Comparative effectiveness of low-level laser therapy versus muscle energy technique among diabetic patients with frozen shoulder: a study protocol for a parallel group randomised controlled trial.

BACKGROUND: Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage  this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy. OBJECTIVES: To evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder. METHODS: This is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up. DISCUSSION: This will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice. TRIAL REGISTRATION: Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022.

The Hausa Northwick Park Neck Pain Questionnaire: translation, cross-cultural adaptation and psychometric assessment in patients with non-specific neck pain.

PURPOSE: To translate and cross-culturally adapt the Northwick Park Neck Pain Questionnaire (NPQ) into Hausa and assess its psychometric properties. MATERIALS AND METHODS: The NPQ was translated and cross-culturally adapted into Hausa using recommended guidelines. A consecutive sample of 92 Hausa-speaking patients with non-specific neck pain recruited from three tertiary hospitals in north-western Nigeria, completed the questionnaire to assess factorial validity (using confirmatory factor analysis), convergent validity (by correlating the Hausa-NPQ with the Numerical Pain Rating Scale [NPRS]), and internal consistency (using Cronbach's α). A subsample of 50 patients completed the questionnaire again 3 days after the first administration to assess relative reliability using intraclass correlation coefficients (ICC) and absolute reliability using standard error of measurement (SEM), smallest detectable change (SDC), and 95% limits of agreement (LOA). RESULTS: The factor analysis confirmed a single-factor structure with excellent internal consistency (α = 0.94). The questionnaire showed a strong positive correlation with the NPRS (rho = 0.68). The ICC was 0.86, with SEM and SDC of 6.32 and 17.5, respectively. The LOA was - 29.3 to + 37.1 with no evidence of proportional bias. CONCLUSIONS: The Hausa-NPQ is a valid and reliable measure of disability due to neck pain.

This study describes the translation, cross-cultural adaptation, and psychometric assessment of the Hausa-NPQ in Hausa-speaking patients with non-specific neck pain.The questionnaire demonstrated adequate psychometric properties in terms of factorial and convergent validity, internal consistency, and test-retest reliability.The questionnaire will be useful in clinical and research settings to assess disability due to neck pain for screening purposes, evaluation of treatment effectiveness, as well as cross-cultural comparisons involving Hausa-speaking individuals with neck pain.

Effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors: a protocol for randomised controlled trial.

BACKGROUND: Post-stroke gait deviations contribute to significant functional disability, impaired walking ability and poor quality of life. Prior studies suggest that gait training with paretic lower limb loading may improve gait parameters and walking ability in post-stroke. However, most gait training methods used in these studies are not readily available, and studies using cheaper methods are limited. OBJECTIVE: The purpose of this study is to describe a protocol for a randomised controlled trial on the effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors. METHODS: This is a two-center, single-blind, two-arm parallel randomised controlled trial. Forty-eight stroke survivors with mild to moderate disability will be recruited from two tertiary facilities and randomly assigned into two intervention arms; overground walking with paretic lower limb loading or overground walking without paretic lower limb loading in a 1:1 ratio. All interventions will be administered thrice weekly for 8 weeks. Primary outcomes will be step length and gait speed whereas the secondary outcomes will include step length symmetry ratio, stride length, stride length symmetry ratio, stride width, cadence and motor function. All outcomes will be assessed at baseline, 4, 8 and 20 weeks after the start of intervention. DISCUSSION: This will be the first randomised controlled trial to report the effects of overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors from low-resource setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT05097391. Registered on 27 October 2021.

Effectiveness of patient education plus motor control exercise versus patient education alone versus motor control exercise alone for rural community-dwelling adults with chronic low back pain: a randomised clinical trial.

