Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire

Background: Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment.Objective: This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ).Methods: Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated.The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts’ reviews to produce the final version.Results: The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerianpatient with LBP.Conclusion: A scale for assessing disability in LBP is made available for use in Nigeria and similar populations.Keywords: Low back pain, Outcome measure, Ibadan, Development, Structural validityFunding: None declare

Influence of well-being and quality of work-life on quality of care among healthcare professionals in southwest, Nigeria

The Nigerian healthcare industry is bedevilled with infrastructural dilapidations and a dysfunctional healthcare system. This study investigated the influence of healthcare professionals' well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. A multicentre cross-sectional study was conducted at four tertiary healthcare institutions in southwest, Nigeria. Participants' demographic information, well-being, quality of life (QoL), QoWL, and QoC were obtained using four standardised questionnaires. Data were summarised using descriptive statistics. Inferential statistics included Chi-square, Pearson's correlation, independent samples t-test, confirmatory factor analyses and structural equation model. Medical practitioners (n = 609) and nurses (n = 570) constituted 74.6% of all the healthcare professionals with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants' well-being = 71.65% (14.65), QoL = 61.8% (21.31), QoWL = 65.73% (10.52) and QoC = 70.14% (12.77). Participants' QoL had a significant negative correlation with QoC while well-being and quality of work-life had a significant positive correlation with QoC. We concluded that healthcare professionals' well-being and QoWL are important factors that influence the QoC rendered to patients. Healthcare policymakers in Nigeria should ensure improved work-related factors and the well-being of healthcare professionals to ensure good QoC for patients

Pattern and determinants of willingness-to-pay for physiotherapy services

Purpose: To evaluate willingness-to-pay for physiotherapy services and explore its determinants. Methods: Willingness-to-pay, health-related quality of life and physiotherapy satisfaction were assessed in 100 physiotherapy out-patients with willingness-to-pay, Short Form-12 and physiotherapy satisfaction questionnaires, respectively. Data were analysed with Chi-square and logistic regression. Results: A 45% ‘no- willingness-to-pay’ rate was found in this study. Pattern of willingness-to-pay for different physiotherapy modalities and techniques were varied. Socio-economic status, treatment duration, amount willing to pay for treatment and physiotherapy satisfaction were significant determinants of willingness-to-pay. With one week increase in treatment duration, the participants were 8.4% less likely willing to pay for physiotherapy. Those who were satisfied with physiotherapy treatment were 21times more likely willing to pay compared with those who were not satisfied. Those in middle and high socio-economic status were more likely willing to pay for physiotherapy compared with low socio-economic status. With an increment in amount willing-to-pay more than median fee [₦1500 ($4.2)]; the participants were more likely willing to pay for physiotherapy. Conclusions: About 50% rate of no-willingness to pay for physiotherapy services was observed among Nigerian patients. Socio-economic status, treatment duration, amount willing-to-pay for treatment and physiotherapy satisfaction were predictors of willingness-to-pay for physiotherapy services

Translation, cultural adaptation, and psychometric testing of the Yoruba version of Fear-Avoidance Beliefs Questionnaire in patients with low-back pain

Purpose: To translate, culturally adapt, and validate the Fear-Avoidance Beliefs Questionnaire into Yoruba language. Materials and Methods: Translation and cultural adaptation of the Yoruba version of the Fear-Avoidance Beliefs Questionnaire was carried out following the Guillemin criteria. One hundred and thirty-one individuals with chronic low-back pain participated in the psychometric evaluation of the Yoruba language translation. Cronbach’s alpha (α), principal component analysis, intra-class correlation, Bland–Altman analysis, Spearman rank correlation coefficient, and minimal detectable difference were used for the analysis. Alpha level was set at p < 0.05. Results and Conclusion: The mean age of the respondents was 53.6 ± 11.6 years. The internal consistency of the Yoruba language version of the Fear Avoidance Beliefs Questionnaire yielded a Cronbach’s alpha of 0.9. Principal component analysis yielded a three-factor structure including the “work”, “beliefs related to work”, and “physical activity” which accounted for 61.6% of variance in the Yoruba translation. Test–retest reliability of the Yoruba translation yielded an Intra class correlation coefficient 0.97 (0.95–0.98). The Yoruba Fear Avoidance Beliefs Questionnaire was poorly correlated with the Visual Analog Scale (r = 0.01) and Roland–Morris Disability Questionnaire (r = 0.3). The minimal detectable difference of the Yoruba translation was 7.0. The Yoruba Fear Avoidance Beliefs Questionnaire demonstrated excellent psychometric properties similar to existing versions and is appropriate for clinical use among Yoruba-speaking patients.IMPLICATIONS FOR REHABILITATION The Fear-Avoidance Beliefs Questionnaire is a culturally sensitive psychosocial outcome measure, necessitating its existence, and adaptation into different languages. The instrument was translated and culturally adapted into the Yoruba language following the Guillemin criteria. The Yoruba translation demonstrated excellent internal consistency, test–retest reliability and weak correlations with the Visual analog scale and Roland–Morris Disability Scale. The Yoruba version of the Fear-Avoidance Beliefs Questionnaire can be used to assess fear-avoidance beliefs among Yoruba speaking patients with low-back pain

