Pain characteristics, activity limitation and their influence on health-seeking behaviours of community-dwelling older adults with osteoarthritis in Nigeria

Background: It is postulated that osteoarthritis (OA) patients' health-seeking behavior depends largely on the disease severity and loss of function. Objective: This study aimed to assess the pain characteristics, activity limitations, and health-seeking behaviors of older adults with OA in Nigeria. Methods: A cross-sectional survey was conducted among 230 purposively selected community-dwelling older adults in a semi-urban setting in Nigeria. Pain characteristics, activity limitations, and health-seeking behavior were assessed by an interviewer using the Chronic Pain Grade Scale, Western Ontario and McMaster Universities Arthritis Index, and Health-Care Seeking Behaviour Questionnaire, respectively. Data were analyzed using descriptive statistics and inferential statistics (chi-square and multiple regression) to predict factors influencing health-seeking behavior, and we set the alpha level at p<0.05. Results: Pain at the knee (73.0%) was the most defining feature of OA, and it was typically severe (59.1%), frequent (51.3%), felt deep in the bone (47.0%), and associated with morning stiffness (27.4%). OA led to severe activity limitation (54.3%), and 51.7% of the respondents had an overall negative health-seeking behavior. Furthermore, activity limitation was significantly associated with religion (p=0.008) and pain severity (p=0.001). Similarly, the age (p=022), sex (p=0.006), marital status (p=0.005), and ethnicity (p=0.018) were significantly associated with health-seeking behavior. In addition, health-seeking behavior was predicted by cost, preference, ethnicity, employment, marital status, and limitation inactivity. Conclusion: OA pain is prevalent among community-dwelling older adults, it imposes a severe limitation on activities of daily living, and sociodemographic factors influenced the health-seeking behaviors of patients with OA

Economic Impact of COVID-19 Lockdown on households

Introduction: this study evaluated the economic impact of the COVID-19 lockdown on individuals and households. Methods: a cross-sectional online survey was used to collect data. Nigerian citizens who were domiciled or restricted from travelling abroad for no less than one month since the COVID-19 restrictions and lockdown were recruited into the study through focal persons purposively selected across the different states in Nigeria. Using WhatsApp® platform, the respondents completed the survey on household income and expenditure before and during the lockdown. Economic burden of COVID-19 lockdown on individuals and families was estimated using a prevalence-based cost of illness approach. Results: four hundred and four (male = 242; female = 162) individuals have participated in the study. The mean (SD) age of the respondents was 30.98 (10.92) years. Monthly income showed no statistically significant difference (p = 0.73) before and during lockdown. The overall household expenditure before and during the lockdown periods were USD 320 and USD 290. The total mean monthly costs for COVID-19 and non-COVID-19 health related problems were ₦11746.25 (USD30.79) and ₦11784.9 (USD 30.89), respectively. Household expenditure for hand sanitizers, facemasks, hand gloves, and disinfectants increased significantly during the COVID-19 restriction lockdown (p < 0.05). However, expenditure on education, water, electricity, fuel, internet data, clothing and wears, toiletries decreased significantly during the lockdown period (p < 0.05). Conclusion: this study suggests that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system

Breastfeeding profile and practice of Nigerian mothers: a cross-sectional survey

Background: Breastfeeding patterns in the developing world are still below the recommended levels and the potential to improve child survival remains untapped. This study investigated the breastfeeding profile and practices of Nigerian nursing mothers.  Methods: This cross-sectional survey involved women at attending selected baby-friendly facilities in Ile-Ife, South-West, Nigeria who had breastfed their most recent baby for a minimum of six months. A self-administered questionnaire was used to obtain data on demographics, infant-maternal characteristics and breastfeeding practices. 383 mothers volunteered for this study, yielding a response rate of 95.7%. Data were analyzed using descriptive and inferential statistics at 0.05 alpha level.Results: The mean age of the respondent was 29.0 ± 4.96 years. Exclusive breastfeeding (EBF) rate was 86.2%. Breastfeeding initiation time of less than 1 hour after delivery and 24 hours rooming-in practice rate was 78.3% and 79.1% respectively. Daily breastfeeding time and total breastfeeding duration was 8.06 ± 2.33 hours and 18.3 ± 4.82 months respectively. The mean onset time for water supplementation was 4.74 ± 1.77 months with a rate of 30.3% within 1-3 months. Weaning initiation time was mostly (43.9%) within 12 to 18 month of infant’s age.  There was significant association between EBF practice and each of maternal education (X2 = 6.554; P = 0.038) and Socio-Economic Status (SES) (X2 = 19.32; P = 0.031) with most of the respondents in the lower SES (56.1%) subscribing to EBF.Conclusions: Exclusive breastfeeding (EBF) rate for the first six months among Nigerian mothers attending baby-friendly clinics was high. Breastfeeding initiation time after delivery was early, water supplementation to breastfeeding was before 5 months of the infant’s life and weaning practice was late. Maternal educational level and socio-economic status significantly influenced EBF practice.

