Knowledge, awareness and use of current practice of palliative care amongst physiotherapists.

Background: Recently, there has been a marked increase in the incidence of cancer, HIV, and other noncommunicable diseases globally. Thus, the demand for palliative care (PC), including end-of-life care, continues to grow worldwide. Physiotherapy has an important role in PC as it aims to alleviate symptoms and improve quality of life by optimising independent levels of function. Objective: To assess the level of knowledge, awareness and current practice of PC amongst Nigerian physiotherapists in clinical practice. Method: Our study used a cross-sectional descriptive census-based method and recruited practising physiotherapists in Nigeria. An electronic questionnaire was used to collect data over 12 weeks, comprising 36 semistructured questions in four domains: personal information, knowledge, awareness and current practices regarding PC. Data were analysed using a pragmatist paradigm. Results: Of the 426 physiotherapists who participated, 50% (n = 213) had a postgraduate degree, 49.5% (n = 211) had a bachelor's degree and 0.5% (n = 2) had a Doctor of Physical Therapy degree. The results also indicate that 73.9% (n = 315) of the participants had sufficient knowledge about PC, 80.5% (n = 343) had a sufficient level of awareness about PC and 66.7% (n = 284) were using current clinical practices in the rehabilitation of critically ill patients or those with chronic conditions. Conclusion: It was concluded that most Nigerian physiotherapists had sufficient knowledge and awareness about PC and were involved in the management of patients requiring PC physiotherapy. Clinical implication: It can be understood that a large proportion of Nigerian physiotherapists have clinical experience managing patients requiring PC, despite inadequate formal training in this field.

Effect of treadmill walking for anxiety, depression, and social well-being in women with diabetes type 2: A randomized controlled trial.

Anxiety and depression are higher in persons with diabetes leading to poor glycaemic control and diabetes-related emotional distress. Some diabetic women do not engage in exercises perceiving it to make their diabetes worse. The researchers' objective of this treadmill walking program was to determine its effect on anxiety, depression and social well-being in women with diabetes type 2 (DT2). We randomized 49 sedentary women with DT2 into treadmill walking at moderate intensity of 40-60% of their age-adjusted maximal heart rate, three times per week on alternate days for 12 weeks. The control attended electronic lectures on diet, diabetes and mental health. The treadmill group had no adverse effects and their anxiety, depression and social well-being scores improved with no significant changes for the control. We offer women with DT2 an easy, safe indoors exercise preventing them from abuse from men, erratic drivers and extreme weather conditions with positive physiological responses.

Prevalence of psychological symptoms and their correlates among physiotherapy clinical students: A cross-sectional study.

Background: Mental health in medical students is well researched, with physiotherapy students receiving less attention even though psychiatry is a recognised specialty within physiotherapy. Objectives: To assess the prevalence and correlates of depression, anxiety and stress among physiotherapy clinical students. Methods: A descriptive cross-sectional study design was employed on 402 physiotherapy clinical students aged 17-40 years using a convenience sampling method. The data were collected using the self-administered 42-items Depression, Anxiety and Stress scale (DASS) and the data were analysed using a Chi-square test and binary logistic regression analysis. Results: The prevalence of depression, anxiety and stress among these students was 79.9%, 85.6% and 81.6%, respectively. The results indicate that financial status and social life influenced depression by 20.6% (odds ratio [OR] [95%] = 1.206 [1.110, 1.311]) and 36% (OR [95%] = 1.360 [1.050, 1.764]), respectively. Fear of repeating a class influenced anxiety by eight times (OR [95%] = 8.330 [6.643, 10.422]). Fear of repeating a class, financial status and academic performance influenced stress by eight times (OR [95%] = 8.360 [6.677, 10.470]), 17.5% (OR [95%] = 1.175 [1.083, 1.275]) and 18.1% (OR [95%] = 1.181 [1.083, 1.276]), respectively. Conclusion: Our study concluded that there was a high prevalence of depression, anxiety and stress among physiotherapy clinical students. These outcomes suggest that more attention needs to be given to improving physiotherapy clinical students' mental health, which will ultimately improve learning outcomes. Clinical implications: The long-term effects of psychological distress could potentially impact students' academic performance. It may also have long-lasting effects after graduation. Therefore, students who are at risk of developing psychological symptoms are needed to be thoroughly examined and then receive early required interventions.

How are children with cerebral palsy managed in public hospitals of KwaZulu-Natal, South Africa?

