Occupational biopsychosocial factors associated with neck pain intensity, neck-disability, and sick leave: A cross-sectional study of construction labourers in an African population.

INTRODUCTION: The burden and impact of neck pain is high in African countries including Nigeria. This study investigated the occupational biomechanical and occupational psychosocial factors associated with neck pain intensity, neck disability and sick leave amongst construction labourers in an urban Nigerian population. METHODS: This cross-sectional study measured clinical neck pain outcomes, occupational biomechanical factors, and occupational psychosocial factors. Descriptive, and univariate/multivariate inferential statistical analyses were conducted. RESULTS: Significant independent factors associated with neck pain intensity were order and pace of tasks being dependent on others (ß = 0.35; p<0.0001); inability to take breaks in addition to scheduled breaks (ß = 0.25; p<0.0001); inability to work because of unexpected events (ß = 0.21; p<0.0001); inability to control the order and pace of tasks (ß = 0.20; p<0.0001); and weight of load (ß = 0.17; p<0.0001); accounting for 53% of the variance in neck pain intensity. Significant independent factors associated with neck disability were weight of load (ß = 0.30; p<0.0001); duration of load carriage (ß = 0.16; p = 0.01); working under time pressure/deadlines (ß = 0.16; p = 0.02); and accounting for 20% of the variance in neck disability. Significant independent factor associated with sick leave was duration of load carriage (ß = 0.15; p = 0.04), in a non-significant regression model explaining -4% of the variance in sick leave. Addition of pain intensity significantly explained more variance in neck disability (31.0%) but less variance in sick leave (-5%), which was not statistically significant (F (10, 190) = 0.902, p = 0.533). CONCLUSIONS: Occupational biomechanical factors may be more important than occupational psychosocial factors in explaining neck disability and sick leave. In contrast, occupational psychosocial factors may be more important than occupational biomechanical factors in explaining neck pain intensity in this population in Nigeria.

Musculoskeletal imaging authority, levels of training, attitude, competence, and utilisation among clinical physiotherapists in Nigeria: a cross-sectional survey.

BACKGROUND: Direct-access physiotherapy practice has led to a global review of the use of differential-diagnostic modalities such as musculoskeletal imaging (MI) in physiotherapy. OBJECTIVE: To explore the MI authority, levels of training, attitude, utilisation, and competence among clinical physiotherapists in Nigeria. METHODS: This national cross-sectional study analysed a voluntary response sample of 400 Nigerian physiotherapists that completed the online version of the Physiotherapist's Musculoskeletal Imaging Profiling Questionnaire (PMIPQ), using descriptive statistics, Spearman's correlation, Mann-Whitney U, Kruskal-Wallis, and Friedman's ANOVA tests. RESULTS: Of the 400 participants, 93.2% believed that physiotherapists should use MI in clinical practice. However, only 79.8% reported having MI authority in their practice settings. The participants' median (interquartile range) levels of training =10 (24) and competence =16 (24) were moderate. Nonetheless, levels of training (χ2 [15] = 1285.899, p = 0.001), and competence (χ2 [15] = 1310.769, p < 0.001) differed across MI procedures. The level of training and competence in x-ray referral and utilisation was significantly higher than magnetic resonance imaging, computed tomography scan, ultrasonography, scintigraphy, and dual-energy x-ray absorptiometry, in that order (p < 0.05). There was a significant positive correlation between the levels of training and competence (rho =0.61, p < 0.001). The participants had a positive attitude =32 (32) and occasionally used MI in clinical practice =21 (28). CONCLUSION: Majority of the respondents believed they had MI authority although there was no explicit affirmation of MI authority in the Nigerian Physiotherapy Practice Act. Participants had a positive attitude towards MI. However, levels of MI training, competence, and utilisation were moderate. Our findings have legislative and curriculum implications.

Effects of Isometric Strengthening Exercises on Pain and Disability Among Patients With Knee Osteoarthritis.

