A systematic review on the effects of non-pharmacological interventions for fatigue among people with upper and/or lower limb osteoarthritis.

Objectives: To identify non-pharmacological fatigue interventions and determine the effectiveness of these non-pharmacological interventions in reducing fatigue immediately and over time in OA. Methods: A review protocol (CRD42020163730) was developed and registered with the PROSPERO database. Included studies comprised peer-reviewed randomized controlled trials (RCTs) that examined the effects of conservative interventions on fatigue in people with upper and lower limb OA. Cochrane Collaboration's tool for assessing the risk of bias (ROB-2) was used to assess the quality of evidence of studies. Narrative synthesis was used to summarize the effectiveness of identified fatigue interventions. Results: Out of 2644 citations identified from databases, 32 reports were included after screening for titles, abstracts and full texts. Of these reports, 30 parallel RCTs, one cluster and one cross-over RCT were included. 13 RCTs were of low ROB, 6 had some concerns and 13 had high ROB. The narrative synthesis identified interventions for fatigue including exercise, activity pacing, cognitive behavioural therapy, telerehabilitation and complementary alternative therapies. Exercise interventions showed the most significant beneficial effects on fatigue. Conclusions: Diverse interventions for fatigue management among individuals with upper and lower limb OA were identified. Of these, exercise interventions appear to be the most promising with the majority of these interventions favouring fatigue improvement. While cognitive behavioural therapy has limited evidence of beneficial effects, there is insufficient evidence regarding the effectiveness of other identified interventions, including complementary and alternative therapies, and telerehabilitation.

Utilisation of partogram at a district in the North West Province, South Africa.

Background: The partogram or partograph is a tool used to monitor the progress of labour and serves as a diagnostic tool for labour-related abnormalities such as prolonged labour, cephalopelvic disproportion (CPD) and obstructed labour. Appropriate utilisation of the partogram aids health caregivers with early diagnosis and facilitates clinical judgement and interventions to prevent complications of abnormal labour. The partogram is thus a mandatory tool to be utilised to monitor the progress of labour for intrapartum care in South Africa. Aim: This study aimed to assess and describe the utilisation of the partogram in a district of the North West Province. Setting: The study was conducted in the private rooms of facilities rendering maternity services in the district. Methods: A quantitative cross-sectional descriptive design was employed. A purposive sampling was used to select healthcare facilities, and simple random sampling was employed to select plotted partograms. Data were collected using a checklist and analysed using Statistical Package for Social Sciences software version 22. Results: A total of 279 partograms were analysed. The average partogram utilisation was 20% correct and 80% substandard or not recorded. All files had partogram documents included. Conclusion: A large percentage (80%) of the partograms were not completed according to the World Health Organization (WHO) standards. There was a concern about high proportions of unrecorded parameters such as monitoring of foetal and maternal conditions, and the progress of labour. Contribution: The findings and recommendations of the study could improve partogram utilisation in maternity care.

Economic Evaluations of Digital Health Interventions for the Management of Musculoskeletal Disorders: Systematic Review and Meta-Analysis.

BACKGROUND: Musculoskeletal disorders (MSDs) are widespread in many countries and their huge burden on the society has necessitated innovative approaches such as digital health interventions. However, no study has evaluated the findings of cost-effectiveness of these interventions. OBJECTIVE: This study aims to synthesize the cost-effectiveness of digital health interventions for people with MSDs. METHODS: Electronic databases including MEDLINE, AMED, CIHAHL, PsycINFO, Scopus, Web of Science, and Centre for Review and Dissemination were searched for cost-effectiveness of digital health published between inception and June 2022 following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. References of all retrieved articles were checked for relevant studies. Quality appraisal of the included studies was performed using the Quality of Health Economic Studies (QHES) instrument. Results were presented using a narrative synthesis and random effects meta-analysis. RESULTS: A total of 10 studies from 6 countries met the inclusion criteria. Using the QHES instrument, we found that the mean score of the overall quality of the included studies was 82.5. Included studies were on nonspecific chronic low back pain (n=4), chronic pain (n=2), knee and hip osteoarthritis (n=3), and fibromyalgia (n=1). The economic perspectives adopted in the included studies were societal (n=4), societal and health care (n=3), and health care (n=3). Of the 10 included studies, 5 (50%) used quality-adjusted life-years as the outcome measures. Except 1 study, all the included studies reported that digital health interventions were cost-effective compared with the control group. In a random effects meta-analysis (n=2), the pooled disability and quality-adjusted life-years were -0.176 (95% CI -0.317 to -0.035; P=.01) and 3.855 (95% CI 2.023 to 5.687; P<.001), respectively. The meta-analysis (n=2) for the costs was in favor of the digital health intervention compared with control: US $417.52 (95% CI -522.01 to -313.03). CONCLUSIONS: Studies indicate that digital health interventions are cost-effective for people with MSDs. Our findings suggest that digital health intervention could help improve access to treatment for patients with MSDs and as a result improve their health outcomes. Clinicians and policy makers should consider the use of these interventions for patients with MSDs. TRIAL REGISTRATION: PROSPERO CRD42021253221; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=253221.

