Musculoskeletal imaging authority, levels of training, attitude, competence, and utilisation among clinical physiotherapists in Nigeria: a cross-sectional survey.

BACKGROUND: Direct-access physiotherapy practice has led to a global review of the use of differential-diagnostic modalities such as musculoskeletal imaging (MI) in physiotherapy. OBJECTIVE: To explore the MI authority, levels of training, attitude, utilisation, and competence among clinical physiotherapists in Nigeria. METHODS: This national cross-sectional study analysed a voluntary response sample of 400 Nigerian physiotherapists that completed the online version of the Physiotherapist's Musculoskeletal Imaging Profiling Questionnaire (PMIPQ), using descriptive statistics, Spearman's correlation, Mann-Whitney U, Kruskal-Wallis, and Friedman's ANOVA tests. RESULTS: Of the 400 participants, 93.2% believed that physiotherapists should use MI in clinical practice. However, only 79.8% reported having MI authority in their practice settings. The participants' median (interquartile range) levels of training =10 (24) and competence =16 (24) were moderate. Nonetheless, levels of training (χ2 [15] = 1285.899, p = 0.001), and competence (χ2 [15] = 1310.769, p < 0.001) differed across MI procedures. The level of training and competence in x-ray referral and utilisation was significantly higher than magnetic resonance imaging, computed tomography scan, ultrasonography, scintigraphy, and dual-energy x-ray absorptiometry, in that order (p < 0.05). There was a significant positive correlation between the levels of training and competence (rho =0.61, p < 0.001). The participants had a positive attitude =32 (32) and occasionally used MI in clinical practice =21 (28). CONCLUSION: Majority of the respondents believed they had MI authority although there was no explicit affirmation of MI authority in the Nigerian Physiotherapy Practice Act. Participants had a positive attitude towards MI. However, levels of MI training, competence, and utilisation were moderate. Our findings have legislative and curriculum implications.

Prehabilitation exercise therapy before elective abdominal aortic aneurysm repair.

