Clinical Profile of Patients with Hip Hemi-arthroplasty Managed at the Physiotherapy Department of a Nigerian Tertiary Health Institution between 2008 and 2013

This study was a review of individuals who had hip hemi-arthroplasty and were managed at the physiotherapy department of a Nigerian tertiary health institution. Information on age, sex, causes of fracture, types of referral, outcomes assessed, treatment provided and discharge pattern were obtained from physiotherapy patients’ register, case files and nursing registers. Data was summarized using descriptive statistics of range, mean, standard deviation, and percentages. A total of 57 cases (26 males; 31 females) aged 76.77±11.59 years (32-92 years) was reviewed. The majority (98.2%) had hip hemi-arthroplasty secondary to femoral neck fracture. Only one case was due to femoral head damage secondary to sickle cell disease. The cause of fracture was documented in 21 cases with 76% of the fractures resulting after falls. Forty-one patients (71%) were referred for ambulation only post-surgery while sixteen (29%) were referred for full physiotherapy. Pain and muscle strength were the only impairment variables assessed in those referred for physiotherapy. Fifty-five (91%) were discharged home with walking aids while three (6%) were deceased. Fourteen (25%) continued physiotherapy on out-patient basis and 12 completed physiotherapy. It was observed that more women had hemi-arthroplasty compared to men. The majority of the patients who had hemi-arthroplasty were aged seventy years and above and were not referred for full physiotherapy. There was poor documentation of the cause of fracture in the files of most of the cases reviewed, though a fall was the cause of fracture in the few that were documented. Outcome measures were underutilized with no record of reported patient-centred outcome measures for all the reviewed cases.KEY WORDS: hemi-arthroplasty, full physiotherapy, ambulatio

Low Back Pain At Work: Knowledge and Attitude of Sectional Heads at the University College Hospital, Ibadan

The purpose of this study was to find out the knowledge and attitude of sectional heads towards managing low back pain (LBP) at work at the University College Hospital, Ibadan. It was also aimed at identifying the difficulties encountered and the organizational needs required in the management of LBP at work. Twenty-nine sectional(16 male and 13 female) heads at the University Teaching Hospital participated in this cross-sectional survey. The participants completed a self-administered questionnaire, adapted from the Management of LBP in the Workplace Questionnaire. Data was analysed using descriptive statistics of mean, standard deviation, frequency, percentages and inferential statistics of Chi square. Level of significance was set at 0.05. Twenty-six (89.7%) of the participants reported no difficulty in managing staff members with low back pain. Seventeen (58.6%) participants had poor knowledge, while 37.9% had fair to good knowledge of managing LBP at work. Twenty-two participants had a positive attitude towards managing staff members with low back pain. There was no significant association (p=0.307) between respondents’ knowledge and attitude towards managing workers with LBP. Organizing workshops for workers was the most frequently reported organizational support required for the management of LBP. Sectional heads at the University College Hospital, Ibadan have poor knowledge but a positive attitude towards managing workers with LBP

Pattern of Motion Restriction in Nigerian Patients with Knee Osteoarthritis

In the Western population, knee osteoarthritis (OA) has been shown to present a characteristic passive motion restriction pattern, called the capsular pattern (extension restriction to flexion restriction ratio ranging from 0.03 to 0.50). The pattern of motion restriction of Nigerian patients with OA has not been previously reported. This study was conducted to determine the pattern of motion restriction in Nigerian patients with knee osteoarthritis. Participants were 50 patients with knee OA (OA Group/OAG), recruited consecutively from two secondary health institutions and 50 age and sex-matched controls (Control Group/CG) without symptoms of OA. Goniometric measurements of passive and active knee motion of participants were taken. Data was analysed using the independent t-test. The OAG, aged 58.1±10.7 years has had OA for 4.0±4.5 years. The CG was aged 55.9±10.3 years. Mean active extension (1.5±5.2°) of the OAG differed significantly (P < 0.05) from that of the CG (0°), but the two groups did not differ significantly in passive extension (OAG = 1.2°±4.4°; CG = 0°). The CG (125.9°±4.6°) had significantly higher (P= 0.0001) active knee flexion than the OAG (99.9°±15.5°). Passive knee flexion of the CG (134.5°±5.0°) was significantly higher (P=0.000) than that of the OAG (110.4°±14.8°). Mean active extension and flexion restriction of OAG was 2.1±5.7° and 26.0±15.4° respectively. Mean passive extension restriction was 1.2±4.4° and passive flexion restriction was 24.0±14.8°, giving a ratio of 0.05 for OAG. Our findings suggest that the passive motion restriction pattern seen in Nigerian patients with knee osteoarthritis is the capsular pattern. KEY WORDS: motion restriction, patients, knee osteoarthriti

