Physiotherapists’ perceptions and experiences of home-based rehabilitation in Libya: a qualitative study

Introduction: home-based rehabilitation (HBR) is a rehabilitation model that aims to help people with disabilities to integrate into the community and be independent as much as possible. HBR is a promising alternative to institution-based rehabilitation, in which rehabilitation services are provided at patients' homes. However, challenges and barriers to HBR practice in Libya have never been researched before. This study explores physiotherapists' perceptions of home-based rehabilitation (HBR) in Libya and examines their views and the concerns they face. Methods: eight physiotherapists (2 females, 6 males) with at least two years of work experience in the Libyan physiotherapy community participated in in-depth semi-structured interviews. The interviews were audio-recorded and transcribed verbatim, and the data were analyzed using framework method. Results: three themes emerged from the data, namely: i) access problems, including lack of infrastructure; ii) lack of governmental policies, such as the absence of governmental support (e.g., lack of programs and resources); iii) poor awareness and misconception issues, including that of patients and families. Conclusion: although all the interviewed physiotherapists described HBR as an essential practice in Libya, they expressed concerns about several factors that hinder its development and may influence the quality of interventions provided in the community. Given the fact that this is the first qualitative study in this field in Libya, there is a need for future research to explore HBR from other perspectives, such as those of policymakers, healthcare planners, or patients and their families and/or caregivers

Development and preliminary validation of a new protocol for postoperative rehabilitation of partial meniscectomy

Background: Meniscal injuries are common among athletic populations and are one of the most common indications of knee joint surgeries. Meniscectomies are a common practice among orthopaedic surgeons in meniscal injury surgical treatment. Currently, no consensus exists for a standardized postoperative rehabilitation protocol after partial meniscectomy. Purpose: This article describes the development and validation of a new rehabilitation protocol for the management of meniscus injury after partial meniscectomy. Methods: A rehabilitation protocol for the postoperative meniscectomy was developed based on literature reviews. Evaluation from clinical experts were done by a 2-hour discussion with a group of seven clinicians to validate the protocol. Finally, an experimental design was used to test the effectiveness of the proposed protocol on a sample of 38 patients who had partial meniscectomies. Results: The final protocol included easy step-by-step directions for physiotherapists. The experts’ validation process resulted in modifications related to clarity, feasibility, technical descriptions, and usability. Our experimental study showed significant improvement of knee joint functions compared to a conventional physiotherapy group. Conclusions: Our final protocol includes detailed instructions which a physiotherapist should be able to follow up rehabilitate patients who have undergone partial meniscectomy from the third day post-surgery until 8 weeks post-surgery. The protocol is clear, easy to follow, and applicable in rehabilitation settings.The research described here was partly supported by the ministry of higher education and scientific research (MHESR), Libya. This work was also supported by resources provided by the department of physical rehabilitation at the Belarusian state University of Physical culture, Belarus

Prevalence, Profile, and Response to Work-Related Musculoskeletal Disorders among Egyptian Physiotherapists

BACKGROUND: Despite that physiotherapists (PTs) are supposed to have adequate knowledge of musculoskeletal disorders and the different prevention strategies, they are at high risk of developing work-related musculoskeletal disorders (WRMDs). AIM: This study aimed to investigate the prevalence, profile, predictors, and response to WRMDs among Egyptian PTs. METHODS: A self-administrated questionnaire was distributed either manually or via e-mail to 564 PTs with at least two years of working experience. Questions elicited information about the personal and occupational history of the respondents in addition to the experience of WRMDs in the past two years. RESULTS: Four hundred and fourteen respondents (82.6%) reported WRMDs within the last two years, with the lower back as the most common area affected (68.8%). More than half the PTs (54.8%) who sustained a WRMD reported that their injury took place in a private setting. Significant predictors for WRMDs were age (AOR = 0.78; 95% CI = 0.66, 0.91) and number of years of experience in physiotherapy practice (AOR = 1.26; 95% CI = 1.07, 1.49). In response to the injury, about 73.9% of the respondents stated that they did not officially report their injury and 55.8% of them reported losing a half day or more from their work. CONCLUSION: The prevalence of WRMDs among Egyptian physiotherapists is high. Despite socioeconomic and cultural differences between Egypt and other countries, our study findings were consistent with the published reports. Further studies are needed to explore the cultural and psychosocial risk factors of WRMDs

Awareness, knowledge, attitudes, and behaviors related to COVID-19 in Libya: a nation-wide online survey