BACKGROUND: An abdominal aortic aneurysm (AAA) is an abnormal dilation in the diameter of the abdominal aorta of 50% or more of the normal diameter or greater than 3 cm in total. The risk of rupture increases with the diameter of the aneurysm, particularly above a diameter of approximately 5.5 cm. Perioperative and postoperative morbidity is common following elective repair in people with AAA. Prehabilitation or preoperative exercise is the process of enhancing an individual's functional capacity before surgery to improve postoperative outcomes. Studies have evaluated exercise interventions for people waiting for AAA repair, but the results of these studies are conflicting. OBJECTIVES: To assess the effects of exercise programmes on perioperative and postoperative morbidity and mortality associated with elective abdominal aortic aneurysm repair. SEARCH METHODS: We searched the Cochrane Vascular Specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Physiotherapy Evidence Database (PEDro) databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 6 July 2020. We also examined the included study reports' bibliographies to identify other relevant articles. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) examining exercise interventions compared with usual care (no exercise; participants maintained normal physical activity) for people waiting for AAA repair. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, assessed the included studies, extracted data and resolved disagreements by discussion. We assessed the methodological quality of studies using the Cochrane risk of bias tool and collected results related to the outcomes of interest: post-AAA repair mortality; perioperative and postoperative complications; length of intensive care unit (ICU) stay; length of hospital stay; number of days on a ventilator; change in aneurysm size pre- and post-exercise; and quality of life. We used GRADE to evaluate certainty of the evidence. For dichotomous outcomes, we calculated the risk ratio (RR) with the corresponding 95% confidence interval (CI). MAIN RESULTS: This review identified four RCTs with a total of 232 participants with clinically diagnosed AAA deemed suitable for elective intervention, comparing prehabilitation exercise therapy with usual care (no exercise). The prehabilitation exercise therapy was supervised and hospital-based in three of the four included trials, and in the remaining trial the first session was supervised in hospital, but subsequent sessions were completed unsupervised in the participants' homes. The dose and schedule of the prehabilitation exercise therapy varied across the trials with three to six sessions per week and a duration of one hour per session for a period of one to six weeks. The types of exercise therapy included circuit training, moderate-intensity continuous exercise and high-intensity interval training. All trials were at a high risk of bias. The certainty of the evidence for each of our outcomes was low to very low. We downgraded the certainty of the evidence because of risk of bias and imprecision (small sample sizes). Overall, we are uncertain whether prehabilitation exercise compared to usual care (no exercise) reduces the occurrence of 30-day (or longer if reported) mortality post-AAA repair (RR 1.33, 95% CI 0.31 to 5.77; 3 trials, 192 participants; very low-certainty evidence). Compared to usual care (no exercise), prehabilitation exercise may decrease the occurrence of cardiac complications (RR 0.36, 95% CI 0.14 to 0.92; 1 trial, 124 participants; low-certainty evidence) and the occurrence of renal complications (RR 0.31, 95% CI 0.11 to 0.88; 1 trial, 124 participants; low-certainty evidence). We are uncertain whether prehabilitation exercise, compared to usual care (no exercise), decreases the occurrence of pulmonary complications (RR 0.49, 95% 0.26 to 0.92; 2 trials, 144 participants; very low-certainty evidence), decreases the need for re-intervention (RR 1.29, 95% 0.33 to 4.96; 2 trials, 144 participants; very low-certainty evidence) or decreases postoperative bleeding (RR 0.57, 95% CI 0.18 to 1.80; 1 trial, 124 participants; very low-certainty evidence). There was little or no difference between the exercise and usual care (no exercise) groups in length of ICU stay, length of hospital stay and quality of life. None of the studies reported data for the number of days on a ventilator and change in aneurysm size pre- and post-exercise outcomes. AUTHORS' CONCLUSIONS: Due to very low-certainty evidence, we are uncertain whether prehabilitation exercise therapy reduces 30-day mortality, pulmonary complications, need for re-intervention or postoperative bleeding. Prehabilitation exercise therapy might slightly reduce cardiac and renal complications compared with usual care (no exercise). More RCTs of high methodological quality, with large sample sizes and long-term follow-up, are needed. Important questions should include the type and cost-effectiveness of exercise programmes, the minimum number of sessions and programme duration needed to effect clinically important benefits, and which groups of participants and types of repair benefit most.

Modes of exercise training for intermittent claudication.