BACKGROUND: Chronic low back pain (CLBP) is a common health problem in rural Nigeria but access to rehabilitation is limited. Current clinical guidelines unanimously recommend patient education (PE) including instruction on self-management, and exercises as frontline interventions for CLBP. However, the specific content of these interventions and how they are best delivered remain to be well-described, particularly for low-resource communities. This study determined the effectiveness of PE plus motor control exercise (MCE) compared with either therapy alone among rural community-dwelling adults with CLBP. METHODS: A single-blind, three-arm parallel-group, randomised clinical trial including 120 adult rural dwellers (mean [SD] age, 46.0 [14.7] years) with CLBP assigned to PE plus MCE group (n = 40), PE group (n = 40), and MCE group (n = 40) was conducted. The PE was administered once weekly and the MCE twice weekly. Each group also received stretching and aerobic exercises twice weekly. All interventions were administered for 8 weeks. Blinded assessments for pain intensity and disability level as primary outcomes, and quality of life, global perceived recovery, fear-avoidance beliefs, pain catastrophising, back pain consequences belief and pain medication use as secondary outcomes were conducted at baseline, 8-week (immediately after intervention) and 20-week follow-ups. RESULTS: All the groups showed significant improvements in all the primary and secondary outcomes evaluated over time. Compared with PE alone, the PE plus MCE showed a significantly greater reduction in pain intensity by an additional -1.15 (95% confidence interval [CI], -2.04 to -0.25) points at the 8-week follow-up and -1.25 (95% CI, -2.14 to -0.35) points at the 20-week follow-up. For disability level, both PE plus MCE and MCE alone showed a significantly greater improvement compared with PE alone by an additional -5.04% (95% CI, -9.57 to -0.52) and 5.68% (95% CI, 1.15 to 10.2) points, respectively, at the 8-week follow-up, and -5.96% (95% CI, -9.84 to -2.07) and 6.57% (95% CI, 2.69 to 10.4) points, respectively, at the 20-week follow-up. For the secondary outcomes, at the 8-week follow-up, PE plus MCE showed a significantly greater reduction in fear-avoidance beliefs about physical activity compared with either therapy alone, and a significantly greater reduction in pain medication use compared with PE alone. However, compared with PE plus MCE, PE alone showed a significantly greater reduction in pain catastrophising at all follow-up time points, and a significantly greater improvement in back pain consequences belief at the 20-week follow-up. Additionally, PE alone compared with MCE alone showed a significantly greater improvement in back pain consequences belief at all follow-up time points. No significant between-group difference was found for other secondary outcomes. CONCLUSIONS: Among rural community-dwelling adults with CLBP, PE plus MCE led to greater short-term improvements in pain and disability compared with PE alone, although all intervention strategies were associated with improvements in these outcomes. This trial provides additional support for combining PE with MCE, as recommended in current clinical guidelines, to promote self-management and reduce the burden of CLBP in low-resource rural communities. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03393104), Registered on 08/01/2018.

Effectiveness of lumbar stabilization exercise with real-time ultrasound imaging biofeedback on lumbar multifidus muscle cross-sectional area in individuals with non-specific chronic low back pain: a study protocol for a randomized controlled trial.

BACKGROUND: Structural impairment of the lumbar multifidus muscle, such as reduced cross-sectional area, is evident among individuals with chronic low back pain. Real-time ultrasound imaging (RUSI) biofeedback has been reported to improve preferential activation of as well as retention in the ability to activate the lumbar multifidus muscle during lumbar stabilization exercises (LSE). However, evidence of the effectiveness of this treatment approach in individuals with non-specific chronic low back pain (NCLBP) is still limited. The purpose of this study is, therefore, to determine the effectiveness of LSE with RUSI biofeedback on lumbar multifidus muscle cross-sectional area in individuals with NCLBP. METHODS/DESIGN: This study is a prospective, single-center, assessor-blind, three-arm, parallel randomized controlled trial to be conducted at National Orthopedic Hospital, Kano State, Nigeria. Ninety individuals with NCLBP will be randomized in a 1:1:1: ratio to receive LSE, LSE with RUSI biofeedback, or minimal intervention. All participants will receive treatment twice weekly for 8 weeks. The primary outcome will be the lumbar multifidus muscle cross-sectional area. The secondary outcomes will include pain (Numerical Pain Rating Scale), functional disability (Roland-Morris Disability Questionnaire), and quality of life (12-Item Short-Form Health Survey). All outcomes will be assessed at baseline, 8 weeks post-intervention,  and 3 months follow-up. DISCUSSION: To our knowledge, this study will be the first powered randomized controlled trial to compare the effectiveness of LSE training with and without RUSI biofeedback in individuals with NCLBP. The outcome of the study may provide evidence for the effectiveness of LSE with RUSI biofeedback on enhancing the recovery of the lumbar multifidus muscle in individuals with NCLBP. TRIAL REGISTRATION: Pan African Clinical Trials Registry ( PACTR201801002980602) . Registered on January 16, 2018.

