Effectiveness of Back care education Programme among school children: a systematic review of randomized controlled trials.

STUDY DESIGN: Systematic review of Randomised controlled trials. OBJECTIVES: With the increasing incidence of back pain among children and its untold implications to their future, back education tailored in an effective way would be indicated. However literature appears unsettled. This study aims to review available literature to determine the effect of school-based back education in preventing and managing low back pain in school children. METHODS: Randomized controlled trials carried out on elementary and secondary school children of ages 6 to 18 years and published in English language were included. Back education taught in hospitals or other settings were excluded. Primary outcome was back pain prevalence and secondary outcomes were constituted from the study characteristics of selected studies which includes: back behavior, knowledge, postural habits, physical activity, fear-avoidance beliefs, back pack carriage, pain intensity, skills and self efficacy. Databases searched were PEDro, HINARI, PubMed, Cochrane, and Google Scholar. Available stiudies from 2000 to March 2022 were retrieved. Quality of studies were assessed using the PEDro scale. Obtained studies were descriptively analyzed. RESULTS: A total 8420 studies were retrieved and 8 studies (with 1239 participants) were included in this review. Four studies each assessed back knowledge and back behavior, and two assessed back pain prevalence. There were improvements in back knowledge and back behaviour, but effectiveness of back care education on back pain prevalence was not conclusive. Forms of education used involved the indirect method of conditioning the environment and the direct method which made use of theory, practical lessons and educational books and materials. CONCLUSION: Back care education programmes in schools are effective in improving back care knowledge, behavior and reduction in low back pain frequency. Reduction in back pain prevalence is not conclusive. Back care education could be incorporated as part of schools' education programmes. Limitations include exclusion of non English language studies and inconsistent outcome measures. FUNDING SOURCE: None. REGISTRATION: This review protocol was registered under the International platform of Registered systematic review and meta-analysis protocol (INPLASY) with the registration number; INPLASY202310044 and DOI number; https://doi.org/10.37766/inplasy2023.1.0044.

Characterization and critical appraisal of physiotherapy intervention research in Nigeria: a systematic review.

OBJECTIVES: Clinical research is the bedrock of clinical innovation, education and practice. We characterized and critically appraised physiotherapy clinical research to avoid implementing misleading research findings into practice and to task the Nigerian physiotherapy societies on responsible conduct of clinical research. METHODS: This is a systematic review of articles published in English between 2009 and 2023. We started with 2009 because at least few Nigerian Physiotherapy school had commenced postgraduate (research) training by then. We searched Pubmed, Medline, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO and African Journal Online, and reference lists of relevant articles. We Data were selected and extracted according to predesigned eligibility criteria and using a standardized data extraction table. Where appropriate, the Pedro and Cochrane ROBINS1 were used to examine the risk of bias. RESULTS: A total of 76 Nigerian studies were included in this study. The mean age of the study participants was 46.7 ± 8.6 years. Approximately, 45% of the participants were males. Of the clinical experiments, the randomized controlled trial (RCT) was the most common design (87.5%). Musculoskeletal conditions (39.3%) were the most studied disorder. Approximately 86% of the RCT had studies possessed fair to good quality. Interventions constituted exercise therapy (76.3%), manual therapy (8.5%) and electrotherapy (8.5%). More than half (67.8%) of the studies recorded medium to large effect sizes. A fair proportion (48.2%) of the studies had a confounding-by-indication bias. Approximately 43% of the clinical experiments were underpowered, and a few studies conducted normality tests (10.9%) and intention-to-treat analysis (37.5%). CONCLUSIONS: RCT is the most frequent clinical experiment, with majority of them possessing fair to good quality. The most important flaws include improper computation of sample size, statistical analysis, absent intention-to-treat approach, among others. The magnitude of effects of Physiotherapy interventions varies from nil effect to large effect. Musculoskeletal condition is the most prevalent disorder and exercise is the most important intervention in Nigerian physiotherapy practice. TRIAL REGISTRATION: We registered the protocol with PROSPERO. The registration number: CRD42021228514.

