An assessment of neuromuscular performance, functional range of motion and quality of life characteristics in children diagnosed with hypermobility syndrome

Introduction: Hypermobility syndrome (HMS) is a common cause of morbidity in children, with the knee most frequently affected by its symptoms. Impaired joint proprioception has been reported in adults with HMS. Muscle weakness, problems with school activities and abnormal gait patterns have been observed in children with this condition. It has also been suggested that activities of daily living and physical and sporting activities may be limited in children with HMS due to pain. To date, the factors associated with HMS in children have not been well reported. The relationships between impairments, function and quality of life (QoL) have not been investigated in children with this condition. The purpose of this study was to identify the range of neuromuscular performance, functional range of motion (ROM) and QoL indices, and investigate the relationships between these features in children with HMS. A purpose-built motorised device was developed and validated for the assessment of knee joint proprioception as an integral part of the research programme. The test-retest repeatability of various outcome measures used for the present study was also investigated in healthy children and those with HMS. Methods: A cross-sectional study was conducted. Twenty nine children with HMS and 37 healthy children (aged 8 – 15 years) were investigated for neuromuscular indices, functional ROM and QoL. Knee joint kinaesthesia (JK) and position sense (JPS) were examined using a motorised device, muscle torque was tested with a digital myometer, passive ROM was measured with a universal goniometer and functional ROM was assessed using the VICON camera system. Pain intensity and QoL were measured using the Coloured Analogue Scale and the Paediatric Quality of life Inventory respectively. Mann-Whitney U tests and independent t-tests were performed to determine the differences between the two groups. The relationships between pain and each of the following: neuromuscular impairments, functional ROM and QoL were examined in children with HMS. The correlation between Beighton scores and each outcome was also evaluated in children with HMS. Results: Knee JK and JPS were significantly poorer (both p < 0.001) in children with HMS compared with the controls. Significantly reduced (p < 0.001) knee muscle torque was also observed in children with HMS. Pain intensity and passive knee ROM were significantly higher (both p < 0.001) in children with HMS. They also demonstrated significantly increased knee extension, reduced knee flexion in loading response and during maximal knee flexion of walking (all p <0.001). Moreover, the overall QoL perception and all the domains were significantly poorer (p range < 0.001 to 0.008) in children with HMS than the controls. No relationship (r range = -0.065 to 0.271; p range = 0.106 to 0.985) was found between pain, neuromuscular impairments and functional ROM in children with HMS. However, a significantly strong negative relationship (r = -0.65; p = <0.001) was established between pain and QoL in children with HMS. In addition, no relationship (r range = -0.014 to 0.315; p range = 0.112 to 0.895) was observed between Beighton scores and neuromuscular impairments, functional ROM and QoL in children with HMS. Conclusions: Children with HMS, compared with their healthy counterparts had knee joint proprioception and knee muscle torque deficits, increased passive knee ROM and pain intensity. Abnormal walking patterns (increased knee extension, reduced knee flexion in both mid stance and maximum knee flexion in swing phase during walking) were also found in children with HMS. They also presented with poorer QoL in comparison with the controls. Clinicians are to be aware of these identified features and should develop appropriate treatment intervention programmes for children with this condition.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

An assessment of neuromuscular performance, functional range of motion and quality of life characteristics in children diagnosed with hypermobility syndrome

