Clinical students' perception of educational environment in a Nigerian university: a mixed method study.

BACKGROUND: Learning environment (LE) research has been given priority in higher education institutions globally because of its influence on learning processes and outcomes. Although studies reporting the perceptions of health science students about LE in Nigeria are available, none have compared the perceptions of students from different health professions. Therefore, this study aimed to assess final-year clinical students' perceptions of their LE from four programs (dentistry, medicine, nursing, and physiotherapy) and compared their LE perceptions. METHODS: This study adopted a cross-sectional study design using a mixed method approach. The quantitative survey involved all the final-year clinical students at the University of Ibadan, and they completed the Dundee Ready Education Environment Measure (DREEM) questionnaire. The qualitative aspect involved 24 consenting students in four focus group discussions. RESULTS: A total of 214 out of 223 copies of the DREEM questionnaire were duly completed and returned, yielding 96.0% response rate. The participants' mean age was 24 ± 2.3 years (ranged between 22 and 25 years, p = 0.001). The mean DREEM scores of the students from the four programs ranged between 119.68 ± 18.02 and 147.65 ± 15.89 out of a maximum of 200, interpreted as more positive than negative perceptions of LE. Physiotherapy students' DREEM score was significantly higher than those of medical, dental, and nursing students (p < 0.001). The DREEM scores of other students did not differ significantly (p > 0.05). Dental and medical students had similar positive perceptions. The qualitative aspect revealed that the students had positive perceptions of their teachers' knowledge base and self-acquisition of knowledge but negative perceptions of their teachers' communication skills, infrastructural facilities, lecturer-student relationships, and hostel accommodations. CONCLUSION: Although the survey indicated that these clinical students had more positive than negative perceptions of their learning environment, the qualitative aspect of the study revealed many challenges that the students were confronted with. The clinical students' perception of their learning environment could be improved if the university authorities would address these challenges.

Cross-cultural adaptation and psychometric testing of the Yoruba lequesne algofunctional index of knee osteoarthritis among patients with knee osteoarthritis.

BACKGROUND: The Lequesne Algofunctional Index of Knee Osteoarthritis (LAIKOA) is a widely used knee osteoarthritis (KOA) outcome measure and is recommended by many international authorities. It has been cross-culturally adapted to many languages, excluding indigenous Nigerian languages. The aim of this study was to cross-culturally adapt and validate the LAIKOA into Yoruba language. METHODS: This was a validation study. Yoruba LAIKOA was translated and culturally adapted from English version following Beaton's guidelines (including cognitive debriefing). The Yoruba LAIKOA was psychometrically tested for test-retest reliability, standard error of measurements (SEM), smallest detectable change (SDC), internal consistency, and construct validity among 108 Yoruba-speaking patients with KOA recruited from selected hospitals in Ibadan, Nigeria. Participants completed the Yoruba and English versions of LAIKOA, and the Yoruba version of Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM). RESULTS: The mean age of participants was 63.60 ± 11.77 years. Acceptable internal consistency was observed for the global index and function domain (α = 0.63-0.82) and good test-retest for items and domains (ICC = 0.81-0.995). Item-to-scale correlation was significant (r = 0.28-0.69). Its three domains demonstrated structural validity when subjected to confirmatory factor analysis (CFI = 0.99, TLI = 0.99, RMSEA = 0.02). Construct validity was supported by the correlation between Yoruba LAIKOA and IKHOAM (r = -0.39, p = 0.011). The overall scores and domain scores of the Yoruba and English versions of LAIKOA did not differ significantly. The Yoruba LAIKOA has no floor or ceiling effects. CONCLUSION: The Yoruba LAIKOA is reliable and valid, and it is recommended for use in clinical settings in southwestern Nigeria and other Yoruba-speaking populations.

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.

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.

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.

Psychometric testing of Ibadan low back pain disability questionnaire.

