Respiratory Therapy Commons^™

Pengaruh Rehabilitasi Berbantuan Robot Terhadap Pemulihan Fungsional Setelah Total Hip Arthroplasty: Literature Review, Dian Rahayu Wijayanti, Kholida Nabila, Nadzifa Salsabila Haris Putri, Nur Afrina Azra, Septina Olivia, Farid Rahman

Jurnal Fisioterapi Terapan Indonesia

Total Hip Arthroplasty (THA) remains a gold standard for restoring joint function in patients with severe hip osteoarthritis, yet achieving optimal functional recovery post-surgery remains a challenge. Robot-assisted rehabilitation (RAR) has emerged as a novel physiotherapy modality offering structured, repetitive, and sensor-driven training that may enhance recovery trajectories. Objective: This literature review aims to identify and synthesise current evidence on the effectiveness of RAR in improving functional outcomes after THA, focusing on gait performance, muscle strength, balance, and quality of life. Methods: A comprehensive search of PubMed, PEDro, ScienceDirect and Google Scholar was conducted for peer-reviewed articles published between 2015 …

Community-Based Exercise Programs Dalam Mengurangi Fear Of Falling Dan Meningkatkan Quality Of Life Pada Lansia: A Systematic Literature Review, Amirah Hasna Rafifah -, Hanif Maulana, Saffanah

Jurnal Fisioterapi Terapan Indonesia

The global increase in the elderly population presents significant challenges in maintaining independence and quality of life among older adults. One of the most common problems experienced by the elderly is fear of falling, which negatively affects physical activity, balance, and psychological well-being. Community-based exercise programs represent an approach that not only improves physical function but also strengthens social interaction and self-confidence among older adults. This study aims to review community-based exercise programs in reducing fear of falling and improving quality of life among the elderly through a Systematic Literature Review (SLR) using the PRISMA 2020 guidelines. The literature …

Prediction Of Lung Vital Capacity Value From Thoracoabdominal Expansion In Young Adults, Aung Myo Htun, Aung Aung Nwe, Chatchaya Jaimanee, Thiwaphon Chatprem, Saowanee Nakmaroeng, Chatchai Phimphasak

Journal of Health Research

Background: Vital capacity (VC) is a fundamental indicator of pulmonary health, but its routine assessment often depends on spirometry devices that may be unavailable (i.e. because of access, cost) in many clinical or community settings. In contrast, lower costal (LC) and upper abdominal (AB) expansions are simple, equipment-free methods commonly used in physiotherapy.

Method: This cross-sectional study was aimed at developing prediction equations for VC using LC or upper AB expansion alongside demographic and anthropometric variables. The study involved 116 healthy nonsmokers (53 male and 63 female individuals) aged 18–39 years. VC was measured via spirometry using a …

Pengaruh Aerobic Low Impact Exercise Terhadap Fungsi Kognitif Lansia Dengan Risiko Demensia Di Sasana Tresna Werdha Cibubur Tahun 2025, Nur Achirda, Liza Laela Abida, Kania Annisa Zahra

Jurnal Fisioterapi Terapan Indonesia

Background: Entering old age, the elderly often face various problems, one of which is impaired cognitive function. Some factors that influence the decline in cognitive abilities in the elderly include gender, education level, occupation, nutritional status, and comorbidities that can interfere with the nervous system, such as dementia and Alzheimer's disease. The problem of dementia in the elderly is an important concern that requires effective prevention and treatment. Dementia in the elderly can include several aspects, such as orientation, registration, attention and calculation, memory, and language. Physiotherapy has an important role in maintaining and improving body movement function, so that …

Pengaruh Deep Neck Flexor Exercise Terhadap Neck Pain Non-Specific Pada Penjahit, Salwa Maylani, Fendy Nugroho, Yoni Rustiana

Jurnal Fisioterapi Terapan Indonesia

Background: tailors tend to bow for a long time which results in excessive activation of the postural muscles in maintaining the position of the neck which causes weakness, decreased activity, and muscle imbalance which results in pain in the neck area. In overcoming these disorders, the intervention that can be given is deep neck flexor exercise. Objective: to determine the effect of deep neck flexor exercise on non-specific neck pain in tailors. Methods: this study used an experimental one group pre and post test with control design which was carried out in May-July 2024 at PT. Iskandar Indah Printing Textile …