Introduction: Hypermobility syndrome (HMS) is a common cause of morbidity in children, with the knee most frequently affected by its symptoms. Impaired joint proprioception has been reported in adults with HMS. Muscle weakness, problems with school activities and abnormal gait patterns have been observed in children with this condition. It has also been suggested that activities of daily living and physical and sporting activities may be limited in children with HMS due to pain. To date, the factors associated with HMS in children have not been well reported. The relationships between impairments, function and quality of life (QoL) have not been investigated in children with this condition. The purpose of this study was to identify the range of neuromuscular performance, functional range of motion (ROM) and QoL indices, and investigate the relationships between these features in children with HMS. A purpose-built motorised device was developed and validated for the assessment of knee joint proprioception as an integral part of the research programme. The test-retest repeatability of various outcome measures used for the present study was also investigated in healthy children and those with HMS. Methods: A cross-sectional study was conducted. Twenty nine children with HMS and 37 healthy children (aged 8 – 15 years) were investigated for neuromuscular indices, functional ROM and QoL. Knee joint kinaesthesia (JK) and position sense (JPS) were examined using a motorised device, muscle torque was tested with a digital myometer, passive ROM was measured with a universal goniometer and functional ROM was assessed using the VICON camera system. Pain intensity and QoL were measured using the Coloured Analogue Scale and the Paediatric Quality of life Inventory respectively. Mann-Whitney U tests and independent t-tests were performed to determine the differences between the two groups. The relationships between pain and each of the following: neuromuscular impairments, functional ROM and QoL were examined in children with HMS. The correlation between Beighton scores and each outcome was also evaluated in children with HMS. Results: Knee JK and JPS were significantly poorer (both p < 0.001) in children with HMS compared with the controls. Significantly reduced (p < 0.001) knee muscle torque was also observed in children with HMS. Pain intensity and passive knee ROM were significantly higher (both p < 0.001) in children with HMS. They also demonstrated significantly increased knee extension, reduced knee flexion in loading response and during maximal knee flexion of walking (all p <0.001). Moreover, the overall QoL perception and all the domains were significantly poorer (p range < 0.001 to 0.008) in children with HMS than the controls. No relationship (r range = -0.065 to 0.271; p range = 0.106 to 0.985) was found between pain, neuromuscular impairments and functional ROM in children with HMS. However, a significantly strong negative relationship (r = -0.65; p = <0.001) was established between pain and QoL in children with HMS. In addition, no relationship (r range = -0.014 to 0.315; p range = 0.112 to 0.895) was observed between Beighton scores and neuromuscular impairments, functional ROM and QoL in children with HMS. Conclusions: Children with HMS, compared with their healthy counterparts had knee joint proprioception and knee muscle torque deficits, increased passive knee ROM and pain intensity. Abnormal walking patterns (increased knee extension, reduced knee flexion in both mid stance and maximum knee flexion in swing phase during walking) were also found in children with HMS. They also presented with poorer QoL in comparison with the controls. Clinicians are to be aware of these identified features and should develop appropriate treatment intervention programmes for children with this condition.sub_phyunpub93_ethesesunpu

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:&nbsp;this study evaluated the economic impact of the COVID-19 lockdown on individuals and households. Methods:&nbsp;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:&nbsp;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 &lt; 0.05). However, expenditure on education, water, electricity, fuel, internet data, clothing and wears, toiletries decreased significantly during the lockdown period (p &lt; 0.05). Conclusion:&nbsp;this study suggests that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system

The Economic Burden of Musculoskeletal Disorders Resulting from Road Trafic Accident in Low and Middle Income Countries: A Systematic Review

Objectives Approximately 20 – 50 million people sustain nonfatal injuries as a result of road traffic accidents (RTA). Treatment costs as well as lost wages associated with this nonfatal injury are substantial. The study reviewed the economic burden of musculoskeletal (MSK) disorders caused from RTA in low and middle-income countries (LMICs). Methods We performed a systematic search of MEDLINE, CINAHL, Cochrane Database of Systematic Reviews (CDSR), Health Economic Evaluations Database (HEED), and Web of Science Database from inception to September 2019. Studies that assessed the economic burden of MSK resulting from RTA in LMICs published in English language were included. The quality of the included studies was assessed using the Drummond and Jefferson criteria. A descriptive data synthesis was used to present the results. Results The search identified 456 studies, and nine of them met the inclusion criteria and were included in this review. The studies were conducted in Iran (n = 3), Nigeria (n = 2), Vietnam (n = 1), India (n = 1), Thailand (n = 1), and Nepal (n = 1). The quality score of the included studies were ≥ 50%. The mean age of the patients in the included studies ranged between 24.6 to 40.3 years. Mean direct and indirect costs in the included studies ranged from $11.04 to$2494 and $33.3 to$189.2, respectively over 12 months. Hospitalisation and treatment were identified as the major cost drivers. Conclusions The findings of the review showed that the costs of injuries resulting from RTA were considerably high relative to health expenditures levels. Hence, it is important that prevention strategies be in place to reduce the economic burden of MSK disorders caused by RTA in LMICs