Background: Medical advances have resulted in the survival of infants who are born prematurely. This makes them at risk of developing neurological manifestations and increases the incidence of children diagnosed with cerebral palsy (CP). Physiotherapy plays an important role in the management of children with CP. However, in KwaZulu-Natal (KZN) there are challenges for rehabilitation of children presenting with CP due to limited equipment, assistive devices and shortage of health care professionals. The aim of this study was to determine the current physiotherapy management for children presenting with CP in public hospitals of KZNMethods: One hundred and fifty-two physiotherapists were recruited using convenience sampling from different levels of public hospitals in KZN. The design was a cross-sectional study using a survey with a self-designed questionnaire to review current physiotherapy management of CP. The data was analyzed and presented by means of descriptive statisticsResults: Seventy-two participants completed the study indicating a 47.4% response rate with an age range of 31 to 40 years. Thirty-five (48.6%) of participants treated one to ten children with CP each month. Twenty-five (34.7%) used outcome measures to evaluate their CP management. This study showed the most common treatment techniques used by physiotherapists were: postural stabilizing activities - 68 (94.4%); respiratory care - 67 (92.9%); and positioning - 67 (92.9%)Conclusion: Despite challenges by physiotherapists in KZN, the overall management of children with CP was holistic and favorable. The most common treatment approach was postural stabilizing activities with children with CP receiving treatment once a month for 30 minutes.

Cross-cultural adaptation and psychometric validation of the Hausa version of Örebro Musculoskeletal Pain Screening Questionnaire in patients with non-specific low back pain.

OBJECTIVES: Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) is widely used in clinical practice and for research purpose to screen the risk of chronicity in patients with Non-specific low back pain (NSLBP). The questionnaire has been cross-culturally adapted into different languages, but to date, there has not been Hausa version of the questionnaire. This study is important as the Hausa language is widely spoken across sub-Saharan Africa. The study aims to cross-culturally translate the English version of the (OMPSQ) into Hausa language (OMPSQ-H) and to test its psychometric properties in Hausa patients with NSLBP. METHODS: This observational study involved the use of forward-backwards translation method for the English version of OMPSQ. Thus, 124 male and female participants with subacute NSLBP were recruited using convenient sampling techniques. The psychometric properties statistically tested included reliability, internal-consistency, ceiling and floor effects, acceptability and construct validity. RESULTS: The Hausa version of OMPSQ has demonstrated good reliability (ICC=0.82) and internal consistency (Cronbach's alpha=0.72) with good acceptability as all questions were answered in 5 min. Responsiveness was adequate as OMPSQ-H retest scores demonstrated good correlation with the global rating of change scale scores (r=0.67, p=0.01). Construct validity was evaluated using principal component analysis and it reveals six components structure for the OMPSQ-H. CONCLUSIONS: The OMPSQ-H was successfully translated and cross-culturally adapted with no problem of comprehension. Moreover, it has shown adequate psychometric properties in terms of internal consistency, reliability, responsiveness and constructs validity. Consequently, the OMPSQ-H can be considered as a valid tool for identifying and screening both psychosocial risk factors and risk of chronicity of NSLBP in Hausa population.

Effectiveness of neck stabilisation and dynamic exercises on pain intensity, depression and anxiety among patients with non-specific neck pain: a randomised controlled trial.