Association between life satisfaction and health behaviours among older adults : a systematic review and meta-analysis protocol

INTRODUCTION: Life satisfaction is a key indicator of successful ageing and reflects well-being. There is evidence of the association between life satisfaction and health behaviours among older adults. Therefore, this systematic review and meta-analysis protocol seeks to determine the strength and direction of the association between life satisfaction and health behaviours among older adults. METHODS AND ANALYSIS: This protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search the electronic databases (MEDLINE, APA PsycINFO, Web of Science, CINAHL and Global Health) from inception to date. Only observational studies that described the association between life satisfaction and health behaviours—smoking, alcohol drinking, physical activity, diet/nutrition and sleep—will be included. Two independent reviewers will conduct screening, data extraction and risk of bias assessment of the articles. The risk of bias will be assessed using the Joanna Briggs Institute critical appraisal tools for cohort and analytical cross-sectional studies. Studies will be included in the meta-analysis if they report zero-order associations between life satisfaction and health behaviours; otherwise, a narrative synthesis will be presented. ETHICS AND DISSEMINATION: This study does not require ethics approval, as it involves analysing secondary data from published studies. The completed review will be published in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42023441386).https://bmjopen.bmj.com/PhysiotherapySDG-03:Good heatlh and well-beingSDG-10:Reduces inequalitie

Development and effectiveness testing of a mobile health education package for stroke prevention among stroke survivors

Background: Addressing limited stroke literacy among stroke survivors based on social cognitive theory, using trending Mobile Health (m-health) devices can be a valuable interventional approach to reduce secondary stroke risk. Objectives of this study were to develop and test effectiveness of m-health based educational package for stroke prevention among stroke survivors. Method: This was a multimodal methodology involving content development and effectiveness testing using Delphi protocol and pre-test and post-test design respectively. Role shifting involved a physiotherapist administering stroke prevention education. Development comprised items selection, rating and retention; script writing, translation and recording into an audio and video educational packages. Effectiveness testing involved 30 consenting, consecutively assigned SSVs in each of audio (AIG) and video (VIG) intervention group. Stroke literacy was assessed at baseline, 2nd and 4th week post-intervention. Data was summarized using descriptive and inferential statistics at p<0.05 Alpha value. Results: Participants were majorly males (63.3%), over 60 years old (51.7%), hypertensive (83.3%) and had tertiary education (31.7%). Knowledge of stroke risk factors improved between AIG and VIG from baseline (11 23 ± 4 01 and 10.07 ± 3.24) to 2nd week (17 73 ± 0.78 and 15.30 ± 1.78) and 4th week (17.97 ± 0.18 and 16.77 ± 1.01) post-intervention respectively. There were significant differences between the two groups (p<0.01). Conclusion: Mobile health education based on social cognitive theory effectively improves stroke literacy among SSVs and should be tested among larger samples in the community

Exploring the relationship between falls, fall‐related psychological concerns, and personality traits in adults : a scoping review protocol

Background and Aims: Personality traits, such as neuroticism and extraversion, are emerging as important predictors of falls. Despite their significance, existing fall prevention programs often overlook these traits, creating a notable research gap. This study aims to conduct a comprehensive scoping review to explore the existing literature on the relationships among personality traits, falls, and fall-related psychological concerns (FrPCs). Methods: This scoping review will adhere to the framework established by Arksey and O'Malley, incorporating extensions recommended by the Joanna Briggs Institute and using the PRISMA-ScR checklist. A thorough search strategy will be employed, aligning with the population, concept, and context (PCC) selection criteria. Electronic databases, including MEDLINE, APA PsycINFO, Web of Science, CINAHL, and SPORTDiscus, will be searched from their inception to the present. Additionally, a manual search of the reference lists of identified and relevant full-text articles will be conducted. Two independent reviewers will screen titles and abstracts, perform full-text reviews, and extract data from pertinent articles. Discussion: Personality traits are increasingly recognized as influential predictors of falls and related psychological concerns. This review aims to make a substantial contribution to the existing literature by being the first to comprehensively explore and provide a descriptive synthesis of the relationship between personality traits and falls, as well as FrPCs in adults. It is hoped that the outcomes of this review will enhance our comprehension of the role of personality traits in falls, potentially informing future research and strategies for this critical area of study. Scoping Review Registration: This scoping review protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/KR74X)

