Rufus A. Adedoyin

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.

Reliability of rating low back pain with a visual analogue scale and a semantic differential scale

Pain rating scales, such as the Visual Analogue Scale (VAS) and the Verbal Rating Scale (VRS) are important tools for assessing patients’ symptom status. For a non-English speaking patient, VRS could pose a problem as a result of language barrier. The objective of this study was to determine the intra-class and inter-class correlations of VAS and a Semantic Differential Scale (SDS) in patients with low back pain. 25 patients with chronic low back pain were purposively selected for the study. Two testers (1 and 2) independently rated the pain experienced by the patients when asked to bend forward and hold on when pain was either exacerbated or aggravated. Finger-to-floor distance (FFD) was taken, as a measure of flexion of the spine, for each patient. Pain was rated using VAS and SDS. Our results showed strong intra-tester correlations between VAS and SDS of each tester (p < .05), and strong inter-tester correlations for VAS and for SDS (p < .05). The result of using two-way ANOVA showed that there was no significant difference in pain ratings with VAS by tester-1, VAS by tester-2, SDS by tester-1, and SDS by tester-2. F-ratio was not significant (p > .05). There was no significant difference between FFDs by the two testers (p > .05). Our results suggest that the two scales are reliable and valid for clinical rating of low back pain. Further studies with larger samples and using other movements of the spine are suggested.

Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults

Background and purpose: Studies on cardiovascular risks in relation to anthropometric factors are limited in Sub-Sahara Africa. The aims of this study were to examine the relationship between anthropometric parameters and blood pressure; and to evaluate body mass index (BMI) across the range of underweight and obesity as a primary risk factor of hypertension in adult Nigerians. Material and methods: 2097 adults aged between 20 and 100 years consented and participated in this door-to-door survey. All participants underwent blood pressure and anthropometric measurements using standard procedures. The population study was separated in normotensive and hypertensive males and females and the possible risk for hypertension were categorized into different classes of value based on BMI definition. Results: The relative risks (odds ratio [OR] and 95% confidence interval [CI]) of developing hypertension among the obese compared with the underweight, normal weight, and overweight persons were (OR 5.75; CI 5.67–5.83), (OR 1.73; CI 1.65–1.81), and (OR 1.54; CI 1.46–1.62) for all the participants, respectively. Among obese (BMI ≥ 30.0 Kg/m2) males, the OR for hypertension was three times (OR 2.78; CI 2.76–2.80) that of normal weight (BMI ≥ 18.5–24.9 Kg/m2) males. Females with obesity had a risk of hypertension three times (OR 3.34; CI 3.33–3.35) that of normal weight females. Conclusion: Our results indicated that the there was a significant positive correlation of obesity indicator with blood pressure. In Nigeria, we found a strong gradient between higher BMI and increased risk of hypertension among all ages. Approaches to reduce the risk of hypertension may include prevention of overweight and obesity.

Prevalence of hypertension in three rural communities of Ife North Local Government Area of Osun State, South West Nigeria.

Background The prevalence of hypertension is increasing rapidly in sub-Saharan Africa, but data are limited on hypertension prevalence. In addition, few population-based studies have been conducted recently in Nigeria on the prevalence and correlates of hypertension in both urban and rural communities. Therefore, we determined the prevalence of hypertension in adults in the three rural communities of Ipetumodu, Edunabon, and Moro, in South West Nigeria. Materials and methods One thousand adults between 15 and 90 years of age were recruited into this cross-sectional study, over a 6-month period, using a multistage proportional stratified random sampling technique. Sociodemographic data and anthropometric variables were obtained, and resting blood pressure (BP) was measured using an electronic sphygmomanometer. Diagnosis of hypertension was based on the JNC VII guidelines, the WHO/ISH 1999 guidelines, and the BP threshold of 160/95 mmHg. Results Four hundred and eighty-six men (48.6%) men and 514 women (51.4%) participated in the study. Their mean age, weight, height, and body mass index were 32.3±14.7 years, 62±13 kg, 1.5±0.1 m, and 23.02 kg/m2, respectively. The prevalence of hypertension, based on the 140/90 mmHg definition, was 26.4% (Male: 27.3%; Female: 25.4%). The prevalence of hypertension, based on the 160/95 mmHg definition, was 11.8% (Male: 13.5%; Female: 10.1%). There were significant positive correlations between BP and some anthropometric indicators of obesity. Conclusion The prevalence of hypertension in the three rural communities was 26.4%, indicating a trend towards increasing prevalence of hypertension. There was also a significant positive correlation between anthropometric indicators of obesity and BP in this population.

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.

Assessment of exercise capacity in African patients with chronic heart failure using six minutes walk test.