Exploration of Gut Microbiome Research in Africa: A Scoping Review.

The crucial role of the gut microbiome in various diseases has led to increased interest in interventions and therapeutics targeting the human microbiome. Accordingly, the current scoping review analyzed the diseases and interventions involved in gut microbiome research in Africa. The electronic databases of PubMed, Google Scholar, and Scopus were searched from inception to October 2021. This study identified 48 studies involving 7073 study participants. Of the 48 studies, 20 (42%) used interventions to modulate gut microbiota, whereas the remaining 28 (58%) did not. Out of the total African countries, only 13% were involved in intervention-based gut microbiome research, whereas a larger proportion of 67% were not involved in any gut microbiome research. The interventions used in gut microbiome research in Africa include supplements, natural products, educational approaches, associated pathogens, albendazole, fresh daily yogurt, iron-containing lipid-based nutrient supplements, fecal microbiota transplant, and prophylactic cotrimoxazole. This scoping review highlights the current state of gut microbiome research in Africa. The findings of this review can inform the design of future studies and interventions aimed at improving gut health in African populations.

Global and regional estimates of clinical and economic burden of low back pain in high-income countries: a systematic review and meta-analysis.

Introduction: Low back pain (LBP) is a common health problem, and the leading cause of activity limitation and work absence among people of all ages and socioeconomic strata. This study aimed to analyse the clinical and economic burden of LBP in high income countries (HICs) via systematic review and meta-analysis. Methods: A literature search was carried out on PubMed, Medline, CINAHL, PsycINFO, AMED, and Scopus databases was from inception to March 15th, 2023. Studies that assessed the clinical and economic burden of LBP in HICs and published in English language were reviewed. The methodological quality of the included studies was assessed using the Newcastle-Ottawa quality assessment scale (NOS) for cohort studies. Two reviewers, using a predefined data extraction form, independently extracted data. Meta-analyses were conducted for clinical and economic outcomes. Results: The search identified 4,081 potentially relevant articles. Twenty-one studies that met the eligibility criteria were included and reviewed in this systematic review and meta-analysis. The included studies were from the regions of America (n = 5); Europe (n = 12), and the Western Pacific (n = 4). The average annual direct and indirect costs estimate per population for LBP ranged from € 2.3 billion to € 2.6 billion; and € 0.24 billion to $8.15 billion, respectively. In the random effects meta-analysis, the pooled annual rate of hospitalization for LBP was 3.2% (95% confidence interval 0.6%-5.7%). The pooled direct costs and total costs of LBP per patients were USD 9,231 (95% confidence interval -7,126.71-25,588.9) and USD 10,143.1 (95% confidence interval 6,083.59-14,202.6), respectively. Discussion: Low back pain led to high clinical and economic burden in HICs that varied significantly across the geographical contexts. The results of our analysis can be used by clinicians, and policymakers to better allocate resources for prevention and management strategies for LBP to improve health outcomes and reduce the substantial burden associated with the condition. Systematic review registration: https://www.crd.york.ac.uk/prospero/#recordDetails?, PROSPERO [CRD42020196335].

Clinical and economic burden of low back pain in low- and middle-income countries: a systematic review.