Kecemasan Orang Tua Yang Memiliki Anak Disabilitas Intelektual Di Slbn 4 Jakarta, Hermito Gidion, Purnama Betty Sitorus, Zahrah Nabila Humayrah

Jurnal Fisioterapi Terapan Indonesia

Anxiety is a common mental condition characterized by feelings of nervousness, fear, and restlessness that can interfere with daily life. Parents who have children with intellectual disabilities often experience anxiety due to various factors, including psychological pressure and high emotional burdens. The aim of this study was to analyze the level of anxiety among parents who have children with intellectual disabilities at SLBN 4 Jakarta and to identify the relationship between predisposing and precipitating factors and the level of anxiety. This research employed a quantitative descriptive approach with a cross-sectional design. The sample consisted of 81 parents at SLBN 4 …

Pengaruh Biofeedback Terhadap Program Peningkatan Kekuatan Otot, Aditya Johan Romadhon, Fendy Nugroho, Pajar Haryatno

Jurnal Fisioterapi Terapan Indonesia

Background: In sport the muscle fiber composition surely affect athlete performances, selective training technic and using advance technology may improve and set a new standards for athlete optimal performances, technology innovation such as computer simulator has been use to generate realistic match simulation in several sport, but the technology is not cheap that many sport clubs can afford, so biofeedback may become innovation to improve athletes performance by monitoring muscle activation to achieve selective muscle contraction in muscle strengthening programs. Objective: The objective of this study was to evaluate whether auditory feedback as biofeedback can improve muscle activation in a …

The Effectiveness Of The Addition Of Slow Deep Breathing To Brain Gym Exercise On Cognitive Impairment Of The Elderly, Dhia Maharani Ms, Mohammad Ali Mr, Zahra Sativani Mrs

Jurnal Fisioterapi Terapan Indonesia

Background: According to WHO, 65.5 million elderly people worldwide have impaired cognitive function. Cognitive impairment can be caused by impaired oxygen supply to the brain, stress, and lack of physical activity. Physiotherapy has a role in elderly cognition through interventions to improve cognition, namely in the form of Brain Gym Exercise with the addition of Slow Deep Breathing. Objective: Knowing the effectiveness of the addition of Slow Deep Breathing to Brain Gym Exercise on cognitive impairment of the elderly at Panti Sosial Tresna Werdha Budi Mulia 4. Methods: This study used quasi experimental with two group pre-post …

Efektivitas Massage Endorphin Untuk Mengurangi Kecemasan Pada Ibu Hamil Menjelang Persalinan, Widiya Saryani, Dini Nur Alpiah

Jurnal Fisioterapi Terapan Indonesia

Pregnancy is a biological process involving complex physiological and psychological transitions that demand high adaptability from women, especially approaching childbirth. Anxiety during the third trimester is frequently reported and is associated with increased cortisol secretion, which may negatively impact labor effectiveness. This literature review aimed to synthesize scientific evidence regarding the effectiveness of endorphin massage in reducing anxiety among pregnant women in the third trimester. The review used a systematic approach based on the PICO framework, covering studies published between 2021 and 2025. Databases such as PubMed, Google Scholar, and SINTA were used to identify quasi-experimental studies comparing endorphin massage …

Peningkatan Keterampilan Makan Pada Anak Down Syndrome Melalui Terapi Okupasi Berbasis Sensory Integration: Studi Kasus, Reza Nur Arsyi, Tambunan Seselia Thresagloria, Muhammad Luthfi, Ayleen Alicia K, Hermito Gideon

Jurnal Fisioterapi Terapan Indonesia

Children with Down Syndrome (DS) frequently experience feeding difficulties due to hypotonia, sensory processing disorder, and oromotor impairments. This case study aimed to describe the clinical reasoning and effectiveness of a sensory integration (SI)-based occupational therapy intervention in improving feeding skills in a 10-year-old child with DS. The intervention consisted of 12 structured sessions focusing on postural stability, proprioceptive awareness, fine motor control, and oromotor coordination. Evaluation tools included Sensory Profile 2 and the Functional Independence Measure (FIM). Post-intervention outcomes indicated significant improvement in spoon use, posture during mealtime, texture tolerance, and self-feeding independence. FIM scores improved from total assistance …

