Comparison of performances of SIREN or MFSRS in stroke risk prediction in an African environment.

BACKGROUND: The Modified Framingham Stroke Risk Score (MFSRS) is a widely utilized stroke risk assessment algorithm usually applied in international comparison. The Stroke Investigative Research and Educational Network (SIREN) is the only known African-specific stroke risk assessment algorithm. AIMS AND OBJECTIVES: To compare stroke risk estimates from the SIREN and the MFSRS in an African community. METHODS: This was a population-based cross-sectional survey involving consecutively recruited 310 consenting adult residents (mean age = 37.21 ± 15.84 years) of a Nigerian community. Risk factors of stroke were assessed among the participants and were utilized in calculating stroke risk estimates on the MFSRS and the SIREN. The obtained data were analyzed using descriptive statistics and the Spearman-rank order correlation test at an alpha level of 0.05. RESULTS: The percentage stroke risk scores estimated by the SIREN and the MFSRS were 34.5% and 6.79% respectively. The most prevalent risk factors among the participants were hypertriglyceridemia (100.0%), raised waist-hip ratio (50.6%), hypercholesterolemia (45.5), physical inactivity (43.2%), psychological stress (41.3%), and hypertension (37.7%). Only two (hypertriglyceridemia and high blood pressure) out of the six factors considered in the MFSRS were rated among the first 10 most impactful risks by the SIREN. There was a weak correlation between the total scores on the MFSRS and the SIREN (rho = 0.39; p < 0.01) suggesting that the two ratings were discordant. CONCLUSION: There were disagreements between the risk estimates on the SIREN and MFSRS with SIREN having a higher estimate that corresponded with the literature; this may be suggesting a poorer estimation of stroke risks by the MFSRS in an African environment. There is a need for large African-based quality control studies to determine and address these lapses.

Social Support, Social Participation, and Life Accomplishment of Older Adult Residents of Assisted Living Facilities and Their Adjoining Communities.

Objectives: To assess and compare levels of social support (SS), social participation (SP) and life accomplishment (LA) among older adults in some assisted-living facilities (ALFs) and their community-dwelling (CD) peers. Methods: One hundred twenty older adults (54 ALF, 66 CD) from a Nigerian population participated in this cross-sectional survey. The Multidimensional Scale for Perceived Social Support, the Participation Scale and the Life Habit Questionnaires were used to evaluate levels of SS, SP, and LA, respectively. Data was analyzed using descriptive statistics, Mann-Whitney U test and Spearman rank order correlation, at .05 alpha level. Results: Participation restriction (PR) was significantly more prevalent among the ALF group compared to the CD group (χ2 = 12.74; p = .01) but the two groups enjoyed comparable level of SS. LA was significantly better for the CD group in the overall score. LA had significant correlation with PR in both the ALFs (r = -.44; p < .05) and CD (r = -.62; p < .05) group. Conclusions: Older adults in ALFs received moderate SS, had LA, and a high PR, while CD older adults received a high SS and LA but had no PR. The findings implicate that social participation and enhancing community support for older adults may be important for a sustainable community.

Population-based stroke risk profile from a West-African community.

Objectives: To determine the stroke risk profile of dwellers of Nnewi community in Nigeria. Methods: This was a cross-sectional survey involving consecutively recruited community-dwelling adults without a previous history of stroke. The Modified Framingham Stroke Risk Score (MFSRS) was used to evaluate the stroke risk profile of the participants. Data was analysed using descriptive and inferential statistics at an alpha level of 0.05. Result: 310 individuals (mean age = 37.21 ± 15.84 years; 68.7% females) participated in this study. The mean MFSRS (6.79 ± 5.21) of the participants was minimal with 16% having a moderate-to-high risk. Dyslipidaemia (100.0%), meat (88.1%) and sugar (70.6%) consumption, hypertension (37.7%), physical inactivity (43.2%), and psychological stress (41.3%) were the most prevalent risk factors in the population. Participants' MFSRS significantly and positively correlated with their body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) and significantly differed across their gender, educational, and occupational categories (p < 0.05). Conclusion: According to MFSRS, the risk of stroke among the sampled community was minimal and was significantly influenced by their BMI, WC, WHR, gender, education, and occupation. However, results revealed that stroke risk might be higher in the population than was depicted by the MFSRS. Enlightenment on the risk of stroke is needed in the community.