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

Burden of musculoskeletal-related disorders resulting from non-fatal road traffic collisions in Africa: a protocol of a systematic review

Introduction In addition to their high mortality rates, road traffic collisions (RTC) are considered a burden within those who do survive. In Africa, injuries related to RTC have been identified as the 10th most common cause of disability-adjusted life years lost for all ages and categories. Moreover, non-fatal RTC are the biggest cause associated with the burden of musculoskeletal disorders (MSD) in Africa. Despite this, the epidemiology of MSD related to non-fatal RTC within this region is still unknown. The objective of this review is to identify and summarise available data regarding the prevalence, incidence and patterns of MSD resulting from non-fatal RTC in Africa. Methods and analysis A systematic review of observational epidemiological studies will be conducted. On October 2019, MEDLINE, Embase, CINAHL Plus, PsycINFO, Web of Science, Global Health and African Journals OnLine will be searched for literature that is in English and published between 1990 and 2018. Two reviewers (MY ad TG) will independently screen results and extract the data, with a third reviewer (FF) resolving any discrepancies through discussion. Additionally, two reviewers (MY and TG) will independently assess the quality of the eligible studies using the US National Institutes of Health National Heart, Lung, and Blood Institute Quality Assessment Tool. Within the eligible studies, data on citation, methods and results will be extracted. Extracted data will be analysed using a narrative synthesis. Findings will be presented in tables, with the main outcomes being prevalence, incidence and disease pattern of MSD and determinants of non-fatal RTC. The final systematic review will be conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Ethics and dissemination As individual patients will not be involved in this study, no ethical approval will be sought. Findings from this review will be disseminated through peer-reviewed journals and relevant conferences. Trial registration number CRD4201913953

Global and regional prevalence and incidence of systemic lupus erythematosus in low and-middle income countries: a systematic review and meta-analysis

Systemic lupus erythematosus (SLE) may be more prevalent among most ethnic groups in the low-and-middle income countries (LMICs), still these countries are under-represented in epidemiological data on SLE. The aim of this study was to review the prevalence and incidence of SLE in LMICs and use meta-analytic techniques. The MEDLINE, CINHAL, Web of Science, Scopus and Global Index Medicus databases were searched for relevant studies published up to July of 2022. Papers selected for full-text review were included in the systematic review if they provided the prevalence or incidence of SLE in LMICs and published in English language. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. The prevalence and incidence of SLE were pooled through random effects model. Pooled estimates were expressed with 95% confidence. Out of 2340 papers, 23 studies were included in the review. The mean age at diagnosis ranged from 25.5 to 45.8 years. Three studies were conducted in Argentina and Brazil, two studies in China and one study in Cuba, Colombia, Democratic Republic Congo, Ecuador, Egypt, India, Kenya, Malaysia, Mexico, Nigeria, Pakistan, Turkey, Ukraine, Venezuela, and Zimbabwe. The SLE prevalence and incidence varied from 3.2 to 159 per 100,000 and 0.3–8.7 per 100,000 persons, respectively. In a random effects meta-analysis (n = 10), the pooled prevalence of SLE was 103 (95% confidence interval [CI] – 17 to 224) per 100,000. Meta‐analysis of data from 6 incidence studies revealed an incidence of 5 cases per year (95% CI 2–8) per 100,000. According to WHO regions, the pooled prevalence of American and Western Pacific regions was 300 (95% CI – 200 to 900) and 36 (95% CI 35–37) per 100,000, respectively. The pooled incidence of the American region was 10 (95%, 0–14) per 100,000 inhabitants. Systemic lupus erythematosus is a common disease with considerable variation in prevalence and incidence among the general population in LMICs. Accurate estimates of prevalence and incidence of SLE are required to put in place appropriate programmes to reduce its burden in LMICs. PROSPERO registration number: CRD: 42020197495, https://www.crd.york.ac.uk/prospero/

Economic Impact of COVID-19 Lockdown on Households in Nigeria

Background: This study evaluated the economic impact of the COVID-19 lockdown on individuals and households in Nigeria. 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. There was difference in mean (SD) monthly income before and during the lockdown (₦263389.27 (USD690.4) (SD ₦2589649.2)) vs. (₦207704.9 (USD544.4) (SD ₦1846806.84)). 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). 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 suggest that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system