Community reintegration among stroke survivors in Osun, southwestern Nigeria.

Background Stroke is a major neurological problem and a leading cause of disability in the elderly in Nigeria. The incidence is increasing due to increasing risk factors, but many stroke victims now survive because of improved medical care. These survivors become community-dwellers after inpatient rehabilitation.Aims To assess community reintegration among stroke survivors and factors associated with it.Methods Cross-sectional survey study of patients who had survived six months or more after a stroke. Participants consisted of stroke patients attending the outpatient physiotherapy clinics of four selected government owned hospitals in Osun state, south-west Nigeria. Community reintegration was assessed using the Reintegration to Normal Living Index (RNLI) and walking ability was assessed using the Functional Ambulatory Categories (FAC).Results A total of 64 patients (43 men and 21 women, mean age 58.80¡À 10.31 years) participated in this study. The mean RNLI was 63.8¡À14.3 for all the participants. Forty eight participants (75%) had slight disability (Score=2) and 16 participants (25%) had moderate disability (Score =3) using Modified Rankin Scale (mRS). Age, sex, physiotherapy duration, number of stroke occurrence and walking ability, were not associated with community reintegration. Post-stroke duration however had a significant association with community reintegration.Conclusion A significant proportion of chronic stroke survivors attending the selected outpatient clinics have mild to moderate level of reintegration and the longer the post stroke duration, the better the satisfaction with community reintegration

Cross-cultural adaptation and psychometric evaluation of the Yoruba version of Oswestry disability index.

INTRODUCTION:Low-Back Pain (LBP) is a common public health problem that is often worsened by maladaptive beliefs and disability. Thus, necessitating the need for availability of outcome measures to assess these sequelae among patients with chronic LBP. This study aimed to cross-culturally adapt and determine the psychometric properties of the Yoruba version of the ODI (ODI-Y). METHODS:The ODI-Y was cross-culturally adapted following the process involving forward translation, synthesis, backward translation, expert review, and pilot testing. Internal consistency and test-retest reliability of the ODI-Y were determined using the Cronbach's alpha and intra-class correlation. Other psychometric properties explored included the factor structure, convergent validity, standard error of measurement and the minimal detectable change. RESULTS:One hundred and thirty-six patients with chronic LBP took part in the validation of the ODI-Y; 86 of these individuals took part in the test-retest reliability (within 1-week interval) of the translated instrument. The mean age of the respondents was 50.5±10.6years. The ODI-Y showed a high internal consistency, with a Cronbach's alpha (α) of 0.81. Test-retest of the Yoruba version of the ODI within 1-week interval yielded an Intra-Class Correlation coefficient of 0.89. The ODI-Y yielded a three-factor structure which accounted for 61.56% of the variance. Correlation of ODI-Y with the visual analogue scale was moderate (r = 0.30; p = 0.001). The standard error of measurement and minimal detectable change of the ODI-Y were 2.0 and 5.5. CONCLUSIONS:The ODI was adapted into the Yoruba language and proved to have good psychometric properties that replicated the results of other obtainable versions. We recommend it for use among Yoruba speaking patients with LBP

Comparative effectiveness of two stabilization exercise positions on pain and functional disability of patients with low back pain

The study investigated the effects of two stabilization exercise positions (prone and supine) on pain intensity (PI) and functional disability (FD) of patients with nonspecific chronic low back pain (NSCLBP). The 56 sub-jects that completed the study were randomly assigned into stabiliza-tion in prone (SIP) (n=19), stabilization in supine (SIS) (n=20), and prone and supine (SIPS) position (n=17) groups. Subjects in all the groups re-ceived infrared radiation for 15 min and kneading massage at the low back region. Subjects in SIP, SIS, and SIPS groups received stabilization exercise in prone lying, supine lying and combination of both positions respectively. Treatment was applied twice weekly for eight weeks. PI and FD level of each subject were measured at baseline, 4th and 8th week of the treatment sessions. Data were analyzed using descriptive and inferential statistics. The alpha level was set at P 0.05) of the treat-ment sessions across the three groups when compared. It can be con-cluded that stabilization exercises carried out in prone, supine and combination of the two positions were equally effective in managing pain and disability of patients with NSCLBP. However, no position was superior to the other

Infant-carrying techniques: which is a preferred mother-friendly method?