Neighborhood safety, fall indices, physical activity level and social participation restrictions from a population of community-dwelling older adults in Nsukka, Enugu State, Nigeria.

BACKGROUND: Restriction in physical activity (PA) and social participation restriction (PR) can be heightened in the presence of fear of fall (FOF), fall experience, and perceived unsafe neighborhood, particularly among older adults. Despite the enormous benefits of social participation and physical activity, many older adults remain vulnerable to participation restriction and this probably accounts for a significant proportion of health challenges for older adults. OBJECTIVE: This study investigated the relationship between neighborhood safety (NS), fall indices, physical activity, and social participation restriction among older adults from selected communities in Nsukka, Enugu state, Nigeria. METHODS: This was a cross-sectional survey of 170 recruited via consecutive non-probability sampling techniques. Socio-demographic variables, co-morbidities, and fall prevalence were obtained using a self-administered questionnaire. The study instruments include the PA neighborhood environment scale - Nigeria (PANES-N), PA scale for elderly (PASE), Participation scale (PS), Modified fall efficacy scale (MFES), and Fall risk assessment tool (FRAT) and fall indices. STATISTICAL ANALYSIS: Descriptive statistics of mean and standard deviations, frequency counts, and percentages were used to analyze the socio-demographic variables, and Inferential statistics of Spearman rank order correlation were used to determine the relationship among the neighborhood safety, fall indices, physical activity level, and participation restrictions. RESULTS: PR has a negative relationship with NS (r = -0.19, p- 0.01), and fall efficacy (r = -0.52, p- 0.001). However, PR has a positive relationship with fall risk (r = 0.36, p = 0.001). CONCLUSION: Participation restriction is negatively correlated with neighborhood safety, fall efficacy, and PA. The PR has a positive relationship with fall risk (FR).

Effects of Otago Exercise Program on Physical and Psychosocial Functions Among Community-Dwelling and Institutionalized Older Adults: A Scoping Review.

To review the effects of Otago exercise program (performed individually or in group) on several physical and psychosocial outcomes for community-dwelling and institutionalized older adults. Fourteen articles met the inclusion criteria. Three electronic databases and reference lists of identified studies were searched. Eligibility criteria included clinical trials of the Otago exercise program conducted among older adults. Two studies were conducted in institutions, 2 in groups. None of the studies reviewed reported the post-intervention result of the Otago exercise program on depression or any other psychological construct. Otago exercise program was effective in reducing falls, improving balance, strength, mobility, and health-related quality of life within the community and in institutions. Available evidence suggests group performance may be better than individual programs. The Otago exercise program is an important and effective exercise strategy which can be administered in groups or individualized to both community-dwelling and institution-resident older adults. Future reviews, especially, systematic reviews with meta-analysis should be performed.

Effect of educational intervention programme on the health-related quality of life (HRQOL) of individuals with type 2 diabetes mellitus in South-East, Nigeria.

BACKGROUND: Diabetes is one of the most important chronic diseases that have a great impact on health as people with diabetes are constantly being reminded of their disease daily; they have to eat carefully, exercise, and test their blood glucose. They often feel challenged by their disease because of its day-to-day management demands and these affect their quality of life. The study aimed at determining the effect of an educational intervention program on the quality of life of Individuals with type 2 Diabetes Mellitus in South East, Nigeria. METHODS: A quasi-experimental controlled study involving three hundred and eighty-two (382) type 2 DM persons recruited from the tertiary health institutions in South East, Nigeria, and randomly assigned to intervention and control groups respectively. Data was collected from the diabetic clinics of the health institutions using the SF - 36 questionnaires. Pretest data collection was done, and thereafter, education on self-care was given to the intervention group. After a 6months follow-up, post-test data were collected from both groups. Analysis was done using an Independent t-test, Analysis of Covariance (ANCOVA), Paired Samples Test, and Spearman rank order correlation at 0.05 alpha level. RESULTS: The control group indicated significantly higher mean HRQOL scores in most domains of the HRQOL before intervention (t = -1.927 to -6.072, p < 0.05). However, 6 months after the intervention, the mean HRQOL scores of the intervention group increased significantly in all the domains of HRQOL (p < 0.05) with an effect size of 0.14 (Eta squared). A comparison of the two groups shows a statistically significant difference (64.72 ± 10.96 vs. 58.85 ± 15.23; t = 4.349. p = 0.001) after the intervention. Age was inversely correlated with some domains of HRQOL; as age increases, HRQOL decreases in those domains. Gender had no significant influence on HRQOL. CONCLUSION: Educational intervention was effective in improving HRQOL in individuals with type 2 DM. Hence, it is recommended for inclusion in all diabetes care plans.

