Quality of life of stroke survivors: A cross-sectional study of association with functional independence, self-reported fatigue and exercise self-efficacy.

OBJECTIVES: Stroke is a leading cause of disability and one of the most debilitating conditions especially in the developing world. Rehabilitation focuses on improving functional ability which may enhance quality of life (QoL). The aims of this study were to investigate the association between QoL and each of functional independence (FI), self-reported fatigue (SRF) and exercise self-efficacy (ESE) in stroke survivors. METHODS: This is a descriptive cross-sectional survey, documenting QoL, FI, SRF and ESE of stroke survivors seen at the physiotherapy outpatient clinics of two health care facilities in Oyo state, Nigeria. Descriptive and inferential statistics were used to analyse the data with significance level set at 0.05. RESULTS: Participants were 110 stroke survivors (64 males; 46 females) aged 60.9 ± 11.9 years. Significant associations were found between QoL and each of FI and ESE (p < 0.01) while no significant association was observed for SRF. FI strongly predicts good QoL in stroke survivors (OR = 16.34; p < 0.01) and high ESE is a determinant of QoL (OR = 6.46; p = 0.04). Stroke survivors with SRF were less likely to report good QoL. DISCUSSION: Functional independence and exercise self-efficacy were directly associated with QoL and were also major predictors of good QoL in stroke survivors.

Patients' Experiences About Exercise Prescription and Education in the Physiotherapy Management of Nonspecific Low-Back Pain.

Low-back pain (LBP) is highly prevalent in the society, and its socioeconomic consequences are quite evident. Physiotherapists play a prominent role in the management of individuals with this condition, and it is, therefore, of utmost importance that physiotherapists engage in the most efficient and effective management practices available. For perceptions of good performance and quality health care, patient experience is an important indicator of effective care and management. A mixed-methods research design-a cross-sectional survey (quantitative research) and a focus group discussion (FGD; qualitative research)-was employed in this study, investigating patients' experience in physiotherapy management of nonspecific LBP. An adapted questionnaire was used for data collection from purposively selected participants recruited from 3 hospitals in Kubwa, Abuja, from April to August 2018. The FGD involved 6 patients recruited by simple random sampling using the fishbowl technique. Descriptive and thematic analyses were done on data collected. A total of 126 patients (male = 41, female = 85) were included, with a mean age of 51.0 ± 14.6 years, while the modal age-group was 60 to 69 years. Of these, 41 (32.5%) had nonspecific LBP for less than a year, and the 2 most applied interventions were exercise and heat therapy, followed by education/advice. In all, 110 (87.3%) reported positive experience about education, while 119 (94.4%) reported positive experience about exercise prescription. The result from the qualitative research is in conformity with that of the quantitative analysis. Patients with nonspecific LBP received adequate education regarding their condition and had good experience in the course of their physiotherapy management.

Effectiveness of neck stabilisation and dynamic exercises on pain intensity, depression and anxiety among patients with non-specific neck pain: a randomised controlled trial.