BACKGROUND: According to international guidelines and literature, all patients with intermittent claudication should receive an initial treatment of cardiovascular risk modification, lifestyle coaching, and supervised exercise therapy. In the literature, supervised exercise therapy often consists of treadmill or track walking. However, alternative modes of exercise therapy have been described and yielded similar results to walking. This raises the following question: which exercise mode produces the most favourable results? This is the first update of the original review published in 2014. OBJECTIVES: To assess the effects of alternative modes of supervised exercise therapy compared to traditional walking exercise in patients with intermittent claudication. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 4 March 2019. We also undertook reference checking, citation searching and contact with study authors to identify additional studies. No language restriction was applied. SELECTION CRITERIA: We included parallel-group randomised controlled trials comparing alternative modes of exercise training or combinations of exercise modes with a control group of supervised walking exercise in patients with clinically determined intermittent claudication. The supervised walking programme needed to be supervised at least twice a week for a consecutive six weeks of training. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data, and assessed the risk of bias for each study. As we included studies with different treadmill test protocols and different measuring units (metres, minutes, or seconds), the standardised mean difference (SMD) approach was used for summary statistics of mean walking distance (MWD) and pain-free walking distance (PFWD). Summary estimates were obtained for all outcome measures using a random-effects model. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: For this update, five additional studies were included, making a total of 10 studies that randomised a total of 527 participants with intermittent claudication (IC). The alternative modes of exercise therapy included cycling, lower-extremity resistance training, upper-arm ergometry, Nordic walking, and combinations of exercise modes. Besides randomised controlled trials, two quasi-randomised trials were included. Overall risk of bias in included studies varied from high to low. According to GRADE criteria, the certainty of the evidence was downgraded to low, due to the relatively small sample sizes, clinical inconsistency, and inclusion of three studies with risk of bias concerns. Overall, comparing alternative exercise modes versus walking showed no clear differences for MWD at 12 weeks (standardised mean difference (SMD) -0.01, 95% confidence interval (CI) -0.29 to 0.27; P = 0.95; 6 studies; 274 participants; low-certainty evidence); or at the end of training (SMD -0.11, 95% CI -0.33 to 0.11; P = 0.32; 9 studies; 412 participants; low-certainty evidence). Similarly, no clear differences were detected in PFWD at 12 weeks (SMD -0.01, 95% CI -0.26 to 0.25; P = 0.97; 5 studies; 249 participants; low-certainty evidence); or at the end of training (SMD -0.06, 95% CI -0.30 to 0.17; P = 0.59; 8 studies, 382 participants; low-certainty evidence). Four studies reported on health-related quality of life (HR-QoL) and three studies reported on functional impairment. As the studies used different measurements, meta-analysis was only possible for the walking impairment questionnaire (WIQ) distance score, which demonstrated little or no difference between groups (MD -5.52, 95% CI -17.41 to 6.36; P = 0.36; 2 studies; 96 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: This review found no clear difference between alternative exercise modes and supervised walking exercise in improving the maximum and pain-free walking distance in patients with intermittent claudication. The certainty of this evidence was judged to be low, due to clinical inconsistency, small sample size and risk of bias concerns. The findings of this review indicate that alternative exercise modes may be useful when supervised walking exercise is not an option. More RCTs with adequate methodological quality and sufficient power are needed to provide solid evidence for comparisons between each alternative exercise mode and the current standard of supervised treadmill walking. Future RCTs should investigate outcome measures on walking behaviour, physical activity, cardiovascular risk, and HR-QoL, using standardised testing methods and reporting of outcomes to allow meaningful comparison across studies.

Physiotherapist-patient communication in entry-level physiotherapy education: A national survey in Nigeria.

BACKGROUND: Clinical communication impacts on physiotherapy treatment outcome and its competence warrants being assessed during training for physiotherapists given the increasing need to improve patient outcomes. OBJECTIVE: This study aimed to investigate the assessment of clinical communication in entry-level physiotherapy programs in Nigeria. METHODS: In a cross-sectional survey, questionnaires were sent by e-mail or hand-delivered to the heads of physiotherapy programs, asking them to consult with faculty members involved in the assessment of clinical communication in undergraduate education. RESULTS: Six of seven physiotherapy programs responded (an 86% response rate). Assessment of clinical communication and methods of assessing clinical communication by the programs showed wide variation. There was an average of two assessments per year. The objective structured clinical examination with patients (21; 38%) and written communications (report/chart) (13; 23%) were the most commonly used assessment methods. Perceived challenges included a lack of facilities, validity, inexperienced examiners, and difficulties in integrating processes and content. CONCLUSION: A variety of assessment methods are being used in entry-level physiotherapy programs in Nigeria, which target different components of clinical communication skills acquisition. More effort is needed to improve limited facilities and human resources training to enhance clinical communication assessment in Nigerian physiotherapy programs.

Health Competency Standards in Physical Therapist Practice.

Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) has a significant negative impact on the quality of life of individuals. Understanding the experiences of people living with PAD will be useful in developing comprehensive patient-centred secondary prevention therapies for this population. AIM: The aim of this study is to identify first-hand accounts of patients' experiences of living with PAD. METHODS: Six databases (CINALH, PsyclNFO, MEDLINE, AMED, EMBASE, Social citation index/Science citation index via Web of Science (WOS)) and reference lists of identified studies were searched until September 2017 (updated February 2018). Qualitative studies reporting patients' account of living with PAD were eligible for inclusion. A framework thematic synthesis was implemented. RESULTS: Fourteen studies with 360 participants were included. Pain and walking limitation were recurrent among the varied symptom descriptions. Patients' ignorance and trivialisation of symptoms contributed to delays in diagnosis. Inadequate engagement in disease understanding and treatment decisions meant patients had poor attitudes towards walking treatments and unrealistic expectations about surgery. Depending on symptom progression, patients battle with walking impairment, powerlessness, and loss of independence which were a source of burden to them. Lack of disease understanding is central through patients' journey with PAD and, although they subsequently began adaptation to long term living with PAD, many worried about their future. CONCLUSIONS: Disease understanding is vital across the illness trajectory in patients with PAD. Although certain experiences are common throughout patient journey, some might be unique to a particular stage (e.g. unrealistic expectation about surgery, or rationale of walking in spite of pain in a supervised exercise program). Given that PAD is an overarching construct ranging from the mildest form of intermittent claudication to severe critical limb ischemia with ulceration and gangrene, consideration of important patient constructs specific to each stage of the disease may enhance treatment success. Systematic review registration CRD42017070417.

Individual and work-related risk factors for musculoskeletal pain among computer workers in Nigeria.

We investigated the prevalence of musculoskeletal pain (MSP) and the association of 1-month prevalence with individual and work-related factors among commercial typists in Enugu. Participants responded to a questionnaire about occurrences of MSP and a 75.6% (242/320) response rate was achieved. Prevalence was summarized in frequencies and percentages while associations between MSPs and risk factors were explored using chi-square. MSP was most common in the low back (58.3%), and low back pain limited 51.7% from activities between 1 and 30 days. Advancing age was significantly associated with MSP in the low back (x2 = 19.885; p = .001), neck (x2 = 28.309; p < .001), shoulder (x2 = 13.122; p = .011), but not wrist/hand (p = .075). Working 1-5 years in this job was associated with increasing prevalence of MSP in all body regions studied. Lesser job control was associated with increased prevalence of wrist/hand pain. Prevalence of MSDs among computer operators in Enugu, Nigeria, is high and highlights the importance of workplace intervention.

A Systematic Review and Meta-Analysis of the Efficacy of Manipulative Therapy in Women with Primary Dysmenorrhea.

OBJECTIVE: To assess the robustness of evidence for the efficacy of manipulative therapy in women with primary dysmenorrhea. METHOD: Seven electronic databases were searched for studies reporting data on manipulative therapy for women with primary dysmenorrhea. The primary and secondary outcomes were pain relief and quality of life, respectively. Quality of eligible studies was assessed using the Physiotherapy Evidence Database (PEDro) guideline. RESULTS: The search yielded 19 citations of which four were systematically reviewed and three eligible for meta-analysis. The systematic review showed above moderate methodological quality with a mean of 6.7 out of 10 on the PEDro quality scale. Manipulative therapy showed evidence of pain reduction in primary dysmenorrhea. CONCLUSION: Manipulative therapy could be considered as adjunct therapy in the relief of pain in primary dysmenorrhea. More high-quality research is needed before the evidence for their utilization can be ascertained. Particularly, items related to assessor blinding should be considered in future studies.

Practices of Nigerian physiotherapists with respect to lifestyle risk factor assessment and intervention: A national cross-sectional survey.

BACKGROUND: Resolutions of the World Health Organization and World Confederation for Physical Therapy declare health promotion a priority for health professionals including physiotherapists. OBJECTIVE: To describe lifestyle-related risk factor assessment and intervention practices of Nigerian physiotherapists, their perceived barriers to such practices, and education needs. METHODS: Physiotherapists (n = 650) were invited to complete a questionnaire with 23 questions about respondent demographics, lifestyle risk factor assessment, and management practices; barriers to such practices; and related education needs. Statistical analysis was descriptive. RESULTS: Response rate was 69% (n = 451). Less than half of respondents indicated that they "always" advised smokers to quit or heavy drinkers to reduce alcohol consumption. Most respondents viewed diet and anthropometrics as risk factors that warrant being addressed, but few respondents did so. Physical inactivity and blood pressure were the commonest risk factors reportedly assessed. Perceived barriers to health promotion practices included time, knowledge, and access to other providers. Continuing education needs identified by respondents included methods for delivering advice regarding smoking cessation, diet, and alcohol consumption. CONCLUSIONS: Nigerian physiotherapists inconsistently assess lifestyle-related risks and intervene to address them. Continuing education is needed to address barriers to health promotion practices by meeting the perceived needs of Nigerian physiotherapists.