OBJECTIVES: Low back pain (LBP) is the leading cause of disability and work absenteeism globally, and it poses significant clinical and economic burden to individuals, health systems and the society. This study aimed to synthesise the clinical and economic burden of LBP in low-income and middle-income countries (LMICs). METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. PubMed, Medline, CINAHL, PsycINFO, AMED, Embase and Scopus databases were systematically searched for studies that examined the clinical and economic burden of LBP in LMICs, published from inception to 10 December 2021. Only studies with clearly stated methodologies and published in English were eligible for review. RESULTS: Nine studies met the inclusion criteria and were reviewed. Of these, three of them were clinical burden studies. The mean Newcastle-Ottawa Quality Assessment Scale (NOS) score of the included studies was 4, with an average from 3 to 6. The included studies were conducted in Argentina, Brazil, China, Ethiopia, Nigeria and Republic of Serbia. The rates of hospitalisation due to LBP ranged between 13.4% and 18.7%. Due to variation of methodological approaches, the reported cost estimates were inconsistent across the studies. A total cost of US$2.2 billion per population and US$1226.25 per patient were reported annually due to LBP. CONCLUSION: This systematic literature review suggests that LBP is associated with significantly high rates of hospitalisation and costs. As LBP is an important threat to the population, health professionals and policymakers are to put in place appropriate programmes to reduce the clinical and economic burden associated with LBP and improve the health outcomes of individuals with this condition in LMICs. PROSPERO REGISTRATION NUMBER: CRD42020196335.

Applying the ICF codes, flag model and C-OAR-SE in the development of return-to-work assessment scale for stroke survivors.

BACKGROUND: The Return-to-Work Assessment Scale (RAS) was developed in 2021 by Ibikunle et al. to assess return-to-work among post-stroke survivors. OBJECTIVE: The aim of this study was to describe how the conceptual (flag model and ICF) and theoretical framework (C-OAR-SE) were used in developing the RAS. METHOD: The development of the RAS consisted of three phases: (i) Initial item generation (ii) Face and content validity (iii) Psychometric testing. With each phase embracing the flag model, international classification of functioning, disability and health (ICF) and the C-OAR-SE an acronym for the six aspects of the theory: 'C' [construct definition], 'OAR' [object representation, attribute classification, and rater entity identification], and 'SE' [selection of item type and answer scale, as well as, enumeration]. RESULTS: A triangulated approach drawn on three separate theories and models. Phase one was developed by using the flag model which provided the semi-structured open ended questions that materialized into the draft instrument while phases two and three were developed using the ICF and the C-OAR-SE. The scale consists of two sections, A and B. Section A comprises general information about post-stroke survivors, which would not be scored, while section B includes three parts that are important to consider when deciding to return-to-work. CONCLUSION: An instrument called RAS was developed, an excellent, internally consistent, as well as reliable tool that has demonstrated good group and structural validity.

Effectiveness of physical activity programs in enhancing sleep outcomes among adolescents: a systematic review.

BACKGROUND: Adolescence is a developmental period characterised by rapid physical and psychological changes that heighten the risk for inadequate sleep. Fortunately, physical activity programs (PAPs) are an easy-to-do intervention that has been associated with improved sleep outcomes in different population groups. This systematic review aimed to provide evidence to support the effects of PAPs on sleep outcomes among apparently healthy adolescents. METHODS: A systematic literature search was performed in online databases of PubMed, Cochrane Library, and PEDro for all dates up to April 2022. All relevant clinical trials reporting on the effects of PAPs on sleep among adolescents were included using a pre-defined inclusion/exclusion criterion (PROSPERO: CRD42020171852). The methodological quality of the included studies was assessed using 'specific checklists per design' (RCTs) provided by the Dutch Cochrane Centre. Qualitative synthesis was used to report the results of the review. RESULTS: Two RCTs were included and analysed in the review. Both studies were of good methodological quality but lacked blinding. The PAPs in the reviewed studies included mainly aerobic exercises in the form of cross-country running in the mornings, SMS-delivered motivational messages to increase daily step counts, and use of a pedometer and step diaries. Sleep was measured both subjectively by means of sleep questionnaires and objectively using sleep electroencephalographic recordings. Nevertheless, qualitative synthesis is suggestive of an overall positive effect of PAPs on some sleep outcomes in adolescents, albeit with limited to moderate evidence. CONCLUSION: PAPs appear to have a beneficial effect on some sleep outcomes among apparently healthy adolescents. Nevertheless, the body of evidence is currently scanty, thus warranting the need for more high-quality RCTs.