Knowledge, attitude, and perception of low back pain and activities that may prevent it among adolescents in Nigeria.

Background: Awareness of activities that may result in low back pain (LBP) among adolescents is fundamental in preventing adulthood LBP. Objective: The aim of this study was to investigate adolescents' knowledge, attitude, and perception of LBP and activities that may prevent LBP in Kano, North-western, Nigeria. Methods: This was a cross-sectional survey involving 400 school-going adolescents recruited using a multistage random sampling technique. Data was analysed using descriptive statistics and Chi-square test with 0.05 set as level of significance. Results: The mean age of the respondents was 16.0±1.50 years. LBP annual prevalence was 34.2%, with more girls (31.1%) reporting having LBP compared to boys (28.4%). More than half (59.3%) of the respondents had poor knowledge of LBP and activities that may prevent it. However, they had a good attitude (63%) and perception (74%) of LBP and activities that may prevent it. There was no significant association of levels of knowledge, attitude, and perception of LBP and activities that may prevent LBP with gender, age, and class of study (p > 0.05). Conclusion: Adolescents in Kano, North-western Nigeria had poor knowledge of LBP and activities that may prevent it. Therefore, there is a need to embark on an LBP prevention program among adolescents in Kano, North-western Nigeria.

Effects of variable frequencies of kinesthesia, balance and agility exercise program in adults with knee osteoarthritis: study protocol for a randomized controlled trial.

BACKGROUND: Knee osteoarthritis (OA) is a common painful and disabling condition that affects older individuals. Proprioceptive training programs in the form of kinesthesia, balance and agility (KBA) exercises have been reported to be beneficial for individuals with knee OA. However, the most optimal training dosage of KBA exercises is still unclear. The aim of this study is to determine the effects of different frequencies of KBA training (i.e., twice-weekly or thrice-weekly) in adults with knee OA. METHODS: A single (assessor) blind, three-arm parallel, multi-center randomized controlled trial will be conducted. One hundred twenty adults with knee OA will be recruited from four tertiary hospitals in Northwestern Nigeria and randomly assigned into one of three intervention groups; twice-weekly KBA (n = 40), thrice-weekly KBA (n = 40), and conventional physiotherapy (n = 40) in the ratio of 1:1:1. Participants in the conventional physiotherapy group will receive two sessions of brief patient education, and sixteen sessions of ultrasound therapy, and stretching and strengthening exercises for 8 weeks. Participants in the two different KBA groups will receive KBA training according to the designed sessions for 8 weeks in addition to the conventional physiotherapy program. All groups will be assessed pre-intervention, immediately post-intervention and at 3 months, 4 months, and 6 months post-randomization. The primary outcome will be physical function (Ibadan Knee and Hip Osteoarthritis Outcome Measure) whereas the secondary outcomes will be pain intensity (Visual Analogue Scale for pain), knee stability (Knee Outcome Survey-Activities of Daily Living Scale), proprioception (electronic goniometer), and quality of life (Osteoarthritis Knee and Hip Quality of Life Questionnaire). DISCUSSION: The findings of this study may provide evidence on the effectiveness of KBA exercise training and the ideal number of sessions needed to achieve the highest effectiveness in adults with knee OA. TRIAL REGISTRATION: Pan African Clinical Trials Registry ( PACTR201810713260138 ). Registered on 28 November 2017.

Effect of integrated neuromuscular inhibition technique compared with positional release technique in the management of piriformis syndrome.