Stratification of Risk Factors of Lung Cancer-Associated Venous Thromboembolism and Determining the Critical Point for Preemptive Intervention: A Systematic Review With Meta-analysis.

Background: Several biomarkers or risk factors have been identified and several prediction models exist. The major limitations inherent in these models include cost-ineffectiveness and lack of systematic stratification of risk factors resulting in the inclusion of clinically insignificant biomarkers in the models. This review aimed to systematically stratify the risk factors of lung cancer-associated venous thromboembolism (VTE) and determine the critical point for preemptive intervention. Methods: This systematic review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-analyses. We searched MEDLINE, PubMed, Cochrane Library, CINAHL, Academic Search Complete, and PsycINFO from the onset to June 2022. We included studies that reported the risk factors of lung cancer-associated VTE and corresponding risk estimates, irrespective of treatment status but studies were excluded if patients were on anti-VTE medications. We employed random effects models of meta-analysis and computed risk stability index and risk weight (Rw) to achieve the review objectives. The review protocol is registered with PROSPERO (CRD42022336476). Results: The clinically significant risk factors of VTE in lung cancer patients were D-dimer (odds ratio [OR] = 5.510, 95% CI = 2.6-11.7; Rw = 5.0), albumin (OR = 2.2, 95% CI = 1.0-4.8; Rw = 1.79), leukocyte (OR = 2.48, 95% CI = 1.9-3.2; Rw = 1.77), histological type (OR = 1.69 , 95% CI = 1.2-2.4; Rw = 1.3), age (OR = 1.56; Rw = 0.99), and hemoglobin (OR = 1.85, 95% CI = 1.3-2.6; Rw = 0.92). Based on the distribution of Rw across risk factors, the critical point (upper third of the upper quartile class) was 4.5 and may mark the point at which preemptive intervention should be commenced. Conclusions: Targeted screening for VTE in lung cancer patients could be patient-specific and should be based on a combination of the most significant risk factors required to meet the critical point, provided that such a combination is affordable as illustrated in the ALBAH model. Registration: The review protocol is registered with PROSPERO (ID: CRD42022336476).

Does Sickle Cell Disease Protect against HIV Infection: A Systematic Review.

OBJECTIVE: The aim of this systematic review was to investigate whether sickle cell disease (SCD) protects against human immunodeficiency virus (HIV) infection by determining the association between SCD and the incidence and virulence of HIV infection. METHODS: This is a systematic review that used MEDLINE, PubMed, CINAHL, and Academic Search Complete as data sources. Articles describing the relationship of SCD with HIV infection were included in this review. The effect measures were converted to correlation coefficients and synthesized accordingly to examine the putative protective role of SCD against HIV infection. Independent full-text screening and data extraction were conducted on all eligible studies. The risk of bias was assessed using the mixed methods appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane's Q statistics, I2, and prediction interval to quantify effect size heterogeneity. RESULTS: SCD reduces the risk of HIV infection by 75% (odds ratio [OR] = 0.25; r = -0.36, p < 0.001; I2 = 71.65). There was no publication bias (Egger's t value = 0.411; p = 0.721). Similarly, risk of HIV virulence was reduced by 77% (OR = 0.23; r = -0.38; p < 0.001; I2 = 63.07). The mechanisms implicated in the protective influence of SCD include autosplenectomy, reduced CCR5 expression, and increased expression of heme and iron-regulated genes. CONCLUSIONS: SCD appears to protect against HIV infection and slows HIV progression.

Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis.