Effectiveness of school-based CPR training among adolescents to enhance knowledge and skills in CPR: A systematic review.

BACKGROUND:  Cardiac arrest is responsible for 5% - 10% of all deaths among children age 5-19 years; therefore, strategies to prevent poor outcomes post cardiac arrest among children are critical within schools. OBJECTIVES:  The purpose of this study was to systematically review the effectiveness of cardiopulmonary resuscitation (CPR) training on CPR knowledge and skills among adolescent school children. METHOD:  This systematic review was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The complete bibliographic databases of PubMed, Cochrane Library, CINAHL and Web of Science were searched from January 2012 to August 2021. Included studies met all the eligibility criteria. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP) and Mixed Method Appraisal tool were used to appraise the quality of the included studies. RESULTS:  Fourteen studies were included in the review, and 5418 participants were found in the databases. The studies were mainly conducted during the last decade, which suggests that the public's attention has been directed toward training schoolchildren in CPR. The most common interventions were taught in video simulation training courses. They also used subjective assessments to evaluate the participants' knowledge and skills. CONCLUSION:  Findings from this systematic review reveal that CPR training within school settings effectively promoted a change in CPR knowledge and skills among adolescents. Hence, continuous training of CPR among schoolchildren should be encouraged by policymakers, school authorities, parents and teachers to optimise the prompt usage of the skills in any cardiac event. However, a high-quality randomised controlled trial would enhance the strength of evidence in this area.

Validation of content and structure of the Return-to-work assessment for post-stroke survivors.

Background: Validation of an instrument consist of three main types: content, criterion and construct. Content validity needs to be determined in order for an instrument to be acceptable for use, validity establishes the fact that an instrument measures exactly what it proposes to measure. The Return-to-work assessment scale (RAS) was developed to measure three aspects of return to work: (Personal factors and/or issues, work issues and contextual factors) in 2021. Objective: To report on the processes followed in establishing the face and content validity of the RAS. Method: Twenty participants took part in our study, they were selected purposively and conveniently from a pool of professionals and post stroke survivors. The Delphi survey technique was used to arrive at consensus and professional opinion on the items included in the RAS. Consensus was sought on the items, domains and subdomains included in the RAS that was used to assess return-to-work after a stroke. Our study was concluded after the third round. Result: One item was remove out of the original 86, three (3) domains made up of eleven (11) subdomains were retained. The RAS had consensus of 100% after three rounds of scrutiny for all items. Conclusion: The RAS was found to be valid, thereby establishing its face and content validity. Clinical implication: The RAS is valid and was recommended for psychometric testing which was the next stage after face and content validity.

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

BACKGROUND: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.

Knowledge, attitude, and perception of low back pain and activities that may prevent it among adolescents in Nigeria.

Background: Awareness of activities that may result in low back pain (LBP) among adolescents is fundamental in preventing adulthood LBP. Objective: The aim of this study was to investigate adolescents' knowledge, attitude, and perception of LBP and activities that may prevent LBP in Kano, North-western, Nigeria. Methods: This was a cross-sectional survey involving 400 school-going adolescents recruited using a multistage random sampling technique. Data was analysed using descriptive statistics and Chi-square test with 0.05 set as level of significance. Results: The mean age of the respondents was 16.0±1.50 years. LBP annual prevalence was 34.2%, with more girls (31.1%) reporting having LBP compared to boys (28.4%). More than half (59.3%) of the respondents had poor knowledge of LBP and activities that may prevent it. However, they had a good attitude (63%) and perception (74%) of LBP and activities that may prevent it. There was no significant association of levels of knowledge, attitude, and perception of LBP and activities that may prevent LBP with gender, age, and class of study (p > 0.05). Conclusion: Adolescents in Kano, North-western Nigeria had poor knowledge of LBP and activities that may prevent it. Therefore, there is a need to embark on an LBP prevention program among adolescents in Kano, North-western Nigeria.

Determination of hand grip strength and its correlates during pregnancy: a cross-sectional study.