BACKGROUND AND AIMS: Non-specific neck pain (NsNP) constitutes a burden to the bearers and a management challenge to physiotherapists globally. Effectiveness of neck stabilisation and dynamic exercises in the management of NsNP has been documented, but it is not clear which exercise regimen is more effective in alleviating its associated pain, depression and anxiety. This study was carried out to compare the effectiveness of neck stabilisation and/or dynamic exercises on pain intensity, depression and anxiety among patients with NsNP. METHODS: Eighty-nine consenting individuals with NsNP participated in this single-blind, randomised controlled trial. They were recruited from the outpatient physiotherapy clinics of the National Orthopaedic Hospital in Dala, Kano State, Nigeria. Participants were randomly assigned into one of three intervention groups: neck stabilisation exercise group (NSEG; n=30), neck dynamic exercise group (NDEG; n=28) and neck stabilisation and dynamic exercise group (NSDEG; n=31). Treatment was administered thrice weekly for 8 consecutive weeks. Variables were assessed at baseline, at the end of the fourth and eighth weeks. Pain intensity was assessed through the use of a visual analogue scale, while depression and anxiety were evaluated using both the Beck Depression Inventory and Beck Anxiety Inventory. The data was analysed using descriptive statistics, multivariate analysis of variance (MANOVA) and post hoc tests with Bonferroni adjustment at the p=0.05 significant level. RESULTS: Ages of participants in NSEG (46.8±12.4 years), NDEG (48.6±11.6 years) and NSDEG (45.1±13.4 years) were comparable. The comparison for NSEG, NSDEG and NDEG within groups revealed that there was significant difference in pain intensity, depression and anxiety scores from baseline, in the fourth and eighth weeks of the study - (F=62.40, p=0.001, F=13.91, p=0.001 and F=20.93, p=0.001); (F=11.92, p=0.001, F=8.75, p=0.004 and F=9.70, p=0.001) and (F=36.63, p=0.001, F=11.99, p=0.001 and F=6.59, p=0.001), respectively. A group comparison of the pain intensity, depression and anxiety scores of participants in the NSEG, NSDEG and NDEG at the baseline of the study revealed that there were no significant differences in the pain intensity and depression and anxiety scores among the three groups: p=0.159, 0.58 and 0.179, respectively. At week 4 of the study, however, a significant difference in pain intensity and anxiety scores across the three groups was recorded - p=0.018, p=0.011, respectively, but no significant difference was noted in depression scores (p=0.93). At week 8 of the study, it was determined that there were significant differences in pain intensity and depression scores p=0.001 and p=0.041, but no significant dissimilarities in the anxiety scores. Post hoc revealed that only pain was significant and lay with NSEG. CONCLUSIONS: The study concluded that the stabilisation, dynamic and stabilisation, plus dynamic exercises were effective in relieving pain and reducing depression and anxiety in patients with NsNP. However, stabilisation showed a more marked effect than the combination exercises of stabilisation plus dynamic exercises, and dynamic exercises in reducing pain intensity in patients with NsNP. IMPLICATIONS: It is recommended that stabilisation exercises be chosen over stabilisation plus dynamic exercises, or dynamic exercise, while treating patients with NsNP. However, both are effective.

An Analysis of Work-Related Musculoskeletal Disorders Among Butchers in Kano Metropolis, Nigeria.

BACKGROUND: Butchering is often associated with high rates of work-related musculoskeletal disorders (WRMSDs). However, published work on the prevalence of WRMSDs among butchers in Nigeria is scarce. This is important because meat processing practices differ across geographical and cultural locations. This study was therefore aimed at analyzing WRMSDs among butchers in Kano metropolis. METHODS: Sociodemographic and work-settings information was obtained from 102 male cattle butchers (age, 37.49 ± 11.68 years) through survey. Information on the prevalence and pattern of musculoskeletal disorders was obtained from the respondents using the Standardized Nordic Questionnaire. Additional information on health seeking practices was also obtained using a pro forma. Associations between the prevalence of WRMSDs and each of the sociodemographic data and work settings were explored using Chi-square analysis. The level of significance was set at p < 0.05. RESULTS: The 12-month and point prevalence rates of WRMSDs among butchers in this study were 88.2% and 74.5%, respectively. Whereas lower back complaints (66.7%) were the overall and lower body quadrant's most commonly reported WRMSDs among the butchers surveyed, wrist/hand complaints were the leading upper quadrant's (45.1%) most commonly reported WRMSDs among the respondents. There were significant associations between age and majority of WRMSDs in the body regions. Only 23.3% of the 90 individuals who had WRMSD visited the hospital to seek redress for their WRMSD. CONCLUSION: The prevalence of WRMSDs is high among butchers in Kano Metropolis. Few individuals with WRMSD utilize healthcare facilities. Age is a major risk factor in this setting.