Introduction: the World Health Organization declared the COVID-19 outbreak to be a global pandemic in March 2020. However, the pandemic cannot be ended overnight and more social distancing and other self-care measures are needed to protect our communities. Therefore, people´s awareness, knowledge, attitudes, and appropriate behaviors are instrumental to containing the pandemic. The aim of this study was to determine COVID-19 awareness, knowledge, attitudes, and related behaviors in Libya. Methods: a cross-sectional online survey was conducted from October 10 th to November 10th, 2020 in 24 cities in Libya. The participants were non-medical professionals who were living in Libya for at least 2 years and were at least 18 years old. Results: a total of 1018 participants completed the questionnaire, with ages ranging from 18-74 years (Mean ± SD = 33.49±13.24); nearly two-thirds were < 40, and 68.2% were females. Almost half of the participants considered the potential threat of COVID-19 to be low, and one in five reported that they were “Not worried at all” about getting COVID-19. In multivariate analyses, participants who were 40-49 years old, had master´s degrees or higher, and worked in the private sector reflected high mean scores for both knowledge and attitudes, while those who lived in the Eastern or Southern regions had lower mean attitude scores. Conclusion: the low levels of awareness as well as the attitudes and behaviors among the public in Libya are worrisome. This study highlighted profound gaps that may put Libyan communities at high risk of a COVID-19 explosion. Therefore, immediate action is needed to address public awareness and attitudes and to improve COVID-19 related behaviors among the Libyan public

The most important considerations in the assessment of functional decline in seniors: a literature review

In recent years, there has been much focus on functional decline associated with aging, but not many studies have examined how functional decline can be effectively evaluated and detected at earlier stages of the aging process. Early detection of functional decline helps to intervene much earlier to avoid many of negative consequences of functional decline and frailty. Late identification of functional decline is problematic to the individuals and the healthcare systems considering that the percentage of the world population represented by people over the age of 65 is increasing rapidly worldwide. The aim of this review was to investigate the most important considerations in the assessment of functional decline in the population of seniors, and to explore relevant literature to provide a ground for an effective functional assessment for this population. Comprehensive literature search of the English-language articles for people aged 65 and over were conducted by searching MEDLINE and PubMed. The literature describes two main segments of elderly population with functional decline that should be assessed in different ways: Hospitalized and community-dwelling elders. When working with elderly clients, it is significantly important to identify all the factors that may contribute to the clinical picture of the client. Identification of risk factors, such as inability to do basic activities of daily living, social isolation, or lack of resources may help healthcare providers to intervene on time to avoid many catastrophic changes that affect seniors' health-related quality of life

Ataxia Rating Scales: Content Analysis by Linking to the International Classification of Functioning, Disability and Health

Ataxia management is mainly based on rehabilitation, symptomatic management, and functional improvement. Therefore, it is important to comprehensively assess ataxic symptoms and their impact on function. Recently, the movement disorders society recommended four generic ataxia rating scales: scale for assessment and rating of ataxia (SARA), international cooperative ataxia rating scales, Friedreich’s ataxia rating scale (FARS), and unified multiple system atrophy rating scale (UMSARS). The aim of the study was to analyze and compare the content of the recommended ataxia rating scales by linking them to the international classification of functioning, disability and health (ICF). A total of 125 meaningful concepts from 93 items of the four included scales were linked to 57 different ICF categories. The ICF categories were distributed in body structure (n = 8), body function (n = 26), activity and participation (n = 20), and environmental factors (n = 3) components. UMSARS and FARS were the only ones that have addressed the body structure or environmental factors component. The content analysis of ataxia rating scales would help clinicians and researchers select the most appropriate scale and understand ataxic symptoms and their impact on function. It seems that SARA is the optimal scale for rapid assessment of ataxia or in busy clinical settings. UMSARS or FARS are more appropriate for the investigating the impact of ataxia on overall health, and monitoring ataxia progression and disability

Investigating behavior, attitudes, knowledge, awareness and barriers to the implementation of evidence-based practice by physiotherapists in Egypt: A cross sectional study

