Development and feasibility testing of a remote support application for adherence to home exercise programs: a randomized pilot study

Objectives: Poor adherence to home exercise programs (HEPs) is a significant barrier to continuity of care and eventual outcomes, thus requiring innovative mitigating approaches. This study aimed to develop and test the feasibility of a remote support application (RSA) designed to encourage adherence to HEPs. Methods: Using standard computer programing, an RSA with administrator and user interfaces was developed for mobile phone or tablet. Consenting patients receiving physiotherapy for musculoskeletal conditions (n=19) were randomly assigned into the experimental group (n=10) or the control group (n=9). The experimental group received their customized HEP reminders via the RSA, whereas the control group used conventional paper handouts for HEPs. Adherence to HEPs was assessed over 4 weeks. The feasibility of the RSA was assessed using the Mobile Application Rating Scale and System Usability Scale (SUS) questionnaires. Data were summarized using descriptive and inferential statistics. Results: The adherence rate of patients in experimental group was significantly higher than that of patients in the control group after 2 weeks [median diff.=−6.0, 95% confidence interval (CI): −8.0 to −5.0; U=5.00; Z=−3.304; P=0.001; r=0.75] and 4 weeks (median diff.=−7.0, 95% CI: −8.0 to −5.0; U=0; Z=−3.695; P<0.001; r=0.84) of intervention. The RSA had a mean SUS score of 82.53±9.04 (out of 100) and a mean app quality rating score of 75.95±4.98 (out of 95). Conclusions: The use of an RSA to improve adherence to HEPs is feasible for patients with musculoskeletal conditions

Reference values for 3-meter backward walk test among apparently healthy adults

Objective: The 3-meter backward walk (3MBW) test is an outcome performance measure to assess backward walking mobility, balance, and risk of fall. However, the lack of baseline values is a potential limitation for its use as a rehabilitation target value or predictor of outcomes. This study aimed at ascertaining a gender- and age-reference value of 3MBW and determining its correlation with sociodemographic and anthropometric variables. Methods: A total of 1,601 Nigerian healthy adults participated in this cross-sectional study. 3MBW was measured following standardized procedure on a marked 3-m floor. Anthropometric and sociodemographic parameters were taken. Data were summarized using the descriptive statistics of mean, standard deviation, and percentile (less than the 25th, between the 25th and 75th, and above the 75th percentiles were regarded as low, average, and high 3MBW, respectively). Results: From this study, less than 2.23 s and 2.60 s were regarded as low risk of fall for males and females, respectively; 2.23–3.00 s and 2.60–3.50 s were regarded as average risk of fall for males and females, respectively, while greater than 3.00–3.9 s and 3.50–3.90 s were regarded as high risk of fall for males and females, respectively. 3MBWT was significantly associated with age (r = 0.51, p = 0.001), sex (r = 0.315, p = 0.001), weight (r = 0.14, p = 0.001), BMI (r = 0.28, p = 0.001), but not height (r = −0.03; p = 0.250). Conclusion: This study provided a reference set of values according to age and gender for 3MBW in healthy individuals. Males have shorter 3MBW than females, and the time taken to accomplish 3MBW increases with age

Effects of a Customized Professionalism Educational Intervention on Physical Therapists’ Knowledge and Attributes of Professionalism

Purpose: There is a growing call around the world to include professionalism in the entry-level education of physical therapists and to teach professionalism as a continuing education professional development workshop for practicing physical therapists. Unfortunately, there is currently no empirical evidence to support the use of didactic instruction to effectuate a change in the knowledge and attributes of professionalism. This study evaluated the effects of a customized professionalism educational intervention on physical therapists’ knowledge and attributes of professionalism. Methods: A quasi-experimental research was conducted among 47 Nigerian physical therapists (Mean age = 41 ± 10.1 years). The educational intervention consisted of a 3-hour classroom lecture and five case studies on professionalism. The impact of the intervention was evaluated by a Professionalism Inventory that assesses the level of knowledge and attributes of professionalism - clinical competence, a spirit of inquiry, accountability, autonomy, advocacy, innovation and visionary, collegiality and collaboration, and ethics and value. Results: Post intervention, the physical therapist\u27s aggregate knowledge of professionalism score improved significantly from 69% to 77% performance level (t = 2.340; p \u3c 0.05). On the contrary, there was no significant difference in the aggregate attributes of professionalism score following the intervention (t = 1.396, p \u3e 0.05). Although the improvement observed in the aggregate attributes of professionalism score was not statistically significant, when the effects of the intervention were examined on the attributes of professionalism subscales, the results revealed that clinical competence, accountability, autonomy, innovation and visionary, and collaborating and collegiality improved significantly (p \u3c 0.05). The intervention was of small practical significance (Cohen d = .34 and .20 for knowledge and attributes of professionalism scores, respectively). Conclusions: It was inferred from the findings that a three-hour classroom instruction consisting of lectures and case studies presentation could improve the knowledge of professionalism of practicing physical therapists. A longer instructional period vis-à-vis mentoring and role modelling in the classroom may be needed to effectuate a practical change in professionalism