Job stress dimension and work-related musculoskeletal disorders among southeast Nigerian physiotherapists.

BACKGROUND: Although publications describe physical demands of the job in the physiotherapy profession, there is a dearth of literature on job stress dimensions (JSDs), and their relationship to work-related musculoskeletal disorders (WMSDs). OBJECTIVE: To investigate JSDs and their relationship to WMSDs among physiotherapists currently practicing in southeast Nigeria. METHOD: A cross-sectional study using items related to the Job Content Questionnaire and the Nordic musculoskeletal questionnaire. Data were summarized with descriptive statistics, and the relationship between WMSDs and JSDs was analyzed with the Mann-Whitney U test. RESULTS: A total of 126 physiotherapists responded. There were high levels of stress in most of the job dimensions investigated: 82.1% and 22.8% of the physiotherapists had WMSDs in at least one body region in the last 12 months and the last 7 days respectively. The lower back was the most commonly affected in both periods. No specific domain was related to development of WMSDs. CONCLUSION: Over 80% of physiotherapists in southeast Nigeria have WMSDs. However, despite high levels of physical demands on the job, physiotherapists have job control and good social support. Intervention programs aimed at reducing WMSDs in physiotherapists should focus on risk factors that target the physical demands of the job.

Effect of Backpack Strap Patterns on Gait Parameters in Young Adults at Self-Selected Normal and Fast Walking Speeds.

BACKGROUND: The effects of backpack load on young adults' gait parameters have received little attention. We previously reported that with a backpack load within 15% body weight (BW), young adults maintain their gait parameters at the expense of increased exertion during a 6-minute walk at self-selected normal walking speed. However, the effect of backpack strap pattern on gait parameters during faster walking or longer stride length has not been evaluated. OBJECTIVE: To determine the effect of different backpack strap patterns on gait parameters during a 12-minute walk test in young adults at self-selected normal and fast walking speeds. DESIGN: A crossover, self-controlled experimental study with repeated measures. SETTING: Department of Medical Rehabilitation, University of Nigeria. PARTICIPANTS: A convenience sample of 24 healthy young adults (21.29 ± 1.20 years) who voluntarily signed an informed consent form, were able to wear a backpack on 1 and on both shoulders, were able to walk independently, and passed the physical activity readiness screening participated in this study. METHODS: Using a validated method of an observational gait analysis, each participant carried out a 12-minute walk test at self-determined normal and fast walking speeds, respectively. The effect of the following test conditions on the selected gait parameters was evaluated: normal and fast walking without load, and normal and fast walking with 10% and 20% BW backpack carried each on 1 and both shoulders. MAIN OUTCOME MEASUREMENT: Stride length, stride time, velocity, cadence, and base of support were assessed by the equation definitions method of the velocity field diagram. RESULTS: At self-selected fast walking speed with 10% BW backpack load, stride time (P = .004) and cadence (P = .006) were significantly decreased when participants wore a double-strap backpack. At self-selected normal walking speed with 20% BW backpack load, cadence was significantly decreased with double-strap backpack carriage (P = .008). Cadence (P < .001), velocity (P < .001), and stride time (P < .001)were also significantly decreased at both conditions of single and double-strap backpack carriage of 20% BW respectively at fast walking speed. CONCLUSION: Backpack strap patterns do not affect the gait parameters of young adults in a 12-minute bout of normal walking speed, provided that the load is less than 20% BW. However, a load up to 10% BW carried on a double strap causes a decrease in stride time and cadence when these individuals walk fast. LEVEL OF EVIDENCE: Not applicable.