Development and feasibility testing of an animated cartoon-based self-care application for low-back pain – a pilot study

Objectives: The use of animated cartoons for pain management is an emerging area, however, in no study has it been explored as a digital platform for the rehabilitation of low-back pain (LBP). This study was aimed to develop and evaluate the feasibility of an animated cartoon-based self-care (ACBSC) app for LBP, and to examine the correlation between the app rating parameters and patients’ pain. Methods: This 2-phase study comprised development and feasibility testing components. Development of the ACBSC app was based on Mckenzie’s Mechanical Diagnosis and Therapy (MDT) extension protocol plus back hygiene following standard it-eration and prototyping process. Twenty-eight consecutive patients with chronic non-specific LBP with ‘direction Preference’ for extension based on the MDT screening algorithm participated in the feasibility phase. The participants utilised the car-toon-based app thrice weekly for 2 weeks. Outcomes were assessed in terms of usability, satisfaction and user experience ap-plying the system usability and mobile application rating scales. The Quadruple Visual Analogue Scale (QVAS) was used to assess the participants’ pain intensity. Results: On a unified scale up to 20, functionality (15.4 ± 2.41) and aesthetics 14 ± 2.00 had highest and least objective quality rating on the app parameters. Total objective and subjective quality rating of the app was 16.9 ± 1.97 and 15.6 ± 2.42, respectively. The total impact and usability scores were 24.1 ± 3.39 (out of 30) and 27.8 ± 3.09 (out of 50). Participants re-ported that the cartoon app for back care mostly affected mindfulness/meditation/relaxation (42.9%), increasing happiness/ well-being (46.4%), leading to behavioural changes (60.7%), while targeting physical health (100%). There was no significant correlation between participants’ pain characteristics and app rating parameters (p>0.05). Conclusion: The animated cartoon-based self-care LBP app has moderate to high usability, functionality, aesthetics and quality rating, and may serve as an effective mobile-app for self-management of long-term LBP

Knowledge and perception of physiotherapy students and lecturers about the involvement of simulated patients in clinical examinations at physiotherapy training institutions in South-West, Nigeria

Background: Medical educators in Nigeria are beginning to incorporate the use of simulated patients (SPs) in clinical examinations. This study was designed to investigate and compare the knowledge and perception of physiotherapy students and lecturers about the involvement of SPs in clinical examinations at physiotherapy training institutions in South-West, Nigeria. Methods: This study used a mixed-method approach, combining cross-sectional analysis and focus group discussions. A validated questionnaire assessed the knowledge and perception of physiotherapy students and lecturers regarding SP involvement in clinical exams. Quantitative data were analyzed with descriptive statistics, chi-square, and Mann–Whitney U tests (p < 0.05). Qualitative data were analyzed using thematic analysis. Results: Two hundred and seven clinical students (83 males, 124 females, average age 22.02 ± 1.65 years) and 37 physiotherapy lecturers (25 males, 12 females, average age 48.27 ± 7.49 years) participated in this study. Among the students, 151 were aware of SP involvement in clinical exams: 35.1% had poor knowledge, 53.0% had fair knowledge, and 11.9% had good knowledge. The majority of lecturers (70.3%) demonstrated good knowledge. Most students (147, 71.0%) and lecturers (32, 86.5%) had positive perceptions of SP involvement in exams. Qualitative analysis indicated insufficient training for SPs in clinical examinations at physiotherapy training institutions in South-West Nigeria. Reported drawbacks included a preference for using models, familiarity with SPs, and limitations in the conditions that SPs can simulate. Conclusion: Physiotherapy students at physiotherapy training institutions in South-West Nigeria had fair knowledge about the involvement of SPs in clinical examinations while lecturers had good knowledge about the involvement of SPs in clinical examinations. However, both students and lecturers had a positive perception about the involvement of SPs in clinical examinations though the concept of SPs should be differentiated from the use of models

A new integrated behavioural intervention for knee osteoarthritis : development and pilot study

Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist. Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists. Results: The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention.Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes