Relationship Between Socioeconomic Status and Body Mass Index Among Adult Nigerians

There is a long tradition of observational studies from developed societies linking overweight and obesity to low socioeconomic status (SES). The aim of this study is to assess the relationship between SES and obesity and determine whether variations in the body mass index (BMI) of adult Nigerians is influenced by their SES. The height and body weight of 1067 adults, aged 30 - 60 years were measured and their BMI was calculated. A structured questionnaire which assessed socioeconomic (SE) variables such as income, education and occupation was used to objectively classify the participants into the different SE strata. A pictorial self-rating SES ladder of nine rungs was employed to assess the participants’ SES and to test the validity of the questionnaire. A high correlation ® = 0.951, P < 0.01) was found between the two SES assessment tools. SE scores were found to be inversely related to weight ® = - 0.113, P < 0.01) and BMI ® = - 0.172, P < 0.01), respectively. There was a significant relationship (X2 = 32.853; p = 0.000) between BMI categories and SES. Individuals in the lower SES had higher rates of overweight (24.8%) and obesity (12.9%). There were significant differences in the weight (F = 8.407; p = 0.000) and BMI (F = 20.66; p= 0.000) across the different SE strata. An inverse relationship was found between SES and BMI. Individuals in the lower SE strata had a greater BMI and a higher prevalence of overweight and obesity. KEY WORDS: socioeconomic status, body mass index, overweight, obesit

Self-reported physical activity versus physical function capacity: alternatives for energy expenditure estimation

Introduction: The extent to which self-report activity measured by the International Physical Activity Questionnaire (IPAQ) can substitute performance-based functional capacity measured by the Six-Minute Walk Test (6MWT) remains inconclusive. This study assessed Physical Activity (PA) and Functional Exercise Capacity (FEC); and also determined the relationship between PA and FEC in apparently healthy young adults. Materials and methods: A total of 342 (145 males and 197 females) undergraduates of Obafemi Awolowo University, Ile-Ile, Nigeria participated in the study. The IPAQ was used to assess PA, while FEC was assessed using the 6MWT, and expressed in terms of the Six-Minute Walk Distance (6MWD), Six-Minute Walk Work (6MWW), Maximum Oxygen Uptake (VO2max) and Metabolic Equivalent (METS). Anthropometric and cardiovascular parameters were measured following standardized procedures. Data was analyzed using descriptive and inferential statistics. The alpha level was set at 0.05. Results: The mean age of the participants was 22.0±2.87 years. The mean IPAQ score of all participants was 1471.4±1086.93. The percentage for low, moderate and high PA was 19% (65), 41.2% (141) and 39.8% (136), respectively. The mean 6MWD, 6MWW, VO2max and METS were 639.47 ±66.6 m, 41805.0 ±8520.6 kg, 28.9 ±1.92 mlO2k-1min-1, 4.05 ±0.32 mL/kg, respectively. There were signifi cant positive correlations between PA and each of the 6MWD (r=0.268; p=0.001), 6MWW (r=0.219; p=0.001), VO2max (r=0.268; p=0.001), METS (r=0.268; p=0.001). Measures of exercise capacity were not signifi cantly correlated with the anthropometric variables (p>0.05). Conclusion: Self-report of physical activity in healthy young adults does not adequately substitute the results of the Six-Minute Walk Test

Comparative effects of burst mode alternating current and resisted exercise on physical function, pain intensity and quadriceps strength among patients with primary knee osteoarthritis

Background and objective: The beneficial effect of Resisted Exercise (RE) in Knee Osteoarthritis (OA) rehabilitation is often hamstrung by the presence of other comorbidities affecting exercise implementation, hence the need for comparative alternative therapies. This study compared the effect of Burst Mode Alternating Current (BMAC) and RE in the management of patients with knee OA. Methods: Forty-seven consenting patients with primary knee OA participated in this study. The participants were recruited from the outpatient physiotherapy department of a Nigerian teaching hospital. The participants were randomly assigned into either RE plus BMAC (RBMAC) or RE Only (REO) groups. The effects of intervention were assessed in terms of physical function, pain intensity and quadriceps strength at the 4th and 8th week of intervention. Descriptive and inferential statistics were used to analyze data at p0.05). Conclusion: In conclusion, resisted exercise alone had significant effects on physical function, pain intensity and quadriceps strength in patients with knee osteoarthritis. However, burst mode alternating current did not show additional effects

Patients' and physiotherapists' perspectives on implementing a tailored stratified treatment approach for low back pain in Nigeria: a qualitative study

Background: Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation. Methods: A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology. Results: Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient's learning journey, trusting the therapist and needing conviction. Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients' trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use. Conclusion: Key barriers identified are the patients' treatment expectations and physiotherapists' adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients' trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research

