Real-world effectiveness and costs of vertical oscillatory pressure manipulation for low back pain

Introduction. Real-world evidence studies using routinely collected data, such as patient clinical records, are innovative ways of generating insight into the effectiveness of healthcare interventions. This study examined the effectiveness of vertical oscil-latory pressure (VOP) on selected clinical outcomes for patients with low back pain (LBP) using routinely collected data. Methods. Retrospective analysis was carried out on the medical records of patients diagnosed with LBP in a tertiary hospital in south-west Nigeria over a 10-year period. Clinical outcomes (pain intensity and functional disability) in patients who received VOP (n = 201) for their LBP were compared with controls that had traditional physiotherapy (TP) (n = 138) in a routine clinical setting. Total costs of intervention were estimated in terms of direct and indirect costs. Results. There were significant differences within group (from baseline to 4th and 8th week of intervention) for the VOP group in pain intensity (p = 0.001) and functional disability (p = 0.001). However, TP group showed no significant differences in pain intensity and functional disability across baseline and week 8 of the study. There was a significant difference in pain intensity (2.95 ± 1.38 vs. 4.16 ± 2.48; p = 0.013) between VOP and TP at week eight. A higher direct and indirect costs associated with VOP compared with TP (both p = 0.042). Conclusions. The findings of this study suggest that VOP is an effective intervention for LBP in the ‘real-world’. VOP is more effective compared to TP on its effect on pain intensity over time

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

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

Translation, cross-cultural adaptation and psychometric evaluation of Yoruba version of the short-form 12 health survey

Background. Short Form 12 (SF-12) health survey has found its utility in clinical and research settings because of its short length that spares time. Though several translations into other languages do exist there is none available in Yoruba language. Hence, this study’s objective was to culturally adapt and determine the reliability and validity of the Yoruba translated version of the SF-12. Methods. Forward and backward translations of SF-12 into Yoruba version of SF-12 (Y-SF-12) were done using the International Quality of Life Assessment Project Guidelines. Healthy participants were assessed using both English and Yoruba versions of SF-12 for the validation phase, and two weeks later were reassessed with the Y-SF-12 for the reliability phase. Results. Participants were 225 males and 171 females. The mean scores for each scale range from 73.4 to 86.1, with no gender difference. All scale and domain scores evidenced a negative skew and ranges from -1.79 to -0.62. Concurrent validity (0.879 – 0.938) and convergent validity (0.786 – 0.907) appeared to be good as reflected by their correlation values. The internal consistency of Y-SF-12 was good as Cronbach’s Alpha ranged between 0.899 and 0.968, while the Intraclass Correlation Coefficient (ICC) ranged between 0.775 and 0.949. Conclusion. This is the first study to assess the psychometric properties of the Y-SF-12. It appears to be valid and may be an appropriate tool for assessing health-related quality of life among Yoruba population. The tool may help to improve the health outcomes of individuals, and redress health inequalities in low and middle-income countries

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

Cultural adaptation and psychometric evaluation of the Yoruba version of the Health Literacy Questionnaire

Background. Health literacy is an important multidimensional concept of public health concern and a determinant of health outcomes and access to healthcare which requires robust measurement. The objective of this study was to culturally adapt and establish the psychometric properties of the Yoruba version of the Health Literacy Questionnaire. Methods. A cross-sectional survey of Nigeria Yoruba speaking adults was conducted with the Health Literacy Questionnaire following its translation and adaptation. Data were subject to psychometric evaluation (confirmatory factor analysis, composite reliability, Cronbach’s alpha, intra class correlation) and association with sociodemographic variables. Results. A total of 258 adults with mean age 26.7 years participated in the study. The easiest scale to score highly was ‘Actively managing my health’ and hardest was ‘Ability to find good health information’ and ‘Navigating the healthcare system’. Six one-factor models fitted well without correlated residuals but the other three had a good fit after model modification. Composite reliability and Cronbach’s α of ≥0.7 were observed for all scales, suggesting good internal consistency of the scales. Test-retest reliability of the Yoruba translation of the Health Literacy Questionnaire was moderate to good in all scales, intra class correlation ranging from 0.66 to 0.76. Conclusion. The Health Literacy Questionnaire was successfully translated and culturally adapted and demonstrated good content and construct validity and high composite reliability. The Yoruba translation of the Health Literacy Questionnaire has the potential of being a useful clinical tool for the assessment of health literacy, especially among Yoruba speaking community of Nigeria. Thereby helping to improve the health outcomes through access to healthcare

The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: A systematic review.