Efektivitas Latihan Aerobik Dalam Mengurangi Gejala Depresi: Literature Review, Putra Adytio Giriyoga, Dini Nur Alpiah

Jurnal Fisioterapi Terapan Indonesia

Depression is one of the most common mental health disorders worldwide and can significantly affect an individual's quality of life. Various treatment approaches have been implemented, with one of the most noteworthy being non-pharmacological interventions in the form of aerobic exercise. This study aims to review the effectiveness of aerobic exercise in reducing depressive symptoms. This research is a narrative literature review, in which 3,610 articles were initially identified and then filtered based on inclusion-exclusion criteria, resulting in 8 articles. After eliminating duplicates, further screening was conducted through critical appraisal. The final selection of 8 articles was reviewed. The findings …

Modified Shuttle Walk Test In Chronic Health Conditions: A Literature Review, Manish Prannath Shukla, Gaurav Chhabra, Ashish Shankarrao Deshmukh Dr

Internet Journal of Allied Health Sciences and Practice

Background: The Modified Shuttle Walk Test (MSWT) is widely utilized to assess exercise capacity across various chronic health conditions. This literature review synthesizes evidence from studies evaluating the MSWT's reliability, validity, and clinical applicability in conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, sarcoidosis, obesity, hypertension, and asthma. Methods: A systematic search was conducted across electronic databases for studies published between 2006 and 2022. Eligible studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Data extraction focused on study objectives, methods, participants, outcomes, and quality assessment. Results: Eleven studies met the inclusion criteria. The MSWT demonstrated …

Occupational Therapy Using Cbt To Improve Work Productivity In Schizophrenia: A Case Study, Artha Nisa Thohiroh Triyantari, Reza Nur Arsyi, Muhammad Luthfi, Ayleen Alicia K, Hermito Gideon, Zulfa Khoirunisah, Putri Dirgantara, Purnama Betty R. Sitorus

Jurnal Fisioterapi Terapan Indonesia

Schizophrenia is a chronic mental disorder that often impairs an individual's social and occupational functioning, including productivity-related activities. Patients with schizophrenia frequently face challenges in maintaining employment or running an independent business due to cognitive and emotional disturbances affecting their adaptive skills. This single-case study integrates Cognitive Behavioral Therapy (CBT) into occupational therapy to enhance productivity in a schizophrenia patient through an entrepreneurial activity—independently opening a coffee shop. The study subject is a 50-year-old male diagnosed with schizophrenia undergoing psychosocial rehabilitation at RSJ Dr. Soeharto Heerdjan. The CBT-based intervention was designed to develop adaptive thinking patterns and occupational skills through …

Enhancement Of Functional Ability In Supraspinatus Tendinitis Using Ultrasound And Isotonic Exercise: Case Study, Tu Lidya Ike Putri, Christabelle Aurelia

Jurnal Fisioterapi Terapan Indonesia

Supraspinatus tendinitis is an inflammation of the supraspinatus tendon caused by the supraspinatus muscle tendon overlapping with the caput longus bicep tendon so that friction and repetitive pressure occur over a long period of time and result in damage to the supraspinatus muscle tendon and supraspinatus tendinitis occurs. Characterized by complaints of pain around the shoulder followed by limitation of motion in the shoulder joint. The clinical question arises "can the application of ultrasound and isotonic exercise reduce pain and functional ability improvement?". To be able to answer this question, an evidence search was conducted on 3 data bases, namely …

Perbandingan Konservatif Fisioterapi Dengan Core Stability Exercise Pada Kasus Nyeri Punggung Bawah, Angria Pradita, Nurul Halimah

Jurnal Fisioterapi Terapan Indonesia

ABSTRACT: Low back pain is a major complaint caused by multifactorial conditions. The most common factors of low back pain complaints are due to age, occupation and gender. This study aims to compare the differences in therapeutic effects of conservative physiotherapy with the provision of electrotherapy, namely; microwave diathermy combined with transcutaneous electrical nerve stimulation (TENS), core stability exercise techniques and a combination of electrotherapy with core stability exercise (CSE). This type of research is quasi experimental with a pre-post test design in a population of 90 low back pain patients who seek treatment at the Physiotherapy clinic. By using …