The mediating role of sedentary behaviour in the relationship between social support and depression among individuals with diabetes

Background and objective: The underlying mechanisms for the well-established link between social support and depression remain less understood. This study examined the mediating role of sedentary behaviour (SB) in the relationship between social support (SS) and depression among individuals with diabetes. Methods: A total of 250 consenting individuals with diabetes attending endocrinology clinic in a Nigerian tertiary hospital were recruited. The International Physical Activity Questionnaire Short Form, Multidimensional Scale of Perceived Social Support, and Center for Epidemiologic Studies Depression Scale were used to collect data on SB, SS and depression respectively. Mediation analysis was performed with hierarchical multiple regression and PROCESS Macro for SPSS. Alpha level was set at p < 0.05. Results: The prevalence of depression among diabetic patients was 30.8%. Social support had a significant negative association with depression and SB, while SB was positively associated with depression (P < 0.001). The results showed that SB was a mediator between social support and depression (a*b = -0.151; BCa 95% CI: -0.207 ~ -0.102). Conclusion: The prevalence of depression was high among Nigerian diabetic patients. In addition, SB has a mediating role in the relationship between social support and depression indicating that SB could reinforce the positive effect of social support on depression

Validation of the Yoruba Version of the Pain Self-Efficacy Questionnaire in patients with chronic low back pain

STUDY DESIGN: Cultural adaptation and psychometric analysis. OBJECTIVE: This study determined the test-retest reliability, acceptability, internal consistency, divergent validity of the Yoruba pain self-efficacy questionnaire (PSEQ-Y). It also examined the ceiling and floor effects and the small detectable change (SDC) of the PSEQ-Y among patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA: There are various indigenous language translations of the PSEQ and none adapted to African language. However, translations of the PSEQ into Nigerian languages are not readily available. METHODS: The validity testing phase of the study involved 131 patients with LBP, while 83 patients with LBP took part in the reliability phase. Following the Beaton recommendation for cultural adaptation of instruments, the PSEQ was adapted into the Yoruba language. The psychometric properties of the PSEQ-Y determined comprised: internal consistency, divergent validity, test-retest reliability, and SDC. RESULTS: The mean age of the participants was 52.96 ± 17.3 years. The PSEQ-Y did not correlate with the Yoruba version of Visual Analogue Scale (VAS-Y) scores (r = -0.05; P = 0.59). The values for the internal consistency and the test-retest reliability of the PSEQ-Y were 0.79 and 0.86, with the 95% confidence interval of the test-retest reliability ranging between 0.82 and 0.90. The standard error of measurement (SEM) and the SDC of the PSEQ-Y were 1.2 and 3.3, respectively. The PSEQ-Y had no floor or ceiling effect, as none of the respondents scored either the minimal or maximal scores. CONCLUSION: This is the first study in Nigeria to culturally adapt PSEQ. The PSEQ-Y showed adequate psychometric properties similar to existing versions. Therefore, the tool can be used to assess pain self-efficacy in clinical and research settings and help to improve the health outcomes of patients chronic LBP.Level of Evidence: 3

Hearing loss, gait and balance impairments and falls among individuals with sub-acute stroke: A comparative cross-sectional study

Background: The impact of hearing loss in stroke is less explored. This study aimed to compare hearing loss in patients with sub-acute stroke with healthy controls and evaluate its association with gait and balance impairments and falls. Methods: This study involved 78 ambulant sub-acute stroke patients and 78 age-sex-matched controls. Hearing loss was assessed with pure tone average, while gait and balance impairments were assessed with the Timed Up and Go test, Berg Balance Scale, Functional Gait Assessment and 10-m walk test (gait speed). Fall occurrence was evaluated by a self-report questionnaire. Results: The prevalence of hearing loss (pure tone average of >25 dB) was higher in stroke patients than in controls (64.1% vs. 35.9%; p < 0.001). The mean pure tone average of stroke patients showed a significant positive correlation with Timed Up and Go test (r = 0.357; p = 0.001) and fall occurrence (r = 0.253; p = 0.025), and a significant negative correlation with Berg Balance Scale (r = −0.299; p = 0.008) and Functional Gait Assessment (r = −0.452; p < 0.001). There was a non-significant negative correlation with gait speed (r = −0.166; p = 0.147). Multiple regression showed that mean pure tone average was associated with Timed Up and Go test (B = 0.096; 95%CI: 0.010, 0.183) and Functional Gait Assessment (B = −0.087; 95%CI: −0.157, −0.017), but not with gait speed (B = −0.003; 95%CI: −0.007, 0.001) and Berg Balance Scale (B = −0.058; 95%CI: −0.165, 0.049). Conclusion: Hearing loss is more prevalent among patients with sub-acute stroke compared with age-sex-matched controls. Hearing loss is also associated with gait and balance impairments and falls among sub-acute stroke patients. We recommend that hearing screening and rehabilitation be incorporated into post-stroke rehabilitation programmes as part of strategies to improve balance and gait and reduce or prevent falls