IGBO Version of the Older People's Quality Of Life Questionnaire (OPQOL-35) Is Valid and Reliable: Cross-Cultural Adaptation and Validation.

To translate, cross-culturally adapt, and psychometrically evaluate the Older People's Quality of Life Questionnaire (OPQOL-35) among the Igbo older adult population in Enugu State. The original English OPQOL-35 (E-OPQOL-35) was translated into Igbo language, synthesized, back translated, and subsequently subjected to expert panel review, pre-testing and cognitive debriefing interview. The final Igbo version (I-OPQOL-35) was tested for internal consistency, concurrent, and structural validities in a cross-sectional study of 115 consenting apparently healthy older adults that were conveniently recruited from Enugu State, at 0.05 level of significance. The Spearman correlation coefficients between the participants' domain and total scores on the I-OPQOL-35 and E-OPQOL-35 (rho = .92-1.00) were excellent. The Mann-Whitney U test revealed no significant difference between corresponding scores in the E-OPQOL-35 and I-OPQOL-35 (P = .65-.94). The internal consistency coefficient of the I-OPQOL-35 was 0.78. The ceiling and floor effects were 0% respectively. The I-OPQOL-35 is therefore a valid and reliable instrument for the assessment of quality of life among Igbo older adults in Nigeria.

Cross-cultural adaptation and validation of the 15-item Geriatric Depression Scale (GDS-15) into Igbo language: a validation study.

BACKGROUND: Late-life experiences such as protracted and indisposing medical disorders can negatively impact older adults' psychological and mental health, making them vulnerable to depression. Majority of the assessment tools for depression were developed for use in western countries. There is therefore the need for availability of culture- and environment-specific tools for assessment of depression in low-and-middle-income countries. This study was designed to cross-culturally adapt and validate the Geriatric Depression Scale-15 (GDS-15) into Igbo language and culture. METHODS: The English version of the GDS-15 was translated into Igbo language; synthesized, back-translated, and underwent expert panel review, pretesting and cognitive debriefing interview, according to the American Academy of Orthopedic Surgeons' guidelines. The Igbo version of the GDS-15 was tested for concurrent and structural validities, and internal consistency among consecutively recruited 140 consenting older adults (62.9% females) in Enugu North Senatorial District at 0.05 level of significance. RESULTS: The English version of the GDS-15 was successfully cross-culturally adapted to Igbo with all the 15 items still retained on the Igbo version of the GDS-15. The Igbo version of the GDS-15 exhibited the same structure as the English version, and displayed a Cronbach's alpha value of 0.53 with no significant ceiling (0%) and floor (0%) effects. The correlation between the participants' total scores on the Igbo and the English versions of the GDS-15 (ρ = 0.86) was adequate. There was no significant difference between corresponding scores in the English and Igbo versions of the GDS-15 (p = 0.89). CONCLUSIONS: The Igbo version of the GDS-15 is a valid and culturally specific instrument, and can be used for assessing depression among Igbo older adults in Nigeria.

Body image, physical activity, quality of life, and community reintegration of individuals with acquired mobility disability in a Nigerian population.