CONTEXT: Studies have indicated that the muscle energy technique (MET) and the positional release technique (PRT) are effective in the management of piriformis syndrome (PS); however, evidence is scarce regarding the combination of these techniques in the form of an integrated neuromuscular inhibition technique (INIT) in the management of individuals with PS. Although a previous trial investigated the effect of INIT for PS, that study did not integrate Ruddy's reciprocal antagonist facilitation (RRAF) method into the INIT protocol, nor did the authors diagnose PS according to established criteria. OBJECTIVES: To examine the effects of INIT with integrated RRAF compared with PRT in the management of patients diagnosed with PS. METHODS: This study was designed as a single blind randomized clinical trial in which participants diagnosed with PS were randomly allocated into INIT and PRT groups. Each group attended two treatment sessions per week for 8 weeks. Patients in the INIT group received a protocol in which the patient's tender point or trigger point was palpated in the belly of the piriformis approximately halfway between the inferior lateral angle of the sacrum and the greater trochanter, at which point the therapist applied an intermittent or sustained pressure and maintained the pressure for 20-60 seconds (depending on the participant's response to pain reduction). For INIT patients, that protocol was also followed by RRAF, a method in which a patient introduces a series of tiny/miniature contractions or efforts (20 times per 10 seconds) against a therapist's resistance. Patients in the PRT group were treated by palpating the same trigger point described in the INIT group, followed by application of light pressure at the location of the trigger point, which was maintained the pressure for 2 minutes or until the pain subsided (determined by asking the participant to report a pain score using a visual analog scale at 30 second intervals). For both groups, three repetitions of the INIT or PRT treatment were performed over 10 minutes at each clinical visit. Additionally, each group also received stretching exercises immediately after the INIT or PRT treatment session. Each participant was assessed at baseline, immediately posttreatment, and at 4 months posttreatment for pain, sciatica, functional mobility, quality of life, hip abduction, and internal rotation. A repeated measures analysis of variance (ANOVA) of within-between group interactions was used to analyze the treatment effect. RESULTS: Forty eight participants (age range, 25-47 years; mean age ± standard deviation, 32.81 ± 3.27 years) were randomized into the INIT and PRT groups, with 24 participants in each group. No significant between-group differences (p>0.05) were observed in the baseline demographic and clinical variables of the participants. A repeated-measures ANOVA indicated that there was a significant time effect for all outcomes, with a significant interaction between time and intervention (p<0.001). The Bonferroni post hoc analyses of time and intervention effects indicated that the INIT group improved significantly compared with the PRT group in all outcomes (p<0.05) immediately posttreatment and at the 4 months follow up period. CONCLUSIONS: INIT was more effective than PRT in the management of individuals with PS. It should be noted the significant improvement achieved in both the groups may have also been contributed to by the stretching exercises that were used as adjunct therapies by both groups.

Development of the Hausa version of the Pain Catastrophizing Scale: translation, cross-cultural adaptation and psychometric evaluation in mixed urban and rural patients with chronic low back pain.

BACKGROUND: Catastrophizing has been recognized as an important contributor to chronicity in individuals with chronic pain syndromes including low back pain (LBP). The Pain Catastrophizing Scale (PCS) is perhaps the most widely used tool to evaluate the degree of pain catastrophizing. However, its use is limited in Hausa-speaking countries due to the lack of a validated translated version. OBJECTIVE: To translate and cross-culturally adapt the PCS into Hausa (Hausa-PCS), and evaluate its psychometric properties in mixed urban and rural patients with chronic LBP. METHODS: The PCS was translated and cross-culturally adapted into Hausa in accordance with established guidelines. To evaluate its psychometric properties, a consecutive sample of 200 patients with chronic LBP was recruited from urban and rural Nigerian hospitals. Validity was evaluated by exploring content validity, factorial structure (confirmatory factor analysis [CFA]), construct validity (Spearman's rho for a priori hypotheses) and known-groups validity. Reliability was evaluated by calculating internal consistency (Cronbach's α), intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement with 95% confidence interval (LOA95%). RESULTS: The Hausa-PCS was comprehensible with good content validity. The CFA confirmed a 3-factor structure similar to the original English version. The concurrent validity was supported as 83% (5/6) of the a priori hypotheses were confirmed. Known-groups comparison showed that the questionnaire was unable to differentiate between male and female or urban and rural patients (p > 0.05). Internal consistency and ICC were adequate for the Hausa-PCS total score (α = 0.84; ICC = 0.90) and the subscale helplessness (α = 0.78; ICC = 0.89) but for the subscales rumination (α = 0.69; ICC = 0.68) and magnification (α = 0.41; ICC = 0.43). The LOA95% for the Hausa-PCS total score was between - 8.10 and + 9.75, with SEM and MDC of 3.47 and 9.62 respectively. CONCLUSION: The Hausa-PCS was successfully developed and psychometrically adequate in terms of factorial structure, construct validity, internal consistency and test-retest reliability when applied in mixed urban and rural patients with chronic LBP. However, the internal consistency and reliability coefficients (ICC) for the individual subscales are inadequate. Thus, we support the use of the total score when evaluating pain catastrophizing for clinical or research purposes.