Background: The purpose of this study was to assess the functional capacity during a 6-minute corridor walk and a 6-minute bicycle ergometry exercise in patients with chronic heart failure (CHF). Method: Thirty five patients with stable CHF were recruited for the study. Each subject performed six minutes corridor walk and 6-minute bicycle ergometry testing. The 6-minute walk required the subjects to walk at a self selected speed on a 20 meter marked level ground for 6-minute. All the subjects also performed a 6-minute exercise on a stationary bicycle ergometer with initial resistance of 20 watts and increased by 10 watts after 3-minutes. The perceived rate of exertion was assessed using a modified Borg Scale after each exercise mode. The maximum oxygen consumption was derived using American College of Sport Medicine equations. Results: Result showed high positive correlation between distance walked in the 6-minute and the maximum volume of oxygen (VO2 max) (r = 0.65, P < 0.01). The average distance walked was 327 m ± 12.03 m. The VO2 max estimated during bicycle ergometry was higher (13.7 ± 1.9 L) than during the six minutes walk (8.9 ± 1.2 L). Conclusion: Six minutes walk could be useful to evaluate exercise tolerance in patients with chronic heart failure, while the bicycle ergometer could be more appropriate in the assessment of maximum functional capacity in these patients.

Socioeconomic status and obesity among semi-urban Nigerians.

Objective: The relation between socioeconomic status (SES) and obesity in Sub-Saharan Africa (SSA) has been inconsistent. Methods: This study examined the prevalence of obesity and SES/obesity relations in 1,067 adults aged 30–60 years from a semi-urban Nigerian population. A structured questionnaire validated by a pictorial selfrating ladder was used to determine the participants’ SES. Results: SES was found to be inversely related (p < 0.010) to weight and BMI, respectively. The odds ratio (OR) and 95% confidence interval (CI) for obesity among lower SES individuals were OR 2.4 and CI 1.91–2.88 compared with OR 2.9 and CI 2.42–3.39 in those of the middle and higher socioeconomic strata. Among males, the OR and 95% CI for obesity among lower SES individuals were OR 1.9 and CI 1.21–2.59 compared with OR 1.7 and CI 1.00–2.39 in those of the middle and higher socioeconomic strata. Among females, the OR and 95% CI for obesity among lower SES individuals were OR 3.0 and CI 2.32–3.68 compared with OR 4.7 and CI 4.02–5.38 in those of the middle and higher socioeconomic strata. Conclusion: SES was inversely associated with the risk of obesity, with a higher prevalence of obesity in the lower socioeconomic stratum of the semi-urban Nigerian population.

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.

Reference Values of Static Back Extensor Muscle Endurance in Healthy Nigerian Adults

Objective: This study aimed to establish gender and age reference values of static back extensor muscle endurance in healthy Nigerian adults. Subjects and Methods: This study involved 373 consecutive participants aged between 21 and 60 years who were grouped into four age strata. A modification of the Sørensen test of Static Muscular Endurance (BSME) was used to quantify static endurance. The mean, standard deviation, range and 25th, 50th, and 75th percentile scores were determined for four gender/age categories. Results: Endurance time differed significantly across the age groups (F = 47.286; p = 0.000). Males exhibited higher mean endurance than females (t = 2.583; p = 0.010). Using percentiles, 25th (poor endurance), 25th–75th (medium endurance) and >75th (good endurance) percentile were 72, 72–161, and >161–240 s, respectively, for males; and 64, 64–142, and >142–236 s, respectively, for females. There was an age and gender variation in the median values. The results suggest that the significant age and anthropometric differences between the categories of participants could contribute to endurance differences. Conclusion: This study established a set of reference values for static back endurance in healthy Nigerians. These values can be used to compare a patient’s score at intake or as an outcome measure in clinical practice.

Prevalence and pattern of overweight and obesity in three rural communities in southwest Nigeria

Background Limited data exist on the prevalence of overweight and obesity in the Nigerian adult rural population. This study therefore assessed the prevalence and pattern of overweight and obesity in adults in three rural communities of the Ife North Local Government Area, Nigeria. Materials and methods A total of 777 adults between 20 and 90 years of age were recruited into this cross-sectional study, which was performed over a 6-month period using a multistage proportional stratified random sampling technique. Sociodemographic data and anthropometric variables were obtained. Results A total of 385 (49.5%) men and 395 (50.5%) women participated in the study. The mean age and body mass index of the participants were 36.3±14.3 years and 23.53±4.6 kg/m2, respectively. The overall crude prevalence of overweight and obesity in the total population were 20.8% and 8.4%, respectively. Obesity increased across the age gradient, peaking in the 51- to 60-year age-group in men and women. Among the overweight and obese subjects (n=227), 70.9% of them were overweight and the remaining 29.1% were obese, with class I obesity accounting for 20.7% of these overweight and obese subjects. Conclusion The prevalence of overweight and obesity in these communities was 20.8% and 8.4% respectively, indicating a trend towards increased prevalence. Class I obesity is the most common obesity pattern, and obesity increased across the age gradient, peaking in the 51- to 60-year age-group. There is a need for regular community education on healthy lifestyles, and regular health screening to control the rising prevalence of overweight and obesity, as well as to prevent or reduce the risk of obesity comorbidities in these communities.