Comparative Efficacy of Clinic-Based and Telerehabilitation Application of McKenzie Therapy in Chronic Low-Back Pain

Studies on validation of telerehabilitation as an effective platform to help manage as well as reduce burden of care for Low-Back Pain (LBP) are sparse. This study compared the effects of Telerehabilitation-Based McKenzie Therapy (TBMT) and Clinic-Based McKenzie Therapy (CBMT) among patients with LBP. Forty-seven consenting patients with chronic LBP who demonstrated ‘directional preference’ for McKenzie Extension Protocol (MEP) completed this quasi experimental study. The participants were assigned into either the CBMT or TBMT group using block permuted randomization. Participants in the CBMT and TBMT groups received MEP involving a specific sequence of lumbosacral repeated movements in extension aimed to centralize, decrease, or abolish symptoms, thrice weekly for eight weeks. TBMT is a comparable version of CBMT performed in the home with the assistance of a mobile phone app. Outcomes were assessed at the 4th and 8th weeks of the study in terms of Pain Intensity (PI), Back Extensors Muscles’ Endurance (BEME), Activity Limitation (AL), Participation Restriction (PR), and General Health Status (GHS). Data were analyzed using descriptive and inferential statistics. Alpha level was set at p< 0.05.Within-group comparison across baseline, 4th and 8th weeks indicate that both CBMT and TBMT had significant effects on PI (p=0.001), BEME (p=0.001), AL (p=0.001), PR (p=0.001) and GHS (p=0.001) respectively. However, there were no significant differences (p>0.05) in the treatment effects between TBMT and CBMT, except for ‘vitality’ (p=0.011) scale in the GHS where TBMT led to significantly higher mean score. Mobile-app platform of the McKenzie extension protocol has comparable clinical outcomes with the traditional clinic-based McKenzie Therapy, and thus is an effective supplementary platform for care of patients with low-back pain

The Clinical and Cost-Effectiveness of Telerehabilitation for People With Nonspecific Chronic Low Back Pain: Randomized Controlled Trial

Background: Telerehabilitation can facilitate multidisciplinary management for people with nonspecific chronic low back pain (NCLBP). It provides health care access to individuals who are physically and economically disadvantaged. Objective: This study aimed to evaluate the clinical and cost-effectiveness of telerehabilitation compared with a clinic-based intervention for people with NCLBP in Nigeria. Methods: A cost-utility analysis alongside a randomized controlled trial from a health care perspective was conducted. Patients with NCLBP were assigned to either telerehabilitation-based McKenzie therapy (TBMT) or clinic-based McKenzie therapy (CBMT). Interventions were carried out 3 times weekly for a period of 8 weeks. Patients’ level of disability was measured using the Oswestry Disability Index (ODI) at baseline, week 4, and week 8. To estimate the health-related quality of life of the patients, the ODI was mapped to the short-form six dimensions instrument to generate quality-adjusted life years (QALYs). Health care resource use and costs were assessed based on the McKenzie extension protocol in Nigeria in 2019. Descriptive and inferential data analyses were also performed to assess the clinical effectiveness of the interventions. Bootstrapping was conducted to generate the point estimate of the incremental cost-effectiveness ratio (ICER). Results: A total of 47 patients (TBMT, n=21 and CBMT, n=26), with a mean age of 47 (SD 11.6) years for telerehabilitation and 50 (SD 10.7) years for the clinic-based intervention, participated in this study. The mean cost estimates of TBMT and CBMT interventions per person were 22,200 naira (US $61.7) and 38,200 naira (US$106), respectively. QALY gained was 0.085 for TBMT and 0.084 for CBMT. The TBMT arm was associated with an additional 0.001 QALY (95% CI 0.001 to 0.002) per participant compared with the CBMT arm. Thus, the ICER showed that the TBMT arm was less costly and more effective than the CBMT arm. Conclusions: The findings of the study suggested that telerehabilitation for people with NCLBP was cost saving. Given the small number of participants in this study, further examination of effects and costs of the interventions is needed within a larger sample size. In addition, future studies are required to assess the cost-effectiveness of this intervention in the long term from the patient and societal perspective

