The Effectiveness of Personalisation on Health Outcomes of Older People: Systematic Review

Purpose: As people get older, they tend to have long-term conditions requiring health and social care intervention such as personalisation. Personalisation is person centred ensuring independence and control. To date, no systematic review has examined the effectiveness of personalisation. This review examined the effectiveness of personalisation in older people. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. Databases searched included: Science Direct and Medline (PubMed) NHSEED and CINAHL. Inclusion criteria were older people living in their own homes receiving personalisation. Excluded were studies carried out in nursing homes. Newcastle-Ottawa Scale was used for quality of assessment. Results: Search yielded 151 published studies with titles and abstracts; 143 studies were excluded and eight included. Studies included showed health outcomes of older people receiving personalisation improved significantly. Conclusions: Review found evidence of improvement in quality of life and mobility in older people

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

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

Cost effectiveness of virtual reality game compared to clinic based McKenzie extension therapy for chronic non-specific low back pain

Background: Low-back pain (LBP) is a major public health problem globally and its direct and indirect healthcare costs are growing rapidly. Virtual reality involving the use of video games or non-game applications are alternatives to conventional face-to-face physical therapy for LBP. The purpose of this study was to assess the cost-effectiveness of Back Extension- Virtual Reality Game (BE-VRG) compared to Clinic-based McKenzie therapy (CBMT) for chronic non-specific LBP in Nigeria. Methods: Patients with chronic non-specific LBP were randomised into either BE-VRG or CBMT group. Patients’ level of disability was assessed using Oswestry Disability Index (ODI) at week 4 and week 8. ODI was mapped to SF-6D to generate quality adjusted life years (QALYs) used for cost-effectiveness analysis. Resource use and costs were assessed based on rehabilitation services from a healthcare perspective. Cost-effectiveness analysis which included direct healthcare costs was conducted. Incremental cost per QALY was also calculated. Results: Forty-six patients (BE-VRG, n = 22; CBMT, n = 24) with the mean (± SD) age of 32.6 ± (11.5) years for BE-VRG and 48.8± (10.2) years for CBMT intervention completed in this study. The mean direct health costs per patient were USD100.67 and USD106.3 for BE-VRG and CBMT, respectively. The mean quality adjusted life years at week 4 and week 8 were (BE-VRG, 0.0574 ± (0.002); CBMT, 0.0548 ± (0.002)); and (BE-VRG; 0.116 ± (0.002); CBMT; 0.114 ± (0.004)), respectively. ICER showed that BE-VRG arm was less costly and more effective than CBMT. Conclusion: The findings of this study suggest that BE-VRG was cost saving for chronic non-specific LBP compared to CBMT. This evidence could guide policy makers, payers, and clinicians in evaluating BE-VRG as a treatment option for people with chronic non-specific LBP

Translation, cross-cultural adaptation, and psychometric testing of the STarT musculoskeletal tool into Yoruba language among persons with low back pain

Background: The STarT Musculoskeletal (MSK) tool is a validated tool used to stratify patients with musculoskeletal disorder, as a guide to applying intervention and prognosticating outcomes. Only few translations and cultural adaptations of it exist. The availability of the tool in local and indigenous languages may help improve comprehensibility and usage among patients. This study was aimed to translate and cross-culturally adapt the STarT MSK tool into the Yoruba language, and to determine its psychometric properties. Methods: The first stage of this study involved translation of the English STarT MSK into the the Yoruba language following the Beaton criteria. A total of 55 respondents with low- back pain attending a University Teaching Hospital participated in the validity testing, while 25 patients responded in the reliability test of the tool. The Quadruple Visual Analogue Scale (QVAS) and the Fear Avoidance Belief Questionnaire (FABQ) were used for the convergent and the discriminant validity of the tool. Results: The mean age of the respondents was 52.13 ± 13.21 years. The Yoruba version of the STarT MSK (STarT MSK–Y) had an acceptable concurrent validity (r = 0.993; p = 0.001). The discriminant validity of STarT MSK–Y with FABQ yielded correlation co-efficient scores of r = 0.287; p = 0.034 and r = 0.033; p = 0.810 for FABQ-Work and FABQ-physical activities. The result indicated that STarT MSK–Y had fair discriminant validity with FABQ-work and a weak correlation with the FABQ-physical activities. The convergent validity of STarT MSK–Y indicated significant correlations with all domains and global score of the QVAS (r = 0.727; p = 0.001). The test- retest reliability and internal consistency (Cronbach’s alpha = α) of the STarT MSK–Y yielded ICC = 1.00 and α = 0.97 for the global score of the items, respectively. The factor loading for five items were satisfactory ranging from 0.46 to 0.83. Conclusion: The STarT MSK–Y has acceptable validity and reliability and can be used as a valid assessment tool among Yoruba- speaking patients with low back pain