PURPOSE: To assess the quality of life (QOL), physical activity (PA), community reintegration (CR), and body image (BI) among adults with acquired mobility disabilities. Relationships between the constructs were also assessed in order to ascertain how a change in one construct could influence the other. MATERIALS AND METHODS: This cross-sectional survey involved 157 adults (mean age = 47.51 ± 21.08 years) consecutively recruited from conveniently selected centers in South-east Nigeria. The Short-Form 36-Item Health Survey, the Multidimensional Body Self Relations, the Reintegration to Normal Living Index, and the Short-Form 7-Day International Physical Activity questionnaires were used to assess participants' QOL, BI, CR, and PA respectively. Participants' scores and socio-demographic information were summarised using descriptive statistics while the Spearman test analysed the relationships between constructs. RESULTS: Participants' mean QOL (43.23 ± 13.07), CR (48.09 ± 22.84), and BI (2.91 ± 0.51) scores were poor while their mean PA score (4.39 ± 4.56 × 103 MET-min/week) was high. PA had significant positive relationships with CR (rho = 0.25; p < 0.01) and QOL (rho = 0.33; p < 0.01). BI had a significant positive relationship with CR (rho = 0.28; p = 0.01). CONCLUSIONS: PA was high for this sample of individuals with mobility disability receiving physiotherapy but QOL, CR, and BI were poor. Based on observed correlations, rehabilitation interventions for enhancing PA may help improve QOL and CR.IMPLICATIONS FOR REHABILITATIONMobility disabilities are very common and burdensome in Nigeria and other African countries.Quality of life, physical activity, community reintegration, and body image can be adversely affected among individuals with mobility disabilities.Understanding relationships between these constructs among individuals with mobility disabilities could help in enhancing rehabilitation planning and outcomes.Physical activity relates to both community reintegration and life quality, whereas body image relates to community integration.

Determination of hand grip strength and its correlates during pregnancy: a cross-sectional study.

BACKGROUND: Pregnancy results in many changes, including reduced hand grip strength (HGS). However, good HGS is required for physical functions such as carrying and breastfeeding the baby after birth. The aim of this study was to determine the factors that may predict HGS during pregnancy. METHODS: The study was a cross-sectional study approved by the Research Ethics Committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital in Kano, north-west, Nigeria. Pregnant women at the designated hospitals were included in the study if they had no serious comorbidities or any known neurological condition that affects the hands and the neck. Demographic characteristics and independent (predictor) variables (age, weight, height, BMI, maternity leave status, number of full-term deliveries, number of preterm deliveries, number of live births, number of abortuses, gravidity, trimester, systolic blood pressure, diastolic blood pressure, inter arm systolic BP difference [IASBP], inter arm diastolic BP difference [IADBP], and heart rate) of each of the participants were recorded by experienced therapists. The data were analysed using descriptive statistics, t-test, Pearson correlation coefficient and standard multiple regression. RESULT: One hundred and sixty-one pregnant women with mean age, 25.04 ± 4.83 years participated in the study. In the dominant hand, 120 participants (74.5%) had weak grip strength. In the non-dominant hand, 135 participants (83.9%) had weak grip strength. For the dominant hand, the total variance explained by the whole model was significant, 28.5%, F(11, 161) = 1.187, R2 = 0.081, p = 0.300 . In the final model, none of the variables significantly predicted HGS. However, systolic blood pressure contributed to the model more than any other variable (Beta = -0.155). For the non-dominant hand, the total variance explained by the whole model was not significant, 33.1%, F(11, 161) = 1.675, R2 = 0.111, p = 0.089 . In the final model, only systolic blood pressure (Beta = -0.254, p = 0.023) significantly predicted hand grip strength. CONCLUSION: Cardiovascular events or changes during pregnancy (such as change in systolic blood pressure) may be related to HGS in pregnant women. It is therefore, important for clinicians to pay attention to this, in planning rehabilitation strategies for pregnant women.

Falls and fear of falling among older adults in an assisted-living facility: A qualitative and foundational study for intervention development in a developing country.

