Neurovascular coupling is altered in women who have a history of brain injury from intimate partner violence: a preliminary study.

Introduction: Intimate partner violence (IPV) is a global health crisis with 30% of women over the age of 15 experiencing at least one event in their lifetime. Brain injury (BI) due to head impacts and/or strangulation is a common but understudied part of this experience. Previous research has shown BI from other injury mechanisms can disrupt neurovascular coupling (NVC). To gain further insight into whether similar changes occur in this population, we assessed NVC responses in women with a history of IPV-BI. Methods: NVC responses were measured for the middle and posterior cerebral arteries (MCA, PCA) using transcranial Doppler ultrasound while participants performed a complex visual search task. The lifetime history of previous exposure to IPV-BI was captured using the Brain Injury Severity Assessment (BISA) along with measures of post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and demographic information. Initial analyses of NVC metrics were completed comparing participants who scored low vs. high on the BISA or did or did not experience non-fatal strangulation followed by a stepwise multiple regression to examine the impact of PTSD, anxiety, and depression on the relationship between the NVC metrics and IPV-BI. Results: Baseline and peak cerebral blood velocity were higher and the percentage increase was lower in the PCA in the low compared to the high BISA group whereas no differences between the groups were apparent in the MCA. In addition, those participants who had been strangled had a lower initial slope and area under the curve in the PCA than those who had not experienced strangulation. Finally, the stepwise multiple regression demonstrated the percentage increase in the PCA was significantly related to the BISA score and both depression and anxiety significantly contributed to different components of the NVC response. Conclusions: This preliminary study demonstrated that a lifetime history of IPV-BI leads to subtle but significant disruptions to NVC responses which are modulated by comorbid depression and anxiety. Future studies should examine cerebrovascular function at the acute and subacute stages after IPV episodes to shed additional light on this experience and its outcomes.

Modifying the Mini-Cog to Screen for Cognitive Impairment in Nonliterate Individuals.

OBJECTIVES: The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, consists of 3-word recall and an executive clock drawing test (CDT). However, CDT requires at least basic literacy and cultural exposure to analog clocks, conditions not met in many population groups around the world. We developed a modification of the Mini-Cog (MMC) for use with nonliterate and literate individuals. METHODS: Participants were adults (≥60 years) with no neurological diagnosis, with known cognitive impairment due to stroke, Parkinsonism, traumatic brain injury, or Alzheimer's disease, and whose family members were able to read and write. We replaced the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task. Family members rated the acceptability and feasibility of the Mini-Cog versions using a 6-point scale and completed a proxy-rated cognitive staging tool, the Dementia Severity Rating Scale (DSRS). Spearman's rho, Mann-Whitney U, and chi-square tests were used to evaluate group differences and associations between measures. RESULTS: Data were collected from 63 participants (75% ≥ 60 years, 67% nonliterate). Literacy was associated with CDT (chi-square strength 0.9, p < 0.001). Both MMC versions correlated with DSRS in healthy adults and patients (rho 0.6-0.7, p < 0.05). In literate individuals, the acceptability and feasibility of CDT and both alternate distractors were similarly high (5/6). CONCLUSIONS: Two alternate distractor tasks may successfully replace CDT in the Mini-Cog. The MMC versions are promising and deserve further study as screening tools for cognitive impairment in larger and more fully characterized samples.

Prevalence assessment of sexually transmitted infections among pregnant women visiting an antenatal care center of Nepal: Pilot of the World Health Organization's standard protocol for conducting STI prevalence surveys among pregnant women.

INTRODUCTION: Sexually transmitted infections (STIs) are common during pregnancy and can result in adverse delivery and birth outcomes. The purpose of this study was to estimate the prevalence of STIs; Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Trichomonas vaginalis (trichomoniasis), and Human Immunodeficiency Virus (HIV) among pregnant women visiting an antenatal care center in Nepal. MATERIALS AND METHODS: We adapted and piloted the WHO standard protocol for conducting a prevalence survey of STIs among pregnant women visiting antenatal care center of Dhulikhel Hospital, Nepal. Patient recruitment, data collection, and specimen testing took place between November 2019-March 2020. First catch urine sample was collected from each eligible woman. GeneXpert platform was used for CT and NG testing. Wet-mount microscopy of urine sample was used for detection of trichomoniasis. Serological test for HIV was done by rapid and enzyme-linked immunosorbent assay tests. Serological test for syphilis was done using "nonspecific non-treponemal" and "specific treponemal" antibody tests. Tests for CT, NG and trichomoniasis were done as part of the prevalence study while tests for syphilis and HIV were done as part of the routine antenatal testing. RESULTS: 672 women were approached to participate in the study, out of which 591 (87.9%) met the eligibility criteria and consented to participate. The overall prevalence of any STIs was 8.6% (51/591, 95% CI: 6.3-10.8); 1.5% (95% CI: 0.5-2.5) for CT and 7.1% (95% CI: 5.0-9.2) for trichomoniasis infection. None of the samples tested positive for NG, HIV or syphilis. Prevalence of any STI was not significantly different among women, age ≤ 24 years (10%, 25/229) compared to women age ≥25 years (7.1%, 26/362) (p = 0.08). CONCLUSIONS: The prevalence of trichomoniasis among pregnant women in this sub-urban population of Nepal was high compared to few cases of CT and no cases of NG, syphilis, and HIV. The WHO standard protocol provided a valuable framework for conducting STI surveillance that can be adapted for other countries and populations.

