Matthew O.B. Olaogun

Transcutaneous Electrical Nerve Stimulation and Interferential Current Combined with Exercise for the Treatment of Knee Osteoarthritis: A Randomised Controlled Trial

Abstract Interferential current (IFC) and transcutaneous electrical nerve stimulation (TENS) are forms of electrical stimulation frequently used to treat knee osteoarthritis (OA). The relative effectiveness of these two modalities is currently unknown. The purpose of this study was to evaluate the effects of IFC and TENS, when used in conjunction with exercise, on pain and function in patients with knee OA. Forty-six subjects with radiographically confirmed OA were randomly assigned to one of three groups: TENS and standardised exercises, IFC and exercises or exercises alone. An electrical stimulator was used to apply IFC or TENS at 80 Hz for 20 minutes. All groups had a standardised exercise programme. Treatment was applied twice per week for 4 weeks. Outcomes included a 10-point pain rating scale for pain intensity and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). A two-way repeated measures ANOVA performed on the pain assessment score showed a statistically significant effect of time ( p p = 0.813) or interaction ( p = 0.067). A similar result was obtained for WOMAC score ( p p = 0.241 and p = 0.130 for time, group and interaction effects, respectively). All treatment protocols led to significant improvements in pain and function over time. Neither IFC nor TENS displayed significant additional effects over exercise alone.

Awareness of risk factors and warning signs of stroke in a Nigeria university.

BACKGROUND Rapid access to medical services which is an important predictor of treatment and rehabilitation outcome requires that there is an understanding of stroke risk factors and early warning signs. This study assessed awareness of stroke risk factors and warning signs among students and staff of Obafemi Awolowo University, Nigeria. METHODS This was a cross sectional survey involving 994 (500 students and 494 staff) respondents. Information on the awareness of stroke risk factors and warning signs was collected with the aid of a structured questionnaire. Descriptive and inferential statistics were used for data analysis. RESULTS Weakness (66.2%) was the most commonly identified warning sign of stroke with more staff (69.8%) identifying correctly than students (62.6%). Hypertension (83.4%) was the most commonly identified stroke risk factor, with more staff (91.7%) identifying correctly than students (83.2%). There were significant differences (p < 0.05) in the awareness of some risk factors (age, hypertension, stress and obesity), and warning signs (dizziness, numbness, weakness, headache and vision problems) between students and staff. Predictors for adequate awareness of both stroke risk factors and warning signs were younger age, smoking history and higher educational level. CONCLUSIONS Majority of the respondents recognized individual important stroke risk factors and warning signs, but few recognized multiple stroke risk factors and warning signs. Awareness programs on stroke should be organized, even in communities with educated people to increase public awareness on the prevention of stroke and on the reduction of morbidity in the survivors.

Comparative lung function performance of stroke survivors and age-matched and sex-matched controls.

BACKGROUND AND PURPOSE Reduced endurance and excessive fatigue in stroke survivors (SS) during exercise may be linked to impairment of lung function and breathing mechanics, but little is known about lung function of SS. The purpose of this study is to determine lung function (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1 /FVC ratio and peak expiratory flow [PEF]) and influence of anthropometrics on lung function in SS compared with healthy controls (CG). METHODS In this case-control, cross-sectional study, we recruited 70 participants (42 males, 28 females), comprising 35 SS and 35 CG (range 34-73 years). Anthropometrics were measured using standard instruments and procedure. Chest excursion was measured at the axilla, xiphoid and lower costal levels. Lung function indices were measured using a micro-computerized spirometer. Ethical approval was obtained from the Ethics and Research Committee of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. RESULTS/FINDINGS Compared with the CG, the SS had significantly lower values for FEV1 (1.99 ± 0.66 vs. 2.36 ± 0.45 L, p = 0.004), FVC (2.55 ± 0.70 vs. 2.90 ± 0.54 L, p = 0.014), PEF (3.88 ± 1.38 vs. 5.24 ± 1.30 L second(-1) , p = 0.001) and chest excursion (3.0 ± 0.71 vs. 3.5 ± 0.91 cm, p = 0.018). Correlations between chest excursion, FEV1 , FVC and PEF were not significant (p > 0.05). DISCUSSION The weakness of respiratory muscles associated with stroke may have contributed to decreases in lung function observed. There was a significant reduction in chest excursion of SS compared with CG. Chest excursion has been used as an indicator of respiratory muscle function because the range of motion of the thorax serves the respiration. Movements of the thorax influence the content of the thorax cavity, leading to alterations in lung volumes. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE Stroke survivors have lower lung function when compared with CG; this has implications for clinicians in stroke rehabilitation, underscoring the importance for inclusion of interventions to improve lung function.