BACKGROUND: The Ibadan Low Back Pain Disability Questionnaire (ILBPDQ) was developed to meet the need for a LBP treatment outcome measure that was appropriate for the Nigerian culture and environment. The objective of this study was to determine the psychometric properties of ILBPDQ. METHODS: This study used the validation design. One hundred and forty-two participants with LBP (LBPPs) and 142 age and sex-matched participants without LBP (NLBPPs) were included. The LBPPs were recruited consecutively from Physiotherapy clinics of selected tertiary hospitals in the six geopolitical zones of Nigeria. Both LBPPs and NLBPPs completed the ILBPDQ - the LBPPs completed the Numerical Pain Rating Scale (NPRS). The ILBPDQ was completed by 113 LBPPs two days after initial assessment. Sixty-four of the LBPPs received physiotherapy for 5-weeks, after which they were reassessed using ILBPDQ and NPRS. RESULTS: ILBPDQ score of LBPPs was significantly higher than that of NLBPPs (construct validity) and LBPPs NPRS score correlated significantly with their ILBPDQ score (r = 0.50) at baseline and post intervention (r =0.35) (divergent validity). ILBPDQ scores at baseline and 48 hours later for LBPPs correlated significantly (Intra Class Correlation =0.80) (test re -test reliability). Cronbach's α for ILBPDQ was 0.84 (internal consistency). The postintervention ILBPDQ and NPRS scores for LBPPs were significantly lower than their pre-intervention ILBPDQ scores (responsiveness) and NPRS scores. The changes in ILBPDQ and NPRS scores of the LBPPs correlated significantly (r =0.62) (responsiveness). CONCLUSION: The ILBPDQ demonstrated evidence of validity, reliability and responsiveness. FUNDING: University of Ibadan Senate Research Grant.

Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire.

BACKGROUND: Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment. OBJECTIVE: This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ). METHODS: Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version. RESULTS: The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP. CONCLUSION: A scale for assessing disability in LBP is made available for use in Nigeria and similar populations. FUNDING: None declared.

Factors influencing the use of outcome measures in knee osteoarthritis: A mixed method study of physiotherapists in Nigeria.

Background: Osteoarthritis (OA) of the knee constitutes a significant proportion of musculoskeletal disorders managed in physiotherapy clinics worldwide. Best practice guidelines in the management of OA ensure the use of outcome measures. Aim: This study explored the factors influencing the use of outcome measures in management of patients with knee OA among physiotherapists in southwestern Nigeria. Methods: Mixed method design was used that involved a cross-sectional survey of 77 purposively selected physiotherapists and a focus group discussion with another 6 physiotherapists. Results: Participants (48 males, 29 females) were aged 35.3 ± 7.3 years. Fifty-two (67.5%) participants reported the use of outcome measures in the treatment of the patients with knee OA. The perceived barriers reported were lack of time/heavy workload (55.9%); lack of standardization of outcome measures (45%); lack of motivation (36.4%); and nonavailability of outcome measures in the clinic (36.4%). Reported perceived facilitators include interest/need to track patient's progress and ethical practice (87.1%); familiarity with outcome measures (87.0%); and understanding of the benefits of using outcome measures (87.0%). Conclusion: There is a need to establish good organizational structure focusing on the use of outcome measures in practice and development of a concessional toolkit of short and easily applicable instruments with user description.

Cross-cultural adaptatiion and validation of the stroke specific quality of life 2.0 scale into Hausa language.