Infant carrying is still trendy among African mothers than in other climes, however, carrying techniques vary mostly along cultural divides. Using a pretest–posttest quasi-experimental design, the authors evaluated the effect of three types of infant-carrying techniques on cardiopulmonary function, metabolic expenditure, fatigue demand, and locomotion. Front wrap infant-carrying technique led to a marginally higher cardiopulmonary demand. Hip sling technique resulted in greater metabolic expenditure and oxygen consumption with high rate of perceived exertion, while back wrap technique did not significantly decrease locomotion parameters. The authors recommend back wrap infant carrying technique based on its slightly lower effects on cardiopulmonary function, metabolic expenditure, fatigue demand, and locomotion

Cross-cultural adaptation, reliability, and validity of the Yoruba version of the Roland-Morris Disability Questionnaire

Study Design. A translation, cross-cultural adaptation, and psychometric analysis. Objective. The aim of this study was to translate, cross-culturally adapt, and validate the Yoruba version of the RMDQ. Summary of Background Data. The Roland-Morris Disability Questionnaire (RMDQ) is a valid outcome tool for low back pain (LBP) in clinical and research settings. There seems to be no valid and reliable version of the RMDQ in the Nigerian languages. Methods. Following the Guillemin criteria, the English version of the RMDQ was forward and back translated. Two Yoruba translated versions of the RMDQ were assessed for clarity, common language usage, and conceptual equivalence. Consequently, a harmonized Yoruba version was produced and was pilot-tested among 20 patients with nonspecific long-term LBP (NSLBP) for cognitive debriefing. The final version of the Yoruba RMDQ was tested for its construct validity and re-retest reliability among 120 and 87 patients with NSLBP, respectively. Results. Pearson product moment correlation coefficient (r) of 0.82 was obtained for reliability of the Yoruba version of the RMDQ. The test-retest reliability of the Yoruba RMDQ yielded Cronbach alpha 0.932, while the intraclass correlation (ICC) ranged between 0.896 and 0.956. The analysis of the global scores of both the English and Yoruba versions of the RMDQ yielded ICC value of between 0.995 (95% confidence interval 0.996-0.997), with the item-by-item Kappa agreement ranging between 0.824 and 1.000. The external validity of RMDQ using Quadruple Visual Analogue Scale was r = -0.596 (P = 0.001). The Yoruba version of the RMDQ had no floor/ceiling effects, as no patient achieved either of the maximum or the minimum possible scores. Conclusion. The Yoruba version of the RMDQ has excellent reliability and validity and may be an appropriate outcome tool for clinical and research purposes among Yoruba-speaking patients with LBP

Validity of the start back tool in patients with low-back pain using spinal flexibility measures

Background: Correlation between prediction tools of disability and traditional physical performance tests in ascertaining disability risks remains unexplored. Objectives: The present study aimed to assess the convergent validity of the STarT back tool (SBT) for predicting disability risk using the spinal range of motion (ROM). Methods: Thirty patients with low-back pain (LBP) volunteered for this study. We used the SBT and Dual inclinometers to assess the future risk for disability and spinal ROM, as well as Anthropometric factors and pain intensity. Results: Poor and moderate spinal ROM for forward (93.3%, 6.7%), left lateral (63.30%, 36.70%) and right lateral (80.00%, 20.00%) flex-ion respectively were common among the participants. Backward extension ROM (36.70%, 46.70%) was mostly good and very good. There was a 60% medium risk for future physical disability based on SBT. There was no significant association between spinal ROM and SBT future disability prediction (χ2 = 3.367, P > 0.05). Conclusions: The SBT and spinal ROM assessment are independent measures of functional disability. They should complement one another in clinical assessment procedures for effective outcomes in the treatment of 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

Porównanie Metody Przesiewowej STarTBack oraz Baterii Testów Opartych na Sprawności Fizycznej Simmonds’a w przewidywaniu ryzyka niepełnosprawności wśród pacjentów z przewlekłym bólem dolnego odcinka kręgosłupa.