Effectiveness Of Using Soft Exosuit In Stroke Case To Improve Walking Speed And Endurance, Aditya Denny Pratama, Rakha Shidqi Widyadhana

Jurnal Fisioterapi Terapan Indonesia

Stroke is a clinically defined syndrome of acute, focal nerve discharge caused by vascular injury (infarction, hemorrhage) of the central nervous system. Punches can cause damage to the brain and affect a person's ability to walk, balance and coordinate movements. Impaired gait is common in stroke cases, often resulting in poor recovery of mobility and inability to carry out daily activities without assistance. One of the interventions that can be used is a soft exosuit. This method can help overcome walking problems in stroke patients where soft exosuits are used to increase walking speed and walking endurance. The purpose of …

Effect Of Segmental Expansion Exercises On Pulmonary Function In Patients With Upper Abdominal Surgery- A Randomized Controlled Trial, Pranali R. Gaikwad, Manish P. Shukla

Internet Journal of Allied Health Sciences and Practice

Background: Following upper abdominal surgeries, restricted pulmonary function and limited chest expansion often occur due to incisions near the diaphragm. This study aimed to assess the influence of segmental expansion exercises on pulmonary function among individuals recovering from upper abdominal surgery. Method: The study involved 88 patients who underwent elective upper abdominal surgery, randomized into two groups. Over a five-day postoperative period, Group A received standard physiotherapy, including diaphragmatic exercises, splinted huffing/coughing, and ambulation. In contrast, Group B received routine physiotherapy along with segmental expansion exercises. The study evaluated pulmonary function through measurements of forced vital capacity, Forced Expiratory Volume …

The Effectiveness Of Massage Gun Treatment Combined With Passive Stretching In Reducing Non-Specific Lower Back Pain, Yudik Prasetyo, Sabda Husain As Shafi, Fatkhurahman Arjuna, Atikah Rahayu, Mohd Izwan Bin Shahril, Mohad Anizu Mohd Nor, Edwin Onyango Otieno

Jurnal Keolahragaan

Non-specific lower back pain is a common condition characterized by strain, muscle spasms, or weakness of the paraspinal muscles, particularly the multifidus muscle, which affects adjacent musculature such as the gluteus, hamstrings, and quadriceps. This study aimed to investigate whether massage gun treatment combined with passive stretching could reduce non-specific low back pain in patients experiencing subacute and chronic phases of this condition. This pseudo-experimental research employed a one-group pretest-posttest design with three treatments. Participants were selected using purposive sampling based on inclusion criteria: suffering from non-specific low back pain, willingness to participate, and age between 20 and 65 years. …

Occupational Therapy In Stroke: A Case Study Using The Bobath Frame Of Reference And Task Oriented Approach, Reza Nur Arsyi, Afifah Fadhilah Nursyam, Muhammad Luthfi, Hermito Gidion, Ayleen Alicia Kosasi, Erna Faryza Mohd Poot, Rosilah Wahab, Nur Atiqah Azman

Jurnal Fisioterapi Terapan Indonesia

Stroke is a sudden neurological disorder caused by vascular injury to the brain, leading to significant functional limitations. This case study examines the use of occupational therapy interventions, specifically the Bobath and Task Oriented approaches, for a 43-year-old male with left hemiparesis to enhance independence in motorcycling. The patient experienced various limitations, including vestibular function, range of motion, muscle tone and strength, postural control, and fine motor skills. Using the Ashworth scale and the Canadian Occupational Performance Measure (COPM) for assessment, occupational therapy interventions showed progress in several aspects, although the primary goal has not yet been fully achieved. This …

Terapi Latihan Pada Fase Satu Pasca Operasi Rekonstruksi Ruptur Anterior Cruciate Ligamentum Sinistra, Aunike Arum Meta Wurgani, Irawan Wibisono

Jurnal Fisioterapi Terapan Indonesia

Anterior Cruciate Ligament (ACL) reconstruction is a surgical procedure involving the grafting of the ACL using tendon tissue. This procedure aims to restore knee stability and joint fixation following an ACL injury. Post-ACL reconstruction often leads to complications such as pain, edema, reduced range of motion, and muscle weakness. The physiotherapy program in this case aims to evaluate the effects of physiotherapy interventions, including quadriceps setting, hamstring setting, straight leg raise (SLR), heel slide, ankle pumping, bridging, and prone hang exercises, in reducing edema and pain, as well as improving the range of motion and muscle strength in the knee …