BACKGROUND: Falls and fear of falling (FOF) have serious adverse effects for older adults. Culturally-specific and environmentally-tailored interventions may help address the problems of falls and FOF. No such interventions are however available for use in the African context. OBJECTIVE: To explore falls and FOF among older adults in an assisted-living facility, as a foundation for developing interventions to address falls and FOF. METHODS: This qualitative study involved purposefully recruiting nine older adults and four caregivers at an assisted-living facility in Southeast Nigeria. Focus group discussions were conducted separately for older adults and the caregivers. Data were analysed using an Inductive Approach. RESULTS: Four themes emerged: incidence of falls and fear of falling; factors associated with falls and fear of falling; health implications of falls and fear of falling; and coping strategies to deal with falls and fear of falling. Older adults were experiencing a high prevalence of falls and FOF perceived to be caused by both cultural/environmental/institutional-related factors (poorly lit environment at night; poor ambulatory surfaces; unwillingness to accept age-related changes in physical capacity; poor disposition towards walking aids; poor treatment of injuries; misconceptions; poor physical activity participation; and external perturbation) and intrinsic factors (psychological/emotional, concentration/attention, socio-demographic and morbidity-related). CONCLUSION: The older adults were experiencing a high prevalence of falls and FOF which has a multifactorial origin of common and cultural/societal/institutional/environmental-related factors. The need for a multicomponent and culturally and environmentally-specific interventions to address falls and FOF in this sample is thus highlighted.

Physical activity level, fear of falling and quality of life: a comparison between community-dwelling and assisted-living older adults.

BACKGROUND: Physical activity (PA), fear of falling (FOF) and quality of life (QOL) are very important constructs in geriatrics. The interplay among these constructs may vary between community-dwelling and assisted-living older adults. However, studies comparing the wellbeing of community-dwelling older adults with those residing in the assisted-living facilities (ALFs) are rather rare especially from developing countries. This study was aimed at comparing PA, FOF and QOL between assisted-living and community-dwelling older adults and also determining the correlations amongst the constructs for each group. METHODS: This cross-sectional survey involved consecutively sampled 114 older adults (≥65 years, ambulant and well-oriented in time, place and person) residing in conveniently selected ALFs (11.3% males) and adjoining communities (54.1% males). PA, FOF and QOL were evaluated using the Physical Activity Scale for the Elderly, the Modified Fall Efficacy Scale and the Short-form Health Survey (SF-36) questionnaire respectively. Data was analysed using descriptive statistics, analysis of covariance and Spearman rank-order correlation test at 0.05 level of significance. RESULTS: Participants from the ALFs had significantly lower domain and overall PA (F=5.6-103.34; p< 0.05) and QOL (F=11.12-118.05; p< 0,05) scores than community-dwelling groups. FOF was significantly more prevalent in assisted-living group (p< 0.05). There were significant positive correlations (p< 0.05) between each pair of PA, FOF and QOL for both assisted-living and community-dwelling groups. CONCLUSIONS: Older adults in the ALFs had lower PA and QOL scores with higher prevalence of FOF than their community-dwelling counterparts. Significant relationships existed between PA, FOF and QOL for participants in either group. Present results may be suggesting that ageing in place ensures better health outcomes than institutionalised ageing. Whenever possible, older adults should therefore be encouraged to age in place rather than moving into ALFs.

Quality of life, fatigue and seizure severity in people living with epilepsy in a selected Nigerian population.

BACKGROUND: Epilepsy, a chronic seizure disorder, can cause elevated fatigue and reduced quality of life (QOL) of the sufferers. Hence, improving QOL, seizure severity (SS) and fatigue are important areas of therapeutic interventions for people living with epilepsy (PLWE). Therefore, there is need to ascertain the levels and interrelationships among these constructs in PLWE. OBJECTIVE: This study compared fatigue and QOL of PLWE with those of apparently healthy individuals (AHIs) and also determined the interrelationships between fatigue, QOL and SS in PLWE. METHOD: This cross-sectional survey involved 91 PLWE and 101 AHIs consecutively recruited from purposively selected hospitals and hosting communities. The Short-form Health Survey (SF-36) questionnaire, the Fatigue Severity Scale, the Modified Fatigue Impact Scale and the Seizure Severity Questionnaire were used to evaluate QOL, fatigue severity (FS), fatigue impact (FI) and SS respectively. Data was analyzed using frequency count, proportions, mean and standard deviation, range, Chi-square test, Mann-Whitney U test and Spearman-rank order correlation. Alpha level was set at 0.05. RESULTS: PLWE had significantly lower QOL compared to AHIs (U = 3057.00;p < 0.01). The two groups however experienced similar fatigue severity, but PWE suffered greater fatigue impact (U = 2798.00;p < 0.01). Significant relationships existed among FI, FS, SS and QOL in PLWE (p < 0.01). CONCLUSION: Compared with AHIs, PLWE had poorer QOL, similar FS, and higher FI. QOL of PLWE was negatively associated with SS, FI and FS. Clinical interventions geared towards minimizing seizure, severity and impact of fatigue may improve the QOL of PLWE.