Physical activity level of postmenopausal women in Nigeria: Association with self-rated health status, overall obesity, and abdominal obesity.

Regular physical activity (PA) has been shown to have many health benefits in various populations, including postmenopausal women (n = 310). Self-rated health has been positively associated with PA. This cross-sectional survey of postmenopausal women in Nigeria was conducted from April to September 2012 to investigate associations among PA level, self-rated health, overall obesity (body mass index [BMI]), and abdominal obesity (waist-height ratio, waist-hip ratio, and waist circumference). The International Physical Activity Questionnaire was used to classify PA. Chi-square and logistic regression were used for analyses with level of significance set at .05. Participants were aged 53.0 ± 4.2 years; moderate to vigorous PA was reported by 188 (60.0%), while 26 (8.4%) self-rated their health as poor/fair, and 242 (78.1%) were either predominantly overweight or obese when classified according to BMI. Participants with fair/poor self-rated health had less odds of involvement in moderate to vigorous PA. Obese postmenopausal women had greater odds of reporting lower PA. PA was positively related to self-rated health, which was negatively associated with overall obesity but not abdominal obesity. Measures to control obesity among postmenopausal women are essential in view of its direct association with poor self-rated health and low PA in this group of women.

Musculoskeletal pain among postmenopausal women in Nigeria: Association with overall and central obesity.

BACKGROUND: Menopausal women experience musculoskeletal changes such as muscle atrophy, muscle weakness and osteoporosis-symptoms associated with advancing age coupled with depletion of the female sex hormone, estrogen. Estrogen is important in the maintenance of the integrity of the musculoskeletal system and its reduction in the circulation due to menopausal transition results in reduced resting metabolic rate, lowered energy expenditure, increase in fat mass, and central adipose tissue accumulation. OBJECTIVE: This study investigated the prevalence of musculoskeletal pain (MSP) in postmenopausal women (PMW) in Nigeria. We examined the association of overall and central obesity with complaints of MSP and the screening potential of obesity measures for risk of musculoskeletal problems among PMW in Nigeria. METHODS: This was a cross-sectional survey of MSP in 310 PMW in Ibadan, Nigeria. MSP was assessed using the Standardized Nordic Musculoskeletal Questionnaire, and overall and central obesity were assessed using body mass index (BMI), waist/height ratio (WHtR), waist circumference, and waist/hip ratio. Data were analysed using descriptive statistics, chi-square test, and logistic regression models with the probability level at p = 0.05. RESULTS: Participants were of the modal age group (51-60 years). The highest prevalence rates of MSP were in the lower extremity (189; 61.0%) and the back (164; 52.9%). A direct association was observed between the categories of BMI and lower extremity symptoms (p < 0.05), and the categories of WHtR and waist circumference were associated with back and lower extremity symptoms (p < 0.05). Postmenopausal women had greater odds of reporting MSP across various classes of BMI. WHtR revealed the greatest odds for back (odds ratio = 1.70, 95% confidence interval 1.07-2.75) and lower extremity symptoms (odds ratio = 2.33, 95% confidence interval 1.44-3.78). CONCLUSION: Lower extremity and back pain symptoms were the most prevalent. For overall and central obesity directly associated with MSP, WHtR seemed the best obesity screening tool for MSP in postmenopausal women.

Physical activity and energy expenditure: findings from the Ibadan Pregnant Women's Survey.

Physical activity, if there are no medical caveats, is beneficial to all people including pregnant women. This study examined the level of physical activity in a group of pregnant Nigerian women. Pregnancy Physical Activity Questionnaire was used to assess the physical activity of 453 pregnant women. The mean age of participants was 30.89 +/- 4.44 years, 222 (49.0%) were sedentary, and only 46 (10.2%) presented with moderate activity level. The highest amount of energy (75.9 MET-h x wk(-1)) was expended on household activities. Women in the third trimester of pregnancy had more than three times the risk of being sedentary (OR = 3.26, 95% CI = 2.11-4.56) but the risk reduced by 58% in gravid > or = 5 women. Most of the pregnant women recorded physical activity that was lower than the recommended level, which could lead to unfavourable health outcomes for mother and child. Efforts to promote physical activity in pregnant women in this environment are desirable.

