Comparative Efficacy of Clinic-Based and Telerehabilitation Application of Mckenzie Therapy in Chronic Low-Back Pain.

Studies on validation of telerehabilitation as an effective platform to help manage as well as reduce burden of care for Low-Back Pain (LBP) are sparse. This study compared the effects of Telerehabilitation-Based McKenzie Therapy (TBMT) and Clinic-Based McKenzie Therapy (CBMT) among patients with LBP. Forty-seven consenting patients with chronic LBP who demonstrated 'directional preference' for McKenzie Extension Protocol (MEP) completed this quasi experimental study. The participants were assigned into either the CBMT or TBMT group using block permuted randomization. Participants in the CBMT and TBMT groups received MEP involving a specific sequence of lumbosacral repeated movements in extension aimed to centralize, decrease, or abolish symptoms, thrice weekly for eight weeks. TBMT is a comparable version of CBMT performed in the home with the assistance of a mobile phone app. Outcomes were assessed at the 4th and 8th weeks of the study in terms of Pain Intensity (PI), Back Extensors Muscles' Endurance (BEME), Activity Limitation (AL), Participation Restriction (PR), and General Health Status (GHS). Data were analyzed using descriptive and inferential statistics. Alpha level was set at p< 0.05. Within-group comparison across baseline, 4th and 8th weeks indicate that both CBMT and TBMT had significant effects on PI (p=0.001), BEME (p=0.001), AL (p=0.001), PR (p=0.001) and GHS (p=0.001) respectively. However, there were no significant differences (p>0.05) in the treatment effects between TBMT and CBMT, except for 'vitality' (p=0.011) scale in the GHS where TBMT led to significantly higher mean score. Mobile-app platform of the McKenzie extension protocol has comparable clinical outcomes with the traditional clinic-based McKenzie Therapy, and thus is an effective supplementary platform for care of patients with low-back pain.

Standardized outcome measures for cerebral palsy among physiotherapists in southwestern Nigeria: awareness, use, barriers, and facilitators.

The use of outcome measures for assessing progress in the management and treatment of cerebral palsy (CP) is widely recommended. This study was, therefore, carried out to determine awareness and use of standardized outcome measures among physiotherapists managing CP in Nigeria. Barriers to and facilitators for the use of outcome measures were also investigated. This was a descriptive study involving 138 physiotherapists from selected hospitals in southwestern Nigeria. A self-administered questionnaire was used to obtain relevant information on socio-demographics, awareness, use, barriers to, and facilitators for the use of seven standardized outcome measures. The Gross Motor Function Measure was the most recognized (78.9%) and commonly used (58%) outcome measure, while the Paediatric Outcomes Data Collection Instrument (23.2%) and the Paediatric Evaluation of Disability Inventory (10.9%) were the least recognized and least used, respectively. The greatest perceived facilitators were familiarity (87.7%), positive attitude (87.7%), and that outcome measures allow for a balanced clinical assessment (89.1%). The greatest perceived barriers identified were the need for extra accommodation to apply outcome measures (63%) and time consumption on the part of patients (44.2%). Many physiotherapists in this study identified the standardized outcome measures, but fewer used them irrespective of educational status and years of work experience. Generally, there was a positive attitude toward the use of outcome measures. The use of outcome measures should be promoted among physiotherapists in Nigeria, through training programs and translation into the native languages, to effectively assess, manage, and monitor the progress of patients with CP, putting into consideration barriers and facilitators.

Fear of falling and quality of life of apparently-healthy elderly individuals from a Nigerian population.

Ageing is associated with increased morbidity, increased fear of falling (FOF) and reduced activity. These may consequently impair the quality of life (QOL) of the elderly. Studies from Africa investigating FOF and its relationship with QOL among elderly individuals are rare. This study investigated the prevalence of FOF and QOL of apparently-healthy elderly residents of two Local Government Areas (LGAs) from Anambra State, Nigeria and also determined the relationship between the two variables. Two hundred and sixty-one (131 males and 130 females) volunteering elderly individuals, from three randomly-selected communities from each of the LGAs, participated in this cross-sectional survey. The Modified Fall Efficacy Scale (MFES) and the Short-Form Health Survey 36-item (SF-36) questionnaire were used to evaluate FOF and QOL respectively. Data were analysed using frequency, percentage, mean and standard deviation, Chi-square, Independent t-test, Pearson correlation and multivariate regression analysis statistics. Alpha level was set at 0.05. FOF was markedly prevalent in the population at 23.4 % and the QOL score of 55.27 ± 17.28 was just modest. QOL was particularly low in the role limitations due to the physical and emotional problems domains but high in the mental health, social function and bodily pain domains. Significant relationship was found between FOF and all the QOL domains. FOF was present in nearly one of every four elderly individuals in the sample and was related to their QOL. FOF should be routinely investigated in community-dwelling elderly and strategies devised to combat it.