Translation, Cross-cultural Adaptation and Psychometric Evaluation of the Hausa Roland-Morris Disability Questionnaire in Mixed Rural and Urban Nigerian Populations with Low Back Pain.

STUDY DESIGN: Cross-cultural adaptation and cross-sectional study. OBJECTIVE: The aim of this study was to translate and cross-culturally adapt the Roland-Morris Disability Questionnaire (RMDQ) into Hausa language, and evaluate its psychometric properties in mixed rural and urban populations with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The RMDQ is one of the most commonly used and recommended condition-specific measures of disability related to LBP. However, no formal adapted and validated Hausa version exists at the time our study was initiated. METHODS: The Hausa version of the RMDQ (Hausa-RMDQ) was developed according to established guidelines. Psychometric properties were evaluated in 125 patients with LBP recruited from rural and urban Nigerian clinics. Internal consistency (Cronbach's α), test-retest reliability using Intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and limits of agreement using Bland-Altman plots were calculated to evaluate reliability. Using Spearman's correlation for a priori hypotheses, the Hausa-RMDQ was correlated with Oswestry Disability Index (ODI) to evaluate concurrent validity, Numerical Pain Rating Scale (NPRS) to evaluate convergent validity, and age, educational level, and occupational status to evaluate divergent validity. Reliability and validity analyses were also conducted separately for rural and urban subgroups. RESULTS: The Hausa-RMDQ had no major translation problems. The questionnaire had adequate internal consistency (α = 0.70), test-retest reliability (ICC = 0.79), minimal SEM (1.30) and MDC (3.60), and good agreement between test-retest values. The Hausa-RMDQ had a strong correlation with ODI (rho = 0.59), a moderate correlation with NPRS (rho = 0.46), and a null correlation with age, educational level, and occupational status (P > 0.05), thus confirming all the (5:5) a priori hypotheses constructed. These reliability and validity results were also replicated in the rural and urban subgroups. CONCLUSION: The Hausa-RMDQ was successfully developed and proved to be a reliable and valid measure of functional disability in Hausa culture. This questionnaire is recommended for future clinical and scientific research purposes.Level of Evidence: 3.

Effects of spinal stabilization exercise with real-time ultrasound imaging biofeedback in individuals with chronic nonspecific low back pain: a pilot study.

The use of real-time ultrasound imaging (RUSI) as biofeedback to enhance the performance of spinal stabilization exercise and recovery from low back pain has been a recent trend in musculoskeletal rehabilitation. The aim of this pilot study was to evaluate whether it would be feasible to conduct a randomized controlled trial investigating the effects of spinal stabilization exercise with RUSI biofeedback in individuals with chronic nonspecific low back pain. This was a single-group pretest-posttest quasi-experimental study. Ten consecutive patients with chronic nonspecific low back pain met the study criteria. They received spinal stabilization exercise with the RUSI biofeedback focusing on lumbar multifidus muscle activation. The intervention was provided twice weekly for 6 weeks. Outcome measures were lumbar multifidus muscle cross-sectional area, pain, disability and quality of life assessed at baseline and after intervention. A paired t-test was applied and effect size (Cohen d) was computed. The recruitment and retention rates were 75% and 83% respectively. No adverse events were reported during the study. Compared with the baseline, the participants demonstrated statistically significant improvement in lumbar multifidus muscle cross-sectional area (P<0.05, d=1.03), pain (P<0.001, d=2.56) and disability (P<0.05, d=1.43) with large effect size after the intervention. However, no statistically significant differences were observed for physical and mental health (P>0.05) after the intervention. It was concluded that spinal stabilization exercise with RUSI biofeedback is effective in improving lumbar multifidus muscle cross-sectional area, pain and disability in individuals with chronic nonspecific low back pain. The results demonstrated the feasibility of conducting a future, larger-scale powered randomized controlled trial to confirm these preliminary findings.