BACKGROUND: Pregnancy results in many changes, including reduced hand grip strength (HGS). However, good HGS is required for physical functions such as carrying and breastfeeding the baby after birth. The aim of this study was to determine the factors that may predict HGS during pregnancy. METHODS: The study was a cross-sectional study approved by the Research Ethics Committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital in Kano, north-west, Nigeria. Pregnant women at the designated hospitals were included in the study if they had no serious comorbidities or any known neurological condition that affects the hands and the neck. Demographic characteristics and independent (predictor) variables (age, weight, height, BMI, maternity leave status, number of full-term deliveries, number of preterm deliveries, number of live births, number of abortuses, gravidity, trimester, systolic blood pressure, diastolic blood pressure, inter arm systolic BP difference [IASBP], inter arm diastolic BP difference [IADBP], and heart rate) of each of the participants were recorded by experienced therapists. The data were analysed using descriptive statistics, t-test, Pearson correlation coefficient and standard multiple regression. RESULT: One hundred and sixty-one pregnant women with mean age, 25.04 ± 4.83 years participated in the study. In the dominant hand, 120 participants (74.5%) had weak grip strength. In the non-dominant hand, 135 participants (83.9%) had weak grip strength. For the dominant hand, the total variance explained by the whole model was significant, 28.5%, F(11, 161) = 1.187, R2 = 0.081, p = 0.300 . In the final model, none of the variables significantly predicted HGS. However, systolic blood pressure contributed to the model more than any other variable (Beta = -0.155). For the non-dominant hand, the total variance explained by the whole model was not significant, 33.1%, F(11, 161) = 1.675, R2 = 0.111, p = 0.089 . In the final model, only systolic blood pressure (Beta = -0.254, p = 0.023) significantly predicted hand grip strength. CONCLUSION: Cardiovascular events or changes during pregnancy (such as change in systolic blood pressure) may be related to HGS in pregnant women. It is therefore, important for clinicians to pay attention to this, in planning rehabilitation strategies for pregnant women.

Chronic diseases of lifestyle risk factor profiles of a South African rural community.

Globally, chronic diseases of lifestyle account for millions of dollars spent annually on health. These diseases share similar risk factors including: physical inactivity, obesity, cigarette smoking, and hypertension among others. This study sought to assess risk factors for chronic diseases of lifestyle of a rural community in South Africa. This study used a survey design with data randomly collected using the WHO STEPS Instrument for Chronic Disease Risk Factor Surveillance from participants who attended routine checks from February to October 2018 from a trained healthcare practitioner. Informed consent was sought from all participants before the administration of the instrument. The research setting was the community Primary Health Center. About 54.0% of participants presented with no family history of hypertension but 19.7% had a family history of type II diabetes mellitus. More women were found to be hypertensive, with the majority (93.4%) monitoring their blood pressure. The study revealed that more men were current smokers. A large number of participants were engaged in a sedentary lifestyle with about one-third of the participants reported being obese. Physical inactivity, sedentary lifestyle, and hypertension were among the lifestyle-related risk factors for chronic diseases among residents of this rural community.

Multimorbidity of chronic diseases of lifestyle among South African adults.

INTRODUCTION: the prevalence of non-communicable and chronic diseases has been on the increase globally and has been a major factor responsible for high morbidity and mortality. Multimorbidity of the chronic diseases in low/medium income countries should be a major concern for public health practitioners because of the communicable diseases they also battle with. This study was carried out to determine the prevalence of multi-morbidity of chronic diseases of lifestyle (CDL) among adult South Africans. METHODS: we employed General House Survey (GHS) data released by Statistics South Africa (Stats SA) in December 2015 with a response rate was 90.5%. Data on diabetes mellitus, high cholesterol, stroke, heart attack/myocardial infarction, hypertension were analysed using descriptive and inferential statistics. RESULTS: the outcome of this secondary data analysis showed that about 16.3% of South Africans respondents aged 18 years and above had a single/or multiple CDL. The majority of the respondents with CDL were females (10.9%), older adults (9.4%), married (8.5%), of the black racial extract (11.9%), and reside in urban areas (3.4%). Also, high blood pressure (13.7%) was the most reported prevalent chronic disease while heart attack (1.1%) was the least reported chronic disease. The outcome of regression analysis after adjustment showed that gender (OR=0.56, CI=0.53-0.60, p<0.001), age [middle-aged adult (R=0.003, CI=0.003-0.004, p=0.001), older adult (R=0.25, CI=0.23-0.26, p=0.001)] and marital status [divorced (OR=1.55, CI=1.44-1.67, p<0.001), separated (OR=1.71, CI=1.46-2.00, p=0.001), single (R=1.88, CI=1.71-2.07, p=0.001)] were among the correlates of chronic diseases of lifestyle for the 1st step of the adjustment. However, White population group (OR=1.17, CI=0.96-1.41, p=0.113), residing in farm settlement (OR=0.99, CI=0.84-1.16, p=0.910) and all the sub-scales of educational status were not correlates of the CDLs for the 2nd adjustment of regression analysis. CONCLUSION: the findings of the study suggest that CDL is endemic among the South African population and that the most susceptible groups are the older adults, females, the married, the uneducated and the coloured individuals.

