Cross-Cultural Adaptation and Psychometric Validation of the Quality of Life Index Among Hausa-Speaking People with Spinal Cord Injury in Northwest Nigeria.

Background: Quality of life (QoL) is an important outcome that is used to measure the success of healthcare interventions. Valid and reliable instruments are required to assess QoL. Hence, we conducted this study to adapt and validate the QoL Index (QLI) among Hausa-speaking people with spinal cord injury (SCI) in northwest Nigeria. Method: Using the International Society for Pharmacoeconomic and Outcome Research principles of good practice and the consensus-based standards for the selection of health measurement instruments guidelines, the QLI-SCI version was translated into Hausa language and tested for content validity, internal consistency, and test-retest reliability among people with SCI in northwest Nigeria. Result: The Hausa QLI (HQLI) demonstrated good content validity (CVI = 92.18%), internal consistency (Cronbach's alpha = 0.855), and test-retest reliability (ICC =0.949 [95% CI, 0.916-0.969]). Conclusion: The HQLI can be deployed to assess QoL among Hausa-speaking people with SCI, thus promoting robust measurement of QoL in an SCI population.

Coping strategies of internally displaced persons and the host community in a region of armed conflict: A cross-sectional study.

BACKGROUND: Conflict leads to the displacement of people, making it more difficult for them to cope with increasing stress. In war-affected regions, people use different strategies to cope with their stress. This study examines the coping strategies of internally displaced persons (IDPs) and those in host communities in war zones. METHODS: People living in the IDP camp and host communities in Maiduguri, Nigeria were recruited using a convenient sampling strategy. A 28-item Hausa version of the Brief COPE Scale wasused for data collection. Data were analyzed using linear regression and presented as unstandardized beta (B) and standard error (SE). RESULTS: A total of 562 participants were recruited (IDPs, n = 281; and the host communities, n = 281). Problem- and emotion-focused coping strategies were identified as the most common approaches used in host communities; however, dysfunctional strategies were morecommon among the IDPs. Age (younger or older adulthood) was identified as a predictor forthe use of emotion-, problem-, and dysfunctional-focused coping strategies. CONCLUSION: Host communities were more likely to use a problem-and emotion-focused approach to coping, while IDPs were more likely to use dysfunctional strategies. Location and demographic factors (being single, aged 18-29years, >50 years and older) also influenced coping.

Malaria vaccine efficacy, safety, and community perception in Africa: a scoping review of recent empirical studies.

AIM: The review summarizes the recent empirical evidence on the efficacy, safety, and community perception of malaria vaccines in Africa. METHODS: Academic Search Complete, African Journals Online, CINAHL, Medline, PsychInfo, and two gray literature sources were searched in January 2023, and updated in June 2023. Relevant studies published from 2012 were included. Studies were screened, appraised, and synthesized in line with the review aim. Statistical results are presented as 95% Confidence Intervals and proportions/percentages. RESULTS: Sixty-six (N = 66) studies met the inclusion criteria. Of the vaccines identified, overall efficacy at 12 months was highest for the R21 vaccine (N = 3) at 77.0%, compared to the RTS,S vaccine (N = 15) at 55%. The efficacy of other vaccines was BK-SE36 (11.0-50.0%, N = 1), ChAd63/MVA ME-TRAP (- 4.7-19.4%, N = 2), FMP2.1/AS02A (7.6-9.9%, N = 1), GMZ2 (0.6-60.0%, N = 5), PfPZ (20.0-100.0%, N = 5), and PfSPZ-CVac (24.8-33.6%, N = 1). Injection site pain and fever were the most common adverse events (N = 26), while febrile convulsion (N = 8) was the most reported, vaccine-related Serious Adverse Event. Mixed perceptions of malaria vaccines were found in African communities (N = 17); awareness was generally low, ranging from 11% in Tanzania to 60% in Nigeria (N = 9), compared to willingness to accept the vaccines, which varied from 32.3% in Ethiopia to 96% in Sierra Leone (N = 15). Other issues include availability, logistics, and misconceptions. CONCLUSION: Malaria vaccines protect against malaria infection in varying degrees, with severe side effects rarely occurring. Further research is required to improve vaccine efficacy and community involvement is needed to ensure successful widespread use in African communities.

Effects of therapeutic exercise on disease severity, balance, and functional Independence among individuals with cerebellar ataxia: A systematic review with meta-analysis.