A Systematic Review of Economic Models for Cost Effectiveness of Physiotherapy Interventions Following Total Knee and Hip Replacement

Background Osteoarthritis is a primary cause of pain and disability, and it places a considerable economic burden on individuals and the society. In the management of total knee or hip replacement (TKHR), the long-term effectiveness of physiotherapy interventions may slowly accumulate over a period. Objectives To evaluate all the model-based cost- effectiveness (CE) of physiotherapy interventions for patients with (TKHR). Data sources A literature search was carried out on AMED, MEDLINE, CINAHL, DARE, HTA, NHSEED and Cost- Effectiveness registry databases from inception to May 2021. Study selection Studies that assessed model-based CE of physiotherapy interventions following TKHR and were published in English language. The methodological quality of the included studies were assessed using the Philips Checklist criteria. Data extraction/data synthesis Two reviewers, using a predefined data extraction form, independently extracted data. A descriptive synthesis was used to present the results. Result Eight hundred eighty-six studies were identified, and the only 3 that met the inclusion criteria were included. Different model structures and assumptions were used in the included studies. The included studies were conducted in the United States of America (n = 1), Singapore (n = 1) and Italy (n = 1). The societal (n = 2) and healthcare (n = 1) perspective were adopted in the studies. The included studies reported an incremental cost effectiveness ratio (ICER) of $57,200 and 27,471 Singapore dollar (SGD) per quality-adjusted life years in a time horizon of lifetime and three months, respectively. Physiotherapy (hydrotherapy) interventions were potentially cost-effective. Conclusion Based on the best available evidence, the findings of this review suggest that physiotherapy interventions were CE and cost saving. However, it is important to note that among others the CE of the interventions was a function of the healthcare system, duration of interventions, patient compliance and price

Correlation between parental willingness to pay, health-related quality of life, and satisfaction with physiotherapy services in Nigeria: a cross-sectional study

Background: Being a parent of a child with a disability requiring many clinic visits is burdensome. Therefore, understanding the willingness-to-pay (WTP) for physiotherapy for children with disability is important to facilitating access to care and for policy-making. This study aimed to investigate patterns and correlates of parental WTP for physiotherapy. Methods: A total of 65 parents of children with disability receiving physiotherapy as outpatients were recruited from selected tertiary hospitals in Nigeria. A WTP questionnaire, SF-12 health survey, and Physiotherapy Satisfaction Questionnaire were used to assess the WTP, health-related quality of life (HRQoL), and satisfaction with physiotherapy respectively. Descriptive statistics of mean, standard deviation, frequency, and percentages were used to summarize the data. Chi-square and regression analysis were also used to test the association and determinants of WTP from each of the socio-demographic factors, satisfaction with physiotherapy, and health-related quality of life, respectively. Results: A majority (49.2%) of the respondents were in the 21–35 years age category. There was 30.8% “no WTP” for physiotherapy among parents of children with disability. A significant association was observed between socio-economic status and WTP for all treatment modalities (p 0.05). Conclusion: There was a high rate of ‘no WTP’ for physiotherapy among parents of children with disability. Level of satisfaction with physiotherapy and health-related quality of life was not significantly associated with parental WTP for physiotherapy