Effectiveness of SP6 (Sanyinjiao) acupressure for relief of primary dysmenorrhea symptoms: A systematic review with meta- and sensitivity analyses.

We reviewed the available evidence for SP6 (Sanyinjiao) acupressure for the relief of primary dysmenorrhea (PD) symptoms, as well as patients' experiences of this intervention. We searched six relevant databases and gray literature for publications dated up to March 2016. The search yielded 72 potential studies. Six of these studies, contributing a total of 461 participants, were included in this review. The primary outcome was pain intensity. Studies with significant homogeneity were pooled for meta-analysis. Qualitative data and quantitative data not suitable for meta-analysis were presented as a narrative synthesis. The Cochrane criteria demonstrated that the included studies were generally of low quality with a high risk of bias. SP6 acupressure delivered by trained personnel significantly decreased pain intensity immediately after the intervention (effect size = -0.718; CI = -0.951 to -0.585; p = 0.000), and pain relief remained up to 3 h after the intervention (effect size = -0.979; CI = -1.296 to 0.662; p = 0.000). However, patient-administered intervention required multiple monthly cycles to effect pain reduction. SP6 acupressure appears to be effective when delivered by trained personnel for some PD symptoms. Findings suggest that self-administered acupressure shows promise for the alleviation of PD symptoms. High-quality research is needed before conclusive recommendations are proposed.

Promoting Physical Activity and Exercise in Daily Practice: Current Practices, Barriers, and Training Needs of Physiotherapists in Eastern Nigeria.

PURPOSE: To investigate current practices, barriers, and training needs for the promotion of physical activity (PA) in physiotherapy practices in eastern Nigeria. METHODS: A total of 141 fully licensed physiotherapists in southeast Nigeria were invited to participate in a cross-sectional survey consisting of 23 questions in five key sections, focusing mainly on risk-factor management practices of physiotherapists. RESULTS: A total of 103 questionnaires were returned. Respondents ranged in age from 25 to 54 years and reported a mean of 11 (SD 10) years of clinical experience. Respondents reported that they regularly assess and advise their clients on PA but rarely give written prescriptions. Although they are confident in assessing and advising their clients on PA and consider including PA intervention as a priority in daily practice, lack of time and lack of access to materials were reported as barriers to effective PA intervention. CONCLUSION: Findings showed the potential for physiotherapists to address physical inactivity and highlighted several barriers. Strategies are needed to improve contact time with clients and make material promoting PA available to practising physiotherapists.

Objet : Étudier les pratiques, les obstacles et les besoins en formation courants qui ont trait à la promotion de l'activité physique (AP) dans les cabinets de physiothérapie de l'est du Nigéria. Méthodes : Au total, 141 physiothérapeutes entièrement autorisés du sud-est du Nigéria ont été invités à participer à une étude transversale comportant 23 questions réparties en 5 sections clés et portant principalement sur les pratiques de gestion des facteurs de risque suivies par les physiothérapeutes. Résultats : Au total, 103 questionnaires ont été renvoyés. L'âge des répondants variait de 25 à 54 ans et ils ont déclaré une moyenne de 11 (ET 10) ans d'expérience clinique. Les répondants ont signalé qu'ils évaluent régulièrement leurs clients et leur conseillent de faire de l'AP, mais leur donnent rarement des ordonnances écrites. Même s'ils se sentent en confiance lorsqu'ils doivent évaluer leurs clients et leur donner des conseils en matière d'AP, et s'ils envisagent de faire de l'intervention sur l'AP une priorité dans la pratique quotidienne, les répondants ont signalé le manque de temps et d'accès au matériel comme obstacles à une intervention efficace sur l'AP. Conclusion : Les constatations ont révélé que les physiothérapeutes pourraient aborder l'inactivité physique et ont dégagé certains obstacles. Des stratégies s'imposent pour améliorer le temps de contact avec les clients et mettre à la disposition des physiothérapeutes en activité du matériel de promotion de l'AP.