BACKGROUND: Balance impairments are common in cerebellar ataxia. Exercises are beneficial in this population. OBJECTIVE: Explore the benefits of therapeutic exercises on disease severity, balance and functional independence in cerebellar ataxia. METHODS: Databases were searched from inception until July 2021. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale and the Newcastle-Ottawa Scale (NOS); and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Twenty-six studies were included and eight studies of low to high PEDro methodological quality were meta-analyzed. 'Low' to 'moderate' GRADE quality evidence supports the use of therapeutic exercises to reduce disease severity, assessed using the Scale for the Assessment and Rating of Ataxia [weighted mean difference (WMD): -3.3; 95% confidence interval (95%CI): -3.7, -2.8; p < .01]; and improve balance, assessed using the Berg Balance Scale (WMD: 2.6; 95%CI: 1.1, 4.2; p < .01). The effect of therapeutic exercises on functional independence was insignificant (WMD: 1.6; 95%CI: -1.5, 4.6; p = .31). CONCLUSION: Low to moderate evidence from studies of low to high methodological quality provides some support for therapeutic exercises for reducing disease severity among non-hereditary degenerative cerebellar ataxia and improving balance among acquired cerebellar ataxia. Exercises did not benefit functional independence. Additional studies of large sample size and high methodological quality are necessary to substantiate these findings.

Physiotherapy interventions for pain relief in individuals with peripheral neuropathic pain: A systematic review and meta-analyses of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness of physiotherapy interventions on peripheral neuropathic pain (pNeP) due to any underlying cause. METHODS: Multiple databases were searched from database inception until Dec 2021. Studies on physiotherapy interventions for pain relief assessed using the visual analogue scale among individuals with pNeP of any underlying cause were included. Methodological quality was assessed using the PEDro scale and the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS: The searches yielded 1498 articles. Seventeen studies met the inclusion criteria and were included in the review. Meta-analysis revealed a significant benefit for laser therapy compared to sham laser on pNeP (weighted mean difference [WMD] -1.27; 95% CI: -2.29 to -0.25; p = 0.01) in people with carpal tunnel syndrome. The pooled analyses revealed a significant effect of spinal cord stimulation compared to control for failed back syndrome (standardised mean difference [SMD; Hedges'g] -0.73; 95% CI: -1.17 to -0.30; p = 0.001) and diabetic neuropathy (SMD -1.63; 95% CI -2.06--1.21; p < 0.001). The effect of acupuncture on chemotherapy-induced pain (SMD - 2.09; 95% CI: -4.27-0.09; p = 0.06) and electromagnetic stimulation on diabetic neuropathic pain (Hedges' g - 0.77; 95% CI: -1.82-0.27; p = 0.15) were insignificant. CONCLUSION: Evidence supports the use of spinal cord stimulation for the treatment of pNeP secondary to failed back surgery syndrome and diabetic neuropathy. Laser therapy was more effective than sham laser for alleviating pain due to carpal tunnel syndrome. The efficacy of acupuncture and electromagnetic therapy for chemotherapy-induced pain and diabetic neuropathy, respectively remains inconclusive.

Transmission Dynamics of Monkeypox Virus in Nigeria during the Current COVID-19 Pandemic and Estimation of Effective Reproduction Number.

Monkeypox virus (MPXV) continues to pose severe threats to global public health, especially in non-endemic areas. Like all other regions, Africa faces potential public health crises due to the ongoing COVID-19 pandemic and other infectious disease outbreaks (such as Lassa fever and malaria) that have devastated the region and overwhelmed the healthcare systems. Owing to the recent surge in the MPXV and other infections, the COVID-19-control efforts could deteriorate and further worsen. This study discusses the potential emergencies of MPXV transmission during the current COVID-19 pandemic. We hypothesize some of the underlying drivers that possibly resulted in an increase in rodent-to-human interaction, such as the COVID-19 pandemic's impact and other human behavioral or environmental factors. Furthermore, we estimate the MPXV time-varying effective reproduction number (Rt) based on case notification in Nigeria. We find that Rt reached a peak in 2022 with a mean of 1.924 (95% CrI: 1.455, 2.485) and a median of 1.921 (95% CrI: 1.450, 2.482). We argue that the real-time monitoring of Rt is practical and can give public health authorities crucial data for circumstantial awareness and strategy recalibration. We also emphasize the need to improve awareness programs and the provision of adequate health care resources to suppress the outbreaks. These could also help to increase the reporting rate and, in turn, prevent large community transmission of the MPXV in Nigeria and beyond.