Postpartum depression (PPD) is a common mental health challenge in resource-constrained sub-Saharan Africa (SSA). Characterizing its correlates will aid prediction, early detection, and pre-emptive interventions. This review aimed to systematically synthesize and stratify PPD correlates in sub-Saharan Africa. The review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-Analyses. We included studies that reported the correlates of PPD in SSA. We searched PubMed, Medline, CINAHL, Academic Search Complete, and PsycINFO for relevant peer-reviewed literature. The correlates of PPD constituted the primary outcome. A random effect model was fitted to estimate the pooled correlation coefficient per correlate. The clinical relevance of correlates was stratified based on strength of correlation (r) and recurrence (f). The mean age of the participants was 27.0 ± 6.0 years, and 68.6% of participants had completed at least secondary education. The correlates of PPD in SSA were intimate partner violence (IPV) ((risk weight (rw) = 2.8; r = 0.212 (confidence interval (CI): 0.11-0.31), poor social support (PSS) (rw = 1.9; r = 0.250 (0.133-0.361)), unwanted pregnancy (UP) (rw = 1.6; r = 0.279 (CI: 0.14-0.41); I2 = 95.89), and maternal age (MA) (rw = 0.96; r = 0.27 (CI: 0.154-0.37)), among others. A cumulative risk weight of ⩾0.95 was predictive of PPD and marks the critical point at which preemptive interventions should be instituted. The stratification of risk PPD factors and computation of risk stability index are useful in identifying the clinical significant risk factors. The provision of critical risk point will simplify early detection thus facilitating cost-effectiveness. Of the correlates of PPD in SSA, IPV, PSS, UP, and MA are the most important. Targeted screening and pre-emptive interventions for women with high risk weight may be a reasonable strategy both in the short and long term.

Contributions of von Willebrand factor to clinical severity of sickle cell disease: a systematic review and metanalysis.

AIM: To evaluate the contributions of VWF to the clinical manifestation and severity of SCD. DESIGN: A systematic review of peer-reviewed articles published in English. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. METHODS: The data sources for the review included MEDLINE, PubMed, CINAHL, and Academic Search Complete. Articles that applied a quantitative approach to the investigation of the relationship of vWF with clinical manifestations and severity indices were included. The risk of bias assessment was carried out with a mixed-method appraisal tool. We computed I 2 to estimate the degree of heterogeneity. RESULT: There was a significantly higher level of VWF in SCD than in the control (d = 2.7, Z = 4.865, P < 0.001, I 2 = 96.41%). Significant positive correlations were obtained for the relationship of VWF with vasoocclusive crisis (r= 0.277, Z= 5.077, P < 0.001, 1 2 =15.62), rate of hemolysis (r=0.441; Z= 4.440, I 2 = <1%), extracellular haemoglobin (r=-0.397, Z=-4.155, I 2 =<1%) and CRP (r = 0.331, Z = 4.566, P < 0.001, I 2 < 1%).The VWF is important in determining the clinical severity of sickle cell disease, which constitutes a putative therapeutic target. More work is required to understand the causal direction underlying the association between VWF levels and the clinical severity of sickle cell disease and the potential role that VWF plays in the clinical manifestations of sickle cell disease. PROTOCOL REGISTRATION: The protocol was registered with PROSPERO (CRD42021262625).

Normative scores for select neuropsychological battery tests for the detection of HIV-associated neurocognitive disorder amongst Nigerians.

Background: The study aimed to derive socio-demographic-corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross-sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla. Aims and Objectives: To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing. Methods: Eligibility criteria were being HIV negative, aged 18-64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS-MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness. Results: All the participants were Nigerians aged 18-64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)-forwards, while education affected all expect IHDS-MS and DST-backwards. The cut-off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS-MS and DST. Conclusions: With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV-associated dementia to a minimum. The lack of variability in the IHDS-MS and DST is unfavourable.

Aerobic exercise for HIV-associated neurocognitive disorders in individuals on antiretroviral therapy: A randomised controlled trial.

