Adesola C. Odole

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.

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 studys objectives were to investigate the prevalence of Adolescent Low Back Pain (ALBP) among secondary school students in Ibadan, Nigeria and the prevalences 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.

A Telephone-based Physiotherapy Intervention for Patients with Osteoarthritis of the Knee

This study assessed the effects of a 6-week telephone based intervention on the pain intensity and physical function of patients with knee osteoarthritis (OA), and compared the results to physiotherapy conducted in the clinic. Fifty randomly selected patients with knee OA were assigned to one of two treatment groups: a clinic group (CG) and a tele-physiotherapy group (TG). The CG received thrice-weekly physiotherapist administered osteoarthritis-specific exercises in the clinic for six weeks. The TG received structured telephone calls thrice-weekly at home, to monitor self-administered osteoarthritis-specific exercises. Participants’ pain intensity and physical function were assessed at baseline, two, four, and six weeks, in the clinic environment. Within group comparison showed significant improvements across baseline, and at weeks two, four, and six for both TG and CG’s pain intensity and physical function. Between-group comparison of CG and TG’s pain intensity and physical function at baseline and weeks two, four, and six showed no significant differences. This study demonstrated that a six-week course of structured telephone calls thrice-weekly to patients at their home, to monitor self-administered osteoarthritis-specific exercises for patients with knee OA (i.e., tele-physiotherapy) achieved comparable results to physiotherapy conducted in the clinic.

Nigerian (Yoruba) version of Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-Y): Cross-cultural adaptation and initial validation

Introduction The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a widely used upper extremity outcome measure. However, it is yet to be translated into any of the major languages in Nigeria, thus limiting its utility in the Nigerian clinical setting. The aim of this study was to cross-culturally adapt the DASH questionnaire into Yoruba, a major Nigerian language and investigate its initial validation. Methods The English version of DASH was adapted into Yoruba through forward–back translations, experts’ committee meetings, pretesting and cognitive debriefing interview in accordance with the guidelines recommended by the developers of DASH. Fifty-two purposively selected patients with upper extremity musculoskeletal disorders participated in a cross-sectional survey. Factor analysis was performed to ensure structural validity of Yoruba version, and construct validity was investigated with Spearman rank correlation coefficient. Results The Yoruba version of DASH has semantic, idiomatic, linguistic and conceptual equivalence with the English DASH. Thirty linear components were identified within the data set. Principal factor analysis of the Yoruba DASH revealed a seven factor scale, having fulfilled all the necessary conditions. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.61, and Barlett’s test of Sphericity was adequate and significant (χ2 (1066) = 435, p = 0.001). Significant correlation (r = 0.994, p = 0.001) exists between scores obtained on English and Yoruba versions of DASH. Conclusion A cross-culturally adapted, valid Yoruba version of DASH is available for use in in south western Nigeria and other similar populations.

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-α=0.88, p=0.000 and work component- α=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.

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.

Augmenting conventional treatment of non-specific low back pain with progressive goal attainment programme

Background: Prospective studies on the effects of progressive goal attainment programme (PGAP) on treatment outcomes and specifically psychosocial variables in individuals with non-specific low back pain (NSLBP) are scarce. The study was aimed at investigating the effects of a 10-week PGAP adjunct therapy on selected pain and psychosocial characteristics in patients with NSLBP. Methods: The quasi-experimental study involved consecutive 70 (42 females; 28 males) patients with NSLBP. Participants were alternately assigned into experimental and control groups. Both groups received conventional treatment of back education, soft tissue mobilisation, transcutaneous electrical nerve stimulation, flexibility, coordination and isometric trunk muscle strengthening exercises thrice a week for 10 weeks but the experimental group had PGAP in addition. Participants’ pain intensity, pain catastrophising, kinesiophobia, perceived disability and self-efficacy were assessed at baseline, end of 5th and 10th week of intervention and 22nd week (follow-up) using Visual Analogue Scale, Pain Catastrophising Scale, Tampa Scale for Kinesiophobia, Revised Oswestry Disability Questionnaire and Self-Efficacy for Rehabilitation Outcome Scale, respectively. Results: Between-group comparison at the end of intervention did not reveal significant difference (p > 0.05) between experimental and control groups in all five measures. There were significant reductions (p < 0.05) in pain intensity, pain catastrophising, kinesiophobia, perceived disability and increase in self-efficacy scores for both groups from baseline to 10th week. At follow-up (22nd week), experimental group had significantly lower scores of pain intensity (p = 0.031), pain catastrophising (p = 0.050), kinesiophobia (p < 0.001), perceived disability (p = 0.001) and higher self-efficacy (p = 0.016) than the controls. Conclusion: Addition of PGAP to conventional treatment is effective for achieving sustained improvement in pain and psychosocial characteristics of patients with NSLBP having psychosocial overlay.