Factors Responsible for Final-Year Medical Students Selecting Orthopedic Specialty in Enugu State.

Background: Medical training is one of the core components of the health system of any country. The specialty preferences of medical undergraduates and young medical graduates reflect the pattern of distribution of specialists in the future work-force in the health care system. The preference of Orthopaedic surgery specialty by medical students has been poor. Objective: This study aims to explore the factors responsible for final year medical students choosing orthopedic surgery specialty in Enugu state, Southeast Nigeria. Materials and Methods: A cross-sectional survey of Final year medical Students from two Universities in Enugu state in Southeastern Nigeria was conducted. The Universities were; University of Nigeria, Nsukka (UNN) and Enugu State University of Science and Technology (ESUT). A structured questionnaire designed using the free software google forms was utilized for the study and electronically distributed randomly to 132 final year medical students in Enugu state, Southeast Nigeria using platforms including Whatsapp® and Telegram®. The data collected was analysed by Statistical Package for the Social Sciences (SPSS). Results: At the end of the study, 132 final year medical students completed and submitted the questionnaires. Majority of the students (73%) were not interested in Orthopaedic surgery. Among those who were interested, most indicated that the interest arose spontaneously (31%, n = 11), about 11% attributed the interest to either seeing a movie that showcased the specialty or to good performance in related courses (Anatomy, Radiology, Surgery), while only 8% attributed the interest to effect of lectures in the course or to having a family member who was an orthopedic surgeon. In another 9%, an interest in orthopaedic surgery developed during their posting in the specialty.Among those who were not interested, about 66% attributed this to the specialty being physically demanding while a minority attributed it to other factors like the long duration of residency program in orthopaedic surgery, the interference by traditional bone-setters and male dominated field. A greater proportion of the female respondents (68%) were discouraged by the physical demands of the specialty compared to males (62%).No factors was found to be significantly associated statistically with the interest/lack of interest in orthopaedic surgery specialty among the reasons (Perceived Job prestige x2 = 0.762 P = 0.859, Perceived income x2=2.962 P = 0.227, Perceived work life balance x2=4.087 P = 0.252, Perceived opportunities for research x2=6.895 P = 0.075, Perceived relevance of orthopaedic specialists x2=1.777 P = 0.620). Significance value was P < 0.05. Conclusion: There is a low preference towards orthopedic surgery among final year medical students. This study attempted to highlight the factors responsible for final year medical students selecting orthopedic surgery in Enugu state, Southeast Nigeria and it revealed that clinical rotations, mentorship, work-life balance, job prestige, income and opportunities for research were all important factors. Recommendation: We recommend that more time be allotted to Orthopedics postings to increase interest in the specialty. More Orthopedic surgeons should provide proper guidance and mentorship to medical students in order to influence students choice of specialty.

Awareness of Hazard Risks and Prevention Among Orthopaedic Surgery Residents in South East Nigeria.

Background: Orthopaedic surgery is a specialty that deals with a lot of complex and delicate procedures which involve the use of power tools as well as handling of sharp tools and bony spicules, which, among other things, expose trainees to day-to-day hazards which can predispose them to an array of health challenges and burden the health sector. Knowledge of different measures in minimizing some of these risks can go a long way to saving lives and resources. Objectives: This study aims to determine the level of awareness among orthopaedic surgical residents about various hazards and risks and to ascertain their views on the prevention thereof to guide certain decision-making concerning surgical hazard risk reduction. Materials and Methods: A cross-sectional survey of orthopaedic surgery residents in South East Nigeria was conducted using a structured questionnaire designed using the free software Google® Form and was electronically distributed randomly to orthopaedic surgery residents in southern Nigeria using platforms including WhatsApp and Telegram. The data obtained were analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 26. Consent was obtained from all respondents by outlining a clear statement of consent at the beginning of the form. Results: At the end of the study period, 49 surgical residents completed and submitted the questionnaire. There was a significant level of awareness of surgical hazard risks among the surgical residents, with over 90% agreeing to radiation exposure, needlestick injury, and inhalation of smoke being the major surgical hazard risks encountered in orthopaedic surgery practice. Over 95.9% of the respondents agreed that the use of sharp collection devices can help reduce needlestick injuries. All respondents agreed that the provision of adequate personal protective equipment (PPE) can help reduce surgical hazards. It was noted that the majority of the respondents (65.3%) had their preliminary knowledge about exposure to surgical hazard risks and appropriate safety measures during their undergraduate education. About 30.6% were aware of a surgery hazard risk safety guideline in their training centres, whereas only 65.3% of those people have studied the guidelines. There was no statistically significant associations between the level of training and marital status and those who had studied the surgical hazard risk guidelines available in their centres (P = 0.086, χ2= 2.942; P = 0.715, χ2=0.133, respectively). All of the residents know that immunization can help reduce the impact of disease risk among the surgery staff, but only 73.5% have completed a hepatitis B immunization and 55.1% have completed the tetanus immunization. Conclusion: Surgical hazards risks are important issues that need to be addressed and measures regularly reviewed appropriately to ensure and maintain the safety and health of the orthopaedic surgical and all other health personnel. There is a significant level of awareness of surgical hazard risks and prevention measures among orthopaedic residents, but the level of compliance to safety guidelines is not yet optimal. Recommendation: PPEs and sharp collection boxes should always be available in theatres and measures should be taken to encourage residents' adherence to studying and practicing established surgical safety guidelines in their hospitals and also completing their immunization schedules.

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.