Physical activity and pattern of blood pressure in postmenopausal women with hypertension in Nigeria.

BACKGROUND: Hormonal changes during menopause have been attributed to hypertension-a common public health concern. This study investigated physical activity (PA) and pattern of blood pressure (BP) in postmenopausal women newly diagnosed with hypertension and referred for treatment at the medicine outpatient clinic of a tertiary health facility in Ibadan, Oyo State, Nigeria. It compared BP pattern and adiposity variables [body mass index (BMI) and waist-hip ratio (WHR)] between two PA groups. METHODS: Purposive sampling technique was used to recruit 220 participants in this cross-sectional survey after obtaining their informed consent. International Physical Activity Questionnaire was used to assess PA level, while a 16-item questionnaire was used to assess socio-demographic and clinical profiles of the women. BP, BMI and WHR were assessed using standard measurement procedures. Descriptive statistics of mean ± standard deviation were used for data summarization and independent t-test was used to compare variables between low level and moderate to vigorous level PA groups. RESULTS: Participants' mean values include: age 61.6 ± 8.5 years, years since menopause 12.75± 8.15, BMI 28.63±4.99kg/m(2), WHR 1.11±0.08, SBP and DBP 145.9±17.9; 93.7±11.4 mmHg respectively. Mean values of SBP, DBP, BMI and WHR were higher among participants with low PA compared to those with moderate to vigorous even though the difference was not statistically significant (P>0.05). CONCLUSION: Involvement in moderate to vigorous physical activities among menopausal women in Nigeria should be encouraged. This may reduce hypertension and adiposity with a possible control of cardiovascular disease risk.

Translation of the fear avoidance beliefs questionnaire into Hausa language.

BACKGROUND: Self-report measures of fear-avoidance beliefs are widely used in clinical practice and research. To date there is no Hausa version of the Fear Avoidance Beliefs Questionnaire (FABQ). This is important as the Hausa language is a widely spoken language in West Africa. OBJECTIVES: The purpose of this study was to translate and validate the Hausa version of the FABQ in patients with non-specific neck pain. METHODS: Two independent bilingual Hausa translators translated the English version of the FABQ into Hausa which was thereafter back translated by one independent bilingual translator. A professional expert panel revised the translations to produce a consensus version. The psychometric testing of the final translated instrument was investigated by surveying 54 Hausa speaking patients with chronic non-specific neck pain. Cross-sectional construct validity was evaluated by comparing Hausa Fear Avoidance Beliefs Questionnaire (FABQ-H) with the English version of the FABQ. Internal consistency of the FABQ-H was examined by Cronbach alpha by comparing the scores between the FABQ-H and its subscales. Test-retest reliability was evaluated by administering the Hausa version twice. RESULTS: The translated Hausa version of FABQ proved to be acceptable. The FABQ-H showed strong correlations (r=0.94, p=0.000) with the original English version. There was also high internal consistency between the FABQ-H and its subscales (physical activity component-alpha=0.88, p=0.000 and work component- alpha=0.94, p= 0.000). The FABQ-H also showed a high test-retest reliability (intra-class correlation coefficient =0.98). CONCLUSION: The FABQ-H demonstrated excellent psychometric properties similar to other existing versions. The FABQ-H is recommended for clinical practice.

Profile of children with new-born brachial plexus palsy managed in a tertiary hospital in Ibadan, Nigeria.