Are Fear of COVID-19 and Vaccine Hesitancy Associated with COVID-19 Vaccine Uptake? A Population-Based Online Survey in Nigeria.

This study examined the association between COVID-19 and fear of contracting COVID-19 and reasons for vaccination refusal. A population-based online survey was conducted via social media in Nigeria using the Fear of COVID-19 scale and items related to vaccination refusal/hesitancy items. Individuals aged 13 years and older were invited to participate. Data were analysed using binary logistic regression to calculate odds ratios (ORs) and associated 95% confidence intervals (CIs) at a p-value of less than 0.05. The study enrolled 577 individuals with a mean age of 31.86 years, 70% of whom were male and 27.7% of whom had received at least one dose of the vaccine against COVID-19. None of the variables on the Fear of COVID-19 scale significantly predicted vaccine uptake in multivariate analysis. However, individuals who were fearful of COVID-19 were more likely to be vaccinated in bivariate analysis (OR: 1.7, 95% CI: 1.06-2.63). The most significant factors among the vaccination refusal items associated with COVID-19 vaccination were doubts about vaccination (adjusted OR: 2.56, 95% CI: 1.57-4.17) and misconceptions about vaccine safety/efficacy (adjusted OR: 2.15, 95% CI: 1.24-3.71). These results suggest that uptake of the vaccine against COVID-19 in Nigeria can be predicted by factors associated with vaccination refusal, but not by fear of COVID-19. To contain the pandemic COVID-19 in Nigeria, efforts should be made to educate people about the efficacy of the vaccine and to increase their confidence in vaccination.

Prevalence of Anxiety and Depression Among the General Population in Africa During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Background: Medical and socio-economic uncertainties surrounding the COVID-19 pandemic have had a substantial impact on mental health. This study aimed to systematically review the existing literature reporting the prevalence of anxiety and depression among the general populace in Africa during the COVID-19 pandemic and examine associated risk factors. Methods: A systematic search of the following databases African Journal Online, CINAHL, PubMed, Scopus, and Web of Science was conducted from database inception until 30th September 2021. Studies reporting the prevalence of anxiety and/or depression among the general populace in African settings were considered for inclusion. The methodological quality of included studies was assessed using the Agency for Healthcare Research and Quality (AHRQ). Meta-analyses on prevalence rates were conducted using Comprehensive Meta-analysis software. Results: Seventy-eight primary studies (62,380 participants) were identified from 2,325 studies via electronic and manual searches. Pooled prevalence rates for anxiety (47%, 95% CI: 40-54%, I2 = 99.19%) and depression (48%, 95% CI: 39-57%, I2 = 99.45%) were reported across Africa during the COVID-19 pandemic. Sex (female) and history of existing medical/chronic conditions were identified as major risk factors for anxiety and depression. Conclusions: The evidence put forth in this synthesis demonstrates the substantial impact of the pandemic on the pervasiveness of these psychological symptoms among the general population. Governments and stakeholders across continental Africa should therefore prioritize the allocation of available resources to institute educational programs and other intervention strategies for preventing and ameliorating universal distress and promoting psychological wellbeing. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228023, PROSPERO CRD42021228023.

COVID-19 pandemic-related mortality, infection, symptoms, complications, comorbidities, and other aspects of physical health among healthcare workers globally: An umbrella review.