Cross-Cultural Adaptation and Validation of Nigerian (Igbo) Version of the Physical Activity Scale for the Elderly.

OBJECTIVES: To cross-culturally adapt and validate the Physical Activity Scale for the Elderly (PASE) into Igbo culture. METHODS: The English version of the PASE (E-PASE) was translated into Igbo, harmonized, back-translated, subjected to expert panel review, and pretested. The final Igbo version of PASE (I-PASE), the E-PASE, and the International Physical Activity Questionnaire were then administered to consecutively recruited 109 consenting Igbo older adults. Data were analyzed using frequency, percentage, mean, standard deviation, Mann-Whitney U test, Spearman rank-order correlation, and Cronbach's alpha at .05 level of significance. RESULTS: All items on the E-PASE were retained on the I-PASE but some modifications were made. The I-PASE had poor internal consistency coefficient (α = .66), poor-to-excellent item, and total score known-group validity (ρ = .24-1.00) and moderate convergent validity (ρ = .50). CONCLUSION: The I-PASE is a valid, reliable, and culturally specific tool for assessing PA among Igbo older adults.

Validation of Igbo version of the modified falls efficacy scale among community-dwelling older adults: a validation study.

BACKGROUND: Fear of falling (FOF) is a very pervasive problem among older adults. Consequently, many scales have been developed for its assessment. The Modified Falls Efficacy Scale (MFES) is one of the most popular FOF scales. The MFES was originally developed for use in developed countries, and thus may not be entirely suitable for use in developing countries due to cultural and environmental differences between the two country categories. This study was therefore designed to cross-culturally adapt and validate the MFES to Igbo culture and environment among community-dwelling older adults in Nnewi community using established guidelines. METHODS: The original English version of the MFES (E-MFES) was translated, synthesized, back-translated, subjected to expert panel review, and pretested before producing the final Igbo version of the MFES (I-MFES). The I-MFES and the Short Falls Efficacy Scale International were randomly administered to consecutively recruited 109 consenting older adult residents of Nnewi (43.1% males; mean age = 74.45 ± 8.78 years). Convergent and structural validities and internal consistency of the I-MFES were assessed at 0.05 level of significance. RESULTS: All the 14 items on the E-MFES were retained on the I-MFES. The I-MFES exhibited the same structure as the E-MFES. The correlation between the total scores on the I-MFES and the Short Falls Efficacy Scale International was excellent (rho = - 0.93) indicating evidence of convergent validity of the I-MFES. The Cronbach's alpha value of the I-MFES was 0.97 showing evidence of excellent internal consistency of the items on the I-MFES. CONCLUSION: This study provides evidence of some aspects of validity and reliability of the I-MFES.

Community integration, self-esteem, and perceived stigma in a Nigerian sample with epilepsy.