BACKGROUND AND AIMS: Non-specific neck pain (NsNP) constitutes a burden to the bearers and a management challenge to physiotherapists globally. Effectiveness of neck stabilisation and dynamic exercises in the management of NsNP has been documented, but it is not clear which exercise regimen is more effective in alleviating its associated pain, depression and anxiety. This study was carried out to compare the effectiveness of neck stabilisation and/or dynamic exercises on pain intensity, depression and anxiety among patients with NsNP. METHODS: Eighty-nine consenting individuals with NsNP participated in this single-blind, randomised controlled trial. They were recruited from the outpatient physiotherapy clinics of the National Orthopaedic Hospital in Dala, Kano State, Nigeria. Participants were randomly assigned into one of three intervention groups: neck stabilisation exercise group (NSEG; n=30), neck dynamic exercise group (NDEG; n=28) and neck stabilisation and dynamic exercise group (NSDEG; n=31). Treatment was administered thrice weekly for 8 consecutive weeks. Variables were assessed at baseline, at the end of the fourth and eighth weeks. Pain intensity was assessed through the use of a visual analogue scale, while depression and anxiety were evaluated using both the Beck Depression Inventory and Beck Anxiety Inventory. The data was analysed using descriptive statistics, multivariate analysis of variance (MANOVA) and post hoc tests with Bonferroni adjustment at the p=0.05 significant level. RESULTS: Ages of participants in NSEG (46.8±12.4 years), NDEG (48.6±11.6 years) and NSDEG (45.1±13.4 years) were comparable. The comparison for NSEG, NSDEG and NDEG within groups revealed that there was significant difference in pain intensity, depression and anxiety scores from baseline, in the fourth and eighth weeks of the study - (F=62.40, p=0.001, F=13.91, p=0.001 and F=20.93, p=0.001); (F=11.92, p=0.001, F=8.75, p=0.004 and F=9.70, p=0.001) and (F=36.63, p=0.001, F=11.99, p=0.001 and F=6.59, p=0.001), respectively. A group comparison of the pain intensity, depression and anxiety scores of participants in the NSEG, NSDEG and NDEG at the baseline of the study revealed that there were no significant differences in the pain intensity and depression and anxiety scores among the three groups: p=0.159, 0.58 and 0.179, respectively. At week 4 of the study, however, a significant difference in pain intensity and anxiety scores across the three groups was recorded - p=0.018, p=0.011, respectively, but no significant difference was noted in depression scores (p=0.93). At week 8 of the study, it was determined that there were significant differences in pain intensity and depression scores p=0.001 and p=0.041, but no significant dissimilarities in the anxiety scores. Post hoc revealed that only pain was significant and lay with NSEG. CONCLUSIONS: The study concluded that the stabilisation, dynamic and stabilisation, plus dynamic exercises were effective in relieving pain and reducing depression and anxiety in patients with NsNP. However, stabilisation showed a more marked effect than the combination exercises of stabilisation plus dynamic exercises, and dynamic exercises in reducing pain intensity in patients with NsNP. IMPLICATIONS: It is recommended that stabilisation exercises be chosen over stabilisation plus dynamic exercises, or dynamic exercise, while treating patients with NsNP. However, both are effective.

Influence of a mini-trampoline rebound exercise program on insulin resistance, lipid profile and central obesity in individuals with type 2 diabetes.

BACKGROUND: Exercises are important as an adjuvant for managing diabetes but due to fatigue and time constraints, individuals with diabetes may not engage in them. Jumping on a mini-trampoline referred to as rebound exercise is an aerobic activity used for exercise training benefits but only little research is available on its effects in diabetes. The purpose of this study was to determine the effect of mini-trampoline rebound exercise on insulin resistance, lipid profile and central obesity in type 2 diabetics. METHODS: Sixty non-insulin dependent type 2 diabetics (median age: 39.0 years, median body mass index: 25.2 kg/m2) recruited using convenience sampling were randomized to a rebound exercise group (N.=30) or a control group (N.=30). The control group read health magazines or watched television while the rebound exercise group jumped on a mini-trampoline at moderate intensity for 30 minutes three times per week for 12 weeks. RESULTS: Postrebound exercise, significant improvements in insulin resistance, lipid profile and waist circumference were noted when compared to the control (P<0.05). The values for high density lipoprotein cholesterol increased with low density lipoprotein cholesterol, triglycerides, insulin resistance decreasing significantly from baseline (P<0.05). CONCLUSIONS: The findings suggest that mini-trampoline rebound exercise is beneficial for individuals with type 2 diabetes and can serve as a useful exercise approach in the management of cardiovascular risk in diabetes.

Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain?

OBJECTIVE: Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain. DESIGN: A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control. Outcome measures were assessed using the subjective periphery neuropathy, brief peripheral neuropathy screening, and numeric pain rating scale. Pain was assessed at baseline, 6 and 12 wks. Data between groups were compared using Kruskal-Wallis, Mann-Whitney U test, and within-groups Friedman and Wilcoxon signed rank tests. RESULTS: There were 136 participants (mean [SD] age = 36.79 [8.23] yrs) and the exercise groups completed the protocols without any adverse effects. Pain scores within and between aerobic exercise and progressive resisted exercise groups showed significant improvement (P < 0.05) from baseline to 6 and 12 wks compared with the control (P > 0.05). CONCLUSIONS: This study supports a rehabilitation program of moderate-intensity aerobic exercise and progressive resisted exercise being safe and effective for reducing neuropathic pain and is beneficial with analgesics for HIV-induced distal symmetrical polyneuropathy.

Does a physiotherapy programme of gross motor training influence motor function and activities of daily living in children presenting with developmental coordination disorder?