Adolescent low back pain among secondary school students in Ibadan, Nigeria

Background: Adolescent low back pain (ALBP) can be considered a signal or precursor of a serious organic disease or telltale sign of future incidence of low back pain in adulthood. Published articles on ALBP in Nigeria are not readily available.Objectives: The study’s objectives were to investigate the prevalence of Adolescent Low Back Pain (ALBP) among secondary school students in Ibadan, Nigeria and the prevalence’s association with some socio-demographic variables.Methods: Participants were adolescent students from 15 secondary schools in Ibadan. Data was collected using a respondent- administered, validated questionnaire on low back pain in adolescents. Participants (Female: 298; Male: 273) aged 14.23 ±2.27 years (range 10-19) were recruited through multi-stage random sampling. Five hundred and seventy-one (83.97%) of the 680 copies of the questionnaire administered were returned. Data was analysed using mean, standard deviation, frequency, percentages, and Chi-square test with alpha level at 0.05.Result: Lifetime, twelve-month, one-month and point prevalence rates of ALBP were 58.0%, 43.8%, 25.6% and 14.7% respectively. Age at first experience of ALBP was 11.86 ± 2.36 years. Gender was not significantly associated with any rate (p ≥0.317). Age (p ≤ 0.043) and engagement in commercial activities (p ≤ 0.025) were significantly associated with all period prevalence rates while injury to the back was significantly associated with all period prevalence rates except point prevalence (p = 0.087).Conclusion: Adolescent low back pain is common among secondary school students in Ibadan and its prevalence is significantly associated with age and engagement in commercial activities, but not with gender.Key Words: Adolescent, low back pain, school childre

Ibadan Knee/Hip Osteoarthritis Outcome Measure: Process of Development

The development of instruments for the assessment of therapeutic intervention has been an age long practice. However, many of the published instruments do not have detailed information on how the instruments were developed. It is necessary for authors to provide detailed (step by step) information on how measuring scales/instruments are developed. The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed as a  Nigerian-environment and culturefriendly instrument for the assessment of the effectiveness of therapeutic interventions in individuals with osteoarthritis of the knee and/or hip. This article outlines the steps involved in developing an outcome measure using IKHOAM as a template

Physiotherapy clinical students’ perception of their learning environment: A Nigerian perspective

Background. A favourable environment has a positive and significant impact on students’ learning, academic progress and well-being. The present study was undertaken to identify the perceptions of physiotherapy students in their clinical years of their learning environment at the College of Medicine, University of Ibadan, Nigeria.Methods. A focus group discussion involving 12 undergraduate  physiotherapy students was used to obtain information about their  perception of their learning environment. Six students from two clinical levels of study were recruited through a simple random sampling  technique. The focus interview guide was developed based on information obtained from the DREEM questionnaire and literature review. The  interviews were analysed using the identified themes from DREEM and grounded theory for emerging subcategories.Results. Five descriptive themes and several subcategories were identified: (i) context of learning (course objectives, student focused/teacher centred, active learning); (ii) context of teachers (knowledgeable teachers, provision of formative assessment, approachable lecturers, cordial teacher-student relationship); (iii) context of students’ perception of their academic skills (understanding the subject); (iv) context of atmosphere (adequacy of facilities, e.g. chairs, classrooms, library, books); and (v) context of social life (religious activities, social functions, school-related social activities).Conclusion. Most students perceived their learning environment as good, especially with regard to student-teacher relationships. Some of the  teachers were described as knowledgeable, and as providing formative  assessment. However, students perceived their learning as being teacher centred. To facilitate an excellent learning environment, particular attention needs to be paid to availability of physiotherapy textbooks in the college library, sufficient appropriate furniture in classrooms, and provision of a functioning departmental library. The findings from this study may provide insights for teachers who wish to enhance the effectiveness of their  teaching and of their students’ learning