BACKGROUND: The COVID-19 pandemic has continued to cause unprecedented concern across the globe since the beginning of the outbreak. Healthcare workers, particularly those working on the front line, remain one of the most affected groups. Various studies have investigated different aspects of the physical health of healthcare workers; however, limited evidence on the overall physical health of healthcare workers has been collectively examined. AIM: To examine the various aspects of physical health and well-being of healthcare workers during the COVID-19 pandemic. DESIGN: An umbrella review. METHODS: We conducted a comprehensive literature search on Academic Search Premier, CINAHL, Cochrane Library and MEDLINE and supplemented the search with Google Scholar. Key terms related to 'COVID-19', 'physical health', 'healthcare worker' and 'systematic review' were used in the search. Systematic reviews with or without meta-analyses were included if they were published in the English language, could be obtained in full-text format, and assessed the physical health impacts of the COVID-19 pandemic on healthcare workers were included. The methodological quality of eligible studies was assessed using the Joanna Briggs Institute's checklist for systematic reviews. The data were narratively synthesised in line with the 'Synthesis Without Meta-analysis' guideline. RESULTS: Thirteen systematic reviews (represented as K = 13) that synthesized data from 1230 primary studies/reports and 1,040,336 participants met the inclusion criteria. The findings indicate a death rate of between 0.3 and 54.2 per 100 infections (K = 4). The overall case-fatality rate was estimated to be 0.87% (approximately 9 deaths per 1000 infections, K = 3). The overall infection rate among healthcare workers ranged from 3.9% to 11% (K = 5), with the highest rate associated with healthcare workers involved in screening. Considering geographic regions, the highest number of infections was reported in Europe (78.2% of 152,888 infected healthcare workers, K = 1). More nurses and female healthcare workers were infected, while deaths occurred mainly among men and medical doctors. The commonly reported symptoms included cough (56-80%, K = 3), fever (57-85%, K = 3), and headache (7-81%, K = 3), while hypertension was the most prevalent comorbidity (7%, K = 1). Additionally, a high prevalence of poor sleep quality (41-43%, K = 2), work-related stress (33-44.86%, K = 5) and personal protective equipment-associated skin injuries (48.2-97%, K = 2) affected the healthcare workers. The most reported preventive measures included laboratory testing, clinical diagnosis, adequate personal protective equipment, self-isolation, and training/orientation for infection control. CONCLUSION: Healthcare workers experienced considerable COVID-19-related physical health issues, including mortalities. This requires targeted interventions and health policies to support healthcare workers worldwide to ensure timely management of the pandemic. TWEETABLE ABSTRACT: This umbrella review highlights the global mortalities, infections, and other aspects of physical health of healthcare workers during the COVID-19 pandemic.

Physiotherapy interventions may relieve pain in individuals with central neuropathic pain: a systematic review and meta-analysis of randomised controlled trials.

Objectives: To evaluate the effectiveness of any form of physiotherapy intervention for the management of central neuropathic pain (cNeP) due to any underlying cause. Methods: Multiple databases were searched from inception until August 2021. Randomised controlled trials evaluating physiotherapy interventions compared to a control condition on pain among people with cNeP were included. Methodological quality and the quality of evidence were assessed using the Physiotherapy Evidence Database Scale and the Grading of Recommendations, Assessment, Development, and Evaluation tool, respectively. Results: The searches yielded 2661 studies, of which 23 randomised controlled trials met the inclusion criteria and were included in the meta-analyses. Meta-analyses of trials examining non-invasive neurostimulation revealed significant reductions in pain severity due to spinal cord injury (SCI; standardised mean difference (SMD): -0.59 (95% confidence interval [CI]: -1.07, -0.11), p = 0.02) and phantom limb pain (weighted mean difference (WMD): -1.57 (95% CI: -2.85, -0.29), p = 0.02). The pooled analyses of trials utilising acupuncture, transcutaneous electrical nerve stimulation (TENS), and mirror therapy showed significant reductions in pain severity among individuals with stroke (WMD: -1.46 (95% CI: -1.97, -0.94), p < 0.001), multiple sclerosis (SMD: -0.32 (95% CI: -0.57, -0.06), p = 0.01), and phantom limb pain (SMD: -0.74 (95% CI: -1.36, -0.11), p = 0.02), respectively. Exercise was also found to significantly reduce pain among people with multiple sclerosis (SMD: -1.58 (95% CI: -2.85, -0.30), p = 0.02). Conclusion: Evidence supports the use of non-invasive neurostimulation for the treatment of pain secondary to SCI and phantom limb pain. Beneficial pain management outcomes were also identified for acupuncture in stroke, TENS in multiple sclerosis, and mirror therapy in phantom limb pain.

Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis.

Objective: To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB). Data Sources: Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021. Review Methods: Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors. Results: Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): -0.614; 95% confidence interval (CI): -1.023, -0.206; p = 0.003) and stroke (SMD: -2.639; 95% CI: -3.804, -1.474; p = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): -12.406; 95% CI: -16.015, -8.797; p = 0.000) and BT (WMD: -9.117; 95% CI: -14.746, -3.487; p = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson's disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: -0.751; 95% CI: -2.426, 0.924; p = 0.380) and BT (WMD: -0.597; 95% CI: -1.278, 0.083; p = 0.085) on UUI due to Parkinson's disease. Conclusions: Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson's disease, although the effects of PFMT and BT on UUI warrant further investigation.