Effectiveness of Telerehabilitation-Based Exercises Plus Transcranial Direct Current Stimulation for Stroke Rehabilitation Among Older Adults: A Scoping Review Protocol

Abstract Background: Physiotherapy rehabilitation of people with vascular dementia of stroke origin is vital in improving patient function and activities of daily living. Stroke rehabilitation is long-term, and background dementia due to a vascular condition such as stroke makes stroke rehabilitation challenging. Novel interventions such as telerehabilitation medium and transcranial direct current stimulation, tDCS, are gaining acceptance in the literature. Combining an exercise intervention and tDCS may improve brain plasticity better than either intervention because of double enhancement of the brain plasticity both endogenously and exogenously. Telerehabilitation is also cost-effective and safe, especially in remote settings and pandemic situations such as the COVID-19 and long COVID. This study aims to provide current evidence on telerehabilitation exercises plus tDCS for stroke rehabilitation among the aged. This review sought to provide a broad overview of the mechanism and effectiveness of telerehabilitation-based exercises plus tDCS for stroke management among older adults. Methods: This scoping review will follow the Joana Briggs Institute guidelines for conducting a scoping review. The principal investigator who has done training in searches of the following databases: Cochrane, MEDLINE via EBSCOHost databases, PubMed, Web of Science, and Scopus databases will search for published papers on telerehabilitation-based exercises plus tDCSfor stroke rehabilitation among the aged (see Appendix I). Bibliography references will also be searched in Google Scholar. The principal investigator will deduplicate the search results of the identified studies with Endnote and Zotero. Two independent reviewers will screen the title and the abstract in the Rayyan environment with the following inclusion criteria: peer-reviewed papers on participants who are older adults of age 55 to 80 with stroke without limitation in gender, type of stroke affectation, and duration of affection. The inclusion criteria will also be studies that are primary studies such as randomised control trials, Quasi-experimental and mixed-method articles relevant to this study but exclude all types of reviews and commentaries. Two independent reviewers will screen for inclusion, and any disagreement will be resolved with a third reviewer. The data extraction will be conducted with the form designed for this study (see Appendix II). Using John Hopkins Appraisal Tool Kit, the two independent reviewers will appraise the studies that met inclusion criteria. Then Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram will be used to present the study findings. Discussion: A scoping review allows for answering a broader question regarding identifying mechanisms and gaps in the literature on a particular area of study. This current study will use scoping review questions to provide a broad view of the evidence of telerehabilitation exercises with an adjunct such as tDCS in the rehabilitation of older adults with stroke. The data will be a chart with the designed form (Appendix II), and the obtained data will be organised into themes and chunks of categories. It is expected that the findings of this study will provide a broad overview of the mechanism and effectiveness of telerehabilitation-based exercises plus tDCS for stroke management among older adults. This study's results is expected to be a major step toward developing future research using RCTs to determine the effectiveness of these interventions for stroke rehabilitation in older adults. Ethics and dissemination: The researchers obtained ethical approval from the Biomedical Research and Ethics, BREC, of the University of KwaZulu-Natal ethical committee. The researchers of this study will share the evidence findings at conferences and in a reputable peer-review journal. Keywords: Aged; an electronic medium of rehabilitation, telerehabilitation; stroke rehabilitation; virtual rehabilitation, tDC

Wartości normatywne statycznej i dynamicznej wytrzymałości mięśni brzucha u zdrowych Nigeryjczyków