Opracowanie i testowanie wykonalności aplikacji do samoopieki opartej na animowanych kreskówkach w przypadku dolegliwości bólowych w dolnym odcinku kręgosłupa — badanie pilotażowe

Cele: Wykorzystanie animowanych kreskówek to rozwijający się obszar w leczeniu bólu, jednak żadne badanie nie analizowało go jako cyfrowej platformy do rehabilitacji bólu w dolnym odcinku kręgosłupa (ang. low-back pain - LBP). Badanie to miało na celu opracowanie i ocenę wykonalności aplikacji do samoopieki opartej na animowanych kreskówkach (ang. Animated Cartoon-Based Self-Care - ACBSC) dla LBP oraz zbadanie korelacji pomiędzy poszczególnymi parametrami aplikacji a bólem odczuwanym przez pacjentów. Metody: To dwufazowe badanie obejmowało komponenty opracowania i testowania. Rozwój aplikacji ACBSC oparto na protokole Rozciągania Metodą Mechanicznej Diagnozy i Terapii Mckenzie’a (ang. Mechanical Diagnosis and Therapy – MDT), oraz higienie pleców po standardowym procesie iteracji i prototypowania. Do fazy wykonalności włączono 28 kolejnych pacjentów z przewlekłym, niespecyficznym LBP z „preferencją kierunku” do rozciągania w oparciu o algorytm przesiewowy MDT. Uczestnicy korzystali z aplikacji opartej na kreskówkach 3 razy w tygodniu przez dwa tygodnie. Wyniki zostały ocenione pod kątem użyteczności, satysfakcji i doświadczenia użytkownika za pomocą skali użyteczności systemu oraz skali ocen aplikacji mobilnych. Do oceny natężenia bólu uczestników zastosowano poczwórną wizualną skalę analogową (ang. Quadruple Visual Analogue Scale - QVAS). Wyniki: Na ujednoliconej skali do 20, funkcjonalność (15,4 ± 2,41) i estetyka (14 ± 2,00) miały najwyższą i najmniej obiektywną ocenę jakości parametrów aplikacji. Całkowita obiektywna i subiektywna ocena jakości aplikacji wyniosła odpowiednio 16,9 ± 1,97 i 15,6 ± 2,42. Całkowity wynik oceny wpływu i użyteczności wyniósł 24,1 ± 3,39 (na 30) i 27,8 ± 3,09 (na 50). Uczestnicy zgłaszali, że aplikacja do pielęgnacji pleców wpływa głównie na uważność/medytację/relaks (42,9%), zwiększa uczucie szczęścia/dobrego samopoczucia (46,4%), prowadzi do zmian zachowania (60,7%) i jest ukierunkowana na zdrowie fizyczne (100%). Nie było istotnej korelacji między charakterystyką bólu uczestników a parametrami oceny aplikacji (p>0,05). Wnioski: Animowana, oparta na kreskówce aplikacja do samoopieki LBP ma umiarkowaną lub wysoką użyteczność, funkcjonalność, estetykę i ocenę jakości oraz może służyć jako skuteczna aplikacja mobilna do samodzielnego radzenia sobie z długoterminowym LBP.Objectives: The use of animated cartoons for pain management is an emerging area, however, in no study has it been explored as a digital platform for the rehabilitation of low-back pain (LBP). This study was aimed to develop and evaluate the feasibility of an animated cartoon-based self-care (ACBSC) app for LBP, and to examine the correlation between the app rating parameters and patients’ pain. Methods: This 2-phase study comprised development and feasibility testing components. Development of the ACBSC app was based on Mckenzie’s Mechanical Diagnosis and Therapy (MDT) extension protocol plus back hygiene following standard iteration and prototyping process. Twenty-eight consecutive patients with chronic non-specific LBP with ‘direction Preference’ for extension based on the MDT screening algorithm participated in the feasibility phase. The participants utilised the cartoon-based app thrice weekly for 2 weeks. Outcomes were assessed in terms of usability, satisfaction and user experience applying the system usability and mobile application rating scales. The Quadruple Visual Analogue Scale (QVAS) was used to assess the participants’ pain intensity. Results: On a unified scale up to 20, functionality (15.4 ± 2.41) and aesthetics 14 ± 2.00 had highest and least objective quality rating on the app parameters. Total objective and subjective quality rating of the app was 16.9 ± 1.97 and 15.6 ± 2.42, respectively. The total impact and usability scores were 24.1 ± 3.39 (out of 30) and 27.8 ± 3.09 (out of 50). Participants reported that the cartoon app for back care mostly affected mindfulness/meditation/relaxation (42.9%), increasing happiness/ well-being (46.4%), leading to behavioural changes (60.7%), while targeting physical health (100%). There was no significant correlation between participants’ pain characteristics and app rating parameters (p>0.05). Conclusion: The animated cartoon-based self-care LBP app has moderate to high usability, functionality, aesthetics and quality rating, and may serve as an effective mobile-app for self-management of long-term LBP