Task Complexity and Image Clarity Facilitate Motor and Visuo-Motor Activities in Mirror Therapy in Post-stroke Patients.

Introduction: Mirror therapy is effective in the recovery of upper-limb function among post-stroke patients. An important component of mirror therapy is imagining finger movements. This study aimed to determine the influence of finger movement complexity and mirror image clarity on facilitating motor and visuo-motor activities in post-stroke patients. Methods: Fifteen post-stroke patients and 18 right-handed healthy participants performed simple or complex finger tapping while viewing mirror images of these movements at varying levels of clarity. The physical setup was identical to typical mirror therapy. Functional near infrared spectroscopy (fNIRS) was used to capture the brain activities elicited in the bilateral primary motor cortices (M1) and the precuneus using a block experimental design. Results: In both study groups, the "complex finger-tapping task with blurred mirror image" condition resulted in lower intensity (p < 0.01) and authenticity (p < 0.01) of the kinesthetic mirror illusion, and higher levels of perceived effort in generating the illusion (p < 0.01), relative to the "simple finger-tapping with clear mirror image" condition. Greater changes in the oxygenated hemoglobin (HbO) concentration were recorded at the ipsilesional and ipsilateral M1 in the "complex finger-tapping task with blurred mirror image" condition relative to that recorded in the "simple finger-tapping task with clear mirror image" condition (p = 0.03). These HbO concentration changes were not significant in the precuneus. Post-stroke patients showed greater changes than their healthy counterparts at the ipsilesional M1 (F = 5.08; p = 0.03; partial eta squared = 0.14) and the precuneus (F = 7.71; p < 0.01; partial eta squared = 0.20). Conclusion: The complexity and image clarity of the finger movements increased the neural activities in the ipsilesional motor cortex in the post-stroke patients. These findings suggest plausible roles for top-down attention and working memory in the treatment effects of mirror therapy. Future research can aim to corroborate these findings by using a longitudinal design to examine the use of mirror therapy to promote upper limb motor recovery in post-stroke patients.

Effects of dance intervention on agitation and cognitive functioning of people living with dementia in institutional care facilities: Systematic review.

INTRODUCTION: Agitation and impaired cognitive functioning are common symptoms of dementia, which require costly medication regimens that are associated with adverse effects. This study investigates the effects of dance interventions on agitation and cognitive function in people living with dementia in institutional care facilities. METHODS: Five electronic databases were searched for eligible studies on dance interventions for people living with dementia published between 2002 and 2021. Standard deviation and post mean values were extracted. Within-group Hedges' g was computed for individual studies. RESULTS: Six randomised controlled trials and three non-randomised studies of satisfactory quality, with a total of 610 participants, were included. Statistical analysis found significant improvements in agitation and cognitive functioning with dance interventions. DISCUSSION: This review provided favourable evidence on the effects of dance interventions on agitation and cognitive functions in people with dementia. However, given the limited evidence, more studies are needed to confirm the effects.

COVID-19 Pandemic and Overall Mental Health of Healthcare Professionals Globally: A Meta-Review of Systematic Reviews.

OBJECTIVE: This meta-review aimed to provide a comprehensive overview of overall mental health of healthcare professionals during the COVID-19 pandemic. METHOD: We conducted a comprehensive literature search on Academic Search Premier, CINAHL, Cochrane Library, and MEDLINE. A predefined eligibility criterion was used to screen the articles. The methodology quality of eligible studies was assessed using Joanna Briggs Institute checklist for systematic reviews. The data were narratively synthesised in line with the meta-review aim. RESULT: Forty systematic reviews (represented as K = 40), which reported data from 1,828 primary studies (N) and 3,245,768 participants, met the inclusion criteria. The findings from a pooled prevalence indicate that anxiety (16-41%, K = 30, N = 701), depression (14-37%, K = 28, N = 584), and stress/post-traumatic stress disorder (18.6-56.5%, K = 24, N = 327) were the most prevailing COVID-19 pandemic-related mental health conditions affecting healthcare workers. Other reported concerns included insomnia, burnout, fear, obsessive-compulsive disorder, somatization symptoms, phobia, substance abuse, and suicidal thoughts. Considering regions/countries, the highest anxiety was reported in the United-Kingdom [22.3, 95% Confidence Interval (CI):7-38, N = 4] compared to other countries, while the highest depression was in the Middle-East, (41, 95% CI:16-60, N = 5) and stress in the Eastern Mediterranean region (61.6, 95% CI:56.4-66.8, N = 2) compared to other regions. The most significant risk factors include female gender, younger age, being a nurse, and frontline professional. The most-reported coping strategies include individual/group psychological support, family/relative support, training/orientation, and the adequacy of personal protective equipment. CONCLUSION: It was concluded that healthcare professionals (nurses, doctors, allied health) have experienced various mental health issues during COVID-19 pandemic. The meta-review, therefore, recommends targeted interventions and health policies that address specific mental health issues to support health professionals worldwide during the duration of the COVID-19 pandemic and similar future health crises. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202126200, identifier: CRD42021262001.