Translation, Cross-cultural Adaptation, and Psychometric Properties of the Hausa Versions of the Numerical Pain Rating Scale and Global Rating of Change Scale in a Low-literate Population With Chronic Low Back Pain.

STUDY DESIGN: Translation, cross-cultural adaptation, and psychometric testing. OBJECTIVE: To translate, cross-culturally adapt, and validate the Numerical Pain Rating Scale (NPRS) and the Global Rating of Change Scale (GRCS) into Hausa language. SUMMARY OF BACKGROUND DATA: The NPRS and GRCS are commonly used patient-reported outcome measures in a variety of pain-related conditions including low back pain. To date, neither the NPRS nor GROC are available in Hausa language. METHODS: The Hausa versions of the NPRS (NPRS-H) and GRCS (GRCS-H) were developed using recommended guidelines. The final versions were then administered to 120 patients with chronic low back pain to access their psychometric properties. Reliability assessment included calculations of intraclass correlation coefficient (ICC) and minimal detectable change among the stable group. Construct validity and concurrent validity were assessed using the Spearman rank correlation coefficient. Internal responsiveness was assessed using mean change scores, standardized effect size, and standard response mean. Receiver operating characteristic curves were plotted to determine the external responsiveness of the NPRS-H using the area under the curve, and minimal important change for small, medium, and large improvements. Outcome measures consisted of the Visual Analogue Scale for pain and Oswestry Disability Index. RESULTS: The NPRS-H and GRCS-H were successfully developed. High test-retest reliability was demonstrated for both the NPRS-H (ICC = 0.95) and GRCS-H (ICC = 0.94) with minimal detectable change points of 1.0 and 1.2 respectively. The scales showed moderate to strong correlation with the Visual Analogue Scale for pain and Oswestry Disability Index. The mean change of the NPRS-H scores correlated moderately with the GRCS-H. Both scales demonstrated good internal responsiveness. External responsiveness of the NPRS-H was demonstrated at three levels with area under the curve  = 0.875 to 0.972, and minimal important change  = 2.5 to 3.5. CONCLUSIONS: The NPRS and GRCS were successfully adapted into Hausa language with acceptable reliability, validity, and responsiveness. These measures are appropriate for clinical and research use among Hausa-speaking patients. LEVEL OF EVIDENCE: 2.

Health-related quality of life and related characteristics of persons with spinal cord injury in Nigeria.

Background: Spinal cord injury (SCI) is impairment of the spinal cord resulting in numerous health problems that considerably affect the quality of life (QOL) of the patients. Moreover, a number of sociodemographic and clinical characteristics may influence the persons' health-related quality of life (HRQOL). However, there is limited information on the HRQOL and related characteristics among affected persons living in Nigeria. This study explores the HRQOL and related characteristics of persons with SCI in Kano, Northwestern Nigeria. Methods: A prospective cross-sectional survey of 41 subjects with SCI and 40 age and gender matched healthy subjects was conducted from January to December 2016. Subjects' sociodemographic and clinical characteristics and HRQOL (using the SF-36 questionnaire) were collected and analyzed. Results: The majority of the subjects were men in both the SCI (85.4%) and healthy (82.5%) groups. The mean injury duration was 28.4 ± 20.2 months. Road traffic accident (46.3%) was the leading cause of injury with paraplegia (70.7%) being the most frequent level of injury. A greater number of the subjects (43.9%) had a complete impairment. Subjects with SCI had significantly lower HRQOL in the domains of general health, physical functioning, bodily pain, social functioning, role-emotional, and mental health compared to healthy controls. Gender, level of injury, and severity of injury were commonly found to be related to lower HRQOL scores. Conclusion: Persons with SCI from Kano, Northwestern Nigeria have lower HRQOL across various domains compared to healthy controls. Common factors related to lower HRQOL scores were gender, level of injury, and severity of injury. There is a need for optimal rehabilitation for persons with SCI in Kano, Northwestern Nigeria.

