-CHN were established. Conclusion: This study developed the ISWT-CHN and showed that it is a valid and reliable measure conceptually comparable to the ISWT-ENG. It will benefit the determination of functional exercise capacity in Chinese-speaking populations. Key messages

This study examined the relationship between academic performance in pre-clinical assessments and clinical placement outcomes among entry-level physiotherapy students in cardiorespiratory physiotherapy. It also compared academic and clinical performance across genders and investigated the correlations between these two areas within the context of cardiorespiratory physiotherapy. The results from two cohorts of physiotherapy students in a single educational institution underwent retrospective analysis. The study compared academic performance data from pre-clinical assessments with clinical placement outcomes, further examined gender differences and investigated correlations between academic and clinical performance. Consistent academic performance was demonstrated across written assessments, but it correlated weakly with clinical placement outcomes. The findings highlight the importance of professional attributes, such as learning and work integration, professionalism, communication, problem-solving, adaptability, and teamwork, which were not assessed in pre-clinical assessments. No significant gender differences were found in academic or clinical performance, except in practical exams. The study suggests that clinical success, in addition to academic results, relies on additional skills not evaluated in pre-clinical assessments. It emphasises the need for holistic assessment frameworks to better bridge the gap between academic and clinical training, ensuring future physiotherapists are prepared for diverse clinical challenges.

Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) are commonly used proxies to measure respiratory muscle strength. Current literature lacks recent large-scale normative reference values (NRV) for these pressures in healthy Singaporean adults. Moreover, no consensus exists on the variables that could influence MIP and MEP. This cross-sectional study aims to: (1) establish the NRV of MIP and MEP; (2) determine the correlations of variables that could influence these pressures; and (3) develop regression equations using non-spirometry variables to estimate reference values for MIP and MEP in the healthy Singaporean population aged 21 to 80 years. MIP and MEP were measured alongside demographic and anthropometric data collected from 391 participants (202 females, 189 males) recruited via convenience sampling. Median MIP and MEP values were significantly higher in males (112 and 85 cmH₂O) than in females (83 and 64 cmH₂O). Spearman correlations revealed significant associations between MIP/MEP and gender, height, weight, body mass index (BMI), waist–hip ratio, and spirometric variables. Regression models using age, gender, height, and weight explained 27.5% and 32.1% of the variance in MIP and MEP, respectively. This study updated the NRV of MIP and MEP and provided practical predictive equations for assessing respiratory muscle strength in Singapore.