Effect of short-term glycemic control and physical activity on health-related quality of life among type 2 diabetes receiving care in a tertiary health facility in Ogun State, Nigeria: a cross-sectional study.

Introduction: there are myriad of factors that influence health-related quality of life (HRQoL) which relationships remain unclear. Some of the factors include glycemic control and physical activity. This study determined the relationship between glycemic control, physical activity, and HRQoL among people living with type 2 diabetes. Methods: data from a cross-section of persons living with type 2 diabetes included information about their most recent fasting blood glucose (FBG), physical activity (PA), and HRQoL. The PA and HRQoL were assessed with long-form international physical activity and short-form-36 questionnaires, respectively while FBG was gleaned from patients´ records. Data were subjected to statistical analysis at p<0.05 regarded as significant. Results: a total of 119 participated in the study with mean age of 61.8±11.8 years and mostly women, 60.5% (n=72). About 68.9% (n=82) were physically active, 84.0% (n=100) had poor short-term glycemic control (median blood glucose 134, IQR (108-187) mm/dl). There was a positive correlation between participants´ PA and physical health (r= 0.425, p=0.001), mental health (r= 0.334, p= 0.001) and overall HRQoL (r= 0.403, p= 0.001) but not with FBG (r= 0.044, p= 0.641). However, their FBG correlated with the mental health domain of the HRQoL (r= -0.213, p= 0.021). The physically active had better overall HRQoL (62.53±19.10 vs 50.28±23.10, p = 0.001) than the physically inactive which effect persisted when stratified for glucose control (68.16±19.19 vs 47.62±21.52, p = 0.001). There was however no influence of glycemic control on the relationship between PA and HRQoL [b = 0.000, 95% CI (0.000, 0.000), t = 0.153, P = 0.88] meaning that the relationship is not moderated by glycemic control. Conclusion: physical activity is beneficial for improved HRQoL in type 2 diabetes irrespective of glycemic control. This calls for increasing the level of awareness and education of type 2 diabetics aimed at improving their physical activity levels and their quality of life.

Translation, Cross-Cultural Adaptation, and Psychometric Testing of Yoruba Version of the EQ-5D Questionnaire in Patients With Musculoskeletal Disorders.

Background: The EuroQol-5 Dimension (EQ-5D) is a generic self-administered questionnaire used for the measurement and economic valuation of a wide range of health conditions, which necessitates its existence and adaptation in different languages. Currently, the tool does not exist in any Nigerian language. This study aimed to translate, cross-culturally adapt, and determine the reliability and validity of the Yoruba version of the EQ-5D-5L questionnaire. Methods: The International Quality of Life Assessment (IQOLA) project guidelines, involving forward translation, reconciliation and harmonization, backward translation, and reconciliation of problematic items were used in the Yoruba translated version of the EQ-5D-5L (EQ-5D-Yor). A total of 113 and 109 persons with musculoskeletal disorders participated in the validity and 7-day test-retest reliability testing of the EQ-5D-Yor. Convergent and discriminant validity of the EQ-5D-Yor were determined using the Yoruba version of the 12-Item Short-Form Health Survey (SF-12) (SF-12-Y) and Visual Analog Scale (VAS). Data were analyzed using descriptive and inferential statistics of Spearman correlation, Intra-Class Correlation, Cronbach alpha, and multi-trait scaling analysis. Alpha level was set as p < 0.05. Results: The construct validity of the EQ-5D-Yor yielded Spearman rho ranging from 0.438 to 1.000, with the EQ-VAS having the highest co-efficient (r = 1.000; p = 0.001). The convergent validity of the EQ-5D-Yor index with scales and domains of the SF-12-Y yielded no significant correlations (p < 0.05), except for the physical functioning scale (r = -0.709, p = 0.001). On the other hand, the divergent validity of the EQ-5D-Yor index with VAS yielded a moderate negative correlation (r = -0.482; p = 0.001). The Intra-class Correlation Coefficient (ICC) and Cronbach's alpha for the test-retest reliability of the EQ-5D-Yor were 1.000 and 0.968. The confirmatory factor analysis showed the factor loadings were poor when including VAS in the model. Conclusion: The EQ-5D-Yor has acceptable validity and reliability and can be used as a valid tool among Yoruba speaking population with musculoskeletal disorders.