Jump To Box Kombinasi Core Plank Knee To Elbow Terhadap Power Otot Tungkai, Maya Triyanita

Jurnal Fisioterapi Terapan Indonesia

Leg power training is defined as a movement to get the jump in athletes doing the maximum jump smash. Badminton requires leg muscle explosive power because it is the muscle's ability to overcome loads and with a high speed of contraction. This study aims to determine differences in the effect of jump to box training, a combination of core plank knee to elbow on increasing leg power in badminton athletes. This study used an experimental design method with a pre-test and post-test design. The treatment group was given the Jump To Box Combination Core Plank Knee To Elbow exercise. The …

The Effectiveness Of An Educational Video Intervention For People With Amyotrophic Lateral Sclerosis Prior To Power Wheelchair Evaluations, Mark Blanchard, Kelly Connelley, Emily Copeland, Quinn Malbrough, Sara Pendleton, Ingrid Franc

Journal of Interprofessional Practice and Collaboration

PURPOSE: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that ultimately requires a power wheelchair (PWC) as the main source of mobility. The purpose of this project was to determine the effectiveness of an educational video to prepare a client for a PWC assessment by addressing four themes: PWC features, home environment, transportation, and client self-efficacy.

METHODS: An educational video was created and used in an ALS Multidisciplinary Clinic to better prepare clients for the PWC evaluation process. The effectiveness of this video was measured using a seven-question Likert scale survey focusing on the themes of the video. Individuals living …

The Ventilatory Management Of Paediatric Central Sleep Apnoea: A Systematic Review, Kane A. Hodge, Anne Jones

Internet Journal of Allied Health Sciences and Practice

Purpose: Paediatric central sleep apnoea (CSA) occurs more frequently in the presence of another medical condition. This systematic review aimed to determine the effectiveness of oxygen therapy and non-invasive ventilation (NIV) for children with CSA and additional underlying comorbidities. Method: A search was undertaken of CINAHL Complete, Emcare, Scopus, MEDLINE, and PubMed with forward and backward citations for studies published between database inception and the 5th of May 2022. Articles of any study design or quality were included, excluding systematic reviews, letters, or study protocols. Articles had to involve only paediatric patients with a diagnosis of CSA with …

Efektivitas Manual Therapy Dan Ultrasound Terhadap Peningkatan Fungsi Gerak Bahu Pada Kasus Nyeri Bahu Et Causa Bursitis Subacromialis Dengan Parameter Spadi Di Rsud Muhammad Natsir, Fadhilah Az-Zahra, Ronal Lufitos, Faizah Abdullah Djawas

Jurnal Fisioterapi Terapan Indonesia

ABSTRACT: Adhesive Capsulitis is a disorder that occurs in the shoulder area in the form of inflammation of the joint capsule which causes a feeling of stiffness and pain. Glenohumeral joint mobilization with the Maitland mobilization technique is using passive mobilization with physiological oscillatory movements which can produce a stretching effect and release of adhesive on the ligament capsule in the shoulder so that the range of motion of the shoulder joint can be increased. Hold relax is an exercise therapy with the principle of reciprocal inhibition which aims to improve antagonistic pattern relaxation, and mobilization, and to reduce pain. …

Neurodynamic Technique Terhadap Penurunan Nyeri, Peningkatan Grip Strength, Dan Peningkatan Kemampuan Fungsional Pada Carpal Tunnel Syndrome, Safrin Arifin, Fathia Dheanisa

Jurnal Fisioterapi Terapan Indonesia

Carpal tunnel syndrome is a syndrome that occurs in 1-4% of the total population worldwide. This condition causes disruption of function and motion in the wrist that spreads to the fingers. Physiotherapy intervention is necessary to reduce the severity of symptoms in patients with CTS. Neurodynamic Techniques are nerve mobilization techniques that aim to restore homeostasis in the nerves so as to reduce pain and improve functional ability. Materials and methods. This research was conducted through searching several databases, found 31 articles which were then filtered and selected as many as 10 articles. However, of the 11 articles, further screening …