New-born Brachial Plexus Palsy (NBPP) is birth injury resulting from traction to the brachial plexus at birth. It is an injury to two or more cervical or thoracic nerve roots. It has been reported to be one of the most common birth injuries of the new-born. Persistent presentation of children with NBPP in Nigeria paediatric practice necessitates the need to examine prevalence, patterns and possible predisposing factors. This study therefore investigated retrospectively, profiles of children who presented with NBPP over a ten year period and were managed at the Physiotherapy department of the University College Hospital, Ibadan Nigeria. A retrospective cross-sectional survey, in which files of children with NBPP located from the database of the Physiotherapy department were retrieved in order to assess infant and maternal information. One hundred and seventy children, 93 (54.7%) males and 77 (45.3%) females were studied. Their mean birth weight was 4.21±0.54 kg, 99 (58.2%) were delivered in private (non-government) hospitals, majority 163 (95.9%) presented with Erb's Palsy. Mothers, 54 (31.8%) were mostly primiparous and a seemingly persistent elevation in two-yearly incidence of NBPP was observed. Improved healthcare policy in child delivery is encouraged in non-government hospitals in Nigeria to provide preventive measures toward incidence of NBPP. Documentation of physiotherapy management of children with NBPP should include outcomes from admission through to discharge.

Research profile of physiotherapy undergraduates in Nigeria.

OBJECTIVES: Physiotherapy training in Nigeria is almost 50 years old with no history of appraisal of research projects produced by the physiotherapy students. Physiotherapy students complete research projects in partial fulfilment of the requirements for graduation. An appraisal will reveal areas of strength and weakness in the research requirement for students, potentially leading to better research capacity and promoting evidence-based clinical practice among graduates. This study describes issues related to the study design, scope, statistical analysis and supervision of physiotherapy undergraduates in Nigerian universities. METHODS: This retrospective study analysed 864 projects undertaken by Nigerian physiotherapy students between years 2000 and 2010. A maximum of 20 projects per academic year were randomly selected from each of the seven physiotherapy institutions in Nigeria. Data were obtained using a self-designed data retrieval form and analysed using descriptive and inferential statistics. RESULTS: Cross-sectional surveys constituted 47.6% of the research projects with mainly non-probability sampling (57.7%) and lack of objective sample size determination in 91.6% of the projects. Most projects (56.4%) did not report any ethical approval. The particular university attended (χ2 = 109.5, P = 0.0001), type of degree offered (χ2 = 47.24, P = 0.00001) and the academic qualification of supervisors (χ2 = 21.99, P = 0.001) were significantly related to the strength of the research design executed by students. CONCLUSIONS: Most research projects carried out by Nigerian physiotherapy students were cross-sectional, characterised by arbitrary sample sizes, and were conducted on human subjects but most without report of ethical approval. Efforts to improve research methodology, documentation and exploration of a wider range of research areas are needed to strengthen this educational experience for students.

Children with paralytic poliomyelitis: utilization of physiotherapy services in Zamfara State, Nigeria.

Physiotherapy is usually indicated for health promotion and the rehabilitation of individuals with paralytic poliomyelitis. The endemic nature of this condition in children in Zamfara State, Nigeria necessitated investigation into the utilization of physiotherapy services by parents or primary caregivers of children affected with polio in this sub-region. Parents and primary caregivers of children with paralytic poliomyelitis were recruited using a purposive multi-stage sampling procedure in a cross-sectional survey. Factors associated with the utilization of physiotherapy services were assessed based on questions extracted from a 4-part, 52-item structured questionnaire originally designed for a study which investigated knowledge, attitude, and beliefs of parents of children with paralytic poliomyelitis. A total of 217 participants were included in this study. The mean age was 32.29 ± 9.89 years and the mean knowledge of polio score was 62.0 ± 17.3%. The mean age of the children with paralytic poliomyelitis was 6.41 ± 2.50 years. Only 27.2% of the parents or primary caregivers had utilized physiotherapy service for their children at some point. No association existed between utilization of physiotherapy service and 'knowledge of paralytic poliomyelitis', 'employment status', and 'family income' of respondents. Explanations for low utilization of physiotherapy services for children with paralytic poliomyelitis by parents or primary caregivers are discussed.