Effects of motor control exercise and patient education program in the management of chronic low back pain among community-dwelling adults in rural Nigeria: a study protocol for a randomized clinical trial.

BACKGROUND: The impact of chronic low back pain (CLBP) is disproportionally higher in rural Nigeria than in urban areas but lack access to rehabilitation. While exercise and education are commonly advocated interventions for the rehabilitation of CLBP, there is a paucity of community-based randomized clinical trials assessing their benefits among adults with CLBP in rural Nigeria. The purpose of this study is to investigate the effects of motor control exercise (MCE) and patient education (PE) in the management of CLBP among community-dwelling adults in rural Nigeria. METHODS: This is an assessor-blind, three-arm parallel randomized clinical trial and will be conducted at Tsakuwa Primary Health Care Center in Kano, Northwestern Nigeria. One hundred and twenty adults with CLBP will be recruited and randomized to one of three intervention arms; MCE plus PE, MCE, or PE groups. The MCE will be administered twice a week for 8 weeks while the PE will be provided once a week for 8 weeks. Participants will be assessed pre-intervention, immediately post-intervention and at 3-month post-intervention. Primary outcomes will be pain intensity and functional disability. Secondary outcomes will be quality of life, fear-avoidance beliefs, pain catastrophizing, back beliefs, global perceived recovery, and physical performance. DISCUSSION: This will be the first community-based trial to assess the benefits of exercise and education in the management of CLBP among adults in rural Nigeria. The study may provide a relatively inexpensive, assessable, and effective alternative intervention for reducing CLBP disability in a low-resource rural Nigerian community. Trial registration:This study is registered at ClinicalTrial.gov and the trial registration number is NCT03393104.

Cross-cultural Adaptation and Validation of the Hausa Version of the Oswestry Disability Index 2.1a for Patients With Low Back Pain.

STUDY DESIGN: Validation of a translated, culturally adapted questionnaire. OBJECTIVE: To translate the Oswestry Disability Index (ODI) version 2.1a into Hausa Language and to validate its use in a cohort of patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The ODI is one of the most commonly used condition-specific questionnaires for assessing functional disability in patients with LBP, yet, no formal cross-culturally adapted and validated Hausa version exists. METHODS: The Hausa version of the ODI 2.1a (ODI-H) was developed according to established guidelines. Validation was performed among 200 patients with LBP recruited from both rural and urban Nigeria. Reliability was assessed using internal consistency (Cronbach α), test-retest reliability by computing intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Convergent validity was assessed by correlating the ODI-H with Visual Analogue Scale for pain, Fear-Avoidance Beliefs Questionnaire, and finger-floor distance test. Divergent validity was assessed by correlating the ODI-H with age, educational level, and occupational status. Exploratory factor analysis (EFA) and confirmatory factor analysis were also performed. Confirmatory factor analysis was performed with three models: 1) one-factor theory-driven model, 2) two-factor theory-driven model (dynamic and static factors), and 3) a model based on our EFA. RESULTS: The ODI-H had high internal consistency (Cronbach α = 0.87) and excellent test-retest reliability (intraclass correlation coefficient  = 0.937) with standard error of measurement and minimal detectable change being 3.69 and 10.2 respectively. The construct validity (convergent and divergent validity) is supported as all (6:6, 100%) the a priori hypotheses were confirmed. The EFA yielded a two-factor model explaining 54.3% of the total variance but demonstrated poor fit. The one-factor and two-factor theory-driven model had acceptable fit but the one-factor theory-driven model was better. CONCLUSION: The ODI-H version 2.1a was transculturally equivalent, reliable, and valid tool for assessing functional disability among Hausa-speaking patients with LBP. The use of this tool can be recommended for future clinical and research purposes. LEVEL OF EVIDENCE: 3.