BACKGROUND: The Stroke Specific Quality of Life 2.0 (SS-QoL 2.0) is a widely used scale that has been cross-culturally adapted to many languages including Yoruba, one of the three major Nigerian languages. Non-availability of SS-QoL 2.0 in Hausa, the indigenous language of Northern Nigeria has restricted its use in Hausa stroke-survivors (SSV). This study was aimed at cross-culturally adapting SS-QoL 2.0 to Hausa and assessing validity and reliability of the Hausa version. The English version of SS-QoL 2.0 was cross-culturally adapted to Hausa following the American Association of Orthopaedic Surgeons' guideline. A final Hausa version (FHV) was produced through forward and back-translations, expert committee review, pretesting and cognitive debriefing interview. The FHV was investigated for test-retest reliability, internal consistency, convergent, construct and known-group validity on 86 consenting Hausa SSV. Hausa version of WHOQoL-BREF was used to assess convergent validity (n = 57) while English versions of SS-QoL was used to assess construct validity (n = 51) of FHV. The FHV was re-administered on 53 of the participants at 7-day interval to assess test-retest reliability. Each scale was administered in random order to eliminate bias. Data were analysed using Spearman correlation, Cronbach's alpha, Intra-class Correlation Coefficient (ICC), Independent t-test and One-way ANOVA at p < 0.05. RESULTS: The SS-QoL 2.0 was successfully cross-culturally adapted to Hausa. Participants' mean overall score on SS-QoL 2.0 (145.30 ± 39.78) did not differ significantly from that of FHV (150.41 ± 40.45) p = 0.28. The mean domains score did not differ significantly except in self-care and work domains. There were weak to good correlations for 6 out of 8 similar domains on Hausa versions of SS-QoL and WHOQoL-BREF (r = 0.21-0.61; p = 0.001-0.006); and good to excellent correlations between Hausa and English versions of SS-QoL (r = 0.70-0.92; p = 0.001). The FHV showed high to excellent test-retest reliability (ICC = 0.86-0.99) and acceptable to excellent internal consistency (Cronbach's α = 0.71-0.90). No significant gender differences were demonstrated for any domains of FHV and for most domains across age groups. CONCLUSION: The FHV is valid and reliable. The scale is recommended for assessing health-related quality of life among Hausa stroke survivors.

A comparative survey of Nigerian physiotherapists' familiarity with, knowledge of and utilisation of standard outcome measures: 10 years after initial survey.

BACKGROUND: The need for physiotherapists to use standardised outcome measures (SOMs) is recognised and recommended in clinical practice guidelines in many countries. AIM: To evaluate changes in physiotherapy practice in Nigeria on the utilisation of SOMs and physiotherapists' familiarity with and knowledge of SOMs over the past decade. METHODS: A comparative cross-sectional survey of present data with 2006 data was undertaken. The existing validated questionnaire of 2006 was used to assess physiotherapists' familiarity with, knowledge of and utilisation of 16 SOMs. RESULTS: There was a noticeable change in familiarity with and utilisation of 16 SOMs in the current data and in knowledge. Between 52% and 90% of physiotherapists were not familiar with 14 SOMs in 2006, whereas 51.4% - 85.8% of physiotherapists were not familiar with 8 SOMs in 2016; 77% - 97% and 63.4% - 97.3% of physiotherapists were not utilising SOMs in the 2006 and 2016 data, respectively. The least utilised SOMs in 2006 were Western Ontario McMaster Osteoarthritis Index, Chedoke McMaster Stroke Assessment and SF-36 Health Survey; in 2016, it was only the Chedoke McMaster Stroke Assessment. The Visual Analogue Scale and Gross Motor Function Measure remained the most utilised in both data. Duration of practice, age and sex were significant factors for the utilisation of and familiarity with SOMs. CONCLUSION: There was an improvement in the familiarity with, knowledge of and utilisation of SOMs over the past decade among Nigerian physiotherapists but the level of utilisation is unsatisfactory. Action is required if routine outcome measurement is to be achieved. CLINICAL IMPLICATIONS: Utilisation of SOMs is part of core standards of physiotherapy practice for effective management of patients. Although the utilisation of SOMs improved over the past 10 years, it is very low. Therefore, studies directed at finding factors responsible for low utilisation of SOMs among Nigerian physiotherapists are warranted.

Can aerobic exercise complement antihypertensive drugs to achieve blood pressure control in individuals with essential hypertension?

Achieving adequate blood pressure (BP) control with antihypertensive medication remains an elusive goal for many patients. The advances in knowledge of hypertension and the increasingly improved upon therapeutic strategies seem not to guarantee even sustainable control rates at the population level. In addition, patients who either discontinue their medications or are non-adherent to drug therapy run the risk of developing uncontrolled BP. Number of daily tablets more than two and number of daily drug administration at least three have been associated with poor adherence with drug therapy. However, BP control seems to go beyond adherence with drug therapy as there are other associated factors. Studies have demonstrated beneficial effect of aerobic exercise in the prevention and management of hypertension. It appears, however, that the majority of these studies failed to explore the possible additive or synergistic effect of aerobic exercise on antihypertensive drugs such that fewer drugs would be required to achieve BP control or that the BP control rate would be increased with the same number of drugs. This review presents the evidence for poor BP control in the general population, and the possible means and process of aerobic exercise complementing antihypertensive drug therapy in order to achieve higher BP control rates.