OBJECTIVE: The objective of the study was to investigate the levels, interrelationships, and associated factors of community integration (CI), perceived stigma (PS), and self-esteem in people living with epilepsy (PWE) in Anambra and Enugu States of south-east Nigeria. METHODS: This was a cross-sectional survey involving 70 consenting adults living with epilepsy consecutively recruited from three purposively sampled specialized clinics in Anambra State. The Reintegration to Normal Living Index, the Epilepsy Stigma Scale, and the Rosenberg Self-Esteem Scale were used to estimate CI, PS, and self-esteem, respectively among the participants. Data were analyzed at 0.05 level of significance. RESULTS: The mean age of the participants (28.6% females) was 34.91 ±â€¯16.21 years. The participants had moderate PS score (43.54 ±â€¯14.20), poor self-esteem score (17.63 ±â€¯6.12), and mild-to-moderately restricted CI score (67.83 ±â€¯24.72). Participants' PS, CI, and self-esteem significantly correlated with one another (p < 0.05) with PS and self-esteem being significant predictors of CI. Participants' PS had a significant correlation with their age at onset of epilepsy, while their self-esteem and CI significantly correlated with their seizure episodes (p < 0.05). Participants' PS and CI were significantly different across different categories of their occupational and educational statuses. Perceived stigma also varied across participants' marital status with divorced participants having the worst score (p < 0.05). CONCLUSION: People living with epilepsy had moderate PS, poor self-esteem, and mild-to-moderate CI, which correlated significantly with one another. Results suggest the possibility of using CI as an outcome for assessing the effectiveness of stigma and self-esteem interventions during epilepsy rehabilitation.

Cross-cultural adaptation and validation of the reintegration to normal living index into IGBO language among individuals with mobility disability.

BACKGROUND: Community reintegration is one of the most important elements of disability rehabilitation globally. Hence, there is need for availability of psychometrically-sound and culturally-specific instruments for its measurement. Most of the available community reintegration measures were developed and validated in developed countries and might therefore not be suitable for use in developing countries. This study was aimed at cross-culturally adapting and validating the original English visual analogue scale version of the Reintegration to Normal Living Index (RNLI) into Igbo Language and culture among people with mobility disability in Igbo land, Southeast Nigeria. The English version of the RNLI was cross-culturally adapted to Igbo following the American Association of Orthopaedic Surgeons' guideline. The RNLI was translated into Igbo Language, synthesized, back translated, and subsequently subjected to expert panel review, pretesting and cognitive debriefing interview. The final Igbo version of the RNLI was tested for internal consistency and construct validity in a sample of 102 consenting participants (61.8% males; 46.92 ± 20.91 years) recruited from conveniently sampled clinics and rehabilitation centres in Anambra and Enugu States of South-Eastern Nigeria. The construct (concurrent) validity was evaluated using Spearman rank correlation, scatter plot and Mann-Whitney U test while the internal consistency was evaluated using Cronbach's alpha at alpha level of 0.05. RESULTS: The RNLI was successfully cross-culturally adapted to Igbo with all the 11 items still retained. The mean total score of the participants on the RNLI was 58.62 ± 21.25. The internal consistency coefficient (α = 0.84) of Igbo version of the RNLI was excellent. The Spearman correlation coefficients between the participants' total, subscale and domain scores on the Igbo and the English versions of the RNLI (r = 0.81-0.95) were excellent. There was no significant difference between corresponding scores in the English and Igbo versions of the RNLI. CONCLUSION: The Igbo version of the RNLI is a valid and reliable outcome measure among Igbo people living with mobility disabilities in Southeast Nigeria. It is therefore recommended for use among this group.

Informal caregivers' well-being and care recipients' quality of life and community reintegration - findings from a stroke survivor sample.