Introduction: Normative databases of abdominal muscles endurance are important in identifying trunk muscles impairments and disability and as a rehabilitation outcome in low-back pain. This study established gender-and-age normative data on static and dynamic abdominal muscles endurance among apparently healthy Nigerians.Materials and methods: Five hundred and three consented volunteers aged between 16 and 70 years participated in this study. Partial curl-up test of the Canadian Standardized Test of Fitness was used to quantify static abdominal muscles endurance (SAME) and dynamic abdominal muscles endurance (DAME). Endurance levels were defined using percentiles as poor (&lt;25th), medium (between 25and 75th), good (between 75 and 95th), and very good (&gt;95th) respectively.Results: The mean SAME and DAME was 37.2±24.3 seconds (s) and 18.1±9.57 repetitions (reps) respectively. SAME that is &lt; 24s was considered poor, between 24 and 44s as medium, 45 and 78s as good and &gt; 78s as very good endurance. DAME &lt; 11 repetitions (reps) was considered poor, between 11 and 23 reps as medium, between 24 and 36 reps as good and &gt; 36 reps as very good endurance. Both SAME and DAME differed significantly across the age groups (p&lt;0.05). Significant correlation existed between SAME and DAME (p = 0.001). Males exhibited a higher SAME and DAME than females (p&lt;0.05).Conclusion: The gender-age reference norms for static and dynamic abdominal muscles endurance established in this study could be used in rehabilitation to estimate the level of endurance impairment in a patient at intake and also serve as an outcome measure of improvement.Wstęp: Znajomość wartości normatywnych dla wytrzymałości mięśni brzucha jest istotna dla identyfikacji zaburzeń i niepełnosprawności, oraz dla określania miar wyniku w rehabilitacji pacjentów z bólami krzyża.Materiał i metoda: W badaniu wzięło udział 504 wolontariuszy w wieku od 16 do 70 lat. Do ilościowego zbadania statycznej (SAME) i dynamicznej (DAME) wytrzymałości mięśni brzucha zastosowano test częściowego unoszenia tułowia z pozycji leżenia tyłem, będący składową Canadian Standardized Test of Fitness. Wytrzymałość określano na podstawie podziału percentylowego, przyjmując jako wytrzymałość słabą wyniki z przedziału 95.Wyniki: Średnie wartości SAME i DAME wynosiły odpowiednio 37,2 ±24,3 sekund (s) i 18,1 ±9,57 powtórzeń (reps). Wartości SAME 78 s za bardzo dobrą wytrzymałość statyczną. Wartości DAME 36 reps za bardzo dobrą wytrzymałość dynamiczną. Zarówno SAME jak i DAME istotnie różniły się w poszczególnych grupach wiekowych (p<0.05). Stwierdzono istotną korelację pomiędzy SAME i DAME (p = 0.001). Mężczyźni wykazywali wyższe wartości SAME i DAME niż kobiety (p<0.05).Wniosek: Określone w tym badaniu, zależne od wieku i płci, wartości normatywne statycznej i dynamicznej wytrzymałości mięśni brzucha mogą być zastosowane w rehabilitacji dla określenia wielkości zaburzeń wytrzymałości tych mięśni, zarówno przy kwalifikowaniu do interwencji oraz jako miara wyniku uzyskiwania poprawy

Quality of life and burden of informal caregivers of stroke survivors

Stroke rehabilitation has concentrated on patient-focused intervention, which has reduced the level of disabilities and has increased the number of stroke survivors being managed at home by caregivers. This study was aimed at determining the level of strain experienced by the caregivers of stroke survivors and the quality of life (QoL) of these caregivers. The QoL and caregiving burden among informal caregivers of stroke survivors seen at the physiotherapy outpatient clinic of two hospitals in south-western Nigeria were documented. Participants completed the Personal Wellbeing index for QoL measurement and Modified Caregivers Strain Index for measurement of Caregivers Burden Score. A total of 130 informal caregivers of stroke survivors participated in this study. The mean age of caregivers was 41.1 ± 14.0 years, while that of stroke survivors was 60.4 ± 10.9 years. Among the stroke survivors, 75 (57.8%) were female, whereas 74 (56.9%) of the caregivers were males. The results showed that caregivers' burden was inversely correlated to their QoL (p < 0.001). The lower functional status of the stroke survivors, as recorded by modified Rankin score and Barthel Index, was significantly associated with lower QoL and higher caregiver strain index of the caregivers