A randomized controlled trial of the effects of aerobic dance training on blood lipids among individuals with hypertension on a thiazide.

PURPOSE: Hypertension is associated with dyslipidemia. Thiazides adversely affect serum lipid levels in hypertensives. There is currently a dearth of information on benefits of aerobic exercise training on serum lipid levels in individuals on thiazides and this study aimed at bridging this gap in knowledge. METHODS: This randomized-controlled trial involved 120 newly-diagnosed adults with essential hypertension (≥65 years). They were treated with 50 mg of hydrochlorothiazide + 5 mg of hydrochloride amiloride and 5 or 10 mg of amlodipine for 4-6 weeks before they were randomly assigned into exercise group (EG) and control croup (CG). Only EG underwent 12-week aerobic dance training at 50-70 % of heart rate reserve three times per week. Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglyceride and total cholesterol were measured and recorded at baseline and post-study. RESULTS: Eighty-eight (45 in EG and 43 in CG) of 120 participants randomly assigned to groups completed the study. Systolic (p = 0.370) and diastolic (p = 0.771) blood pressures (BP) were similar between the two groups at baseline. Systolic (p < 0.001) and diastolic (p < 0.001) BPs reduced significantly in exercise and control groups. LDL-C (from 120.10 ± 33.41 to 110.50 ± 31.68 mg/dl; p = 0.037) and triglyceride (from 117.49 ± 45.12 to 100.63 ± 35.42 mg/dl; p = 0.002) decreased in EG post-study but no significant between-group differences were observed. CONCLUSIONS: Although, LDL-C and triglyceride are reduced after aerobic dance training, they were not any more than without it. Aerobic dance training has favorable effects on LDL-C, triglyceride, and systolic and diastolic BP in individuals with hypertension on a thiazide.

Differential perceptions of body image and body weight among adults of different socioeconomic status in a sub-urban population.

This study explored the association of socioeconomic status with individuals' perception of their body image (BI) and body weight (BW) among adults in a sub-urban Nigerian population. The cross-sectional sample comprised 1521 residents (775 males and 746 females) of the town of Nnewi. Perceived BI was assessed using figural representations of different sizes for males and females. Perceived BW was determined by presenting participants with BW category options to choose from. Body mass index (BMI) was calculated from objectively measured BW and height using standardized procedures. Actual BW categories were derived from participants' BMIs using WHO criteria. Perceived BI and BW differed from actual BW among unskilled and non-tertiary males (p<0.001) and female (p<0.001 to p<0.04) in all BW categories whereas these variables differed (p<0.001) among skilled and tertiary males and females in normal weight, overweight and obese categories. Perceived BW differed (p<0.001) from actual BW among unskilled and non-tertiary males in underweight, overweight and obese categories whereas these variables differed (p<0.001) among unskilled and non-tertiary females, skilled and tertiary males and females in overweight and obese categories. Underweight 'unskilled' and 'non-tertiary' males perceived their BI to be different from their actual BW (p<0.001). Overweight and obese 'skilled' and 'unskilled', and 'tertiary' and 'non-tertiary', males and females perceived their BI and BW to be different from their actual BW (p<0.001). Significant differences in perceived BI existed between 'skilled' and 'unskilled' (p<0.001), and 'tertiary' and 'non-tertiary' (p=0.005), overweight males, and between 'skilled' and 'unskilled' (p<0.001), and 'tertiary' and 'non-tertiary' (p=0.008), normal-weight females. The 'skilled' participants had a lower risk of perceiving a larger BI (OR 0.51, 95% CI 0.41-0.64; p<0.001) and larger BW (OR 0.71, 95% CI 0.53-0.96; p=0.03) than the 'unskilled' participants. The 'tertiary' participants had a lower risk of perceiving a larger BI (OR 0.51, 95% CI 0.40-0.63; p<0.001) and larger BW (OR 0.71, 95% CI 0.53-0.95; p=0.02) than the 'non-tertiary' participants. After adjusting for possible confounders, all the risks became insignificant except for perception of BI by the 'skilled' participants (OR 0.70, 95% CI 0.50-0.99; p=0.04). Individuals in the different occupational and educational categories perceived their BI differently but their BW similarly. Given the same BMI, age, perceived ideal BI and sex, only occupation is found to be associated with perception of BI.