Cross-cultural adaptation, validity, and reliability of the Nepali version of the Exercise Adherence Rating Scale: a methodological study.

BACKGROUND: The Exercise Adherence Rating Scale (EARS) is a commonly used outcome tool, which helps to identify the adherence rate of exercises and reasons for adherence and non-adherence. There is no evidence of the availability of any measurement tools to assess exercise adherence in the Nepalese context and cultural background. Therefore, we conducted a cross-cultural adaptation of the EARS into the Nepali language and investigated its reliability and validity. METHODS: Cross-cultural adaptation of the EARS was done based on Beaton guidelines. Psychometric properties were evaluated among 18 participants aged 18 years or older with pre-diabetes or confirmed diagnosis of any disease who were prescribed with home exercises by physiotherapists. Any disease that limited participants from doing exercise and individuals unwilling to participate were excluded. Reliability was evaluated through internal consistency, using Cronbach's alpha. Exploratory Factor Analysis (EFA) was performed to explore construct validity and confirm its unidimensionality. Receiver Operating Characteristic (ROC) curve was analyzed to identify cut-off score, sensitivity and specificity of the tool. RESULTS: The Cronbach's alpha was 0.94 for EARS-adherence behavior. The EFA of 6-items adherence behavior revealed the presence of one factor with an eigenvalue exceeding one. The scree-plot suggested for extraction of only one factor with strong loading (75.84%). The Area Under the Curve was 0.91 with 95% confidence interval 0.77-1.00 at p = 0.004. The cutoff score was found 17.5 with 89% sensitivity and 78% specificity. CONCLUSIONS: The EARS was cross-culturally adapted to the Nepali language. The reliability and construct validity of the Nepali version of the EARS were acceptable to assess exercise adherence in Nepali-speaking individuals. This validated tool might facilitate the evaluation of exercise-related interventions. Future studies could investigate other psychometric properties of the Nepali EARS.

Feasibility and Effectiveness of Telephone-Based Telephysiotherapy for Treatment of Pain in Low-Resource Setting: A Retrospective Pre-Post Design.

Introduction: Telephysiotherapy (TPT) is a provision of physiotherapy services at a distance, using telecommunication technology when an in-person visit is not a feasible option. The objective of this study was to investigate the effectiveness of TPT in management of pain caused due to various problems among patients living in rural areas of a developing country. Methods: This retrospective study conducted in rural areas of Nepal recruited all patients who met the eligibility criteria during a day campaign. Two physiotherapists, one for assessment and another for treatment, were involved. Based on pretraining assessment finding, evidence-based individualized physiotherapy was prescribed. Pamphlets containing pictures of the prescribed exercises and instructions in the Nepali language were distributed. The treating physiotherapist made telephone calls to every patient each week to give necessary information, correction, modification, and progression of the exercise whatever required. At the end of the second and fourth weeks, pain was assessed using the Numeric Pain Rating Scale (NPRS) through telephone calls. The data were analyzed using ANOVA with repeated measures followed by pairwise comparisons. Results: Fifteen patients having pain due to various conditions participated in the study. The NPRS demonstrated significantly decreased pain (at rest: F = 3.5, p = 0.04, when worst: F = 26.4, p < 0.001, during activities of daily living: F = 16.6, p < 0.001, and during occupation: F = 15.6, p = 0.001) across time. The result met the minimal clinically important difference of NPRS, which is 2. Conclusions: The telephone-based TPT interventions demonstrated significant reduction in pain caused by various musculoskeletal problems. It could be a feasible and effective treatment option for the patients living in rural areas. However, we recommend for large-scale trials to establish effectiveness of the intervention and for its implication into routine clinical practice.