Introduction Osteoarthritis (OA) is the most common form of arthritic disease of the joint worldwide, with the knee joint being the most affected in the body. This study investigated the effects of isometric strengthening exercises on pain and disability among patients with knee osteoarthritis. Methods This randomized control trial research design was carried out at the Physiotherapy Departments of Nnamdi Azikiwe University Teaching Hospital, Nnewi, and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka in Anambra State, Nigeria. A total of 40 subjects, nine (22.5%) males and 31 (75.5%) females, were randomly assigned into exercise and control groups. Prior to intervention, the weight and height of each subject were measured. Pain intensity, active range of motion (AROM) and passive range of motion (PROM), and functional ability of both groups were recorded using the Numerical Pain Rating Scale (NPRS), universal goniometer, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. All participants in the exercise group performed isometric quadriceps and straight leg raise exercises, and the control group received no intervention whatsoever. After six weeks, the pain intensity, AROM, PROM, and functional ability scores were re-measured and documented. Results While comparing the pre-test and post-test scores using paired t-test, the exercise group showed a significant difference in each parameter (NPRS, AROM, PROM, and WOMAC = 0.000), while the control group showed no significant difference. Independent sample t-test outcome at six weeks (exercise and control groups) showed significant reduction of pain intensity (NPRS = 0.000), increased range of motion (AROM = 0.000, PROM = 0.003), as well as improvement in function (WOMAC = 0.000) at a significant level of p ˂ 0.05. Conclusion At the end of the six weeks, isometric strengthening exercises showed a significant effect on pain intensity, range of motion, and functional ability among subjects with knee osteoarthritis.

Knowledge, practices and perceived barriers of physiotherapists involved in disaster management: a cross-sectional survey of Nigeria-based and trained physiotherapists.

BACKGROUND: Disasters represent substantial health risks to the human population. Proper interventions at all stages of disaster management (DM) are essential for human-related outcomes. The role of physiotherapy in DM should not be underestimated, but unfortunately information on the involvement of physiotherapists in DM is limited in sub-Saharan Africa. METHODS: One hundred and fifty Nigeria-based and trained physiotherapists were recruited to complete a questionnaire investigating the knowledge, practices and perceived barriers of the role of physiotherapists in DM. RESULTS: Physiotherapists had moderate knowledge of their role at every stage of DM. However, their involvement in specific DM-related activities during various stages of DM in the country was low. Major barriers to the involvement of physiotherapists in DM included a lack of established government policies on the integration of physiotherapists in DM (90.0%) and a lack of specialty clinical practice areas in DM (89.3%). For improved involvement of physiotherapists in DM in Nigeria, respondents recommended creating an awareness of the role of physiotherapists in DM (91.3%), providing continuous education programmes on DM (90.6%) and inclusion of DM in physiotherapy training programmes in Nigeria (90.0%). CONCLUSION: Physiotherapists perceived that they are not adequately involved in DM in Nigeria, despite their moderate knowledge of their role during DM.

Association of tibiofemoral angle, quadriceps angle and body mass index in a selected adolescent population.

BACKGROUND: Tibiofemoral angle (TFA) and quadriceps angle (QA) are important in the evaluation of patients with knee pathologies associated with these angles. OBJECTIVES: This study investigated correlations among TFA, QA and body mass index (BMI) among Nigerian adolescent population. METHODS: A total of 519 (262 males and 257 females) adolescents aged between 10-18 years selected by stratified random sampling technique from some randomly selected schools in Nnewi metropolis. This study utilised the cross-sectional survey design. A height meter and bathroom weighing scale were used to collect data for BMI while a universal plastic goniometer was used to measure TFA and QA. Independent t- test, paired t-test and Pearson Product Moment Correlation were used to analyse the data obtained. RESULTS: Findings of this study showed there was significant difference between right and left QA of males (t= 2.824; p= 0.005), and females (t= -2.012; p= 0.045) with the right QA been higher than the left in both males and females. Males have a higher TFA and QA (p<0.05 in all cases) than females. A significant negative correlation was found between BMI and right TFA (p=0.034), and between TFA and QA (p= <0.0001). CONCLUSION: TFA positively significantly correlated with QA, with males having higher QA and TFA than females. The obtained information is important in the assessment and management of knee pathologies associated with these angles.

An evaluation of the nature and level of musculoskeletal imaging training in physiotherapy educational programmes in Nigeria.