TENS and heat therapy for pain relief and quality of life improvement in individuals with primary dysmenorrhea: A systematic review.

The present systematic review aimed to synthesize evidence for the effectiveness of TENS and heat therapy interventions from randomized trials. Six relevant databases were searched for studies on TENS and heat therapy for primary dysmenorrhea. Menstrual pain intensity and quality of life were the primary and secondary outcomes respectively. The search yielded 46 citations from which six studies on TENS and three studies on heat therapy were systematically reviewed. On the PEDRO quality scale, the trials methodological quality was 4.8 out of 10 for TENS and 6.3 out of 10 for heat therapy. TENS and heat therapy both showed evidence of pain reduction, but no study included quality of life as an outcome. Meta-analysis was not possible due to substantial heterogeneity in included studies. TENS and heat therapy show potential as adjunct remedies in the management of primary dysmenorrhea, but rigorous high quality trials are still needed to made conclusive recommendation.

Patient education interventions to improve physical activity in patients with intermittent claudication: a protocol for a systematic mixed-studies review.

INTRODUCTION: Peripheral arterial disease (PAD) and intermittent claudication (IC) decrease an individual's capacity to engage in physical activity (PA) with potentially negative effects on PA behaviour. Strategies to improve PA among this population may provide a range of positive health benefits. We present a protocol to assess the components of patient education interventions that improve PA capacity and PA behaviour in patients with PAD and IC. METHODS AND ANALYSIS: Published peer-reviewed studies will be searched in the following databases: CINAHL, the Cochrane Library, OVID, ProQuest, AMED, MEDLINE, PsycINFO, Web of Science Core Collection and PEDro, to identify literature investigating the effect of patient education on PA of patients with PAD and IC, or studies that investigated patients' perceptions or experience with these interventions. Two authors will independently perform screening for study eligibility, result synthesis and then appraise study quality. For interventions without follow-up, primary outcome measures will include change in PA capacity, or change in free-living PA behaviour; where there was a follow-up postintervention, the primary outcome will be rate of adherence to PA behaviour improvement. A three-phase sequential explanatory synthesis of mixed studies will be employed to answer the research questions. Homogenous quantitative data will be analysed using a random-effects model of meta-analysis with results presented as relative risk for dichotomous outcomes and as weighted or standardised means for continuous outcomes. Qualitative data will be analysed using thematic synthesis. This review protocol is reported according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines. TRIAL REGISTRATION NUMBER: CRD42015027314.

Work-related back discomfort and associated factors among automotive maintenance mechanics in Eastern Nigeria: A cross sectional study.

BACKGROUND: Back pain has been identified as a common cause of disability in the working population. Automotive mechanics habitually use awkward back posture in their course of manual activity and hence may be at risk of work-related back pain. OBJECTIVE: To investigate the prevalence, pattern and severity of back pain among automotive maintenance mechanics, as well as the personal and job variables associated with or predicting occurrence of back pain. METHOD: Using a cross-sectional design, information about self-reported back pain and the associated variables were collected among 684 randomly recruited automotive mechanics. RESULT: Prevalence of back pain was 76.02%; with the majority experiencing low back pain. 63.3% of the workers reported they limited their activity due to the back pain. Older workers (>50 years), daily work lasting ≥5 hours duration, no more than primary education, being normal weight, frequent use of kneeling and sustained postures, and lack of knowledge of ergonomic postures were associated with increased prevalence of back pain. Lack of job autonomy, inadequate task clarity, heavy physical work load, manual material handling, strenuous posture, noisy environment, vibrations, work schedule and inadequate auxiliary support were also associated with increased prevalence of back pain among the mechanics. CONCLUSION: Work-related back pain is prevalent among automotive maintenance mechanics. Work-related back pain is high among automotive maintenance mechanics. Workstation policy and legislation on reduction of risks with combined health literacy and ergonomic education programs in this occupational group are imperative.