Can physical activity attenuate the impact of internet addiction on anxiety in young adults? A moderation analysis

Background: The potential moderators of the nexus between internet addiction (IA) and symptoms of anxiety are less understood. This cross-sectional study aimed to assess the moderating roles of physical activity (PA) and gender in the association between IA and anxiety. Methods: A cross-sectional study of 510 Nigerian undergraduate students was carried out. IA, anxiety, and PA levels (low, moderate, and high) were assessed using Internet Addiction Test, anxiety sub-scale of Depression Anxiety Stress Scale-21, and Patient-Centered Assessment and Counseling for Exercise Plus Nutrition, respectively. Moderation analysis was applied while controlling for important covariates. Results: The mean age of the respondents was 21.33 ± 2.63 years. The prevalence of IA and anxiety was 57.6 % and 52.6 %. IA was positively associated with anxiety (b=0.307, 95 % CI: 0.2168-0.3982, t (498) =6.660, p < 0.001). PA level, but not gender seem to moderate the association between IA and anxiety (F (2, 498) =3.561, p=0.029, R2 change =0.011). Moreover, interaction between PA and gender indicated that the moderating effect of PA was less pronounced among females compared with males (F (3, 498) =2.895, p=0.035, R2 change =0.014). Conclusions: PA can attenuate the deleterious nexus between IA and anxiety in young adults. The attenuation of PA in IA-anxiety nexus is weaker among female young adults compared with male counterparts. PA is a viable low-cost intervention strategy in combating the effect of IA on symptoms of anxiety among young adults. Further longitudinal and experimental studies are needed to better understand the underlying mechanisms among IA, anxiety symptoms, PA, and gender

Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain

Purpose. The study compared the influence of Clinic-based McKenzie Therapy (CbMT) and a Virtual Reality Game (VRG) version on pain intensity, back extensor muscles endurance, activity limitation, participation restriction, fear avoidance belief, kinesiophobia, and general health status of patients with chronic non-specific low-back pain. Methods. This quasi-experimental study involved 46 patients (CbMT: n = 24; VRG: n = 22) with ‘directional preference’ for extension, randomized into CbMT or VRG group. Treatment was applied thrice weekly for 8 weeks. Outcomes were assessed at the end of the 4th and 8th week. Data analysis employed descriptive and inferential statistics of independent t-test, Mann-Whitney U test, repeated measure ANOVA, Friedman’s ANOVA, and ANCOVA. The significance level was set as = 0.05. Results. There were no significant differences in the treatment outcomes (mean change) across the groups (p > 0.05), except for kinesiophobia, where VRG led to a significantly higher decline in mean rank at week 4 (28.3 vs. 19.1; p = 0.018) and 8 (28.7 vs. 18.7; p = 0.009), and vitality (a general health status item) at week 4 (27.6 vs. 19.8; p = 0.042) and 8 (28.1 vs. 19.3; p = 0.042). ANCOVA showed that significant baseline parameters were not significant predictors of vitality (F = 1.986; p = 0.070) or kinesiophobia (F = 0.866; p = 0.563) outcomes. Conclusions. The VRG mode of McKenzie therapy is comparable with the clinic-based approach in most outcomes. VRG has a superior effect on kinesiophobia, but may take a higher toll on vitality/energy

Awareness, attitude and expectations of physiotherapy students on telerehabilitation

Background and Objective: Explosion in information technology knowledge and utilization among young people, referred to as digital natives, seems less explored in the health sector and training. This study was aimed to assess awareness, attitude and expectations of physiotherapy students on telerehabilitation. Methods: This cross-sectional survey employed systematic probability sampling technique to recruit 200 physiotherapy students. A self-developed questionnaire which was tested for its face and content validity was used to obtain data. Data was analysed using descriptive and inferential statistics. Alpha level was set at p < 0.05. Results: The mean age of the respondents was 21.2 ± 2.04 years. There was higher prevalence of moderate awareness (43%) and positive attitude towards telerehabilitation (39%). Majority of the respondents (62%) had high expectation towards future telerehabilitation products and services. There was significant association between level of awareness of telerehabilitation and age (X2 = 7.119; p = 0.001). Discussion: The responding students in this study are by age in the class of digital natives, who should be conversant with technology. This could account for the higher moderate level of awareness of telerehabilitation. However, the higher rates of negative attitude towards telerehabilitation could be attributed to prevailing barriers to its utilization in Nigeria. Nonetheless, a large percentage of the students had high expectations for the future of telerehabilitation. Conclusion: Nigerian physiotherapy students have moderate awareness and high expectation for future telerehabilitation applications. However, a larger number of them hold negative attitude towards it use