Exposure to Meta-Analysis During Graduate and Postgraduate Trainings Predicts the Good Knowledge and Use of Randomized Controlled Trials, Systematic Reviews, and Meta-Analyses Among Nigerian Physiotherapists.

Background Evidence-based practice (EBP) is essential for physiotherapy as an integral part of the multidisciplinary rehabilitation team. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses are the gold standard in the hierarchy of evidence. However, the extent of knowledge, attitudes, and professional use of RCTs and meta-analyses among physiotherapists in Nigeria remains unclear. Therefore, this study aimed to describe and explore the predictors of Nigerian physiotherapists' knowledge, attitudes, and professional behaviors toward RCTs, systematic reviews, and meta-analyses. Methods In this observational study, an electronic version of an adapted questionnaire assessing the knowledge, attitudes, and professional use of RCTs and meta-analyses was shared across electronic platforms of Nigerian physiotherapy professional organizations. Results We found good overall knowledge (76 {80.8%}) and attitude (83 {88.3%}) toward the use of RCTs, systematic reviews, and meta-analyses for evaluating health interventions. Exposure to meta-analysis during graduate and postgraduate training (odds ratio {OR}, 7.102; 95% CI, 1.680-30.021; p = 0.008) and the presence of a medical library at the workplace (OR, 0.264; 95% CI, 0.070-0.997; p = 0.049) were significant predictors of good knowledge of RCTs, systematic reviews, and meta-analyses. Self-rated (OR, 56.476; 95% CI, 1.356-2357.430; p = 0.034) and overall levels of knowledge (OR, 0.013; 95% CI, 0.000-0.371; p = 0.011) predicted the good use of RCTs, systematic reviews, and meta-analyses among respondents. Discussion To equip physiotherapy practitioners with the requisite skill in using RCTs, systematic reviews, and meta-analyses, graduate and postgraduate trainings should prioritize education on the use of RCTs, systematic reviews, and meta-analyses to inform clinical decisions and practice, while capable workplaces may set up medical libraries to ease access and enhance the use of RCTs, systematic reviews, and meta-analyses.

Multisite Pain and Intensity were Associated with History Fall among Older Adults: A Cross-Sectional Study.

Purpose: This study examined the independent associations among multisite pain, pain intensity, and the risk of falls, including a history of falls in the previous 12 months and frequent falls (≥ two falls vs one or two falls) among community-dwelling older adults. Methods: A cross-sectional design from Wave 2 of the National Social Life, Health, and Aging Project was used. Data on pain intensity and location (45 sites) over the past 4 weeks were collected. Multisite pain was categorized into four groups: none, one, two, and three or more sites. The main outcomes of falls were a history of falls and frequent falls. The covariates included age, sex, race, body mass index, education, medications, and comorbidities. Results: Among 3,196 participants in Wave 2, 2,697 were included because of missing key variables related to pain and fall history. The prevalence of falls and frequent falls were 30.3% (n = 817) and 12.6% (n = 339), respectively. Multisite pain at ≥ three sites (odds ratio (OR) 2.04, confidence interval (CI) [1.62, 2.57]; p < 0.001) and two sites (OR 1.72, 95% CI [1.30, 2.27]; p < 0.001) was significantly associated with an increased risk of falls. An increase in pain intensity was significantly associated with an increased risk of fall (OR 1.28, 95% CI [1.15, 1.44], p < 0.001), independent of multisite pain. Multisite pain at ≥3 sites (OR 2.19, 95% CI [1.56, 3.07], p < 0.001) and 2 sites (OR 1.54, 95% CI [1.01, 2.34], p = 0.045) was associated with an increased risk of frequent falls. An increase in pain intensity was associated with risk of frequent falls (OR 1.64, 95% CI [1.40, 1.91], p < 0.001), independent of multisite pain. Conclusion: Multisite pain and pain intensity were associated with a history of falls and frequent falls among older adults, emphasizing the need for routine pain evaluation to develop fall prevention strategies in this population.

Current Rehabilitation Practices and Return to Sports Criteria After Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists in Saudi Arabia.

CONTEXT: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. DESIGN: Online cross-sectional survey-based study. METHODS: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. RESULTS: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. CONCLUSIONS: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements.

Self-Reported Moderate-to-Vigorous Physical Activity: Its Association with Health-Related Quality of Life in a Large Cohort of People with Chronic Diseases.

