Measuring global activity performance in children with cerebral palsy in West Africa: validation of an adapted version of the ACTIVLIM-CP questionnaire.

PURPOSE: To calibrate a West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) for children with cerebral palsy (CP). MATERIALS AND METHODS: We recruited 287 children with CP of various age range: 2-6 years (n = 117, preschoolers), 6-12 years (n = 96, children) and 12-19 years (n = 74, adolescents). Caregivers of children of each age range completed the experimental version of the ACTIVLIM-CP-WA including 76 (preschoolers), 78 (children) and 76 (adolescents) global daily life activities. Responses were analyzed using the Rasch RUMM2030 software. RESULTS: The final West-African version of ACTIVLIM-CP including 31 items (both common and age-specific items) defined a unidimensional, linear scale with well-discriminated response categories. It presented a high internal consistency (R = 0.94). Moreover, all items were locally independent and the item difficulty hierarchy was invariant regarding caregivers' education, children's age and gender, MACS and GMFCS levels. The ACTIVLIM-CP-WA measures were significantly correlated (p < 0.05) with Gross Motor Function Classification System (ρ = -0.77), Manual Ability Classification System (ρ = -0.75), Box and Block test (dominant hand r = 0.51; non-dominant hand r = 0.49), One-minute walking test (r = 0.28), and Timed up and Go test (r = -0.40). CONCLUSIONS: The ACTIVLIM-CP-WA questionnaire provides a valid and reliable tool that has the potential to follow children's evolution and quantify changes consecutive to neurorehabilitation in Sub-Saharan Africa.IMPLICATIONS FOR REHABILITATIONThe West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) measures global activities requiring a combination of lower and upper extremities in children with cerebral palsy.As a Rasch-built scale, measures are unidimensional and linear to document changes in children with cerebral palsy from 2 to 19 years in Sub-Saharan Africa.Rehabilitation professionals are encouraged to use the ACTIVLIM-CP-WA questionnaire as a psychometrically robust assessment tool measuring the global performance in daily life activities in children with cerebral palsy in Sub-Saharan Africa.

Mothers' perception of cerebral palsy in a low-income country of West Africa: a cross-sectional study.

PURPOSE: Investigating mothers' perceptions of Cerebral Palsy (CP) and the impact of caregiving on family life in Benin, a west-African low to middle-income country (LMIC). METHODS: In this cross-sectional study we interviewed at their homes 88 mothers of children with CP about their perception of the cause of CP and stigmatization issues. Additionally, they completed the Impact on Family Scale and the Family Support Scale questionnaires. Multinomial and ordinal regressions analyses were used (p < 0.05). RESULTS: Most mothers (78%) referred to non-biomedical causes of CP (God's will or curse). Caregivers with a limited education level were more likely to report non-biomedical beliefs. Only 28% reported having received from physicians an explanation of the causes of CP. Around 38% endorsed neighbors considered their children as cursed, which is a source of stigmatization. Mothers perceived a high impact of caregiving on their family life that correlated with non-biomedical beliefs, low education level, and the severity of CP. CONCLUSION: There is a need in Benin, and probably in West-African LMICs generally, to shift to a family-centered care system and to inform the public about the root causes of CP to improve social integration of children with CP and decrease the negative impact on their families.Implication for rehabilitationMothers with a limited education level are more likely to report non-biomedical causes of CP in this LMIC;mothers' level of education and non-biomedical beliefs of causes of CP are associated to a high impact of caregiving on family life in this LMIC;mothers of children with CP in this LMIC do not perceive health-workers helpful.

Efficacy of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in young children with bilateral cerebral palsy (GMFCS III-IV) in a low and middle-income country: protocol of a randomised controlled trial.