Few studies exist regarding the attitudes and behaviours of Egyptian physiotherapists in relation to the use of evidence in practice (EBP). The purpose of this study was to describe the beliefs, attitudes, knowledge, and behaviours of Egyptian physical therapists as they relate to evidence-based practice. It also explores their perception of possible barriers to implement EBP. Four hundred and seventy Egyptian therapists responded to our questionnaire with results revealing participants’ awareness towards EBP was quite diverse. Only terms of systematic review and randomized controlled trial were well understood while remaining terms showed various level of comprehension which were rather low. Results also revealed significant correlations between attitudes towards EBP and overall awareness as well as attitudes and knowledge (r = 0.270 and 0.107) respectively. In addition, a significant relationship was also found between EBP awareness and knowledge with (r = 0.219). With regards to the barriers, insufficient teaching in previous education was identified as the primary barrier (34.4 %), followed by lack of funding and resources (31.1 %), while lack of time (10.2 %) was reported as the least. These barriers highlight the need to enhance implementation of EBP within Egyptian Physiotherapists. Findings of this study can be used as a foundation for the implementation of EBP in various clinical settings by understanding the limitations and barriers reported. Our study concluded that despite Egyptian physiotherapists declare their awareness of EBP, nevertheless, knowledge is restricted to a small number of terms. More focus is required to enhance the knowledge and practice of EBP. Focusing on adjustable factors, including increasing the awareness of value of research would help reduce time and resource demands for physiotherapists when implementing EBP

The Efficacy of Muscle Energy and Mulligan Mobilization Techniques for the Upper Extremities and Posture after Breast Cancer Surgery with Axillary Dissection: A Randomized Controlled Trial

Background: Breast cancer surgeries affect the upper extremities and posture. This study aimed to examine the efficacy of muscle energy and Mulligan mobilization techniques on the upper extremities and posture after breast cancer surgery with axillary dissection. Methods: A total of 90 female participants who had undergone breast cancer surgery with axillary dissection were recruited and randomly assigned to three groups. Group A received a combination of the Mulligan and muscle energy techniques, while Groups B and C received either the Mulligan or muscle energy techniques for six weeks, respectively. The study measured the shoulders’ range of motion, posture, and upper-extremity disabilities. Outcome measurements were taken at three different time points: baseline, post-intervention, and at eight-week follow-up. Results: All the interventions significantly improved the study outcomes. The combination of the Mulligan and muscle energy techniques was significantly better than a single intervention. Mulligan mobilization was superior to the muscle energy techniques in terms of improving the shoulders’ range of motion and disability. The interventions showed a significant effect pre-post-treatment and pre-follow-up but not post-follow-up. Conclusions: The Mulligan mobilization and muscle energy techniques have been found beneficial in improving the postural changes and shoulder outcomes after breast cancer surgery with axillary dissection. The superior effectiveness of the combined interventions points out the importance of integrating multiple therapeutic approaches for optimal outcomes. Regular examination and long-term follow-up assessment are important for studying the effect of rehabilitation interventions in people after the late stages of breast surgery

Computed tomography-guided Tru-cut biopsy of lung mass, as an important diagnostic tool: Histopathological characteristics, age, sex distribution, and risk factors in Misurata Cancer Center, Libya

Background: Lung biopsies may be classified according to the method of access or by the reason for biopsy. Tru-cut biopsy is a simple, relatively safe, rapid, and reliable technique for the diagnosis of lung mass lesions, particularly with the aid of computed tomography (CT) scan. This procedure is commonly used worldwide to detect different kinds of lung tumors, but its usefulness in Libya is not yet studied. Objectives: The aim of this study was to assess the usefulness of Tru-cut biopsy as a diagnostic method in lung tumors and also to determine the incidence of lung cancer in various ages and sex groups and in relation to smoking data. Patients and Methods: Retrospective study was done on 136 patients who underwent CT-guided Tru-cut biopsy from January 2012 to March 2015. The included patients have lung mass lesions suspected to be neoplastic according to chest radiograph and/or CT scan. Results: We found biopsies and histopathology reports of 136 cases. The patients’ age was from 20 to 85 years with the peak incidence in the sixth and seventh decades. The benign lesions were 18 (13.23%), and malignant lesions were 118 (86.76%) documented microscopically. The most common tumor was squamous cell carcinoma (25.17%), followed by adenocarcinoma (23.02%) and small cell lung carcinoma (17.26%). Nonspecific inflammation was found in 8.63%. Conclusion: CT-guided Tru-cut biopsy is a simple, safe, and reliable procedure with high diagnostic accuracy for the diagnosis and subtyping of lung cancer. The definitive result of malignancy is a base for correct decision for the patient's treatment after careful clinical correlation with performance state, radiology findings, and complete serological investigations