The aim of this study was to investigate the dose-response relationship between physical activity and health-related quality of life (HRQoL) in a large population-based sample of people with chronic disease. We analysed the data of 29,271 adults (15,315 women) who were diagnosed with chronic diseases and participated in the Welsh Health Survey (Wales, UK; data collection 2011-2015). Participants were classified, based on their weekly minutes of moderate-to-vigorous physical activity (MVPA), into four groups as follows: inactive (no MVPA), insufficiently active (<150 min/week), sufficiently active (≥150-<300), and very active (≥300). The main outcome was HRQoL measured via the Short-Form 36 Health Survey (SF-36). This study found a curvilinear association between MVPA and HRQoL and a dose-response relationship for the perception of general health and vitality domains. Compared to inactive participants, those who were very active had higher HRQoL scores (coefficient = 12.54; 95% confidence interval [CI] 11.39-13.70), followed by sufficiently active (coefficient = 11.70; 95% CI 10.91-12.49) and insufficiently active (coefficient = 9.83; 95% CI 9.15-10.51) participants. The fully adjusted regression model showed curvilinear associations between MVPA and the domains of SF-36. Future research should find ways to motivate people with chronic diseases to engage in physical activity. The evidence to support regular exercise in individuals with chronic diseases in all age groups is strong and compelling, and patients should be encouraged to regularly devote more time to physical activity in order to improve their health and well-being.

Hypertension Is Associated with Joint Pain Severity Among Individuals with Osteoarthritis.

Previous studies have reported an association between hypertension (HTN) and osteoarthritis (OA). However, limited research has examined the association between HTN and symptoms, such as pain severity, in people with OA. Therefore, the aim was to investigate the prevalence of HTN in individuals with OA and the association between HTN and pain severity in this population. This study was cross-sectional and included participants aged 50 years and older from the community. Demographic data were included and self-reported history of chronic illnesses including diabetes, HTN, cardiovascular disease, dyslipidemia, anemia, osteoporosis, neurological disease, and back pain were obtained. Numerous medications and chronic diseases were included. A subsample of people who self-reported osteoarthritis was included in this study. Pain severity was measured over the past 7 days using a pain numeric rating scale. Multiple linear regression was used after adjusting for covariates. A total of 82 participants with OA were included, and the prevalence of HTN among individuals with OA was 28.91%. Hypertension was significantly associated with increased joint pain severity in this population after adjustments for covariates (B=1.81; 95% CI, 0.65, 2.97; p = .003). Hypertension is prevalent in individuals with OA and is significantly associated with pain severity in this population. Future research should consider the effect of HTN control and medication on symptoms in people with OA. Clinicians may implement screening for HTN among individuals with OA because of the association between HTN and symptoms, such as pain, in this population.

Using the Y-balance Test as a Predictor Tool for Evaluating Non-contact Injuries in University League Football Players: A Prospective Longitudinal Study.

Background Football is a highly competitive sport, and participants can experience various contact and non-contact sports injuries in the sporting process. In any elite sport, screening players using different scientific tools is an important injury prevention strategy. The Y- Balance test (YBT) was found to be a predictive tool for non-contact injury. However, the use of criteria from these tests to predict injuries has not been substantiated and should be further investigated. Purpose The aim of this study was to determine the predictors for injury among athletes using baseline YBT, number of matches, and minutes of physical activity; the cutoff scores for predictors of injury, including baseline YBT, number of matches, and minutes of physical activity; and the clinical prediction rules for predicting injury in this population. Methods A total of 39 young student football players were included in this study. The mean age was 20.28 years, and the mean body mass index (BMI) was 23.83 kg/m2. A baseline assessment of the participant's characteristics was taken and each participant performed the YBT once before starting the league. After the university league football players had finished their tournament, we asked them questions related to non-contact injuries. Results The results showed that the prevalence of injury was 17.95% among this population. An increase in the YBT score was significantly associated with a decrease in the odds of having an injury [odds ratio (OR) 95% confidence interval (CI): 0.94 (0.88, 0.99), p = 0.047). In addition, the number of matches was significantly associated with an increase in the odds of having an injury p = 0.012. However, the minutes of physical activity were not statistically significant p = 0.065. The highest Youden index was ≤97.89, with a sensitivity of 87.50% and specificity of 71.43%, for the posterior medial reach and ≤92.88, with a sensitivity of 90.62% and specificity of 57.14%, for the posterior lateral reach. The clinical prediction rule was an area under the curve (AUC) of 0.88. Conclusions The results of the study provide evidence for the potential utility of the YBT as a predictor tool for evaluating non-contact injuries in university league football players. By identifying players with lower YBT scores who were at higher risk for injury, targeted interventions could be implemented to address functional movement deficits and potentially reduce injury risk.

Retro walking treadmill training reduces C-reactive protein levels in overweight and obese young adults: A randomized comparative study.