Endurance of low back musculature: normative data for adults.

BACKGROUND AND OBJECTIVE: Lack of baseline values is a limitation in the quantification of physical performance testing of the low back muscles. The purpose of this study is to present an age and gender normative values for static back extensor muscles' endurance in adults. SUBJECTS AND METHODS: Five hundred and sixty one healthy adults aged between 19 to 67 years volunteered for this study. Endurance of the low back musculature was assessed using modified Biering-Sørensen test of Static Muscular Endurance. The mean, standard deviation, and percentile scores for endurance time were determined for five gender / age groups classified on a range of 10 years. RESULTS: The mean endurance time of all the participants was 113 ± 46 seconds. Men had higher mean endurance than women (t=3.309; p=0.001). Significant difference (F=32.702; p=0.001) was found in the endurance time across the age groups. There was an age and gender variation in the percentile values. The normative values demonstrate that a decrease in endurance time is expected with increasing age. The significant age and anthropometric differences across the age groups could contribute to the endurance differences. CONCLUSION: These values could be used to compare a patient's score at intake and also serve as clinical target for which subsequent testing after treatment, at discharge and/or follow up can be compared, providing an indication of change in endurance capacity over time.

Comparison of four physiotherapy regimens in the treatment of long-term mechanical low back pain.

OBJECTIVE: This study compared efficacy of combinations of Back Muscles Endurance Exercise (BMEE) and McKenzie Exercise (ME) and McKenzie Back Care Education (MBE) in the management of long term mechanical Low Back Pain (LBP). SUBJECTS AND METHODS: A single-blind randomized controlled comparative trial was employed. Seventy three participants mean age 45.3 ± 8.1 years were recruited for the study but only 53 completed the study. Participants in group A were treated with a combination of BMEE, ME and MBE. Group B: A combination BMEE and MBE. Group C: A combination of ME and MBE. Group D: MBE only. Participants were seen thrice weekly for 8 weeks. They were measured for pain intensity, lumbar flexibility, activities limitation and self esteem. Data were analysed using descriptive and inferential statistics of F-test. Significance was set at 0.05 alpha-level. RESULTS: At the end of the study, the four treatment groups had significant reduction in pain intensity p<0.05. Post hoc analysis showed groups A, B, and C had significantly greater reduction than D, and groups A and C had significantly greater reduction than B. Groups A, B and C also had significant improvement in activities limitation p<0.05. Post hoc analysis showed groups A, B and C had significantly greater improvement than D, and group B significantly greater improvement than C. CONCLUSION: Combination physiotherapy regimens proved effective in the management of long- term mechanical LBP. Regimen A is recommended in managing long-term mechanical LBP.

Isometric endurance of the back extensors in school-aged adolescents with and without low back pain.

BACKGROUND AND OBJECTIVE: Studies on back extensor endurance in adolescents are scarce. This study sought to establish reference data and pattern of back extensor endurance in school-aged adolescents with and without low-back pain (LBP) from Nigeria. SUBJECTS AND METHODS: This study recruited 625 adolescents aged 11 to 19 years from eight randomly selected secondary schools. The modified Biering-Sørensen test of Static Muscular Endurance (BSME) was used to assess isometric endurance of the back extensors. Demographic and anthropometric data were collected. A modified LBP questionnaire was used to assess the presence of LBP. Descriptive and inferential analyses were used to analyze data. Significance was set at 0.05 alpha-level. RESULTS: The mean isometric holding time (IHT) of all the participants was 132.9 $\pm$ 65.6. Males had significantly higher significant (p=0.026) IHT than females. Adolescents without LBP had a higher significant IHT (p=0.042) than those with reported history of previous LBP and those with present LBP (p=0.000) respectively. Using percentile values, poor endurance was defined as IHT that is < 90.0 s and < 67 s for males and females respectively; medium endurance was defined as IHT that ranged between 90 and 193 s and 67 and 170 s for males and females respectively while good endurance was defined as IHT that is > 193 s and > 170 s for males and females respectively. IHT was significantly related to each of body mass index, hip circumference and waist-to-hip ratio (p < 0.05). CONCLUSION: Isometric back extensors endurance in Nigerian adolescents was comparable to the original Biering-Sørensen mean value. Majority of the participants had medium endurance performance with the back endurance pattern in the ratio 1:2:1. Male had higher isometric back extensors endurance than females. Decreased isometric back extensors endurance was associated with the presence of LBP in adolescents.