Development and Feasibility Testing of Video Home Based Telerehabilitation for Stroke Survivors in Resource Limited Settings

Tele-physiotherapy has been shown to be valuable to improve clinical outcomes after stroke. Yet, home-based interventions for stroke survivors (SSVs) who speak indigenous African languages are sparse. This study developed a video-based home exercise programme (VHEP) for SSV speakers of Yoruba.  A qualitative descriptive pilot study was conducted in two phases: development and feasibility testing. VHEP development followed the American Stroke Association’s recommendations to include demonstrations of task-specific mobility-task and postural training; trunk exercises, and overground walking. The exercise instructions were presented in the Yoruba language. Each exercise was demonstrated for five minutes on video for a total of 30 minutes. The feasibility testing involved ten consenting chronic SSVs.  Each imitated the VHEP twice per week for two weeks and thereafter completed a feasibility questionnaire. Criteria for feasibility were: cost of using VHEP, recruitment rate, retention of participants, adherence to the exercises, and intervention delivery. The ten SSVs were recruited within one week, had prior home access to a video player at no-cost, adhered to the exercises as recorded, completed the 30 minute-duration for two weeks, and confirmed intervention delivery of VHEP. Most participants liked the novel use of Yoruba as the language of instruction on VHEP. The VHEP was feasible and acceptable among the studied sample of SSVs. Video based home telerehabilitation for SSVs therefore has the potential to meet the growing need for tele-physiotherapy in resource limited settings. 

Influence of neighborhood environment and social support on physical activity among patients with diabetes mellitus

This study was aimed to determine the relationship of physical activity (PA) with the neighborhood environment and social support for PA among patients with diabetes mellitus (DM). A total of 193 consenting individuals with DM attending endocrinology clinic in a Nigerian tertiary hospital participated in this cross-sectional study. The international physical activity questionnaire short form, physical activity neighborhood environment scale (PANES), and physical activity and social support scale (PASSS) were used to assess the PA level (low, moderate, and high), neighborhood environment and social support for PA, respectively. The results of bivariate analyses showed that all elements of built environment and social support were significantly associated with PA. Regression model analyses indicate that PANES score was associated with moderate (adjusted odds ratio [aOR]: 10.76; 95% confidence interval [CI]: 3.82-30.32) to high (aOR: 45.73; 95% CI: 12.14-172.27) PA. In addition, easy access to quality walking facilities (aOR: 46.53; 95% CI: 3.89-557.32; aOR: 46.13; 95% CI: 2.65-802.40) and easy access to recreation infrastructure (aOR: 46.89; 95% CI: 3.95-487.83; aOR: 17.99; 95% CI: 1.28-252.98) were associated with moderate to high PA, respectively, while safety from crime (aOR: 0.21; 95% CI: 0.07-0.64) and easy access to services and shops (aOR: 21.90; 95% CI: 1.83-262.59) were associated with moderate and high PA. Informational social support was associated with moderate PA (aOR: 1.44; 95% CI: 1.04-2.00). In conclusion, the neighborhood environmental and social support factors were associated with the PA activity level among Nigerian patients with DM

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&lt; 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&gt;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

Quality of Work Life (QoWL) and Perceived Workplace Commitment among Seasonal Farmers in Nigeria

This study set out to research the impact of Quality of Work Life (QoWL) in Low- and Middle-Income Countries (LMICs) and the perception of farm workers regarding how both intrinsic and extrinsic control elements within and outside the work setting impact their productivity within the farming industry in Nigeria. To our knowledge, this is the first study that has considered QoWL among farm workers in Nigeria. Farm workers in the Middle Belt region in Nigeria (n = 435) were surveyed using a QoWL questionnaire consisting of 32 Likert scale items to measure their perceived quality of work life based on seven dimensional factors. Results indicated that more than half (60.6%) of the sampled group confirmed working far above the national working hours of 40 h per week. Significant differences exist between respondent gender on control at work (CAW) (F = 10.03, p &lt; 0.001) and working conditions (WCS) (F = 12.04, p &lt; 0.001), with women having better QoWL. Farm worker job satisfaction, especially in LMICs, is an important element that can lead to high productivity and sustainability of the sector. To achieve a level of sustainability and food security in Nigeria, there is the need to improve opportunities for greater stability among farmers. Farm workers could benefit from tailored training initiatives around stress management and work–life balance, as well as workplace safety nad health and wellbeing as a means of boosting their confidence and enhance sustainable productivity. In addition, this paper holds the potential to inform framework development for assessing QoWL within the farming industry in Nigeria and encourage further research around the impact of job insecurity on the nation’s food security