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.

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. LEVEL OF EVIDENCE: 3.

Influence of Mckenzie protocol and two modes of endurance exercises on health-related quality of life of patients with long-term mechanical low-back pain.

INTRODUCTION: Long-term Mechanical Low-Back Pain (LMLBP) negatively impacts on patients' physical capacity and quality of life. This study investigated the relationship between Health-Related Quality of Life (HRQoL) and pain intensity, and the influence of static and dynamic back extensors' endurance exercises on HRQoL in Nigerian patients with LMLBP treated with the McKenzie Protocol (MP). METHODS: A single-blind controlled trial involving 84 patients who received treatment thrice weekly for eight weeks was conducted. Participants were assigned to the MP Group (MPG), MP plus Static Back Endurance Exercise Group (MPSBEEG) or MP plus Dynamic Endurance Exercise Group (MPDBEEG) using permuted randomization. HRQoL and pain was assessed using the Short-Form (SF-36) questionnaire and Quadruple Visual Analogue Scale respectively. RESULTS: Sixty seven participants aged 51.8 ± 7.35 years completed the study. A total drop-out rate of 20.2% was observed in the study. Within-group comparison across weeks 0-4, 4-8 and 0-8 of the study revealed significant differences in HRQoL scores (p < 0.05). Treatment Effect Scores (TES) across the groups were significantly different (p = 0.001). MPSBEEG and MPDBEEG were comparable in TES on General Health Perception (GHP) at week 4; and GHP and Physical Functioning at week 8 respectively (p > 0.05). However, MPDEEG had significantly higher TES in the other domains of the SF-36 (p = 0.001). CONCLUSION: HRQoL in patients with LMLBP decreases with pain severity. Each of MP, static and dynamic back extensors endurance exercises significantly improved HRQoL in LMLBP. However, the addition of dynamic back extensors endurance exercise to MP led to greater improvement in HRQoL.

Pathologic fractures of long bones in Nigerian children.

BACKGROUND: Pathologic or spontaneous fractures are recognised causes of morbidity in children. There is a paucity of data on their aetiology and patterns in African children. METHODS: A combined retrospective and prospective study of 47 children aged 15 and below with pathologic fractures of long bones seen from January 2000 to December 2006. The setting was the Orthopaedic and Traumatology department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: A total of 47 patients with a mean age of 5.3 years +/- SD with pathologic fractures of 50 long bones were seen and treated. The most commonly affected bones were the femur (28%), tibia (28%) and humerus (26%). Chronic osteomyelitis following inadequately treated acute haematogenous osteomyelitis was the commonest cause of pathologic fractures (74.5%). The mean duration of fracture union was 6.8 +/- 2.3 months and the outcome was satisfactory in 91.4% of cases. CONCLUSIONS: The aetiology of pathologic fractures in the African population is different from their causes in Caucasian children. Chronic osteomyelitis following inadequately treated acute haematogenous osteomyelitis continues to plague many children in our environment.

Immunohematological characteristics of Nigerian sickle cell disease patients with osteomyelitis.

OBJECTIVE: We aimed in this paper to investigate some immunohematological characteristics of Nigerian sickle cell anemia (SCA) patients with osteomyelitis. METHODS: Thirty SCA patients with osteomyelitis (SO) and 30 SCA patients without osteomyelitis (S) were investigated. The PCV, WBC and platelet count were done on automated counter, while the erytorocyte sedimentation rate (ESR) was determined by Westergren's technique. C3 activator, C1-INH, IgA, IgG and IgM were estimated by the single radial immunodiffusion method. RESULTS: The SO patients weighed less (z =1.943, p<0.055) and were shorter (z = -2.064, p<0.039). High serum levels of IgG, IgM, C1-INH and C3 activator were also found in the SO group. ESR correlated positively with hematocrit (r=0.371, p<0.04) and C3 activator (r=0.468, p<0.03) in SO. Similarly, WBC correlated positively with C1-INH (r=0.806, p<0.01), while we also noted positive correlation between C1-INH and C3 activator (r=0.525, p<0.02). In SO, ESR correlated positively with both IgM (r=0.531, p<0.02) and C3 activator (r=0.449, p<0.05). CONCLUSION: This study suggests some derangement in immune status in Nigerian SCA patients with osteomyelitis and that C1-INH and C3 activator may be useful markers of immune status in SCA patients.