INTRODUCTION: The increasing burden of self-limiting forms of HIV-associated neurocognitive disorder (HAND) in the antiretroviral therapy era calls for adjunctive interventions. The study aimed to determine the effects of a 12-week aerobic exercise programme on HAND. METHODS: This is a parallel-group, randomized controlled trial with concealed allocation and intention-to-treat analysis. This study was a clinic-based programme. Seventy-three patients with HAND were enrolled in the trial. The intervention comprised a moderate-intensity aerobic exercise, 20-60 min per session, three times per week, for twelve weeks. The control group received exercise education. Prevalence of HAND constituted the primary outcome. HAND was identified and classified following the Frascati criteria. We computed the odds ratio and number needed-to-treat to estimate the treatment effect. RESULTS: There were 73 patients (38 in exercise and 35 in control arm). Individuals in the exercise arm recorded a significantly higher reduction in working memory deficit (OR = 5.14; CI = 2.6-10.4; NNT = 6) but not in attention-deficit (OR = 0.31, CI = 0.2-0.5; NNT = -5) compared to the control group at twelve-week. Reductions in attention deficit (OR = 1.55, 95 CI = 1.0-2.4; NNT = 5) and HAND prevalence (OR = 1.8, 95 CI = 1.2-2.8); NNT = 8) were significantly higher in the exercise group compared the control group at three-month. No significant between-group difference in functional independence was observed immediately after exercise (p > 0.05). DISCUSSION: The neuroprotective effects of aerobic exercise appear selective and vary with cognitive abilities impaired and aerobic capacity, with a greater change occurring with improved aerobic capacity. CONCLUSION: Individuals with working memory and attention deficits may benefit more from moderate-intensity aerobic exercise.

Correction: Aerobic Exercise in HIV-Associated Neurocognitive Disorders: Protocol for a Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/29230.].

Impact of HIV-associated cognitive impairment on functional independence, frailty and quality of life in the modern era: a meta-analysis.

HIV-associated neurocognitive disorder (HAND) is an important sequela of HIV infection. Combined antiretroviral therapy (cART) has improved the health outcomes of many people living with HIV but has given rise to a less severe but limiting form of HAND. The study aimed to evaluate the impact of HAND on medication adherence, activities of daily living (ADL), quality of life and frailty. This systematic review adheres to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched MEDLINE, PubMed, CINAHL, Academic Search Complete, and PsycINFO online databases. Studies were included if they examined the relationship between HAND and medication adherence, ADL, quality of life and frailty, and were conducted between 1997 and 2021. We used a random-effects meta-analysis model to assess the impact of HAND on outcome variables. Forty papers, totaling 11,540 participants, were included in the narrative and quantitative syntheses. Cognitive impairment was associated with poorer medication adherence (r = 0.601, CI 0.338 to 0.776, p = 0.001, I2 = 94.66). Cognitive impairment did not influence ADL (r = 0.167, CI-0.215 to 0.505, p = 0.393) and quality of life (r = 0.244, CI 0.117 to 0.548, p = 0.182). In the cART era, HAND appears to be associated with adherence to medication, which may influence future health outcomes. In PLWHIV who are adherent to cART, cognitive impairment does not appear to interfere with ADL and quality of life.

Effects of aerobic exercise on quality of life of people with HIV-associated neurocognitive disorder on antiretroviral therapy: a randomised controlled trial.

BACKGROUND: HIV-associated neurocognitive disorder (HAND) negatively impacts quality of life (QoL) of people living with HIV who are on antiretroviral therapy (ART). Behavioural intervention adjunct to ART may improve QoL of people with HAND. We determine the effect of a 12-week aerobic exercise programme on QoL in people with HAND who were receiving ART. TRIAL DESIGN: This was a parallel-group, randomised controlled trial with concealed allocation and intention-to-treat analysis. METHODS: We identified 73 participants diagnosed with HAND. Participants were sampled from an earlier study that examined the prevalence of HAND according to the Frascati criteria. Participants were randomised and allocated to an intervention of 12-weeks of aerobic exercise, comprising three 20-60 min sessions per week of moderate-intensity aerobic exercise using a cycle ergometer. The primary outcome was QoL, which was evaluated using the World Health Quality of Life Questionnaire (WHOQoL)-BREF. RESULTS: Participants in the exercise (n = 39) and control (n = 35) groups had similar sociodemographic characteristics (p > 0.05). Following the 12-week aerobic exercise programme, participants in the exercise group had improved physical (p < 0.001), psychological (p = 0.008) and environmental (p = 0.001) domains of the QoL (p = 0.001) and overall QoL (p = 0.001) relative to the control group. Similarly, participants in the exercise group had lower depression scores than participants in the control group. Depression scores in the exercise group were still lower 3 months post-intervention (p = 0.007). Only the improvements in physical (p = 0.02) and psychological (p = 0.007) domains of QoL were sustained at 3 months post-intervention. CONCLUSIONS: Aerobic exercise improves the QoL of people with HAND. To ensure sustained benefits, people with HAND may need to engage in long-term physical exercise. Trial registration The trial is registered with the PAN African Trial Registry (PACTR). Date: 01/09/2020, ID: PACTR202009483415745.

