Aderonke O. Akinpelu

Quality of life of stroke survivors and apparently healthy individuals in southwestern Nigeria

Quality of life (QoL) data have been used to assess treatment outcomes and to guide programme and rehabilitation efforts. QoL data in stroke survivors (SSV) from Nigeria are rare. This study compared the QoL of 84 SSV and 87 matched apparently healthy individuals (AH) in southwestern Nigeria. The effect of poststroke duration (PSD) on QoL and the relationship between QoL and motor performance (MP) were also investigated. SSV were recruited from all (7) tertiary health institutions in southwestern Nigeria. The fifth edition of Comprehensive Quality of Life Adult questionnaire and the Modified Motor Assessment Scale were used to assessed QoL and MP, respectively. Data were analyzed by using Mann-Whitney U-test, Spearmans correlation test, independent t-test, and Kruskaal-Wallis test (α=0.05). The SSV and AH were aged 59.7±11.9 and 60.0±12.1, respectively. SSVs’ mean PSD and MP score were 17.8±15.4 months and 55.3%±18.9%, respectively. Objective QoL of SSV (42±12.8) was significantly lower (p < 0.05) than that of the AH (56.3±6.7). Subjective QoL of SSV (67.8±10.6) was also significantly lower than that of the AH (74.2±6.4). AH had significantly higher QoL than SSV in all but material, intimacy, and safety (subjective and objective) domains. There was no significant relationship between MP and QoL, and PSD had no significant influence on QoL. Our findings suggest that stroke survivors in southwestern Nigeria have lower QoL than their apparently healthy counterparts and may benefit from comprehensive management programmes.

Prevalence, pattern and impact of depression on quality of life of stroke survivors

Abstract Objective. This study documented the incidence, pattern and impact of depression on QoL of stroke-survivors within 6-month post-stroke. Methods. This study involved 65 stroke survivors consecutively recruited at ictus from a tertiary health institution in Nigeria. The National Institute of Health Stroke-Scale, Stroke-Specific Quality-of-Life (SSQOL), international classification of diseases (tenth edition) and Center for Epidemiological Scale-Depression (CES-D) were administered at ictus to assess stroke-severity, QoL and depression respectively. The SSQOL, ICD-10 and CES-D were subsequently administered every other week for 6 months. Data were treated using Spearmans correlation coefficient, Mann–Whitney U-test and multivariable stepwise linear regression analysis (P=0.05). Results. Participants were age 58.1±15.7 years; 38 and 27 hemorrhagic and ischaemic stroke respectively. Twenty-six (40%) and 60.0% had moderate and severe stroke, respectively. The QoL at post-stroke periods were significantly influenced (P<0.05) by depression, age, marital status, spouse supports, stroke-severity, and educational-attainment. Depression determined (P<0.05) poor QoL in stroke-survivors. Co-morbidity with stroke severity was a determinant (P<0.05) of poor QoL and death. The haemorrhagic stroke survivors had significantly higher (P<0.05) QoL at post-stroke periods. Conclusion. Depression is associated with stroke. It is common within the first 6 months post-stroke and has negative impact on quality of life of stroke-survivors.

Self-Reported Quality of Life Before and After Aerobic Exercise Training in Individuals with Hypertension: A Randomised-Controlled Trial

BACKGROUND The Effects of Aerobic Exercise Training (AET) on self-reported Quality of Life (QoL) in people with hypertension have been previously documented. However, data on black populations, especially from Africa, seem not to be available. This study investigated the effects of AET on QoL and exercise capacity in Nigerians on treatment for essential hypertension. METHOD This randomised-controlled trial involved newly diagnosed individuals, with mild-to-moderate essential hypertension randomly assigned to antihypertensive drugs (ADs) alone (control: n = 60) and AET+ADs (exercise: n = 60) groups. The study lasted for 12 weeks. QoL was measured using the World Health Organization QoL Short Form (WHOQoL-BREF) and exercise capacity was assessed using the Rockport Fitness Walk Test pre- and post-study. RESULTS Physical health, psychological health, and social relationships domains of QoL improved significantly in the exercise and control groups post-intervention. The environment domain of QoL and exercise capacity improved significantly in only the exercise group. There were larger improvements in the physical health, psychological health, and environment domains of QoL, and exercise capacity in the exercise group. CONCLUSION Aerobic exercise improves QoL and exercise capacity in individuals with essential hypertension.

Adiposity and quality of life: a case study from an urban center in Nigeria.