INTRODUCTION: Cerebral palsy (CP) is highly prevalent in sub-Saharan Africa, where clinically-based studies have shown a considerable over-representation of the severe bilateral subtype. However, children's access to rehabilitation care is limited by many local factors, notably the lacking of rehabilitation services, insufficient knowledge of caregivers and financial constraints. In such a context there is an urgent need for studies of the evidence-based rehabilitation approach. Here, we describe the protocol of a randomised controlled study to investigate the efficacy of Hand-Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in young children with bilateral CP in Benin Republic, a representative low and middle-income country of western Africa. METHODS AND ANALYSIS: Forty children with bilateral CP aged between 24 and 59 months and with level III-IV in the gross motor function classification will be randomised to either a high intensity conventional therapy or HABIT-ILE therapy. Both therapies will be delivered as a day-camp model over 2 weeks to a total of 50 hours (5 hours per day). The assessor-blinded primary outcomes will include the gross motor function measure and both hands assessment. Secondary outcomes will be the adapted version of the ACTIVLIM-CP questionnaire, the Canadian Occupational Performance Measure, and a perception of CP interview form. Children will be assessed at baseline, after intervention and at 6-week follow-up. A 2 (group)×3 (test sessions) repeated analysis of variance will evaluate changes after the interventions. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of the rehabilitation department of the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, Benin (approval decision: N°01-2019/MS/CNHU-HKM/CEI/CUMPR). All participants' parents/caregivers will provide their written informed consent. Data will be managed with confidentiality. TRIAL REGISTRATION NUMBER: PACTR201911894444879.

Disability and functioning in primary and secondary hip osteoarthritis in Benin.

BACKGROUND: In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis. OBJECTIVES: The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis. METHOD: This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou.Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a t-test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status. RESULTS: Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification. CONCLUSION: Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life.

Disability and functioning in primary and secondary hip osteoarthritis in Benin

Background: In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis. Objectives: The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis. Method: This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou. Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a t-test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status. Results: Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification. Conclusion: Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country.

Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children's mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.

Comparison between self-reported and observed locomotion ability scores in patients with stroke: a cross-sectional study.

This study aimed to investigate (i) the validity of self-reported scores of locomotion ability in stroke survivors using the ABILOCO-Benin questionnaire, and (ii) the congruence between online Rasch analysis of the ABILOCO-Benin raw scores and a conversion table set along with the questionnaire development. Thirty-five adult poststroke patients [mean age: 52 (SD: 10) years, 60% men] recruited from the rehabilitation department of National University Hospital of Cotonou (Benin), self-reported their locomotion ability, filling out the ABILOCO-Benin questionnaire [self-reported scores (SRS)]. Afterwards, a physical therapist observed and rated the patients' locomotion ability, while they performed each of the 15 items of the questionnaire [performance-based scores (PBS)]. Both raw SRS and PBS were then converted to linear measures using (i) an online Rasch analysis method and (ii) an ordinal-to-interval transformation table. Analyses showed high correlation (intraclass correlation coefficient=0.74, P<0.001) and nonsignificant difference (P=0.778) between SRS and PBS. Linear measures from online Rasch and a conversion table also exhibited high correlation (intraclass correlation coefficient=0.92; P<0.001). However, the difference between online analysis and the conversion table was significant (P=0.022). In conclusion, self-report is a valid method to administer ABILOCO-Benin in stroke patients. The conversion table offers a valid opportunity for quick transfer of raw scores to linear measures. However, the accuracy of linear measures from the conversion table may be slightly affected by missing responses.

La lombalgie chronique : effets d'une thérapeutique multidisciplinaire

Introduction : La lombalgie est un symptôme fonctionnel fréquent. Sa prévalence a augmenté de 9,7% de 1990 à 2010. La restauration fonctionnelle du rachis (RFR) a été développée et proposée aux patients ayant un syndrome de déconditionnement et encore en activité professionnelle. Nous rapportons ici l'expérience du Centre Hospitalier Nord Caraïbe site du carbet, Martinique, France.Méthodes : Etude rétrospective, descriptive et analytique portant sur tous patients recrutés dans le programme restauration fonctionnelle du rachis de janvier 2010 à décembre 2014.Résultats : 144 patients ont été isolus. L'âge moyen était 48,7±10,1 ans, sans prédominance de sexe. Ils étaient essentiellement des lombalgiques (84,7%) et lombo-sciatalgiques (15,3%) évoluant depuis 6,7 ans et en surpoids. L'évaluation à l'entrée retrouvait : une EVA moyenne à 5,6/10. La distance doigt-sol était à 13cm, angle poplité à 153,2°, les tests d'endurance d'Ito-Shirado à 70±72 et de Sorensen 58±46. La qualité de vie, les capacités fonctionnelles et les croyances de ces patients significativement améliorés (p=0,001). Seul la douleur était significativement plus améliorée chez les opérés du rachis (p=0,001) comparés aux non-opérés.Conclusion : Le protocole restauration fonctionnelle du rachis est proposé aux lombalgiques chroniques, avec des résultats très satisfaisants dans les domaines physiques et fonctionnels mais modestes sur la douleur.D'autres études sont nécessaires pour confirmer ces résultats