The SPLASH/ICPC integrity marathon in Ibadan, Nigeria: incidence and management of injuries and marathon-related health problems.

BACKGROUND: The growing interest in marathon runners and marathons in Nigeria has not been reflected in reports of injuries and other health problems associated with these events. This study therefore outlines the incidence of injuries, marathon-related health problems and delivery of physiotherapy at the maiden and second editions of the Splash 105.5 FM/ICPC Integrity Marathon in Ibadan city, south-west Nigeria in 2009 and 2010. METHODS: Using a data entry sheet, demographics and information on running experience, past and present injuries and other health problems reported en route and at the finish line by the runners were documented. The prevalence of injuries and other health problems reported by previous and first-time runners were compared. RESULTS: In both events, 16.3% and 17.2% of the runners respectively reported injuries with significant occurrence in first-time runners (p = 0.003 for 2009; p = 0.002 for 2010) mostly at the finish line. The reported injury type and site were muscle cramps and the thigh (39.7% and 76.4% respectively). Heat exhaustion was reported by 42.8% of runners in 2009 and 56.3% in 2010. Cryotherapy was mostly used in combination with other physiotherapy modalities in both years. CONCLUSION: Most of the injuries and other health problems were reported by first-time marathon runners mainly at the finish line. The most reported site of injury was the thigh while muscle cramps and heat exhaustions were the most reported types of injuries and health problems. First-time marathon runners should be adequately informed of the predisposition to injury during marathons and adequate body conditioning should be emphasized. Ample preparation and effective involvement of the physiotherapy team is essential for management of injured runners en route and at the finish line in a marathon.

Children with paralytic poliomyelitis: a cross-sectional study of knowledge, attitudes and beliefs of parents in Zamfara state, Nigeria.

BACKGROUND: Nigeria is one of the major African countries in which incidences of polio infection persist in spite of several eradication efforts. The preponderance of paralytic poliomyelitis particularly in the northern part of Nigeria raises the question as to whether parents of children affected with polio know how polio is contracted and spread, whether having a disabled child affects the parents' attitude towards these children, and what they believe about poliomyelitis in view of their socio-cultural and belief system in the sub-region. Zamfara State, in the north-west of Nigeria is one of the endemic areas where resistance to the global campaign on polio eradication was very high. Therefore this study was conducted to investigate the knowledge, attitudes and beliefs of parents/primary caregivers of children affected with paralytic poliomyelitis in Zamfara State. METHODS: This study is a cross-sectional survey in which the multistage probability sampling technique was used to randomly select two local government areas in Zamfara State where consenting parents/primary caregivers of children with paralytic poliomyelitis were purposively selected. The knowledge, attitudes and beliefs of parents were assessed with the aid of a 4-part 52-item structured researcher administered questionnaire and the data obtained were analyzed. RESULTS: Two hundred and seventeen parents/primary caregivers participated in the study. One hundred and forty-two, (65.4%) reported good, 51 (23.8%) reported fair, while 24 (11%) of participants reported poor knowledge of paralytic poliomyelitis. More respondents 120 (55.3%) showed a positive attitude towards children with paralytic poliomyelitis. Younger age (P=0.016) and paid employment (P=0.020) were positively associated with good knowledge of paralytic poliomyelitis. Female gender (P=0.020), higher educational level (P=0.015), being employed (P=0.010) and having from middle to high household income (P=0.016) were positively associated with a positive attitude toward children with paralytic poliomyelitis. Most respondents showed a reasonable belief over the cause of their children's condition rather than the erroneous traditional belief that paralytic poliomyelitis is caused by spirit forces. CONCLUSIONS: It is of great concern that the good knowledge, positive attitude and reasonable belief by parents/primary caregivers about paralytic poliomyelitis observed in this study did not play a prominent role in preventing susceptibility of children in north-west Nigeria to paralytic poliomyelitis. It is imperative that Nigerian policy makers should device more strategic measures toward the prevention of paralytic poliomyelitis in this sub region.