OBJECTIVE To determine relationship between adiposity indices and quality of life (QOL) of residents of a housing estate in Lagos, Nigeria. DESIGN Cross-sectional survey employing multistep random sampling method. SETTING Urban residential estate. PARTICIPANTS This study involved 900 randomly selected residents of Abesan Housing Estate, Lagos, Nigeria. MAIN OUTCOME MEASURES Body mass index (BMI); waist circumference (WC); waist-to-hip ratio (WHR); triceps skin-fold thickness (TSFT); and abdominal skin-fold thickness (ASFT) were measured using International Standard of Anthropometric Assessment methods. QOL was assessed using Short Form-20. ANALYSIS Data were analyzed using the Pearson product moment correlation coefficient and multiple regression analysis. RESULT The mean age of participants was 37.7 +/- 14.3 years, with a range of 20 to 80 years. The mean values of adiposity indices were 24.1 +/- 4.3 kg/m(2) (BMI), 11.5 +/- 5.3 mm (TSFT), 18.5 +/- 6.2 mm (ASFT), 81.8 +/- 11.2 cm (WC), and 0.89 +/- 0.1 (WHR). Although the overall mean QOL score was 72.02 +/- 11.9, women had significantly (P < .05) lower scores (70.1 +/- 5.2) than men (73.5 +/- 11.3). There was inverse correlation between QOL and each of the age and adiposity indices. CONCLUSION AND IMPLICATIONS Quality of life of the urban-dweller Nigerians decreased with increasing body adiposity and age. This finding suggests the need to further educate the Nigerian public on the association between high body fat and poor health.

Can aerobic exercise complement antihypertensive drugs to achieve blood pressure control in individuals with essential hypertension

Achieving adequate blood pressure (BP) control with antihypertensive medication remains an elusive goal for many patients. The advances in knowledge of hypertension and the increasingly improved upon therapeutic strategies seem not to guarantee even sustainable control rates at the population level. In addition, patients who either discontinue their medications or are non-adherent to drug therapy run the risk of developing uncontrolled BP. Number of daily tablets more than two and number of daily drug administration at least three have been associated with poor adherence with drug therapy. However, BP control seems to go beyond adherence with drug therapy as there are other associated factors. Studies have demonstrated beneficial effect of aerobic exercise in the prevention and management of hypertension. It appears, however, that the majority of these studies failed to explore the possible additive or synergistic effect of aerobic exercise on antihypertensive drugs such that fewer drugs would be required to achieve BP control or that the BP control rate would be increased with the same number of drugs. This review presents the evidence for poor BP control in the general population, and the possible means and process of aerobic exercise complementing antihypertensive drug therapy in order to achieve higher BP control rates.

Body size perceptions and weight status of adults in a nigerian rural community

Background: Overweight and obesity are now recognized worldwide as increasing public health problems throughout the life course and wrong perception of ones body size may reduce the motivation for an overweight person to lose weight. Aim: This study was conducted to investigate how Nigerian rural dwellers perceive their body size and how their perception agrees with their body mass index (BMI). Subjects and Methods: A cross-sectional sample of 183 adults living in a rural community, South-West Nigeria was randomly recruited into the study. Their verbal and visual body size perceptions were assessed through structured questions and body images. Descriptive and inferential statistics were used to analyze the data. Results: Thirty-five percent (64/183) of participants were classified as either overweight or obese by BMI. More than half of the participants perceived themselves as normal weight. More women perceived themselves to be obese than men in both verbal and visual perceptions. Based on BMI classification, 43% (79/183) and 54% (98/183) of participants misperceived themselves in verbal and visual perception, respectively. Underestimation of body size was higher in men (38.3%, 36/94) while overestimation was higher in women (9.0%, 8/89). Men had consistently higher values of kappa coefficient which indicate greater agreement than women in both types of perception. Conclusion: We found considerable gender differences in body weight perception of adults in the Nigerian rural community. A large proportion of these rural dwellers could not appropriately classify their weight status; and over 30% (64/183) and nearly 50% (92/183) of them underestimated their own body weight in verbal and visual perceptions respectively.

The Reliability of the English Version of Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM)

ABSTRACT Background: The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) an outcome measure developed for evaluating the outcome of therapeutic interventions in patients with knee and/or hip osteoarthritis (OA) in Nigerian clinical settings and similar environment. The aim of this study was to investigate the reliability of the English version of the IKHOAM. Methods: Fifty-four English-speaking patients with OA of knee/hip from physiotherapy clinics of all secondary and tertiary health institutions in Ibadan participated in this cross-sectional survey. The participants completed the self-reported parts of IKHOAM at 48-hr interval. Clinician-measured part of IKHOAM was administered once to each participant by three physiotherapists at the same time and for a second time by one of the physiotherapists after 48 hr. Data were summarized using descriptive statistics (mean, standard deviation, and percentage) and analyzed using intraclass correlation coefficient and Spearman rank order correlation. Results: The test–retest reliability for patient measured ranged from 0.94–0.99 (p < 0.01), while the intrarater reliability and interrater reliability for the clinician measured of the English version of the IKHOAM were 0.96 (p < 0.05) and 0.60 (p < 0.05), respectively. Conclusion: The English version of the IKHOAM is a reliable outcome measure, and it is recommended for integration in the assessment of patients with knee and/or hip OA in Nigerian clinical settings and similar environment.