Relationship between post-stroke functional recovery and quality of life among Nigerian stroke survivors.

AIMS AND OBJECTIVES: This study explored relationship between post-stroke functional recovery and QoL among Nigeria SSv with first-ever stroke. PATIENTS, MATERIALS AND METHODS: This Study involved 65 (33 males and 32 females) individuals diagnosed of first-ever episode of stroke in the University College Hospital, Ibadan, Nigeria. The National Stroke Severity scale was used to assess their stroke sequeles. Their functional performance and QoL was assessed using the combination of the standard values of Barthel Index and Frenchay Activities Index, and the Stroke-Specific QoL questionnaire respectively. They were assessed at 14 days and fortnightly for 12 months post-stroke. Data were analysed using the Pearson's Moment Correlation and paired t-test at p=0.05. RESULTS: Fifty-five (84.61%) out of the 65 SSv completed this study while 10 (15.39%) died. Participants' age was 58.1±15.7 years with majority (90.6%) of them between 40 years and 79 years. Mean QoL score increased significantly at day 14-day through 6-month and non-significantly through 12-month post-stroke. Mean functional performance significantly increased from 3.2±2.1 at day 14 to 66.3±14.2 at 6-month but non-significantly from 6-month to 76.14±12.1 at 12-month post-stroke. Their functional recovery had direct positive relationship with their QoL scores during the 12 months follow-up. CONCLUSION: Stroke has negative impact on both the functional performance and quality of life of stroke survivors. Quality of life of stroke survivors increases with improvement in functional recovery.

Self-reported quality of life before and after aerobic exercise training in individuals with hypertension: a randomised-controlled trial.

BACKGROUND: The Effects of Aerobic Exercise Training (AET) on self-reported Quality of Life (QoL) in people with hypertension have been previously documented. However, data on black populations, especially from Africa, seem not to be available. This study investigated the effects of AET on QoL and exercise capacity in Nigerians on treatment for essential hypertension. METHOD: This randomised-controlled trial involved newly diagnosed individuals, with mild-to-moderate essential hypertension randomly assigned to antihypertensive drugs (ADs) alone (control: n = 60) and AET+ADs (exercise: n = 60) groups. The study lasted for 12 weeks. QoL was measured using the World Health Organization QoL Short Form (WHOQoL-BREF) and exercise capacity was assessed using the Rockport Fitness Walk Test pre- and post-study. RESULTS: Physical health, psychological health, and social relationships domains of QoL improved significantly in the exercise and control groups post-intervention. The environment domain of QoL and exercise capacity improved significantly in only the exercise group. There were larger improvements in the physical health, psychological health, and environment domains of QoL, and exercise capacity in the exercise group. CONCLUSION: Aerobic exercise improves QoL and exercise capacity in individuals with essential hypertension.

Development of the tibiofemoral angle in a cohort of Nigerian children during the first 3 years of life.