Itinerário terapêutico de pacientes com dor lombar crônica atendidos em ambulatório de fisioterapia / Therapeutic itinerary of patients with chronic low-back pain attending outpatient physiotherapy clinic

Objetivo: avaliar o itinerário terapêutico de pacientes com lombalgia crônica. Métodos: estudo qualitativo envolvendo a utilização de entrevista semiestruturada em profundida-de, para coleta de dados sobre o itinerário terapêutico de dez pacientes com lombalgia crônica atendidos em clínica de fisioterapia de um hospital terciário. Os dados foram analisados por meio da análise de conteúdo temática. Re-sultados: os temas emergentes foram: início da dor lombar, sintomas que iniciaram a jornada para o cuidado, etapas to-madas para encontrar alívio para a dor, percepção do entre-vistado sobre o atendimento recebido, interferência da dor na vida normal, família e relações, práticas múltiplas nas quais pacientes com dor lombar crônica se envolvem, per-cepção da eficácia das múltiplas práticas e obstáculos para buscar atendimento. Conclusão: pacientes com dor lombar crônica seguem caminhos diferentes em busca de atendi-mento. A dor lombar crônica alterou significativamente a vida dos pacientes e os tornou propensos a praticar o plu-ralismo médico. (AU)

Adult stroke survivor's reintegration to normal living: a scoping review protocol.

BACKGROUND: To the best of our knowledge, a scoping review of the published literature investigating the determinants of adult stroke survivors' reintegration to normal living has not been conducted. This scoping review aims to critically review the evidence investigating reintegration to normal living following a stroke. The following questions on reintegration to normal living after stroke will pivot this review: (i) what factors are associated with returning to normal living of stroke survivors? (ii) what are the overall determinants of reintegration to normal living of stroke survivors? To fully understand these questions, we also ask, how is reintegration to normal living assessed throughout stroke literature? METHODS: A scoping review will be conducted based on the methodology presented by Arksey and O'Malley and extended by Levac and colleagues. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR) was adopted to develop the protocol. This study will include studies involving participants ≥ 18 years old, who are stroke survivors reintegrating to normal living in the community. With no time limitations, English language publications and all study designs reporting on reintegration to normal living of stroke survivors' will be sourced. The abstract and full-text screening will be conducted by two independent reviewers, including data charting. Thematic analysis will be used to align relevant themes and will be presented in a narrative. DISCUSSION: We anticipate that the scoping review will highlight the available resources and evidence on factors that determine reintegration to normal living of stroke survivors. This may contribute to informed empirical evidence for rehabilitation professionals to enhance the functional recovery of stroke survivors. It may also reveal other areas for research into reintegration to normal living for stroke survivors. SCOPING REVIEW REGISTRATION: The protocol has been registered prospectively on the Open Science Framework ( https://osf.io/36tuz/ ).

Qualitative exploration into reasons for delay in seeking medical help with diabetic foot problems.

PURPOSE: Delay in reporting foot symptoms in patients with diabetes to health-care professionals is said to be responsible for limb amputation. While reasons for these delays have been investigated elsewhere, they are not well documented in Nigeria. This study explored the causes of delayed presentation in a Nigerian sample of patients with diabetic foot ulcers. METHOD: The study followed an explorative qualitative design in which the lived experience of eight participants with diabetes were explored. The participants completed in-depth interviews which were digitally audio-recorded and transcribed verbatim. Data were analysed thematically using deductive reasoning. RESULTS: The study identified four themes which included knowledge and awareness of foot challenges, risk perception, health seeking triggers and behaviours and competing priority as the factors responsible for delay in presentation of diabetic foot complications. CONCLUSIONS: Limited knowledge and awareness and negative health seeking behaviours including self-management and consultation of traditionalists were the major reasons for delays.

