Effects of core-stabilization and dynamic strengthening exercises on patients with non-specific chronic low back pain in Lagos: A pilot study

Objectives: Exercise is the most widely used form of treatment adopted for gaining relief from low back pain. But the efficacy of core stabilization and dynamic strengthening exercise on cardiopulmonary parameters of non-specific chronic low back pain patients needs to be established. This study therefore compared the effects of core stabilization and dynamic strengthening exercises on pain related disability and selected cardiopulmonary parameters in patients with non-specific chronic low back pain (NSCLBP).Methods: A total of 20 (44.55±10.78years) NSCLBP patients participated in this study. They were assigned into two different groups. Group A and B received core stabilization exercise and dynamic strengthening exercise respectively. Participants went through this protocol twice weekly for 4 consecutive weeks and were thereafter assessed for pain-related disability, and selected cardiopulmonary parameters.Results: The result of this study revealed that both exercises (core stabilization and dynamic) improved pain–related disability (p=0.011; p=0.004) and some cardiopulmonary parameters in peak expiratory flow rate (PEFR) (p= 0.001, P=0.034) and rate of perceived exertion (RPE) (P=0.001, P=0.001) Pulse rate (PR) (P=0.042, P=0.005).Conclusions: This study showed that both interventions (core stabilization and dynamic strengthening exercise) led to similar result in managing pain-related disability and selected cardiopulmonary parameters except in systolic blood pressure (SBP), Diastolic blood pressure (DBP) and peak expiratory flow rate (PEFR) in patients with NSCLBP when between groups comparison was done. Keywords: Exercise, cardiopulmonary assessment, chronic low back pain, pilot stud

Management of Knee Osteoarthritis: Knowledge and Adherence to Clinical Practice Guidelines Among Physiotherapists in Selected Hospitals in Lagos State, Nigeria

Osteoarthritis of the knee joint (OA) is one of the most common conditions resulting to chronic disability predominantly in elderly population. The management of knee OA has been characterized by variations among physiotherapists within Lagos state, Nigeria. However, there is a need for physiotherapists as a whole to embrace evidence –based clinical practice guidelines in the management of this condition. This study was aimed at determining if the physiotherapist’s characteristics (such as age, highest educational attainment, year of induction, years of experience and setting of practice) influence the knowledge and adherence to clinical practice guidelines in knee OA management and to find out if there is a need to develop clinical practice guidelines in the management of knee OA. This was a cross-sectional descriptive survey involving 104 physiotherapists from selected health care facilities in Lagos state. They were required to complete a 33-item questionnaire which collected information on socio-demographic data, work experience, treatment activities and their knowledge and adherence to knee OA clinical practice guidelines. Only a small percentage (16.30%) of the respondents were knowledgeable about knee OA clinical practice guidelines while even a smaller percentage (14.40%) of the respondents adhere to knee OA clinical practice guidelines. Knowledge and adherence were influenced by setting of practice (p=0.001, p=0.027). Majority (93.30%) of the respondents recommended the need for knee OA clinical practice guidelines in Nigeria. A small population of the respondents is knowledgeable and adheres to knee OA clinical practice guidelines. Some of the characteristics of the physiotherapists influence the knowledge and adherence to knee OA clinical practice guidelines. However, findings show that there is a need to develop a knee OA clinical practice guideline in Nigeria in other to standardize and improve effective treatment outcome in patient care

The Relationship Between Diaphragmatic Mobility And Other Respiratory Parameters Of Patients With Selected Neurological Conditions