Evaluation of Missed Physiotherapy Appointment and Its Influence on Cost, Efficiency and Patient Outcomes

Evaluation of Missed Physiotherapy Appointment and Its Influence on Cost, Efficiency and Patient Outcomes Fatoye F1, Gebrye T2, Fatoye C3, Mbada C4, Afolabi O5, Fasuyi F5 1Manchester Metropolitan University, Manchester, LIN, UK, 2Manchester Metropolitan University, Manchester, UK, 3Manchester Metropolitan University, Manchester, LAN, UK, 4Obafemi Awolowo University, Ile-Ife,, Nigeria, 5University of Medical Sciences, Ondo, Nigeria OBJECTIVES: Missed appointments (MAs) contribute to the rising costs of physiotherapy and are a significant challenge to healthcare administration, organisational workflow and health outcomes for patients. This study assessed prevalence and pattern of missed physiotherapy appointments, wait time, and its impact on cost, efficiency and patient outcome in Nigeria. METHODS: A retrospective study was conducted at the Outpatient Physiotherapy Clinic of Obafemi Awolowo University, Ile-Ife, Nigeria. A total of 3243 physiotherapy appointments booked between 2009 and 2018 were assessed. Data were collected on socio-demographic and patient outcomes related to Mas. MAs was defined as any appointment where a patient did not show up at all, or attend to follow up appointment or notify staff of a cancellation. The total revenue loss due to MAs was calculated as a product of the total of MAs and per treatment cost. Descriptive of mean, standard deviation and frequency and inferential statistics of t-test were used to analyse the data. RESULTS: MAs constituted 1701 (52.5%) of all appointments and the average wait time for first appointment was 9.6 ± 23.2 days. The proportion of MAs was higher among females (50.2%), middle-aged adults (34-55 years) (31.7%), patients who were not resident close to the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from orthopaedic surgeons (32.8%). There were significant associations (p < 0.05) between MAs and age, sex, location of patient’s residence and the source of referral. Considering the per treatment schedule cost of 1000 naira, a 52.5% MAs rate resulted in a lower efficiency of 76.6% with an efficiency ratio of 0.23. CONCLUSIONS: MAs for physiotherapy treatment poses a significant challenge on costs, efficiency and patients’ outcome. Thus, an innovative reminder system may help reduce patients’ non-attendance of physiotherapy and its consequences

Comparative functional exercise capacity of patients with type 2-diabetes and healthy controls: a case control study

Introduction:&nbsp;functional Exercise Capacity (FEC) is a valid measure of physical fitness in health and disease. However, there is paucity of studies on FEC in African patients with Type-2 Diabetes (T2D). This study compared FEC between patients with T2D and healthy controls. Methods:&nbsp;thirty five patients with T2D (18 men, 17 women) and 35 (16 men, 19 women) age-sex matched healthy controls participated in this case-control study. Anthropometric and demographic characteristics and cardiovascular parameters were measured following standard procedures. A glucometer was used to determine the Fasting Blood Glucose (FBG) level following at least 8 hours of overnight fasting. FEC was assessed using the Six-Minute Walk Test (6MWT) while Hand Grip Strength (HGS) test was measured with an electronic dynamometer. Data were analyzed using descriptive and inferential statistics. Alpha level was set at p&lt; 0.05. Results:&nbsp;patients with T2D and controls were similar in age (p&gt;0.05). There were significant differences in the distance covered during 6MWT between patients and controls (t= 0.329; p =0.03), exercise capacity (t=0.329; p=0.03), FBG (t=7.403; p=0.001), systolic and diastolic blood pressure (t=12.56; p=0.001 and t = 27.23; p = 0.001) respectively. There were significant inverse relationships between 6MWD and Body mass index (r = -0.39; p=0.02) and FBS(r = -0.51; p=0.02) in patients with type-2 respectively. No significant association was found between exercise capacity and HGS (p&gt;0.05). Conclusion:&nbsp;patients with type-2 diabetes demonstrated lower functional exercise capacity than healthy controls. High body mass index and fasting blood glucose were significantly associated with lower functional exercise capacity