Promotion of healthy nutrition in clinical practice: A cross-sectional survey of practices and barriers among physiotherapists in southeast Nigeria.

BACKGROUND: Healthy diet counselling is an important concept in health promotion. Physiotherapists are well positioned to initiate or support healthy nutrition in addition to physical activity counselling, in routine patient consultation. OBJECTIVE: To determine the practices about and barriers to diet counselling practices among physiotherapists in Southeast Nigeria. METHODS: In this cross-sectional survey, a total of 140 questionnaires were distributed among physiotherapists. RESULTS: Overall, 103 physiotherapists responded. Physiotherapists are confident and consider the incorporation of dietary counselling very important and of high priority in their daily clinical work. They, however, assessed and counselled on dietary status opportunistically in patients. Notwithstanding, physiotherapists believed that the diet counselling they give could be effective in helping patients change their unhealthy dieting practices. Patients were also amenable to physiotherapists advocating on diet issues as part of their consultation. Several barriers to incorporating diet counselling into physiotherapy practice were identified, including lack of access to a dietician/health promotion staff/counsellors, lack of proper patient education materials, lack of expertise in relation to dietary risk factors' assessment and management, and uncertainty about what dietary services to provide. CONCLUSION: Although physiotherapists consider it important to incorporate diet counselling in their daily clinical practice, development and implementation of strategies to improve physiotherapists' diet counselling knowledge, competence, skills, and practice are warranted.

Effect of single and double backpack strap loading on gait and perceived exertion of young adults.

BACKGROUND/AIM: Backpack effect posture, walking and physiological costs but there is dearth of literature on effects of backpack strap (1 versus 2 straps) on gait and perceived exertion among young adults. We determined the influence of type of backpack shoulder strap on gait parameters and perceived exertion of young adults in a free-living normal walking speed. METHODS: Twenty-five young adults with a mean age of 22 years underwent a self-selected normal speed walking for six minutes each under 3 testing conditions: without a backpack; with 1 strap; and with 2 straps. Selected gait parameters and perceived exertion were assessed. RESULTS: There were no significant difference in stride length, stride time, step length, step time, gait speed, and cadence among the three walking conditions. However, perceived exertions were significantly higher when the backpack was carried with 15% irrespective of 1 strap or 2 straps. CONCLUSION: Momentary carriage of a backpack either on 1 strap or 2 straps does not appear to influence gait phases. However, this short bout of normal walking appear to increase perceived exertion in young adults irrespective of whether the backpack is wore on single or double shoulder strap.

As Acupressure Decreases Pain, Acupuncture May Improve Some Aspects of Quality of Life for Women with Primary Dysmenorrhea: A Systematic Review with Meta-Analysis.

Primary dysmenorrhea is the most common gynecological symptom reported by women and constitutes a high health, social, and economic burden. Chemotherapies, along with their side effects, have not yielded satisfactory outcomes. Alternative nonpharmacological interventions, including acupuncture and acupressure, have been advocated, but evidence regarding their beneficial effect is inconclusive. This study sought to obtain evidence on the effectiveness of acupuncture and acupressure interventions. Twelve electronic databases were searched by using menstrual pain intensity and quality of life as primary and secondary outcomes, respectively, with the PEDro guideline for quality appraisal. Data unsuitable for a meta-analysis were reported as descriptive data. The search yielded 38 citations, from which eight studies were systematically reviewed, four of the eight being eligible for meta-analysis. The systematic review showed moderate methodological quality with a mean of 6.1 out of 10 on the PEDro quality scale. Acupressure showed evidence of pain relief while acupuncture improved both the mental and the physical components of quality of life. In conclusion, physiotherapists should consider using acupuncture and acupressure to treat primary dysmenorrhea, but a need exists for higher quality, randomized, blinded, sham-controlled trials with adequate sample sizes to establish clearly the effects of these modalities.