BACKGROUND: Children with developmental coordination disorder (DCD) lack motor coordination and have difficulty performing motor skills and activities of daily living. Research shows these children do not outgrow their motor difficulties and without intervention do not improve. Physiotherapy is relevant for these children, but due to limited clinical protocols for DCD the aim of this study was to determine the effect of a gross motor training programme for 6-12-year-old children with DCD. METHODS: This randomised pre-test, post-test study recruited 64 children with scores of 15th percentile or below using the Movement Assessment Battery for Children (M-ABC). The children were divided equally into an intervention group receiving 8 weeks of gross motor training for core stability, strengthening exercises, balance and coordination with task-specific activities for 30 min per week, while the control group continued with general therapy and activities of daily living. The M-ABC and Developmental Coordination Disorder Questionnaire (DCDQ) were used to assess each child before and after 8 weeks. RESULTS: Sixty children completed the study, with 43 males and 17 females (mean age 10.02 years, SD = 2.10). There were no adverse reactions to the programme and M-ABC scores for the intervention programme improved by 6.46%, ball skills (3.54%) and balance (4.80%) compared with the control (0.17%) and (0.15%), respectively. There were significant (p < 0.05) improvements in DCDQ scores, but teachers allocated lower scores than parents. CONCLUSION: This study supports 8 weeks of gross motor training which can be a beneficial intervention for physiotherapists to improve gross motor function for DCD.

Rebound exercise: A beneficial adjuvant for sedentary non-insulin-dependent type 2 diabetic individuals in a rural environment.

OBJECTIVE: Although physical activity and exercises are recommended for diabetes, fear of fatigue and resources are often constraints. Rebound exercise on a mini trampoline is a relatively new aerobic exercise and this study evaluated its impact on glycosylated haemoglobin (HbA1c ), fasting plasma glucose (FPG) and body mass index (BMI) for sedentary type 2 diabetic (T2D) individuals from a rural environment. DESIGN/SETTING: A randomised controlled single-blind, pre- and post-test study in an outreach rural rehabilitation gymnasium. PARTICIPANTS AND INTERVENTION: Ninety T2D individuals from rural Nigeria aged 39.44 ± 8.61 attending a diabetic outpatient clinic participated in this study as a control (n = 45) or rebound exercise (n = 45) group. The control group watched videos and read health magazines while the rebound group exercised three times per week for 20-30 min over 9 weeks at moderate intensity of 40-60% of heart rate maximum. OUTCOME MEASURES: Heart and respiratory rates, blood pressure, oxygen saturation, HbA1c , FPG and BMI values were recorded pre- and post-interventions. RESULTS: There were no significant differences between groups at baseline and compliance with rebound exercise was 93% (n = 42). Post 9 weeks there were significant improvements (P < 0.05) in mean HbA1c (8.65 to 7.12%), FPG (9.08 to 6.92 mmol L(-1)) and BMI (26.1 to 25.6 kg m(-2)) in the exercise group with blood pressure, heart and respiratory rates also increasing during the exercise but without any adverse reactions. CONCLUSION: Rebound exercise is simple, inexpensive and enjoyable. It can be a beneficial recreational adjuvant exercise for improving HbA1c , FPG and BMI in T2D individuals in a rural environment and reduce health care costs and pharmacological complications associated with diabetes.

Rehabilitation program for the quality of life for individuals on highly active antiretroviral therapy in KwaZulu-Natal, South Africa: a short report.

Patients on highly active antiretroviral therapy (HAART) spend less time on vigorous activities due to lower aerobic capacity with functional limitations that can be attributed to a detraining effect, resulting in a poor quality of life (QoL). The overall aims of rehabilitation are to restore, to maintain, and to enhance the QoL and this detraining effect could possibly be reversed by a rehabilitation program. This randomized controlled prospective longitudinal descriptive study evaluated the impact of a rehabilitation program of moderate-intensity cycling and treadmill walking exercises with a home program on the QoL for individuals on HAART. Fifty-two participants with baseline QoL values formed the experimental and control groups with a 3-month pretest and posttest using the short-form health survey (SF-36) questionnaire. No adverse effects from exercises were experienced, and 20 (77%) of the experimental and 16 (62%) of the controls completed the program. A significantly higher number of women dropped out (P<0.04), with four (15%) from the experimental group and six (23%) from the control group. There were significant improvements in all QoL domains (P<0.05) for the experimental group compared with the control group, with the physical component summary (P<0.018) and mental component summary (P<0.021) scores being significantly higher after rehabilitation. Sick leave decreased from a mean of 7 days to 3 for the experimental group and 5 for the control group. These results indicate that a rehabilitation program of moderate-intensity exercises with a home program significantly improved the QoL for individuals on HAART. Further research with a comprehensive rehabilitation program and a larger sample is recommended.