BACKGROUND: Stroke is highly debilitating and requires long-term care. Informal caregivers of stroke survivors play important roles in stroke rehabilitation. Caring for stroke survivors can negatively affect the caregivers' well-being and may adversely impact on their caregiving quality and subsequently on stroke survivors' well-being. There seems to be a dearth of research on the relationships between caregivers' and stroke survivors' well-being. AIMS AND OBJECTIVES: This study was designed to determine the relationships among informal caregivers' burden and quality of life (QOL) and stroke survivors' QOL and community reintegration. METHODS: This ethically certified cross-sectional survey involved 82 stroke survivors (mean age = 60.48 ± 11.13 years) and their 82 primary caregivers (mean age = 36.13 ± 13.69 years) consecutively recruited from seven conveniently sampled tertiary hospitals in Nigeria. Caregivers Strain Index, Igbo-culture adapted Maleka Stroke Community Reintegration Measure and Short-Form 36-item Health Survey questionnaires were used to assess the caregivers' burden, survivors' community reintegration and QOL (of survivors and caregivers), respectively. Data were analysed using descriptive statistics, Spearman rank, Mann-Whitney U and Kruskal-Wallis tests at alpha level of 0.05. RESULTS: The mean stroke survivors' community reintegration and QOL were 34.05 ± 21.54% and 34.93 ± 16 ± 49%, respectively. The mean caregivers' QOL and burden scores were 74.49 ± 12.61% and 9.13 ± 3.18, respectively. About 80.5% of the caregivers experienced significant burden. Stroke survivors' QOL and community reintegration, and caregivers' QOL and burden significantly correlated with one another (p < 0.05). Poststroke duration, survivor-caregiver cohabitation duration, survivors' community-dwelling duration and daily care-giving hours significantly correlated with each of stroke survivors' community reintegration and QOL, and caregivers' burden and QOL (p < 0.05). CONCLUSIONS: Stroke survivors' community reintegration and QOL were poor while caregivers' had moderate QOL and high prevalence of significant burden. Significant correlations exist between caregivers' well-being and stroke survivors' QOL and community reintegration. Interventions targeted at reducing caregivers' burden may help improve both caregivers and survivors' well-being.

Informal caregiving burden and perceived social support in an acute stroke care facility.

BACKGROUND: Providing informal caregiving in the acute in-patient and post-hospital discharge phases places enormous burden on the caregivers who often require some form of social support. However, it appears there are few published studies about informal caregiving in the acute in-patient phase of individuals with stroke particularly in poor-resource countries. This study was designed to evaluate the prevalence of caregiving burden and its association with patient and caregiver-related variables and also level of perceived social support in a sample of informal caregivers of stroke survivors at an acute stroke-care facility in Nigeria. METHODS: Ethical approval was sought and obtained. Fifty-six (21 males, 35 females) consecutively recruited informal caregivers of stroke survivors at the medical ward of a tertiary health facility in South-Southern Nigeria participated in this cross-sectional survey. Participants' level of care-giving strain/burden and perceived social support were assessed using the Caregiver Strain Index and the Multidimensional Scale of Perceived Social Support respectively. Caregivers' and stroke survivors' socio-demographics were also obtained. Data was analysed using frequency count and percentages, independent t-test, analysis of variance (ANOVA) and partial correlation at α =0.05. RESULTS: The prevalence of care-giving burden among caregivers is 96.7% with a high level of strain while 17.9% perceived social support as low. No significant association was found between caregiver burden and any of the caregiver- or survivor-related socio-demographics aside primary level education. Only the family domain of the Multidimensional Scale of Perceived Social Support was significantly correlated with burden (r = - 0.295). CONCLUSION: Informal care-giving burden was highly prevalent in this acute stroke caregiver sample and about one in every five of these caregivers rated social support low. This is a single center study. Healthcare managers and professionals in acute care facilities should device strategies to minimize caregiver burden and these may include family education and involvement.

Depression, functional disability and quality of life among Nigerian older adults: Prevalences and relationships.

BACKGROUND: Ageing is associated with increased morbidity, depression and decline in function. These may consequently impair the quality of life (QoL) of older adults. PURPOSE: This study was used to investigate the prevalence of functional disability, depression, and level of quality of life of older adults residing in Uyo metropolis and its environs, Nigeria. METHOD: This cross sectional survey involved 206 (116 females and 90 males) older adults with mean age of 69.8±6.7. The World Health Organization Quality of Life-OLD, Functional status Questionnaire (FSQ) and Geriatric Depression Scale (GDS) were used to measure quality of life, functional disability and depression respectively. Data was analysed using frequency counts and percentages and Spearman rank-order correlation coefficient, at 0.05 alpha level. RESULTS: 45.5% of participants had depression, and at least 30% had functional disability in at least one domain, but their quality of life was fairly good (>60.0%) across all domains. Significant correlation existed between depression scores and individual quality of life and functional disability domains and between overall QoL and each functional disability domain (p<0.001). CONCLUSIONS: Depression and functional disability were quite prevalent among sampled older adults but their QOL was not too severely affected. Since the constructs were interrelated, it seems interventions targeted at depression and functional status may invariably enhance the quality of life of the older adults.