Effects of Lower Limb Constraint Induced Movement Therapy in People With Stroke: A Systematic Review and Meta-Analysis.

Background: Constraint induced movement therapy (CIMT) is effective at improving upper limb outcomes after stroke. Aim: The aim of this study was to carry out a systematic review and meta-analysis of the effects of lower limb CIMT studies of any design in people with stroke. Materials/ Method: PubMED, PEDro, OTSeeker, CENTRAL, and Web of Science were searched from their earliest dates to February 2021. Lower limbs CIMT studies that measured outcomes at baseline and post-intervention were selected. Sample size, mean, and standard deviation on the outcomes of interest and the protocols of both the experimental and control groups were extracted. McMaster Critical Review Form was used to assess the methodological quality of the studies. Result: Sixteen studies with different designs were included in this review. The result showed that lower limb CIMT improves functional, physiological and person's reported outcomes including motor function, balance, mobility, gait speed, oxygen uptake, exertion before and after commencement of activities, knee extensor spasticity, weight bearing, lower limb kinematics and quality of life in people with stroke post intervention. However, there were only significant differences in quality of life in favor of CIMT post-intervention [mean difference (MD) = 16.20, 95% CI = 3.30-29.10, p = 0.01]; and at follow-up [mean difference (MD) = 14.10, 95% CI = 2.07-26.13, p = 0.02] between CIMT and the control group. Even for the quality of life, there was significant heterogeneity in the studies post intervention (I 2 = 84%, p = 0.01). Conclusion: Lower limb CIMT improves motor function, balance, functional mobility, gait speed, oxygen uptake, weigh bearing, lower limb kinematics, and quality of life. However, it is only superior to the control at improving quality of life after stroke based on the current literature.

Autonomy-hindering scope for physiotherapy practice in African countries: Results of creatures and antinomies of regulatory laws.

BACKGROUND: Healthcare professionals in different countries are governed by laws and statutes for their scopes of practice to ensure that services are rendered by suitably licenced and qualified professionals in order to protect the public. A few of these laws are found to paradoxically hinder the autonomy of physiotherapy. OBJECTIVE: My article documents the autonomy-hindering scope for physiotherapy practice in selected African countries. METHOD: The methodologies used in my article were both a review and comparative approach for the interpretation of statutes. RESULTS: Three African countries presented a clear legal definition of physiotherapy in their regulatory frameworks and regulated other rehabilitation professions as well. In my article, these regulations are referred to as 'combo regulations'. The rationale for 'combo regulations' is not clear and found to hinder professional autonomy. Only one statute from Rwanda provided a scope for physiotherapy that was not autonomy-hindering. CONCLUSION: There is, therefore, a need for urgent review of most laws regulating physiotherapy in the selected African countries to assist with the duty of protecting the public. All autonomy-hindering scopes for physiotherapy practice in African countries should be repealed and amended accordingly. CLINICAL IMPLICATIONS: A clear scope shall assist with protecting the public and clinical practice and clearly states 'what physiotherapy is and what it is not'.

COVID-19: Are Non-Communicable Diseases Risk Factors for Its Severity?