Exploração qualitativa do itinerário terapêutico de crianças com deficiência física na Nigéria usando análise de conteúdo temática / Exploración cualitativa del itinerario terapéutico de niños con discapacidades físicas en Nigeria utilizando análisis de contenido temático / Qualitative exploration into therapeutic itinerary of children with physical disabilities in Nigeria using thematic content analysis

Resumo Objetivo Explorar o itinerário terapêutico na busca de cuidados para crianças com deficiências físicas pelos cuidadores. Métodos Um plano qualitativo descritivo que recrutou nove cuidadores de crianças com deficiência física, com consentimento, que frequentavam um Hospital Universitário Nigeriano. Foi utilizado um guia de entrevista semi-estruturado para coletar dados sobre o itinerário terapêutico, que foi definido como os caminhos percorridos pelos indivíduos para resolver o seu problema de saúde. As entrevistas foram gravadas em áudio e transcritas literalmente. Os dados foram analisados utilizando a análise do conteúdo temático. Resultados os temas emergentes revelaram que os cuidadores iniciaram o itinerário terapêutico para os respetivos filhos após a observação de quaisquer deficiências que vão para além de doenças casuais. A falta de capacidade dos hospitais privados, que servem como ponto inicial de entrada na busca de cuidados, encorajou a procura por cuidados nos hospitais públicos, lares espirituais, e clínicas tradicionais. A entrada na fisioterapia dependia de auto-referências, referências por parentes e médicos. Cuidar de crianças com deficiência física prejudicou de modo significativo a vida social, as finanças, o trabalho do cuidador; e expectativas não alcançadas de que a criança melhorasse o mais cedo possível encorajaram um pluralismo contínuo. Conclusão e implicações para a prática O fato de ter crianças com deficiências e de ter havido atraso nos progressos levou os cuidadores a práticas múltiplas e complexas na busca de cuidados de saúde.

Resumen Objetivo Explorar el itinerario terapéutico para la búsqueda de cuidado de niños con discapacidad física por parte de los cuidadores. Métodos Un diseño cualitativo descriptivo que recluta a nueve cuidadores de niños con discapacidades físicas que asisten a un hospital universitario de Nigeria. Se utilizó una guía de entrevista semiestructurada para recopilar datos sobre el itinerario terapéutico que se definió como los caminos que recorren los individuos para abordar su problema de salud. Las entrevistas fueron grabadas en audio y transcritas textualmente. Los datos se analizaron mediante análisis de contenido temático. Resultados Los temas emergentes revelaron que los cuidadores iniciaron un itinerario terapéutico para sus hijos al observar cualquier impedimento que vaya más allá de las enfermedades casuales. La falta de capacidad en los hospitales privados, que sirve como punto inicial de entrada en la búsqueda de atención, fomenta la vacilación en los hospitales públicos, hogares espirituales y clínicas tradicionales. La entrada en fisioterapia dependía de las autorremisiones, las derivaciones de familiares y médicos. El cuidado de niños con discapacidad física afectó significativamente la vida social, las finanzas y el trabajo del cuidador; y las expectativas no satisfechas de que un niño se recupere lo antes posible fomentaron el pluralismo continuo. Conclusión e implicaciones para la práctica El hecho de que los niños presentaran discapacidades e hitos retrasados condujo a múltiples prácticas complejas de búsqueda de atención médica entre los cuidadores. Por lo tanto, estos cuidadores se vuelven médicos pluralistas y encubiertamente no se adhieren a las prescripciones de tratamiento hospitalario.

Abstract Objective To explore the therapeutic itinerary for seeking care for children with physical disabilities by caregivers. Methods A descriptive qualitative design recruiting nine consenting caregivers of children with physical disabilities attending a Nigerian Teaching Hospital. A semi-structured interview guide was used to collect data on therapeutic itinerary which was defined as the paths taken by individuals to address their health problem. Interviews were audio-recorded and transcribed verbatim. Data was analyzed using thematic content analysis. Results Emerging themes revealed that caregivers commenced therapeutic itinerary for their children upon observation of any impairments that go beyond casual illnesses. Lack of capacity in private hospitals, which serves as initial point of entry into care seeking, encourage vacillation into public hospitals, spiritual homes, and traditional clinics. Entry into physiotherapy was dependent on self-referrals, referrals by relatives, and physicians. Caring for children with physical disability significantly affected caregiver's social life, finances, work; and unmet expectations for a child to get well as soon as possible encouraged continuous pluralism. Conclusion and implications for the practice Having children presenting with impairments and delayed milestones led to complex multiple health care seeking practices among caregivers. Thus, these caregivers become medical pluralists and covertly non-adherent to hospital treatment prescriptions.