Translation, cross-cultural adaptation, and psychometric properties of the Hausa version of the Fear-Avoidance Beliefs Questionnaire in patients with low back pain.

Background and aims The Fear-Avoidance Beliefs Questionnaire (FABQ) is the most widely used self-reported measure of fear-avoidance beliefs about work and physical activity in low back pain (LBP). However, there is no Hausa version for use in patients with LBP. This study aimed to translate, cross-culturally adapt, and test the psychometric properties of the Hausa version of the FABQ in patients with LBP. Methods The Hausa form of FABQ was developed using a forward-backward translation procedure according to recommended guidelines. The pre-final version of the questionnaire was pre-tested on 10 patients with acute LBP and 10 patients with chronic LBP. Psychometric testing was performed in 70 patients with acute LBP and 130 patients with chronic LBP. Reliability was assessed using internal consistency (Cronbach α) and test-retest reliability through intraclass correlation coefficient (ICC). Construct validity was assessed by exploratory factor analysis and divergent validity (Spearman rank correlation coefficient). Responsiveness was also investigated on 40 patients with chronic LBP. Results The Hausa version of the FABQ was successfully translated and proved to be well-understood. The internal consistency was adequate for the questionnaire (0.773) and its physical activity (0.816) and work (0.606) subscales. Test-retest reliability was excellent with an ICC value of 0.928 for the questionnaire and values of 0.901 and 0.863 for the physical activity and work subscales, respectively. Exploratory factor analysis yielded a three-factor structure in both acute and chronic LBP samples explaining 66.4% and 58.6% of the total variance, respectively. The first factor represents fear-avoidance beliefs due to work, the second factor represents fear-avoidance beliefs due to physical activity whereas the third factor represents the fear that pain aggravates due to work. Divergent validity showed moderate to weak correlation between the questionnaire and pain intensity (r=0.502), disability (r=0.415), lumbopelvic motion (r=0.00). The physical activity and work subscales weakly correlated (r=0.280). The effect size and standardized response mean were moderate to small with the work subscale having the lowest effect size (0.34) and standardized response mean (0.34) values. The MDC of the questionnaire was 5.4 points. The questionnaire had no ceiling or floor effects. Conclusions The FABQ was successfully translated into Hausa and cross-culturally adapted with acceptable psychometric properties similar to those of existing versions. The results suggest that the Hausa FABQ can be used to evaluate fear-avoidance beliefs about LBP in Hausa-speaking population for both clinical and research purposes.

Motor control exercise and patient education program for low resource rural community dwelling adults with chronic low back pain: a pilot randomized clinical trial.

This pilot randomized clinical trial assessed the feasibility of implementing motor control exercise (MCE) and patient education (PE) program for the management of chronic low back pain (CLBP) in a low resource rural Nigerian community. Thirty patients with CLBP were recruited and randomly assigned to MCE, PE, or MCE plus PE groups. The MCE program was provided twice a week while the PE program was provided once a week all for 6 weeks. Feasibility was assessed through recruitment rate, treatment compliance, retention/dropout rate, report of adverse events, perceived helpfulness, overall satisfaction, and clinical outcome of pain (numeric pain rating scale) and functional disability (Oswestry Disability Index). Many patients were willing to participate in the study and the recruitment rate was 77%. Treatment compliance in all the three groups were >65% for supervised treatment sessions and <50% for prescribed home program. Retention rate was high and greater overall satisfaction with the interventions was reported. Compared with the baseline, all the three groups improved significantly in pain and disability (P<0.05) after 6 weeks. Pairwise comparison revealed that the MCE plus PE group was superior to the PE group for pain and to the MCE for disability (P<0.05), with large effect size. It was concluded that the designed interventions are promising and conducting a full-scale randomized clinical trial in the future is feasible to confirm the effectiveness of the interventions for the management CLBP in rural Nigeria. (Trial registration: ClinicalTrials.gov, NCT03398174).