Factors influencing depression in individuals with traumatic spinal cord injury and caregivers' perceived burden in a low-income country: a cross-sectional study.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To investigate factors influencing depressed mood in individuals with traumatic spinal cord injury (TSCI) and caregivers' perceived burden in a low-income country. SETTING: Dhulikhel Hospital and Spinal Injury Rehabilitation Center, Nepal. METHODS: We recruited 95 couples (one person with spinal cord injury and one caregiver) aged 18-65 years. Participants with various levels and types of TSCI with post-injury duration of or providing care for ≥1 month were eligible for the study. The Nepali Beck Depression Inventory and the Zarit Burden Interview-12 were used to identify depressed mood of those with TSCI and caregivers burden, respectively. Linear regression analyses to explore associations was performed. RESULTS: Mean ages of the individuals with TSCI and caregivers were 34.8 (11.0) and 33.6 (12.3) years, respectively. Most of the participants with TSCI were male (67.4%) and (73.7%) had paraplegia. The caregivers were predominantly female (61.1%). Depressed mood was seen in 68% of those with TSCI, and burden was reported by 91.6% of caregivers. Depressed mood was significantly associated with gender, education, lesion type, and duration since the injury. Caregiver burden was associated with occupation, education, level of injury, length of care, and depressed mood level in the person with TSCI. Economic burden was found to be the highest (71.5%) followed by responsibility (22.2%) and time-related (6.3%) burden. CONCLUSIONS: The prevalence of depressed mood among individuals with TSCI and the burden of caregiving among caregivers was high. Depressed mood in those with TSCI was associated with caregiver burden. Country-specific contextual factors need to be considered in deriving rehabilitation protocols.

A structured workshop enhanced Physiotherapists' skills in clinical decision-making: A pre-post study.

CONTEXT: Effective clinical decision-making skills enhance the quality of patient care. Clinical reasoning and decision-making are fundamental aspects of best physiotherapy clinical practice. AIMS: To evaluate the effectiveness of an evidence-based structured educational workshop in enhancing physiotherapists' clinical decision-making skills. SETTINGS AND DESIGNS: A pre-post design conducted in a medical college. METHODS AND MATERIALS: A workshop protocol was developed based on the existing evidence and clinical practice guidelines. The workshop was advertised on the social media page of Nepal Physiotherapy association. On the first come first serve method; physiotherapists were selected. Those who met eligibility criteria were recruited for one of two workshops. Discussion was made on clinical scenarios aimed at enhancing clinical decision-making skills. Data were collected before and after the workshop using a self-administered clinical decision-making skills assessment tool to evaluate effectiveness of the workshop. Paired and unpaired t-tests were used to analyze within and between groups respectively. RESULTS: Significant improvement in clinical decision-making skills was found for all individual items (P < 0.001 in all items, effect size: 0.6 - 0.9), total EP score (P < 0.001, effect size: 0.8) and total clinical decision-making score (P < 0.001, effect size: 0.9). A significant difference was found between Bachelor and Master level education (P < 0.05). CONCLUSIONS: An evidence-based structured educational workshop enhanced physiotherapists' clinical decision-making skills. The findings of this study could be relevant to all health care professionals working in clinical practice. Larger studies with a control group are recommended to strengthen the findings of this study.

Community-based rehabilitation for physically impaired earthquake victims: An evidence-based practice protocol and its pre-post experimental study.

BACKGROUND: A natural disaster like earthquake is a sudden event that causes not only the loss of life but also mental, emotional, and physical disabilities. An earthquake of 7.8 magnitudes hit Nepal and injured more than 18,500 people in 2015. There was a critical need to develop rehabilitation protocols. Therefore, we aimed to structure community-based rehabilitation protocols for physically impaired earthquake victims and to investigate immediate effect of the intervention to address disability and reduce public health burden. MATERIALS AND METHODS: Evidence-based rehabilitation protocols for various injuries were structured to address the victims' impairments and activity limitations. The protocols were administered to 13 victims of one of the most affected community sites, for 60 min/day, 12 days in 2 weeks at their own doors. Local resources were used to make the protocols sustainable. An immediate effect of the protocols was evaluated within the group. The World Health Organization Disability Assessment Schedule, numerical pain rating scale, and time up and go (TUG) test were used to measure disability level, pain, and mobility status, respectively. Wilcoxon's signed rank test was used to analyze pre-post data. RESULTS: All participants completed the rehabilitation without adverse effects. The treatment demonstrated significant reduction in disability level (P < 0.001, effect size = 0.63) and pain level (P = 0.007). However, change with TUG was not significant. CONCLUSION: The evidence-based, structured community rehabilitation protocols demonstrated benefits in improving the victim's quality of life. Follow-ups will be continued to explore sustainability and long-term effects of the interventions.