Quality of life of stroke survivors in Africa: a systematic review and meta-analysis.

PURPOSE: Functional impairments and socioeconomic constraints associated with stroke affect quality of life (QoL). With limited care and social support resources, there is a greater anticipated decline in QoL among stroke survivors in Africa. This study aims to examine post-stroke QoL, properties of outcome measures adopted and predictors of the QoL among African stroke survivors. METHODS: African Journals Online, CINAHL, PsychINFO, PubMed and Web of Science databases were searched from inception to February 2020. Methodological quality was assessed using the Agency for Healthcare Research and Quality (ARHQ) methodology checklist for observational studies. RESULTS: Twenty-eight studies recruiting 2572 (76.4%) stroke survivors and 795 (23.6%) healthy volunteers were included. Studies were conducted in eight African countries between 2007 and 2019. Methodological quality of studies was good. Overall, stroke survivors reported a low QoL. Six studies comparing QoL between stroke survivors and healthy controls were pooled for meta-analysis. Results showed a biased-adjusted standardised mean difference (Hedges's g) of 1.13 (95% CI 0.71 to 1.56; p < 0.001), indicating better QoL among healthy controls. Only 4 (14.3%) studies used translated or cross-culturally adapted QoL assessment tools. The most commonly reported predictor of QoL was post-stroke disability (35.8% of studies) which is followed by depression (28.6%) and stroke severity (28.6%). CONCLUSIONS: Overall, African stroke survivors reported comparatively lower QoL as compared to age-matched healthy controls. This highlights the need for cross-culturally validated assessment tools and more robust post-stroke QoL evaluation across the African continent. To improve QoL of stroke survivors in Africa, early interventions should focus on reducing disability and depression associated with stroke. PROSPERO registration number: CRD42019137653.

Neural Processes Underlying Mirror-Induced Visual Illusion: An Activation Likelihood Estimation Meta-Analysis.

Introduction: Neuroimaging studies on neural processes associated with mirror-induced visual illusion (MVI) are growing in number. Previous systematic reviews on these studies used qualitative approaches. Objective: The present study conducted activation likelihood estimation (ALE) meta-analysis to locate the brain areas for unfolding the neural processes associated with the MVI. Method: We searched the CINAHL, MEDLINE, Scopus, and PubMed databases and identified eight studies (with 14 experiments) that met the inclusion criteria. Results: Contrasting with a rest condition, strong convergence in the bilateral primary and premotor areas and the inferior parietal lobule suggested top-down motor planning and execution. In addition, convergence was identified in the ipsilateral precuneus, cerebellum, superior frontal gyrus, and superior parietal lobule, clusters corresponding to the static hidden hand indicating self-processing operations, somatosensory processing, and motor control. When contrasting with an active movement condition, additional substantial convergence was revealed in visual-related areas, such as the ipsilateral cuneus, fusiform gyrus, middle occipital gyrus (visual area V2) and lingual gyrus, which mediate basic visual processing. Conclusions: To the best of our knowledge, the current meta-analysis is the first to reveal the visualization, mental rehearsal and motor-related processes underpinning the MVI and offers theoretical support on using MVI as a clinical intervention for post-stroke patients.

Impact of physical activity and traumatic exposure on occurrence of gestational hypertension: a survey of pregnant women in an armed-conflict region in Nigeria.