Background and Aims: Retro walking has been shown to acquire a greater metabolic cost, placing a higher cardiopulmonary demand on the body, when compared with forward walking at a similar speed. The aim of this study was to compare the effect of retro walking with that of forward walking on C-reactive protein (CRP) levels, body mass index (BMI) and blood pressure (BP) and to understand the influence of independent factors namely systolic blood pressure (SBP), diastolic blood pressure (DBP) and BMI on CRP in untrained overweight and obese young adults. Methods: This was a randomised controlled trial whereby 106 participants underwent either retro walking (n = 53) or forward walking (n = 53) treadmill training four times a week for 12 weeks before and after which CRP, BMI, and BP levels were measured. Comparison of the measured values before and after intervention and between the groups was done and influence of BMI and BP on CRP levels was determined. Results: Both groups recorded a significant decrease (p < 0.001) in CRP, BMI, and BP levels postintervention. The participants who underwent retro walking training showed a significantly (p < 0.001) higher decrease in all the outcomes as compared with the forward walking group. C-reactive protein levels were seen to be influenced by BMI and DBP. Conclusion: Retro-walking training leads to greater decrease in CRP, BMI, and BP when compared with forward walking, and CRP levels are influenced by BMI and DBP. Retro walking treadmill training can be used preferentially to bring about reduction in cardiovascular risk factors.

Comparing the effects of retro and forward walking on serum adiponectin levels in obese young adults.

Objectives: Retro walking or backward walking expends greater energy and places less stress on joints compared with forward walking at a similar speed. This study conducted in obese young men was primarily aimed at comparing the effects of backward walking with forward walking on adiponectin levels. The secondary aim was to describe the effects of concomitant factors, namely C-reactive protein, body mass index (BMI), waist to height ratio, and waist to hip ratio, on adiponectin levels in obese young men. Methods: In this randomized comparative study, 102 participants underwent either retro walking or forward walking treadmill training four times a week for 12 weeks before and after which adiponectin, C-reactive protein, BMI, waist to height ratio, and waist to hip ratio were measured. Comparison of the measured values before and after intervention and between the groups was done, and the influence of C-reactive protein, BMI, waist to height ratio, and waist to hip ratio on adiponectin levels was determined. Results: Adiponectin levels were significantly increased (p < 0.001) and C-reactive protein, BMI, waist to height ratio, and waist to hip ratio were significantly decreased (p ≤ 0.001) post-intervention. The participants who underwent retro walking training showed a significantly higher change in C-reactive protein levels, BMI, and waist to hip ratio compared to the forward walking group (p < 0.001). Adiponectin levels were influenced by BMI (p < 0.001). Conclusion: Retro walking training leads to a greater increase in adiponectin and reduction in C-reactive protein, BMI, waist to height ratio, and waist to hip ratio compared to forward walking, and adiponectin levels are influenced by BMI. Retro walking treadmill training can be preferentially used to decrease cardiovascular risk factors.

Effectiveness of Spinal Stabilization Exercises on Dynamic Balance in Adults with Chronic Low Back Pain.

Background: Dynamic balance is a vital aspect of everyday life. It is important to incorporate an exercise program that is useful for maintaining and improving balance in patients with chronic low back pain (CLBP). However, there is a lack of evidence supporting the effectiveness of spinal stabilization exercises (SSEs) on improving dynamic balance. Purpose: To determine the effectiveness of SSEs on dynamic balance in adults with CLBP. Study Design: A double-blind randomized clinical trial. Methods: Forty participants with CLBP were assigned randomly into either an SSE group or a general exercise (GE) group, which consisted of flexibility and range-of-motion exercises. Participants attended a total of four to eight supervised physical therapy (PT) sessions and performed their assigned exercises at home in the first four weeks of the eight-week intervention. In the last four weeks, the participants performed their exercises at home with no supervised PT sessions. Participants' dynamic balance was measured using the Y-Balance Test (YBT) and the normalized composite scores, Numeric Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire scores were collected at baseline, two weeks, four weeks, and eight weeks. Results: A significant difference between groups from two weeks to four weeks (p = 0.002) was found, with the SSE group demonstrating higher YBT composite scores than the GE group. However, there were no significant between-group differences from baseline to two weeks (p =0.098), and from four weeks to eight weeks (p = 0.413). Conclusions: Supervised SSEs were superior to GEs in improving dynamic balance for the first four weeks after initiating intervention in adults with CLBP. However, GEs appeared to have an effect equivalent to that of SSEs after 8-week intervention. Levels of Evidence: 1b.

Effectiveness of Spinal Stabilization Exercises on Movement Performance in Adults with Chronic Low Back Pain.