Background: Patients with neurological conditions such as stroke and Spinal cord injury (SCI) present with reduction in respiratory function. The diaphragm, which is the chief muscle of inspiration may be impaired in these patients.Objective: This study evaluated the diaphragmatic mobility and other respiratory parameters of patients with stroke and cervical SCI.Methods: The study involved 43 patients with stroke and 30 with cervical SCI in the acute stage. Their diaphragmatic mobility,  spirometry and Maximum Inspiratory and Expiratory Pressures (MIP and MEP) were assessed using a diagnostic ultrasound machine, a spirometer and a manometer respectively. Data obtained were compared with that of their age and sex matched apparently healthyindividuals. Mann Whitney U test was used to compare the data obtained from the subjects with neurological conditions with those obtained from their age and sex matched apparently healthy individuals. Spearman's rank test was used to determine the correlation between diaphragm mobility and other respiratory parameters assessed. Level of significance was set at p<0.05.Results: Subjects with stroke, had significant reduction in the diaphragmatic mobility (right hemiplegics: p=0.009, left hemiplegics: p=0.002) of the paretic side when compared to the non paretic side. There was significant reduction in diaphragm mobility (on both hemi-thorax), spirometry, MIP and MEP of the subjects with stroke and SCI when compared with those of their age and sex matchedapparently healthy individuals (p=0.001). There was a positive correlation among diaphragm mobility and Forced Vital Capacity (FVC), Forced Expiratory Volume in First second (FEV ) and MIP (p<0.05) in 1 subjects with stroke while subjects with SCI, had positive  correlation among diaphragm mobility and all Spirometry and MIP (p<0.05). Diaphragm mobility showed no correlation with MEP in both stroke and SCI (p>0.05).Conclusion: Patients with stroke and SCI in the acute stage have reduced diaphragmatic mobility and other respiratory parameters (Spirometry, MIP and MEP). The diaphragmatic mobility was also positively correlated with the pressure generated by the inspiratory muscles and some Spirometry. This necessitates adequate rehabilitation of the respiratory function in this group of patients. Keywords: Diaphragm Mobility, Spirometry, Maximum Inspiratory and Expiratory Pressure, Stoke, Spinal Cord Injur

Comparative efficacy of two physiotherapy approaches in restoring functional performance in individuals after abdominal surgery: a clinical controlled study

Background: Abdominal surgery leads to reduction in respiratory and functional performance post-operatively. Despite the document benefits of the different physiotherapeutic techniques, there is still a wide gap in knowledge on the most effective technique in restoring early functional performance post-operatively.Objective: This is to compare the efficacy of spirometry and chest-physiotherapy approaches in restoring functional performances in individuals after abdominal surgery.Methods: This study involved 90 individuals (randomized into 3 groups of 30), who had abdominal surgery in a Nigerian tertiary health institution. Group 1 received chestphysiotherapy; group 2 received incentive-spirometry and group 3 received the combination of both approaches. Functionality was assessed using 10-Meter Walk Test (10MWT) and Barthel Index (BI) while a spirometer was used to assess Forced Vital Capacity (FVC) and Force Expiratory Volume in one-second (FEV1). The BI, FEV1 and FVC were assessed at 24-hour pre-operation, and 24-hour, 3rd-day and 7th-day post-surgery while 10MWT was assessed at 24-hour pre-surgery and 7th-day post-surgery. Data was analysed with Analysis of Variance and Kruskal walis test.Results: Eighty-seven participants completed the study while 3 died. The groups were matched in all the varaibles at the pre-operation stage. There was drastic reduction in BI, FEV1 and FVC scores at immediate 24-hour post-surgery but increased rapidly throughout the 7-day period. The group who received the combined therapy performed significantly better (p<0.05) in 10MWT at 7th day postoperation. There was no significant diferent (p>0.05) in the BI, FEV1 , FVC and in the development of complications among the groups at the 3rd and 7th days post-operation.Conclusion: Abdominal surgery cause remarkable decline in functional performances. Early and monitored chest-physiotherapy and spirometry result in rapid improvement in functional performance in individuals within a week of the surgery. However, the combination of the two approaches yields better result in improving functional performance.Keywords: Abdominal Surgery, Spirometry, Chest- Physiotherapy, Functional Performanc