OBJECTIVE: To compare physical activity level and traumatic exposure between normotensive and hypertensive pregnant women in an armed conflict region of Nigeria. METHODS: 130 normotensives and hypertensive pregnant women comprising of 65 participants per group participated in the study. Harvard Trauma Questionnaire and Pregnancy Physical Activity Questionnaire were used to assess traumatic events and physical activity respectively. RESULTS: Significant difference was observed on total traumatic event (p = 0.008) and all domains and intensities of physical activity except inactivity and sedentary (p > 0.05). Household activities (OR: 0.989; 95% CI: 0.981-0.996), occupational activities (OR: 0.936; 95%CI: 0.879-0.996) and sport/exercise activities (OR: 0.898; 95%CI: 0.832-0.969) were associated with a decrease hypertensive pregnancy. CONCLUSION: Despite exposed to traumatic events, physical activity is associated with normotensive pregnancy in an armed conflict region.

Does task complexity influence motor facilitation and visuo-motor memory during mirror therapy in post-stroke patients?

Stroke is one of the most common causes of mortality and reduced disability-adjusted life years worldwide. Hemiparesis due to reduced skeletal-muscle power is an effect of brain lesions. Mirror therapy can significantly improve motor performance among post-stroke patients. To determine if altering the complexity of the mirror task in the mirror therapy paradigm would enhance top-down motor facilitation and visuo-motor memory demand, we conducted a pilot study on four post-stroke patients. Our preliminary results showed that performing complex finger tapping task resulted in enhanced activities in the primary motor cortex and precuneus, ipsilateral to the moving hand in the mirror therapy paradigm. We hypothesise the following: (a) complex finger tapping would result in stronger top-down motor facilitation and higher demand on visuo-motor memory than simple finger tapping in the mirror therapy paradigm, and (b) observing a blurred mirror image would result in increased top-down motor facilitation and higher demand on visuo-motor memory than a clear mirror image. To confirm these hypotheses, we propose a cross-sectional observational study on a large sample of post-stroke patients. This paper reports the findings of the pilot study, the rationale for testing the hypotheses, the experimental set-up, the task design and the assessment protocol for functional near-infrared spectroscopy.

Economic evaluations of physiotherapy interventions for neurological disorders: a systematic review.

Purpose: To identify the existing evidence evaluating the cost-effectiveness of physiotherapy treatments for people with neurological disorders.Methods: Multiple databases were searched from database inception until July 2018. Studies estimating the cost-effectiveness as incremental cost-effectiveness ratios, cost per quality-adjusted life year, cost per disability-adjusted life year and cost per other measurable results were included. Physiotherapy Evidence Database scale, and Consensus on Health Economic Criteria list were used for rating the quality of the evidence.Results: Ten studies involving 1462 participants were included. Aerobic training, progressive strength training, and a pragmatic physiotherapy program (combination of stretching, strength, and balance training) were reported as potentially cost-effective for older adults with vascular cognitive impairment, falls prevention in Parkinson's disease and multiple sclerosis respectively. Physiotherapy as an adjuvant for pain control was also reported as cost-effective for reflex sympathetic dystrophy. One study testing extra physiotherapy-by-physiotherapy assistant in cerebral palsy and two studies testing extra therapy using a robotic arm and Wii therapy for hand rehabilitation in stroke were reported as not cost-effective.Conclusions: There are limited studies that have evaluated the cost-effectiveness of physiotherapy treatments in neurological disorders. Three studies that combined extra physiotherapy-by-physiotherapy assistant and novel interventions with conventional physiotherapy were found not cost-effective.Implications for RehabilitationProgressive muscle strengthening exercise over a period of 6-month is reported to be cost-effective for falls prevention in people with Parkinson's diseaseAerobic training is reported as potentially cost-effective for older adults with vascular cognitive impairmentPhysiotherapy given as an adjuvant treatment is reported to be potentially cost-effective for reflex sympathetic dystrophy of less than 1-year durationOne study reported physiotherapy involving static stretching, aerobic exercise, strengthening exercise, and balance training as cost-effective for people with multiple sclerosisAdditional physiotherapy-by-physiotherapy assistant or family member for improving motor development in cerebral palsy and the use of novel physiotherapy techniques such as robotics or Wii plus conventional physiotherapy for improving arm function in stroke are found not cost-effectiveGroup therapy for improving physical activity in mild Alzheimer's disease is found not cost-effective.