Sobrecarga e qualidade de vida de cuidadores informais de crianças com paralisia cerebral / Burden and quality of life of informal caregivers of children with cerebral palsy

RESUMO Objetivo: analisar a sobrecarga e qualidade de vida de cuidadores informais de crianças com paralisia cerebral. Métodos: o estudo transversal envolveu 109 cuidadores recrutados em uma clínica de fisioterapia em um hospital terciário. A qualidade de vida e a sobrecarga foram avaliadas por meio do Personal Wellbeing Index e do Modified Caregivers' Strain Index, respectivamente. Os dados foram analisados de forma descritiva e inferencial. Resultados: as médias do índice de sobrecarga e dos escores de qualidade de vida foram 11,85 ± 5,72 e 64,68 ± 8,03, respectivamente. A maioria (67,9%) dos cuidadores apresentou bem-estar pessoal razoável, enquanto cerca de um terço (33,0%) apresentou alta sobrecarga. Idade da criança (B=2,454; p<0,005) e ocupação dos cuidadores (B= -2,547; p=0,001) foram preditores de tensão do cuidador. Conclusão: cuidar de crianças com paralisia cerebral impôs uma sobrecarga substancial aos cuidadores e a idade da criança e a ocupação dos cuidadores foram variáveis preditoras.

ABSTRACT Objective: to analyze the caregiver burden and the quality of life of informal caregivers of children with cerebral palsy. Methods: the cross-sectional survey involved 109 caregivers of children with cerebral palsy recruited from physiotherapy clinic at a tertiary hospital. The quality of life and caregiver burden were assessed using the Personal Wellbeing Index Scale and the Modified Caregivers' Strain Index, respectively. Data were analysed using descriptive and inferential statistics. Results: the mean strain index and quality of life scores of the participants were 11.85 ± 5.72 and 64.68 ± 8.03 respectively. The majority (67.9%) of the caregivers had fair personal well-being, while about one-third (33.0%) had high caregiver's strain. Child's age (B=2.454; p<0.005) and caregivers' occupation (B= -2.547; p=0.001) were predictors of caregiver strain. Conclusion: caring for children with cerebral palsy imposed a substantial burden on the caregivers and child's age and caregivers' occupation were predictor variables.

Itinerário terapêutico de sobreviventes de acidente vascular cerebral em um hospital terciário nigeriano / Therapeutic itinerary of stroke survivors in a Nigerian tertiary hospital

RESUMO Objetivo analisar o itinerário terapêutico de sobreviventes de acidente vascular cerebral, desde sua ocorrência até a reabilitação. Métodos itinerário terapêutico percorrido por 12 sobreviventes de acidente vascular cerebral para resolver seus problemas de saúde foi explorado usando entrevistas em profundidade e análise temática. Resultados as rotas dos sobreviventes foram influenciadas pelo tipo e estado do paciente no início do acidente vascular cerebral. A falta de capacidade contribuiu para indecisão entre buscar atendimento em hospitais privados ou públicos. A entrada na fisioterapia dependeu da demanda espontânea e de encaminhamentos realizados por médicos que atuam como sentinelas dos pacientes. O acidente vascular cerebral afetou significativamente a vida social dos sobreviventes. A extensão do comprometimento do acidente vascular cerebral e expectativas não atendidas promovem o pluralismo médico entre os sobreviventes. Conclusão sobreviventes de acidente vascular cerebral estão envolvidos em itinerários terapêuticos complexos e extensos, caracterizados pela prática de busca de múltiplos cuidados.

ABSTRACT Objective to analyze the therapeutic itinerary of stroke survivors from stroke occurrence to rehabilitation. Methods therapeutic itinerary - route taken by individuals to solve their health problems, of 12 stroke survivors was explored using in-depth interviews and was thematically analyzed. Results stroke survivors' routes were influenced by type of stroke and the state of the patient at onset of stroke. Lack of capacity facilitates vacillation from private to the public hospital settings. Entry into physiotherapy was dependent on self-referrals and referrals from physicians who often serve as gatekeeper of patients. Stroke significantly affected social life of stroke survivors, and the extent of stroke impairment and unmet expectations promotes medical pluralism among the survivors. Conclusion stroke survivors are involved in intricate and lengthy therapeutic itineraries that are characterized by multiple care seeking practice.