OBJECTIVE: To identify and describe the mechanisms of lifestyle characteristics-obesity, DM, hypertension and physical inactivity-that may lead to the severity of illness among individuals with COVID-19. DATA SOURCE: A scoping review was conducted by searching electronic databases of PubMed and Scopus from December 2019 to August 2020. INCLUSION/EXCLUSION CRITERIA: inclusion criteria were studies that explicitly describe the mechanism of COVID-19 in relationship with either hypertension, type 2 diabetes mellitus type 2 (DM), obesity and/or physical inactivity. Studies of epidemiological background, descriptive surveys and interventional studies were excluded. DATA EXTRACTION: study characteristics were tabulated according to purpose, type of non-communicable diseases (NCDs), the hypothesis on the mechanism of infestation (MOI) and conclusion. DATA SYNTHESIS: NCDs were categorized according to type and hypothesis on mechanisms of infestation. The interplay between COVID-19, type of NCDs and MOI leading to the severity of the disease was appraised. RESULTS: Twenty-four (24) studies were identified from 357 unique records. Eight studies postulated the mechanism of infestation and interaction between COVID 19 illness severity and Obesity, while 7 studies described COVID-19 and DM. Five studies highlighted the interaction between COVID-19 and hypertension with 4 studies showing how physical activity restriction suppresses immunity. CONCLUSION: The current review, identified and explicitly described the mechanisms of the lifestyle characteristics that may increase the severity of illness among people with COVID-19.

Comparing Two Different Modes of Task Practice during Lower Limb Constraint-Induced Movement Therapy in People with Stroke: A Randomized Clinical Trial.

Background: Constraint-induced movement therapy (CIMT) is used for the rehabilitation of motor function after stroke. Objectives: The aim of this study was to compare the effects of lower limb CIMT that uses number of repetition of tasks with the one that uses number of hours of practice. Method: The study was a randomized clinical trial approved by the Ethics Committee of Kano State Ministry of Health. Fifty-eight people with stroke participated in the study. Groups 1 and 2 performed daily 600 repetitions and 3 hours of task practice, respectively, 5 times weekly for 4 weeks. Motor impairment (primary outcome), balance, functional mobility, knee extensor spasticity, walking speed and endurance, and exertion before and after commencement of activities were assessed at baseline and postintervention. The data was analyzed using Friedmann and Mann-Whitney U tests. Result: The results showed that there was only significant difference (p < 0.05) in knee extensor spasticity (group 1 (median = 0(0), mean rank = 27.50); group 2 (median = 0(0), mean rank = 31.64)), exertion before commencement of activities (group 1 (median = 0(0.5), mean rank = 21.90); group 2 (median = 1(0.5), mean rank = 37.64)), and exertion after commencement of activities (group 1 (median = 1(1), mean rank = 20.07); group 2 (median = 1(0), mean rank = 39.61) postintervention in favour of the experimental group (group 1)). Conclusion: The group 1 protocol is more effective at improving outcomes after stroke.

Body Weight Misperception and Dissatisfaction Among Overweight and Obese Adult Nigerians.

BACKGROUND: The increase in the prevalence of overweight and obesity in low- and medium-income countries has a negative impact on overall health. Correct perception of one's body weight is a step in seeking healthy help toward weight reduction in overweight and obese individuals. OBJECTIVE: This study was carried out to assess the body weight misperception and dissatisfaction among overweight and obese adults in an urban African setting. METHODS: This study was part of a larger cross-sectional study that was designed to plan an intervention for overweight and obese adults in an urban African setting. For this study, we randomly selected only overweight and obese adults (≥18 years old) who consented to participate in the study from 15 enumeration areas in Alimosho Local Government Area of Lagos State, Nigeria. We followed the World Health Organization guidelines for conducting community surveys in recruiting overweight and obese participants. We assessed body weight perception and dissatisfaction through their responses to the following: "How do you describe your weight?" and "I feel bad about myself because of my weight." Data for this study were collected between November 2012 and March 2013. RESULTS: We recruited 567 participants, of whom more than half (n=304, 53.6%) misperceived their weight as either underweight or normal weight, and 61.2% (n=186) of whom were women. The strength of agreement between the actual body mass index and weight perception was very poor (κ=.032, SE .015, P=.04). The strongest predictor of weight perception was sex (female) with an odds ratio of 1.63 (95% CI 1.13-2.35). About 41.1% (n=233) of the participants were dissatisfied with their weight, of whom 30.0% (n=70) were men. Age (young adult) was a predictor of weight dissatisfaction with an odds ratio of 2.37 (95% CI 1.62-3.46). CONCLUSIONS: More than half of the participants misperceived their body weight as either underweight or normal weight, and the majority of them were women. More men were not happy with their body weight, and participants in the young adult age group were more dissatisfied with their body weight.