Introduction: Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP). Methods: Forty participants, 20 in each group, with CLBP were recruited and randomly allocated into one of two interventions: SSEs and general exercises (GEs). All participants received their assigned intervention under supervision one to two times per week for the first four weeks and then were asked to continue their program at home for another four weeks. Outcome measures were collected at baseline, two weeks, four weeks, and eight weeks, including the Functional Movement ScreenTM (FMSTM), Numeric Pain Rating Scale (NPRS), and Modified Oswestry Low Back Pain Disability Questionnaire (OSW) scores. Results: There was a significant interaction for the FMSTM scores (p = 0.016), but not for the NPRS and OSW scores. Post hoc analysis showed significant between-group differences between baseline and four weeks (p = 0.005) and between baseline and eight weeks (p = 0.026) favor SSEs over GEs. Further, the results demonstrated that all participants, regardless of group, had significant improvements in movement performance, pain intensity, and disability level over time. Conclusion: The results of the study favor SSEs over GEs in improving movement performance for individuals with CLBP, specifically after four weeks of the supervised SSE program.

Knowledge, Attitude, and Practice among Physical Therapists toward COVID-19 in the Kingdom of Saudi Arabia-A Cross-Sectional Study.

To curb the COVID-19 pandemic, the knowledge, attitude, and practice (KAP) of preventive measures play an essential role, and healthcare workers have had to endure a burden to care for COVID-19 patients. Thus, this study aimed to assess the weight of the KAP of physiotherapists in Saudi Arabia during the COVID-19 pandemic. This was a cross-sectional study, where we circulated an online KAP questionnaire to 1179 physical therapists, and among those, 287 participated and completed the questionnaire. The collected responses were analyzed using descriptive statistics, t-test, ANOVA, correlation, and regression analyses, and p-value ≤ 0.05 was considered statistically significant. Both males and females participated in almost equal numbers; most of the participants were <40 years, had a bachelor's level of education, and were from the central region of Saudi Arabia. Social media and the internet were the primary sources of COVID-19-related information (74.6%). Knowledge components A (92%) and B (73.9%) were excellent among most participants. Approximately half of the participants (50.5%) had a moderate attitude toward COVID-19, and regarding the practice component, most participants (74.6%) scored moderately. Correlation analysis showed a low positive relationship between knowledge A, attitude, and practice components. Still, there was a very low positive relationship between knowledge B, attitude, and practice components, but both were statistically significant. Our study showed that physical therapists in Saudi Arabia exhibit good knowledge, attitude, and practice toward COVID-19.

Reliability and Validity of the Y-balance Test in Young Adults with Chronic Low Back Pain.

BACKGROUND: Individuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined. PURPOSE: To determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group. STUDY DESIGN: Reliability and validity study. METHODS: Fifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant's dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis. RESULTS: The YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001). CONCLUSIONS: The results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP. LEVEL OF EVIDENCE: 2b.

Reliability and Validity of the Functional Movement Screen™ with a Modified Scoring System for Young Adults with Low Back Pain.

Background: Low back pain (LBP) is one of the most common complaints in individuals who seek medical care and is a leading cause of movement impairments. The Functional Movement Screen (FMS™) was developed to evaluate neuromuscular impairments during movement. However, the reliability and validity of the FMS™ have not yet been established for the LBP population because of a limitation of its original scoring system. Purpose: The purposes of this study were to determine the reliability and validity of the FMS™ with a modified scoring system in young adults with and without LBP. The FMS™ scores were modified by assigning a zero score only when there was an increase in LBP during the FMS™, not simply for the presence of pain, as in the original FMS™ scoring system. Study Design: Reliability and validity study. Methods: Twenty-two participants with LBP (8 males and 14 females, 26.7 ± 4.68 years old) and 22 age- and gender-matched participants without LBP (26.64 ± 4.20 years old) completed the study. Each participant performed the FMS™ once while being scored simultaneously and independently by two investigators. In addition, each participant's FMS™ performance was video-recorded and then was scored by another two investigators separately. The video-recorded performance also was scored twice six weeks apart by the same investigator to determine intra-rater reliability. Results: The results showed excellent inter-rater and intra-rater reliability of the FMS™ composite score with intraclass correlation coefficients ranging from 0.93 to 0.99 for both groups. In addition, the LBP group scored significantly lower than the group without LBP (p = 0.008). Conclusions: The results indicate that the FMS™ is able to distinguish between individuals with and without LBP, and that it could be a useful test for clinicians to quantify movement quality and to assess movement restrictions in individuals with LBP. Levels of Evidence: 2b.