PURPOSE: Findings from cross-sectional studies of knee angle development in Nigerian children vary in values and in the age at which the varus angle changes to the valgus angle. This study was conducted to describe knee angle development and to determine the age when the knee angle changes from the varus to the valgus angle. METHODS: This was a longitudinal survey of 152 Nigerian children recruited within 3 weeks of life and followed up monthly until age 3 years. Their knee angle was measured using clinical methods. RESULTS: The mean tibio-femoral/varus knee angle (13.2 ± 3.8°) at birth-3 weeks of life decreased sharply to 5.6 ± 0.7° at 9 months, increased slightly to 6.3 ± 1.1° at 13 months, and then decreased again up to age 18 months (0.3 ± 2.1°). The mean valgus knee angle increased from -2.4 ± 2.5° at 19 months of life to -8.5 ± 2.5° at 27 months and then decreased to -7.7 ± 2.2° at 36 months. Intercondylar/intermalleolar distances (ICD/IMD) showed a similar pattern, changing from an extreme varus knee (ICD) at birth-3 weeks of life (2.5 ± 0.7 cm), decreasing to 0.6 ± 0.2 cm at 9 months, increasing to 0.8 ± 0.5 cm at 12 months, and decreasing to 0.1 ± 0.4 cm at 15 months. The mean IMD increased from -0.1 ± 0.8 cm at 16 months of life to -2.0 ± 1.5 cm at 29 months and then decreased up to 36 months. Our tri-modal analysis showed that the transition from the varus to the valgus angle was between 18 and 19 months. CONCLUSION: Our findings suggest that the developmental pattern of the knee angle in Nigerian children is at maximal varus at birth, neutral at 18 months of life, and valgus at 19 months, with the valgus angle continuing to increase up to 36 months.

Cross-cultural adaptation and initial validation of the Stroke-Specific Quality of Life Scale into the Yoruba language.

Stroke-Specific Quality of Life 2.0 (SS-QoL 2.0) scale is used widely and has been cross-culturally adapted to many languages. This study aimed at the cross-cultural adaptation of SS-QoL 2.0 to Yoruba, the indigenous language of south-western Nigeria, and to carry out an initial investigation on its validity. English SS-QoL 2.0 was first adapted to Yoruba language by including Yoruba culture-specific examples in items SC4, UE2 and UE6. The adapted English version (AEV) was independently translated into Yoruba by two language experts who later agreed on a consensus translation, which was then back translated, subjected to an expert committee review and pretested; a cognitive debriefing interview was also carried out to generate the Yoruba translated version (YTV). Thirty-five stroke survivors completed the AEV and Yoruba version (YV) in English and Yoruba. The order of administration was randomized. Data were analysed using Spearman's rank order correlation and Wilcoxon's signed-rank test at a P value less than 0.05. The mean age of the participants (23 men, 12 women) was 58.5±11.3 years. The domain scores of the participants on AEV and YV did not differ significantly, except in the work/productivity domain. In both versions, the mean domain score of the participants was the highest in the language domain [22.6±3.8 (AEV) and 22.7±3.4 (YV)] and the lowest in the work domain [9.0±3.7 (AEV) and 8.0±3.3 (YTV)]. Domain scores on both versions correlated significantly (P<0.05). Participants' ratings of their current state and prestroke state correlated significantly (P<0.01) in all the general areas, except energy and mood. The YTV of SS-QoL 2.0 fulfilled the initial criteria for validity.

Prevalence, pattern and impact of depression on quality of life of stroke survivors.

Abstract Objective. This study documented the incidence, pattern and impact of depression on QoL of stroke-survivors within 6-month post-stroke. Methods. This study involved 65 stroke survivors consecutively recruited at ictus from a tertiary health institution in Nigeria. The National Institute of Health Stroke-Scale, Stroke-Specific Quality-of-Life (SSQOL), international classification of diseases (tenth edition) and Center for Epidemiological Scale-Depression (CES-D) were administered at ictus to assess stroke-severity, QoL and depression respectively. The SSQOL, ICD-10 and CES-D were subsequently administered every other week for 6 months. Data were treated using Spearman's correlation coefficient, Mann-Whitney U-test and multivariable stepwise linear regression analysis (P=0.05). Results. Participants were age 58.1±15.7 years; 38 and 27 hemorrhagic and ischaemic stroke respectively. Twenty-six (40%) and 60.0% had moderate and severe stroke, respectively. The QoL at post-stroke periods were significantly influenced (P<0.05) by depression, age, marital status, spouse supports, stroke-severity, and educational-attainment. Depression determined (P<0.05) poor QoL in stroke-survivors. Co-morbidity with stroke severity was a determinant (P<0.05) of poor QoL and death. The haemorrhagic stroke survivors had significantly higher (P<0.05) QoL at post-stroke periods. Conclusion. Depression is associated with stroke. It is common within the first 6 months post-stroke and has negative impact on quality of life of stroke-survivors.