Opracowanie i testowanie wykonalności aplikacji do samoopieki opartej na animowanych kreskówkach w przypadku dolegliwości bólowych w dolnym odcinku kręgosłupa – badanie pilotażowe

Objectives: The use of animated cartoons for pain management is an emerging area, however, in no study has it been explored as a digital platform for the rehabilitation of low-back pain (LBP). This study was aimed to develop and evaluate the feasibility of an animated cartoon-based self-care (ACBSC) app for LBP, and to examine the correlation between the app rating parameters and patients’ pain. Methods: This 2-phase study comprised development and feasibility testing components. Development of the ACBSC app was based on Mckenzie’s Mechanical Diagnosis and Therapy (MDT) extension protocol plus back hygiene following standard iteration and prototyping process. Twenty-eight consecutive patients with chronic non-specific LBP with 'direction Preference’ for extension based on the MDT screening algorithm participated in the feasibility phase. The participants utilised the cartoon-based app thrice weekly for 2 weeks. Outcomes were assessed in terms of usability, satisfaction and user experience applying the system usability and mobile application rating scales. The Quadruple Visual Analogue Scale (QVAS) was used to assess the participants’ pain intensity. Results: On a unified scale up to 20, functionality (15.4 ± 2.41) and aesthetics 14 ± 2.00 had highest and least objective quality rating on the app parameters. Total objective and subjective quality rating of the app was 16.9 ± 1.97 and 15.6 ± 2.42, respectively. The total impact and usability scores were 24.1 ± 3.39 (out of 30) and 27.8 ± 3.09 (out of 50). Participants reported that the cartoon app for back care mostly affected mindfulness/meditation/relaxation (42.9%), increasing happiness/well-being (46.4%), leading to behavioural changes (60.7%), while targeting physical health (100%). There was no significant correlation between participants’ pain characteristics and app rating parameters (p>0.05). Conclusion: The animated cartoon-based self-care LBP app has moderate to high usability, functionality, aesthetics and quality rating, and may serve as an effective mobile-app for self-management of long-term LBP.Cele: Wykorzystanie animowanych kreskówek to rozwijający się obszar w leczeniu bólu, jednak żadne badanie nie analizowało go jako cyfrowej platformy do rehabilitacji bólu w dolnym odcinku kręgosłupa (ang. low-back pain – LBP). Badanie to miało na celu opracowanie i ocenę wykonalności aplikacji do samoopieki opartej na animowanych kreskówkach (ang. Animated Cartoon-Based Self-Care – ACBSC) dla LBP oraz zbadanie korelacji pomiędzy poszczególnymi parametrami aplikacji a bólem odczuwanym przez pacjentów. Metody: To dwufazowe badanie obejmowało komponenty opracowania i testowania. Rozwój aplikacji ACBSC oparto na protokole Rozciągania Metodą Mechanicznej Diagnozy i Terapii Mckenzie’a (ang. Mechanical Diagnosis and Therapy – MDT), oraz higienie pleców po standardowym procesie iteracji i prototypowania. Do fazy wykonalności włączono 28 kolejnych pacjentów z przewlekłym, niespecyficznym LBP z „preferencją kierunku” do rozciągania w oparciu o algorytm przesiewowy MDT. Uczestnicy korzystali z aplikacji opartej na kreskówkach 3 razy w tygodniu przez dwa tygodnie. Wyniki zostały ocenione pod kątem użyteczności, satysfakcji i doświadczenia użytkownika za pomocą skali użyteczności systemu oraz skali ocen aplikacji mobilnych. Do oceny natężenia bólu uczestników zastosowano poczwórną wizualną skalę analogową (ang. Quadruple Visual Analogue Scale - QVAS). Wyniki: Na ujednoliconej skali do 20, funkcjonalność (15,4 ± 2,41) i estetyka (14 ± 2,00) miały najwyższą i najmniej obiektywną ocenę jakości parametrów aplikacji. Całkowita obiektywna i subiektywna ocena jakości aplikacji wyniosła odpowiednio 16,9 ± 1,97 i 15,6 ± 2,42. Całkowity wynik oceny wpływu i użyteczności wyniósł 24,1 ± 3,39 (na 30) i 27,8 ± 3,09 (na 50). Uczestnicy zgłaszali, że aplikacja do pielęgnacji pleców wpływa głównie na uważność/medytację/relaks (42,9%), zwiększa uczucie szczęścia/dobrego samopoczucia (46,4%), prowadzi do zmian zachowania (60,7%) i jest ukierunkowana na zdrowie fizyczne (100%). Nie było istotnej korelacji między charakterystyką bólu uczestników a parametrami oceny aplikacji (p>0,05). Wnioski: Animowana, oparta na kreskówce aplikacja do samoopieki LBP ma umiarkowaną lub wysoką użyteczność, funkcjonalność, estetykę i ocenę jakości oraz może służyć jako skuteczna aplikacja mobilna do samodzielnego radzenia sobie z długoterminowym LBP