Effect of clinic-based and telemonitored home-based intervention on pain intensity, functioning and quality of life in patients with knee osteoarthritis

Introduction and aim. The study assessed and compared the effects of clinic-based and telemonitored home-based interventions on pain intensity, functioning and quality of life in patients with knee osteoarthritis (KOA). Material and methods. Forty-two patients were recruited purposely and randomly allocated into clinic-based (CBG) and telemonitored home-based group (THG) equally. The CBG and THG received isometric exercises to strengthen the quadriceps and hamstring muscles using theraband. THG received the exercise at home they were monitored on phone thrice in a week, while the CBG did the exercise in the hospital. The subjects performed four sets of eight repetitions three days in a week for eight weeks. Pain intensity, functioning and health related quality of life (HRQoL) were assessed at pretreatment, 6th and 8th week of intervention. Data was analyzed with descriptive and inferential statistics. Alpha level was set at 0.05. Results. There was a significant reduction (p<0.001) among pre-treatment, 6th and 8th week intervention in pain intensity, functional pain intensity and quality of life of CBG and THG. CBG showed significant reduction (p<0.001) in pain intensity, function and increase in HRQoL than THG at 8th week. Conclusion. Clinic-based and telemonitored home-based interventions were both effective in the management of KOA but clinic-based intervention was better than telemonitored home-based intervention

Development and feasibility testing of clinical decision support tool to aid physiotherapists with diagnosis of low back pain

Background: The advent of technological innovation is considered a significant improvement in the management of low-back pain (LBP). However, decision support systems (DSS) for patients with LBP remains largely unexplored, despite its potential benefits to service providers and users. A DSS for LBP will help put in order the variety of routine tests and questions the physiotherapist needs to perform and enquire to arrive at a specific diagnosis. The study developed and assessed the feasibility of a clinical decision support tool (CDST) to aid physiotherapists with clinical diagnosis of LBP. Methods: Qualitative and quantitative research methods were employed in this study. The qualitative phase was used for the development of the decision support tool (DST) using a three rounds Modified Delphi approach among purposive respondents including physiotherapists and orthopaedic surgeons. The feasibility testing phase of the developed DST was implemented after a two-week period and outcomes were assessed in terms of engagement, satisfaction, level of motivation and user experience. Descriptive of mean, standard deviation and frequency and inferential statistics of t-test were used to analyse the data. Results: A three-end user (patient, physiotherapist and admin) DST was developed. The most positively rated items were “frequency of usage” (100%), “ease of usage” (60%), “technical support” (60%), and “ease of learning” (60%) System Usability Scale (SUS). The tool had a modified mobile app rating scale (M-MARS) score of 16.5 ± 1.00 before the intervention and 18.3 ± 0.57 after the intervention out of a total of 22.5. Moreover, there were significant differences between participants’ rating of the tool before and after intervention in “information” (22.0 ± 1.87 vs 25.4 ± 1.52; p = 0.04) and “total app quality rating” (16.5 ± 1.00 vs 18.3 ± 0.57; p = 0.04). Conclusion: The findings of this study show that the developed DST for LBP diagnosis has high usability, quality rating, and change in health behaviour. Also, there was a significant increment in participants’ rating of the tool after use. The implication of this study is that DST could potentially assist with diagnosis in the management of LBP. Ethics: Ethical approval was sought from the Health Research Ethics Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria (Registration number: IPHOAU/12/1396). Funding: There was no funding received in relation to the study

Association among disability risk, pain catastrophising, fear-avoidance beliefs and kinesiophobia among patients with chronic low back pain