BACKGROUND: Deficiency in musculoskeletal imaging (MI) education will pose a great challenge to physiotherapists in clinical decision making in this era of first-contact physiotherapy practices in many developed and developing countries. This study evaluated the nature and the level of MI training received by physiotherapists who graduate from Nigerian universities. METHODS: An online version of the previously validated Physiotherapist Musculoskeletal Imaging Profiling Questionnaire (PMIPQ) was administered to all eligible physiotherapists identified through the database of the Medical Rehabilitation Therapist Board of Nigeria. Data were obtained on demographics, nature, and level of training on MI procedures using the PMIPQ. Logistic regression, Friedman's analysis of variance (ANOVA) and Kruskal-Wallis tests were used for the statistical analysis of collected data. RESULTS: The results (n = 400) showed that only 10.0% of the respondents had a stand-alone entry-level course in MI, 92.8% did not have any MI placement during their clinical internship, and 67.3% had never attended a MI workshop. There was a significant difference in the level of training received across MI procedures [χ2 (15) = 1285.899; p = 0.001]. However, there was no significant difference in the level of MI training across institutions of entry-level programme (p = 0.36). The study participants with transitional Doctor of Physiotherapy education were better trained in MI than their counterparts with a bachelor's degree only (p = 0.047). CONCLUSIONS: Most physiotherapy programmes in Nigeria did not include a specific MI module; imaging instructions were mainly provided through clinical science courses. The overall self-reported level of MI training among the respondents was deficient. It is recommended that stand-alone MI education should be introduced in the early part of the entry-level physiotherapy curriculum.

Profile of practitioners, and factors influencing home care physiotherapy model of practice in Nigeria.

The present study investigated factors that influenced home care physiotherapy (HCP) services and profile of the practitioners in Nigeria. It also investigated if the service was registered with the Regulatory Agency. Three hundred and thirty conveniently sampled physiotherapists in Nigeria participated in the cross-sectional survey. A newly developed, nine-part, content-validated questionnaire was used to obtain information about the demographics, sources of referral, case types, frequency of treatment, costing, benefits, and challenges of the HCP, job satisfaction, and registration status. Data were analyzed using descriptive statistics. All the respondents (100%) were involved in HCP irrespective of their professional profile. The mean duration of practice experience was 9.09 ± 7.34 years. Stroke (41.8%) was the most prevalent case treated. Poor working environment (M = 4.16, R = 1-5), transportation cost (M = 4.16, R = 1-5) and intrusion by impostors (M = 3.66, R = 1-5), were some of the factors that had impact on the HCP services. A preponderance of HCP services was not registered with the Regulatory Agency in Nigeria.

Physiotherapist's musculoskeletal imaging profiling questionnaire: Development, validation and pilot testing.

BACKGROUND: Many countries have started adopting musculoskeletal imaging as part of physiotherapy practice and their educational programmes are expected to bridge the gaps in training. OBJECTIVES: To develop an instrument that can be used to explore the level and nature of training, attitude, competence and utilisation of musculoskeletal imaging among physiotherapists. METHOD: An exploratory sequential mixed methods design was used. An in-depth international literature search was conducted, followed by a focus group discussion (FGD). The FGD informants were recruited through maximum variation sampling. The results of the FGD and the information from relevant literature were used to draft the physiotherapist's musculoskeletal imaging profile questionnaire (PMIPQ). The PMIPQ was then subjected to face, content and criterion validity and pilot testing. The final version of the PMIPQ consists of six domains: (A) demographic details, (B) nature of training in musculoskeletal imaging, (C) level of training, (D) attitude towards musculoskeletal imaging, (E) utilisation and (F) competence. Data were analysed using means, standard deviation, Spearman's correlation (ρ) and Cronbach's alpha (α); SPSS 20 software (p ≤ 0.05). RESULTS: The results showed that the PMIPQ has good psychometric properties: validity and internal consistency. The test-retest reliability (p-value) across the domains was: C (0.973), D (0.979), E (0.842) and F (0.716). CONCLUSION: Physiotherapist's musculoskeletal imaging profile questionnaire is a relevant instrument for assessing the musculoskeletal imaging profile of physiotherapists in Nigeria and in other countries with a similar scope of training and practice. CLINICAL IMPLICATIONS: Musculoskeletal system imaging is a potentially useful adjunct to physiotherapists in clinical practice.