Prevalence and correlates of bullying in physiotherapy education in Nigeria

Background: Bullying is an unexpressed part and parcel of medical education but it is largely unexplored in physiotherapy. This study assessed the prevalence and socio-demographic correlates of bullying in physiotherapy education in Nigeria. Methods: Two hundred and nineteen clinical physiotherapy students from three purposively selected Federal Universities in Nigeria participated in this study. Following a cross-sectional design, the Students Perception of Professor Bullying Questionnaire (SPPBQ) was used to obtain information on bullying. The SPPBQ includes a working definition of lecturer bullying followed by other sections inquiring about lecturers bullying experiences. Data was collected on socio-demographic characteristics, bullying experiences and availability of adequate policy and support on bullying. Descriptive and inferential statistics were used analyze data. Alpha level was set at p < 0.05. Results: Lifetime and point prevalence of bullying in physiotherapy education were 98.6 and 99.1%. 94.5% of the respondents had witnessed physiotherapy students bullying and there was a 100% rate of 'no attempt' to stop a physiotherapy lecturer from bullying. 38.4 and 44.7% of the respondents believed there was adequate school policy and support available on bullying. There was no significant association between bullying and each of age (í2 = 0.117, p = 0.943), gender (í2 = 0.001, p = 0.974), level of study (í2 = 0.000, p = 0.995) and any specific university (í2 = 1.343, p = 0.511). Conclusion: There is high lifetime and point prevalence of bullying in physiotherapy education in Nigeria, which are largely unchallenged or redressed. Being a clinical physiotherapy student ordinarily predisposes to bullying without necessary contributions of intrinsic and extrinsic factors