Background: Chronic low-back pain (CLBP) is the most common cause of long-term disability in middle age individuals. This study investigated the association between disability risk, pain catastrophising, fear-avoidance beliefs and kinesiophobia in patients with CLBP. Methods: This cross-sectional study involved patients with CLBP. Disability risk was assessed using the STarT back screening tool. Pain catastrophizing, fear-avoidance beliefs and kinesiophobia levels were assessed by Pain Catastophizing Scale, Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia, respectively. Data was analysed using descriptive statistics of mean, standard deviation, percentage and inferential statistics of Pearson Chi-square test of association. Result: Thirty patients with CLBP with mean (SD) age 54.7(13.6) years participated in the study. The results of the study revealed that low, medium and high disability risk for CLBP were 43.3%, 33.3% and 23.3%, respectively. A significant association was found between disability risk and pain catastrophising (χ2 = 6.909 p = 0.014), fear-avoidance beliefs (χ2 = 9.108 p = 0.04) and kinesiophobia (χ2 = 8.877 p = 0.006). Compared to those in low risk group, patients with medium and high disability risk had significantly higher levels of fear-avoidance beliefs (χ2 = 9.108 p = 0.04) and kinesiophobia (χ2 = 8.877 p = 0.006). Conclusion: There were significant associations between disability risk and pain, catastrophising, fear-avoidance beliefs, and kinesiophobia levels. This study provides additional information assessing the association among disability risk, pain catastrophising, fear-avoidance beliefs and kinesiophobia for the management of patients with LBP Ethics: Ethical approval was sought from the Health Research Ethics Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria (Registration number: ERC/2019/12/13). Funding Acknowledgement: There was no funding received in relation to the study

Economic Impact of COVID-19 Lockdown on Households

Introduction: this study evaluated the economic impact of the COVID-19 lockdown on individuals and households. Methods: a cross-sectional online survey was used to collect data. Nigerian citizens who were domiciled or restricted from travelling abroad for no less than one month since the COVID-19 restrictions and lockdown were recruited into the study through focal persons purposively selected across the different states in Nigeria. Using WhatsApp® platform, the respondents completed the survey on household income and expenditure before and during the lockdown. Economic burden of COVID-19 lockdown on individuals and families was estimated using a prevalence-based cost of illness approach. Results: four hundred and four (male = 242; female = 162) individuals have participated in the study. The mean (SD) age of the respondents was 30.98 (10.92) years. Monthly income showed no statistically significant difference (p = 0.73) before and during lockdown. The overall household expenditure before and during the lockdown periods were USD 320 and USD 290. The total mean monthly costs for COVID-19 and non-COVID-19 health related problems were ₦11746.25 (USD30.79) and ₦11784.9 (USD 30.89), respectively. Household expenditure for hand sanitizers, facemasks, hand gloves, and disinfectants increased significantly during the COVID-19 restriction lockdown (p < 0.05). However, expenditure on education, water, electricity, fuel, internet data, clothing and wears, toiletries decreased significantly during the lockdown period (p < 0.05). Conclusion: this study suggests that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system

Translation, cross-cultural adaptation and psychometric testing of Yoruba Version of the EQ-5D Questionnaire in patients with musculoskeletal disorders

Background: The EuroQol- 5 Dimension (EQ-5D) is a generic self-administered questionnaire used for the measurement and economic valuation of a wide range of health conditions, which necessitates its existence and adaptation in different languages. Currently, the tool does not exist in any Nigerian language. This study was aimed to translate, cross-culturally adapt, and determine the reliability and validity of the Yoruba version of the EQ-5D-5L questionnaire. Methods: The International Quality of Life Assessment (IQOLA) project guidelines, involving forward translation, reconciliation and harmonisation, backward translation, and reconciliation of problematic items was used in the Yoruba translated version of the EQ-5D-5L (EQ-5D-Yor). A total of 113 and 109 persons with musculoskeletal disorders participated in the validity, and seven-day test-retest reliability testing of the EQ-5D-Yor respectively. Convergent and discriminant validity of the EQ-5D-Yor were determined using the Yoruba version of the SF-12 (SF-12-Y) and Visual Analogue Scale (VAS). Data was analysed using descriptive and inferential statistics of Spearman correlation, Intra-Class Correlation, Cronbach alpha and multi trait scaling analysis. Alpha level was set as p < 0.05. Results: The construct validity of the EQ-5D-Yor yielded Spearman rho ranging from 0.438 to 1.000, with the EQ-VAS having the highest co-efficient (r = 1.000; p = 0.001). The convergent validity of the EQ-5D-Yor index with scales and domains of the SF-12-Y yielded no significant correlations (p < 0.05), except the physical functioning scale (r = -0.709, p = 0.001). On the other hand, the divergent validity of the EQ-5D-Yor index with VAS yielded a moderate negative correlation, (r = -0.482; p=0.001). The Intra-class Correlation Coefficient and Cronbach alpha for the test-retest reliability of the EQ-5D-Yor were 1.000 and 0.968. The confirmatory factor analysis showed the factor loadings were poor when including VAS in the model. Conclusion: The EQ-5D-Yor has acceptable validity and reliability and can be used as a valid tool among Yoruba speaking population with musculoskeletal disorder