Aerobic Exercise Terhadap Peningkatan Endurance Pada Pasien Penyakit Jantung Koroner Dengan Pemeriksaan 6mwt : Studi Kasus, Dela Fariha Fuadi, Andrew Wijaya Saputra, Nabilla Nur Awaliah Dzatikhulwani

Jurnal Fisioterapi Terapan Indonesia

Background: Coronary heart disease (CHD) is a condition in which the heart's blood vessels (coronary arteries) are blocked by fat deposits. Based on data from Riskesdas (2018) it is revealed that cases of heart and blood vessel disease in Indonesia are increasing every year, increasing the mortality rate. This is due to the presence of risk factors that support the emergence of coronary heart disease. Objective: The aim of this paper is to evaluate the evaluation of aerobic exercise to increase endurance in patients with coronary heart disease by examining 6MWT. Method: This research is in the form of a …

Physiotherapy Rehabilitation In Bilateral Lower Limbs Amputations Following Dry Gangrene: A Case Report, Pranali R. Gaikwad, Manish P. Shukla, Santosh P. Dobhal

Internet Journal of Allied Health Sciences and Practice

Background: Bilateral lower limb amputation is becoming more frequent in recent years. This case report will outline the pre-operative and post-operative physiotherapy protocol for bilateral lower limb amputations following dry gangrene. Additionally, this case was evaluated to see if postoperative physiotherapy treatment consisting of prevention of complications, patient education, independent self-care, and functional mobility improved outcome. Case: A 76-year-old man came to the hospital with clinical features of dry gangrene of both feet. Preoperatively he was given education on care for his limbs along with the therapy plan following surgery. Pain on VAS scales were taken prior to surgery and …

Pengaruh Diaphragmatic Breathing Dan Endurance Exercise Terhdap Peningkatan Kapasitas Kardiorespirasi Pada Pasien Hospital-Acquired Pneumonia, Alifia Azzahra, Annisya Puspitarani, Zahra Sativani, Riza Pahlawi

Jurnal Fisioterapi Terapan Indonesia

The purpose of this case study is to determine the effect of diaphragmatic breathing and endurance exercise in hospital-acquired pneumonia (HAP) cases. HAP is a nosocomial pneumonia that occurs 48 hours or more after the patient is admitted to the hospital, without any signs of pulmonary infection at the time of initial treatment. The existence of clinical manifestations that appear, patients with HAP tend to avoid physical activity which can decrease the functional capacity of the respiratory system and have an impact on decreasing endurance. Diaphragmatic breathing exercise is thought to be able to help reduce shortness of breath, reduce …

Pengaruh Diaphragmatic Breathing Dan Endurance Exercise Terhadap Peningkatan Kapasitas Kardiorespirasi Pada Pasien Hospital-Acquired Pneumonia, Alifia Azzahra, Annisya Puspitarani, Zahra Sativani, Riza Pahlawi

Jurnal Fisioterapi Terapan Indonesia

The purpose of this case study is to determine the effect of diaphragmatic breathing and endurance exercise in hospital-acquired pneumonia (HAP). Nosocomial pneumonia that occurs in 48 hours or more after the patient admitted to the hospital, without any signs of pulmonary infection. The existence of clinical manifestations that appear, patients with HAP tend to avoid physical activity which can decrease the functional capacity of the respiratory system and have an impact on decreasing endurance. Diaphragmatic breathing exercise is thought to be able to help reduce shortness of breath, reduce the work of the accessory muscles of breathing, improve breathing …

The Feasibility And Efficacy Of Telespirometry For Pulmonary Monitoring Of Cystic Fibrosis: A Systematic Review, Tessa Yap, Anne Jones

Internet Journal of Allied Health Sciences and Practice

Background: Spirometry via telehealth (telespirometry) involves remote monitoring of lung function, which is useful to detect pulmonary changes and increase continuity of care for patients with cystic fibrosis (CF). Purpose: This systematic review aims to evaluate the feasibility and efficacy of telespirometry assessments for paediatric and adult CF patients. Method: A comprehensive search of health-related databases (CINAHL, Emcare (Ovid), Medline (Ovid), PEDRo and Scopus) was conducted. For inclusion, patients had to be clinically diagnosed with CF and studies could be of any study design or level according to the National Health and Medical Research Council (NHMRC) evidence hierarchy, had to …