OBJECTIVE: To evaluate the effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury. METHODS: The following databases were searched: PubMed, Ovid, The Cochrane Library and Web of Science. Studies published between the inception of the databases and December 2015 were sought using appropriate keywords in various combinations. This search was supplemented with a manual search of the references of selected studies. Studies were assessed for methodological quality using the Physiotherapy Evidence Database scale. RESULTS: A total of 500 studies were identified, of which eight studies met the inclusion criteria and were included in the present review. The average Physiotherapy Evidence Database score for the studies included was 5.8, which reflects an overall moderate methodological quality.The eight studies investigated a total of 451 subjects of which 71% (n=319) were males. The age of the participants in the eight studies ranged from 15 to 57 years. The duration of the intervention in the studies ranged from 3 to 24 weeks. This review found that pre-operative physiotherapy rehabilitation is effective for improving the outcomes of treatment following anterior cruciate ligament injury, including increasing knee-related function and improving muscle strength. However, whilst there was a significant improvement in quality of life from baseline following intervention, no significant difference in quality of life was found between the control and intervention groups. CONCLUSIONS: There is evidence to suggest that pre-operative physiotherapy rehabilitation is beneficial to patients with anterior cruciate ligament injury

Pattern and determinants of willingness-to-pay for physiotherapy services

Purpose: To evaluate willingness-to-pay for physiotherapy services and explore its determinants. Methods: Willingness-to-pay, health-related quality of life and physiotherapy satisfaction were assessed in 100 physiotherapy out-patients with willingness-to-pay, Short Form-12 and physiotherapy satisfaction questionnaires, respectively. Data were analysed with Chi-square and logistic regression. Results: A 45% ‘no- willingness-to-pay’ rate was found in this study. Pattern of willingness-to-pay for different physiotherapy modalities and techniques were varied. Socio-economic status, treatment duration, amount willing to pay for treatment and physiotherapy satisfaction were significant determinants of willingness-to-pay. With one week increase in treatment duration, the participants were 8.4% less likely willing to pay for physiotherapy. Those who were satisfied with physiotherapy treatment were 21times more likely willing to pay compared with those who were not satisfied. Those in middle and high socio-economic status were more likely willing to pay for physiotherapy compared with low socio-economic status. With an increment in amount willing-to-pay more than median fee [₦1500 ($4.2)]; the participants were more likely willing to pay for physiotherapy. Conclusions: About 50% rate of no-willingness to pay for physiotherapy services was observed among Nigerian patients. Socio-economic status, treatment duration, amount willing-to-pay for treatment and physiotherapy satisfaction were predictors of willingness-to-pay for physiotherapy services

Self-reported drunkenness among adolescents in four sub-Saharan African countries: associations with adverse childhood experiences

<p>Abstract</p> <p>Background</p> <p>Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use.</p> <p>Methods</p> <p>The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina Faso, Ghana, Malawi, and Uganda. Logistic regression models were employed to identify correlates of self-reported past-year drunkenness. Exposure to four adverse childhood experiences comprised the primary independent variables: living in a food-insecure household, living with a problem drinker, having been physically abused, and having been coerced into having sex. We controlled for age, religiosity, current schooling status, the household head's sex, living arrangements, place of residence, marital status, and country of survey. All analyses were conducted separately for males and females.</p> <p>Results</p> <p>At the bivariate level, all independent variables (except for coerced sex among males) were associated with the outcome variable. Overall, 9% of adolescents reported that they had been drunk in the 12 months preceding the survey. In general, respondents who had experienced an adverse event during childhood were more likely to report drunkenness. In the multivariate analysis, only two adverse childhood events emerged as significant predictors of self-reported past-year drunkenness among males: living in a household with a problem drinker before age 10, and being physically abused before age 10. For females, exposure to family-alcoholism, experience of physical abuse, and coerced sex increased the likelihood of reporting drunkenness in the last 12 months. The association between adverse events and reported drunkenness was more pronounced for females. For both males and females there was a graded relationship between the number of adverse events experienced and the proportion reporting drunkenness.</p> <p>Conclusions</p> <p>We find an association between experience of adverse childhood events and drunkenness among adolescents in four sub-Saharan African countries. The complex impacts of adverse childhood experiences on young people's development and behavior may have an important bearing on the effectiveness of interventions geared at reducing alcohol dependence among the youth.</p