ANTHROPOMETRIC DETERMINANTS OF RESTING BLOOD PRESSURE AND HEART RATE OF NIGERIAN SCHOOL CHILDREN

Blood pressure, heart rate and anthropometric parameters were measured in 807 Nigerian school-age children. There was no significant difference between the blood pressure and heart rate of boys and girls after adjusting for differences in age and anthropometric parameters. The stepwise regression analysis revealed that the strong determinants of blood pressure levels were weight, Quetelet index and triceps skinfold thickness. Based on our findings, we recommend that body weight norms rather than age should be used in evaluating abnormal blood pressure levels in Nigerian children.

Gait and balance performance of stroke survivors in South-Western Nigeria - A cross-sectional study

Introduction Stroke survivors are often left with neurological and functional deficits, which impair their ability to walk and affect their balance. This study assessed gait parameters and balance performance among stroke survivors and examined the relationship between these two factors. Methods Seventy stroke survivors (65.7% males) who were 6 months or more post stroke participated in this study. Using Observational Gait Analysis, the gait of participants was assessed by gait speed and cadence. Balance performance was assessed using the Activities-specific Balance Confidence scale for balance self-efficacy and Functional Reach Test for standing balance. Resuls Participants had a mean age of 53.5±10.4 years. Forty five (64.3%) stroke survivors had haemorrhagic stroke while 25 (35.7%) had ischaemic stroke. The mean gait speed and cadence were 0.6±0.3m/s and 69.1±38.1 steps/min, respectively. The mean balance self-efficacy score was 66.5±17.7 and mean functional reach distance was 18.7±2.6cm. There were significant relationships between gait speed and balance self-efficacy (r =0.461, p =0.001) and between cadence and functional reach distance (r =0.247, p =0.020). Conclusion This study concluded that stroke survivors with higher cadences had higher functional reach distances, and those with higher gait speeds had better balance self-efficacy. Gait speed and cadence are factors related to balance performance. These factors should be considered during gait and balance retraining and should go pariparsu in the rehabilitation of stroke survivors.

Comparative effects of proprioceptive and isometric exercises on pain intensity and difficulty in patients with knee osteoarthritis: A randomised control study

PURPOSE The study compared the effects of isometric quadriceps exercise and proprioceptive exercise on pain, joint stiffness and physical difficulties of patients with knee osteoarthritis. SUBJECTS Forty-five patients with history of knee osteoarthritis were randomly allocated into two groups; A with 23 subjects and B with 22 subjects. METHODS All subjects received infrared radiation for 20 minutes and kneading massage with methyl salicylate ointment. Group A underwent proprioceptive exercises while Group B had isometric quadriceps exercise. Each exercise session lasted for 10 minutes according to standard protocol, twice in a week for six weeks. Pre-treatment, 3rd week and 6th week pain intensity, joint stiffness and physical difficulties were assessed using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical package for social sciences (SPSS) version 17 was used to analyse the data while descriptive and inferential statistics were used to summarise the result. RESULTS Proprioceptive exercises reduced pain intensity significantly (F = 4.76; p = 0.00) at 6th week with effect size of 2.79, and physical difficulty (F = 3.69; p < 0.04) with effect size of 7.53 better than isometric exercises. There was a significant reduction in the pain intensity (F = 12.08; p < 0.001), and physical difficulties (F = 3.69, p = 0.04) in pre-treatment, 3rd week and 6th week in both Group A and B. CONCLUSION Both exercises are effective but proprioceptive exercises may be more effective in the management of patients with knee osteoarthritis (KOA) than isometric exercises.

First-contact physiotherapy practice in Nigeria

First-contact physiotherapy practice implies independent practice by physiotherapists. It means that physiotherapists may need to see patients without formal referral from a medical practitioner, and then assess and treat patients if their conditions are appropriate for physiotherapy management.This paper reviews the traditional referral system, whereby medical practitioners make all the decisions, and compares this with recent developments in Nigeria. Some alternative models of referral are suggested in which the physiotherapy professional would have greater independence of practice. Strategies for bringing this about include legislation, the creation of greater public awareness and an expansion of the physiotherapy curriculum.Finally, recommendations are offered in the area of research, treatment prescription, clinical training, internship, professionalisation of degrees and personal comportment of the individual physiotherapist.