Pattern of Spinal Pain Managed at the Physiotherapy Department of a Tertiary Health Institution in Nigeria

Spinal pain (SP) is one of the clinical conditions managed at the  orthopaedic unit of physiotherapy departments of hospitals all over the world. There is a dearth of information on the pattern of SP being  managed in these departments. The aim of this study was to investigate the pattern of SP managed at the physiotherapy outpatient department of the University College Hospital, Ibadan, Nigeria. Newly referred SP cases seen at the outpatient unit of the physiotherapy department, University College Hospital, Ibadan, from January 2006 to December 2010, were identified from the departmental patients’ attendance register. Socio-demographic and clinical information were obtained from the case notes and recorded in a self-designed data recording form. These data were then analysed using descriptive statistics of mean, standard deviation and percentage. The results showed that the cases of SP involved patients between the ages of 13-89 years with a mean age of 53.42±15.08 years. Patients in the age group of 60 years and above had the highest  prevalence (35.23%) of spinal pain. Cases with SP constituted 59.2% of all the cases managed; and more females (62.9%) were reported to have SP. Lumbar spondylosis was the mostly recorded diagnosis while there was no record of coccydynia during the study period. Outcome measures were underutilized with no record of reported outcome measures for the majority of the patients (51.44%). Physiotherapists discharge rate of SP was 9.14%.It can be concluded that SP is a common clinical condition managed in the physiotherapy department of this tertiary health institution, accounting for about 60% of new patients seen and managed at the orthopaedic unit.It is more common in females than males. Lumbar spondylosis was the most frequently reported diagnosis. Utilization of outcome measures and the discharge pattern of these patients by physiotherapists who managedthe patients were poor. This study revealed the need for improvement in clinical documentation of cases, usage of standardized outcome  assessment and the need for improvement in the clinical reasoning skills of physiotherapists.KEYWORDS: spinal pain, physiotherapy department, university college hospital, orthopaedic unit, interventio

Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain

Purpose. The study compared the influence of Clinic-based McKenzie Therapy (CbMT) and a Virtual Reality Game (VRG) version on pain intensity, back extensor muscles endurance, activity limitation, participation restriction, fear avoidance belief, kinesiophobia, and general health status of patients with chronic non-specific low-back pain. Methods. This quasi-experimental study involved 46 patients (CbMT: n = 24; VRG: n = 22) with ‘directional preference’ for extension, randomized into CbMT or VRG group. Treatment was applied thrice weekly for 8 weeks. Outcomes were assessed at the end of the 4th and 8th week. Data analysis employed descriptive and inferential statistics of independent t-test, Mann-Whitney U test, repeated measure ANOVA, Friedman’s ANOVA, and ANCOVA. The significance level was set as = 0.05. Results. There were no significant differences in the treatment outcomes (mean change) across the groups (p > 0.05), except for kinesiophobia, where VRG led to a significantly higher decline in mean rank at week 4 (28.3 vs. 19.1; p = 0.018) and 8 (28.7 vs. 18.7; p = 0.009), and vitality (a general health status item) at week 4 (27.6 vs. 19.8; p = 0.042) and 8 (28.1 vs. 19.3; p = 0.042). ANCOVA showed that significant baseline parameters were not significant predictors of vitality (F = 1.986; p = 0.070) or kinesiophobia (F = 0.866; p = 0.563) outcomes. Conclusions. The VRG mode of McKenzie therapy is comparable with the clinic-based approach in most outcomes. VRG has a superior effect on kinesiophobia, but may take a higher toll on vitality/energy

Comparison of start back screening tool and simmonds physical performance based tests battery in prediction of disability risks among patients with chronic low-back pain

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 was 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

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