Objectives This study identified disability sub-groups of patients with chronic low back pain (LBP) using the Subgroup for Targeted Treatment (or STarT) Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the aim to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction were carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to-stand, 360-degree rollover, Sorenson fatigue test, unloaded reach test, and 50 foot walk test). Pain intensity was assessed using the Quadruple Visual Analogue Scale. Data on age, sex, height, weight and BMI were also collected. Descriptive and inferential statistics were used to analyze data at p<0.05 Alpha level. Results The mean age, weight, height and body mass index of the participants were 51.4 ±8.78 years, 1.61 ±0.76 m and 26.6 ±3.18 kg/m2 respectively. The mean pain intensity and duration were 5.37 ±1.37 and 21.2 ±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. Under SBST sub-grouping the majority of participants were rated as having medium disability risk (76%), whilst SPPTB sub-grouped the majority as having high disability risk (71.4%). There was a significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT showed both floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’, the lowest and highest obtainable scores. The ‘Area Under Curve’ for sensitivity (0.83) and specificity (0.23) of the SBST to predict ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST were 0.77, 0.23, 0.31, and 0.69 respectively. Conclusion The Start Back Screening Tool is able to identify the proportion of patients with low back pain with moderate disability risks, while the Simmonds Physical Performance Tests Battery is better able to identify high disability risks. Thus, SBST as a self-report measure may not adequately substitute physical performance assessment based disability risks prediction. However, SBST has good divergent predictive validity with pain intensity. In contrast to SPBBT, SBST exhibited no floor or ceiling effects in our tests, and demonstrated high sensitivity but low specificity in predicting ‘high-disability risk’.Cele: W badaniu tym zidentyfikowano podgrupy niepełnosprawności pacjentów z przewlekłym bólem dolnego odcinka kręgosłupa (ang. Chronic Low Back Pain, LBP) używając Podgrupy do Ukierunkowanego Leczenia – ang. Subgroup for Targeted Treatment (or STarT), Metody Przesiewowej Badania Pleców (Back Screening Tool, SBST) oraz Baterii Testów Simmonds’a oceniających Sprawność Fizyczną (Simmonds Physical Performance Test Battery, SPPTB). Ponadto, aby przyspieszyć i dokładniej przewidzieć ryzyko niepełnosprawności wśród pacjentów z przewlekłym LBP, w badaniu zbadano trafność różnicową SBST i porównano trafność predykcyjną SBST i SPPTB u pacjentów. Metody: To przekrojowe badanie poznawcze obejmowało 70 (52,0% kobiet i 47,1% mężczyzn) pacjentów z przewlekłym niespecyficznym LBP, którzy wyrazili zgodę i uczestniczyli w fizjoterapii ambulatoryjnej, przy udziale Kliniki Ortopedycznej w Szpitalu Uniwersyteckim w Obafemi Awolowo, Ile-Ife oraz Szpitala Uniwersytetu Technologii w Ladoke Akintola, Osogbo, w Nigerii. Podgrupowanie ryzyka niepełnosprawności i prognozowanie przeprowadzono przy użyciu SBST i SPPTB (składającego się z sześciu zadań funkcjonalnych: wielokrotnego zginania tułowia, wstawania z pozycji siedzącej, 360-stopniowego przewrotu, testu zmęczenia Sorenson’a, testu zasięgu bez obciążenia i testu chodu na odległość 50 stóp). Intensywność bólu oceniano za pomocą Poczwórnej Wizualnej Skali Analogowej (ang. Quadruple Visual Analogue Scale – QVAS). Zebrano również dane dotyczące wieku, płci, wysokości ciała, masy ciała i BMI. Do analizy danych użyto statystyki opisowe i inferencyjne na poziomie istotności statystycznej Alpha p< 0,05. Wyniki: Średni wiek, masa ciała, wzrost i wskaźnik masy ciała uczestników wynosiły odpowiednio 51,4 ±8.78 lat, 1,61 ±0,76 m i 26,6 ±3,18 kg/m2. Średnia intensywność bólu i jego czas trwania wyniosły odpowiednio 5,37 ±1,37 i 21,2 ±6,68. Trafność różnicowa SBST z procentem ogólnej intensywności bólu wyniosła r = 0,732; p = 0,001. W klasyfikacji zgodnie z SBST, większość uczestników oceniono jako średnie ryzyko niepełnosprawności (76%), podczas gdy SPPTB sklasyfikowało większość jako wysokie ryzyko niepełnosprawności (71,4%). Stwierdzono istotną różnicę w ocenie ryzyka niepełnosprawności między grupami poddanymi SBST i SPPTB (χ ² = 12,334; p = 0,015). SBST nie miał efektów podłogowych ani sufitowych, ponieważ mniej niż 15% uczestników osiągnęło najniższy (2,9%) lub najwyższy (1,4%) możliwy wynik. Natomiast SPPBT pokazał zarówno efekty podłogowe, jak i sufitowe, ponieważ nie był w stanie wykryć „1” i „9”, najniższego i najwyższego osiągalnego wyniku. „Obszar Pod Krzywą” dla czułości (0,83) i swoistości (0,23) SBST do przewidywania „wysokiego ryzyka niepełnosprawności” wynosił 0,51. Oszacowana częstość występowania dla przewidywanego „wysokiego ryzyka niepełnosprawności” przy zastosowaniu SBST wyniosła 0,76. Szacowana wartość dla wyników prawdziwie dodatnich, fałszywie dodatnich, prawdziwie ujemnych i fałszywie ujemnych dla przewidywania „wysokiego ryzyka niepełnosprawności” w przypadku SBST wyniosła odpowiednio 0,77, 0,23, 0,31, i 0,69. Wnioski: Metoda Przesiewowa StarT Back jest w stanie lepiej zidentyfikować odsetek pacjentów z bólem dolnego odcinka kręgosłupa znajdujących się w grupie średniego zagrożenia niepełnosprawnością, podczas gdy Bateria Testów Sprawności Fizycznej Simmonds’a jest w stanie lepiej zidentyfikować wysokie zagrożenie niepełnosprawnością. Tym samym SBST jako narzędzie do samooceny, nie może w wystarczającym stopniu zastępować przewidywania zagrożenia niepełnosprawnością w oparciu o ocenę sprawności fizycznej. Jednakże SBST ma dobrą trafność różnicową przewidywań w kwestii intensywności bólu. W przeciwieństwie do SPBBT, SBST nie wykazywał w naszych testach żadnych efektów podłogowych ani sufitowych i wykazał się wysoką czułością, ale niską swoistością w przewidywaniu „wysokiego ryzyka niepełnosprawności”