A comparative survey of Nigerian physiotherapists’ familiarity with, knowledge of and utilisation of standard outcome measures: 10 years after initial survey

Background The need for physiotherapists to use standardised outcome measures (SOMs) is recognised and recommended in clinical practice guidelines in many countries. Aim To evaluate changes in physiotherapy practice in Nigeria on the utilisation of SOMs and physiotherapists’ familiarity with and knowledge of SOMs over the past decade. Methods A comparative cross-sectional survey of present data with 2006 data was undertaken. The existing validated questionnaire of 2006 was used to assess physiotherapists’ familiarity with, knowledge of and utilisation of 16 SOMs. Results There was a noticeable change in familiarity with and utilisation of 16 SOMs in the current data and in knowledge. Between 52% and 90% of physiotherapists were not familiar with 14 SOMs in 2006, whereas 51.4% – 85.8% of physiotherapists were not familiar with 8 SOMs in 2016; 77% – 97% and 63.4% – 97.3% of physiotherapists were not utilising SOMs in the 2006 and 2016 data, respectively. The least utilised SOMs in 2006 were Western Ontario McMaster Osteoarthritis Index, Chedoke McMaster Stroke Assessment and SF-36 Health Survey; in 2016, it was only the Chedoke McMaster Stroke Assessment. The Visual Analogue Scale and Gross Motor Function Measure remained the most utilised in both data. Duration of practice, age and sex were significant factors for the utilisation of and familiarity with SOMs. Conclusion There was an improvement in the familiarity with, knowledge of and utilisation of SOMs over the past decade among Nigerian physiotherapists but the level of utilisation is unsatisfactory. Action is required if routine outcome measurement is to be achieved. Clinical Implications Utilisation of SOMs is part of core standards of physiotherapy practice for effective management of patients. Although the utilisation of SOMs improved over the past 10 years, it is very low. Therefore, studies directed at finding factors responsible for low utilisation of SOMs among Nigerian physiotherapists are warranted.

Factors influencing the use of outcome measures in knee osteoarthritis: A mixed method study of physiotherapists in Nigeria

ABSTRACT Background: Osteoarthritis (OA) of the knee constitutes a significant proportion of musculoskeletal disorders managed in physiotherapy clinics worldwide. Best practice guidelines in the management of OA ensure the use of outcome measures. Aim: This study explored the factors influencing the use of outcome measures in management of patients with knee OA among physiotherapists in southwestern Nigeria. Methods: Mixed method design was used that involved a cross-sectional survey of 77 purposively selected physiotherapists and a focus group discussion with another 6 physiotherapists. Results: Participants (48 males, 29 females) were aged 35.3 ± 7.3 years. Fifty-two (67.5%) participants reported the use of outcome measures in the treatment of the patients with knee OA. The perceived barriers reported were lack of time/heavy workload (55.9%); lack of standardization of outcome measures (45%); lack of motivation (36.4%); and nonavailability of outcome measures in the clinic (36.4%). Reported perceived facilitators include interest/need to track patient’s progress and ethical practice (87.1%); familiarity with outcome measures (87.0%); and understanding of the benefits of using outcome measures (87.0%). Conclusion: There is a need to establish good organizational structure focusing on the use of outcome measures in practice and development of a concessional toolkit of short and easily applicable instruments with user description.

Psycho-social Determinants of Achievement of Functional Independence in Individuals with First-ever Stroke

Aim: To investigate psycho-social determinants of achievement of functional independence in first-ever stroke patients. Methods: This study involved 65 first-ever stroke patients enrolled within 24 hours of stroke from a Nigeria tertiary health institution. Stroke-type was classified using brains’ CT scan results while stroke severity was assessed using the national Institute of Health Stroke scale. Weighted-values of Barthel and Frenchay Activities Indexes were combined to indicate the functional performances. Depressive features were assessed with the Centre for Epidemiological Scale-Depression. Spousal support was measured using numerical rating scale. Measurements were taken fortnightly for 1-year. Data were analyzed using multivariate step-wise regression analysis. Results: Fifty-five participants completed the study while ten died. Forty of them were married out of which 76.4% reported enjoying spousal support. Twenty-six (47.3%) had ischaemic stroke and 52.7% had haemorrhagic stroke. Age (AOR= 3.2), type of marriage (AOR= 2.2), spousal support (AOR= 7.5), incontinence (AOR= -1.4) and depressive features (AOR= -4.1) significantly determined achievement of functional independence at 1-year post-stroke. Conclusion: The combination of being married into monogamous family and having good spousal support together with the absence of incontinence and depressive features within 14 days was a positive determinant achievement of functional independence in first-ever stroke patient.