Aerobic Exercise in HIV-Associated Neurocognitive Disorders: Protocol for a Randomized Controlled Trial.

BACKGROUND: Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. OBJECTIVE: This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. METHODS: At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. RESULTS: This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. CONCLUSIONS: This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR202009483415745; https://tinyurl.com/2p97zpu9. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/29230.

Influence of Post-Stroke Depression on Functional Independence in Activities of Daily Living.

BACKGROUND: Little attention has been paid to screening of depression among stroke survivors in outpatient physiotherapy clinics. Post-stroke depression is reported to have a negative impact on functional recovery. However, the exact influence on the outcome of rehabilitation such as level of functional independence remains controversial. This study aims at ascertaining the influence of post-stroke depression on functional independence in activities of daily living. METHODS: The study is a cross sectional survey of stroke survivors attending outpatient physiotherapy clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, and the Enugu State University Teaching Hospital (ESUTH). Participants were evaluated for socio-demographic characteristics. Post-stroke depression and level of functional recovery in Activities of Daily Living were assessed using the Hamilton Depression Rating Scale and the Barthel Index respectively. Data was analyzed using SPSS version 23, with α set at 0.01. RESULTS: A total of 66 participants, 42 females and 24 males, were purposively recruited into the study. Over 80% (56) of the participant had depression, with over 50% (32) being severely depressed. Post-stroke depression was associated with less functional independence in activities of daily living (p=0.000). A significant difference was found in the level of functional independence between participants with and without depression (p=0.00). CONCLUSION: Participants with post-stroke depression have less independence in activities of daily living. A longitudinal study with a larger sample size is, however, recommended so as to improve the external validity. In the mean time, outpatient rehabilitation of depressed stroke survivors should include pharmacological and psychological components.

Influence of post-stroke depression on functional independence in activities of daily living

BACKGROUND: Little attention has been paid to screening of depression among stroke survivors in outpatient physiotherapy clinics. Post-stroke depression is reported to have a negative impact on functional recovery. However, the exact influence on the outcome of rehabilitation such as level of functional independence remains controversial. This study aims at ascertaining the influence of post-stroke depression on functional independence in activities of daily living. METHODS: The study is a cross sectional survey of stroke survivors attending outpatient physiotherapy clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, and the Enugu State University Teaching Hospital (ESUTH). Participants were evaluated for socio demographic characteristics. Post-stroke depression and level of functional recovery in Activities of Daily Living were assessed using the Hamilton Depression Rating Scale and the Barthel Index respectively. Data was analyzed using SPSS version 23, with α set at 0.01. RESULTS: A total of 66 participants, 42 females and 24 males, were purposively recruited into the study. Over 80% (56) of the participant had depression, with over 50% (32) being severely depressed. Post-stroke depression was associated with less functional independence in activities of daily living (p=0.000). A significant difference was found in the level of functional independence between participants with and without depression (p=0.00). CONCLUSION: Participants with post-stroke depression have less independence in activities of daily living. A longitudinal study with a larger sample size is, however, recommended so as to improve the external validity. In the mean time, outpatient rehabilitation of depressed stroke survivors should include pharmacological and psychological components