Characterization and critical appraisal of physiotherapy intervention research in Nigeria: a systematic review.

OBJECTIVES: Clinical research is the bedrock of clinical innovation, education and practice. We characterized and critically appraised physiotherapy clinical research to avoid implementing misleading research findings into practice and to task the Nigerian physiotherapy societies on responsible conduct of clinical research. METHODS: This is a systematic review of articles published in English between 2009 and 2023. We started with 2009 because at least few Nigerian Physiotherapy school had commenced postgraduate (research) training by then. We searched Pubmed, Medline, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO and African Journal Online, and reference lists of relevant articles. We Data were selected and extracted according to predesigned eligibility criteria and using a standardized data extraction table. Where appropriate, the Pedro and Cochrane ROBINS1 were used to examine the risk of bias. RESULTS: A total of 76 Nigerian studies were included in this study. The mean age of the study participants was 46.7 ± 8.6 years. Approximately, 45% of the participants were males. Of the clinical experiments, the randomized controlled trial (RCT) was the most common design (87.5%). Musculoskeletal conditions (39.3%) were the most studied disorder. Approximately 86% of the RCT had studies possessed fair to good quality. Interventions constituted exercise therapy (76.3%), manual therapy (8.5%) and electrotherapy (8.5%). More than half (67.8%) of the studies recorded medium to large effect sizes. A fair proportion (48.2%) of the studies had a confounding-by-indication bias. Approximately 43% of the clinical experiments were underpowered, and a few studies conducted normality tests (10.9%) and intention-to-treat analysis (37.5%). CONCLUSIONS: RCT is the most frequent clinical experiment, with majority of them possessing fair to good quality. The most important flaws include improper computation of sample size, statistical analysis, absent intention-to-treat approach, among others. The magnitude of effects of Physiotherapy interventions varies from nil effect to large effect. Musculoskeletal condition is the most prevalent disorder and exercise is the most important intervention in Nigerian physiotherapy practice. TRIAL REGISTRATION: We registered the protocol with PROSPERO. The registration number: CRD42021228514.

Intermachine Variation of Ultrasound Strain Elastographic Measures of the Quadriceps and Patellar Tendons in Healthy Participants: Implications for Clinical Practice.

OBJECTIVES: To evaluate intermachine variation and compare intraoperator and interoperator agreement and repeatability characteristics of 2 ultrasound (US) systems for measurements of quadriceps and patellar tendons by strain elastography (SE). METHODS: Forty tendons from 20 healthy participants were investigated by operators with different experience (operator 1, 12 years of US experience and >50 SE examinations; operator 2, no US experience and 1 day of SE training). Repeated measures were performed on GE Healthcare (Waukesha, WI) and Esaote (Genoa, Italy) US systems. The percentage of agreement, Cohen κ, intraclass correlation coefficient, and correlation tests assessed agreement, repeatability, and associations of SE measures. A paired t test and Wilcoxon signed rank test assessed differences in SE measures. RESULTS: The study participants included 5 male and 15 female volunteers (mean [range] age, 29.3 [21-39] years). Better agreement and repeatability characteristics were observed for the patellar compared to the quadriceps tendon and the color score (CS) method over the elasticity ratio (ER). Intraoperator agreement was better for the experienced operator. Intraoperator repeatability was achieved in 55% of ER (intraclass correlation coefficient, 0.40-0.91; P < .05) and 77% to 85% (κ = -0.25-1) of CS measures. Interoperator repeatability was achieved in 35% (t/z, -2.93-7.94; P < .001-.048) of all ER measures. No significant differences in proximal (z, -0.13- -0.78) and distal patellar (z, -1.52-2.26; P > .5) patellar ER measures were observed. Seventy-four percent to 75% mean agreement (κ = 0-0.5) for CS measures comparable across both US systems was observed. Intermachine ER associations were poor (r = -0.39-0.13; P > .05), whereas greater than 70% agreement (κ = -0.87-0.53) for the CS was achieved. CONCLUSIONS: The reproducibility of knee tendon SE measurements is influenced by the operator experience, US system, and tendon site.

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.

Physical inactivity among internally displaced persons in Nigeria.

Background: Physical inactivity may complicate physical and mental health problems among internally displaced persons (IDPs). This study aimed to assess the prevalence of physical inactivity and its sociodemographic correlates among IDPs in Northeastern Nigeria. Methods: A total of 363 participants recruited from four IDP camps were categorized into physically inactive and active using International Physical Activity Questionnaire. Multiple logistic regression was used to explore the association between physical inactivity and sociodemographic correlates. Results: The prevalence of physical inactivity was 36.2%. Those who were males (Odd Ratio (OR) = 4.52, 95% Confidence Interval (CI) = 2.33 to 8.78) and Kanuri (OR = 2.53, 95% CI = 1.44 to 4.45) were more likely to be physically inactive. Younger participants were less likely to be physically inactive than those who were aged >49 years old. Conclusion: There is a high prevalence of physical inactivity among IDPs in Nigeria, and we found important sociodemographic factors associated with physical inactivity.

Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis.

OBJECTIVE: The aim was systematically to identify and evaluate factors related to fatigue in individuals with hip and/or knee OA. METHODS: A systematic literature search was conducted using AMED, CINAHL, MEDLINE, ProQuest and Web of Science Core Collections databases. Inclusion criteria comprised cross-sectional, case-control or longitudinal studies on patients with a diagnosis of hip and/or knee OA that included self-reported fatigue measures. Study quality was assessed using the National Heart, Lung and Blood Institute quality appraisal tool, and factors were synthesized within a bio-behavioural framework. Study designs and quality were combined to determine current evidence levels using best evidence synthesis grading. The full review protocol is available from PROSPERO (PROSPERO 2019: CRD42019138571). RESULTS: Twenty-four studies were included, of which 19 were high, 4 moderate and 1 low quality. There was strong evidence of an association between poor self-reported physical function and high depressive symptoms with higher fatigue. Moderate evidence of an association was found between severe pain, high numbers of co-morbidities and low physical activity levels with higher fatigue. There was moderate or limited evidence of no association between most sociodemographic factors and radiographic OA severity with fatigue. CONCLUSION: Targets for fatigue management might include improving physical function, reducing depressive symptoms, pain and co-morbidities, and increasing physical activity levels. There is a need for more rigorous longitudinal studies to understand the causal effect of fatigue determinants within the hip and knee OA populations.

Determinants of generalized fatigue in individuals with symptomatic knee osteoarthritis: The MOST Study.

AIM: The aim of the study was to identify sociodemographic, disease-related, physical and mental health-related determinants of fatigue at 2-year follow-up in individuals with symptomatic knee osteoarthritis (OA). METHODS: A longitudinal analysis of participants with symptomatic knee OA from the Multicenter Osteoarthritis Study (MOST) was conducted to identify predictors of fatigue at 2-year follow-up. Participants self-reported fatigue at baseline for the first time in the MOST cohort and at follow-up using a 0-10 visual analog scale. At baseline, questionnaires on sociodemographics, disease-related symptoms, physical and mental health factors were completed. Data were analyzed using linear regressions with a backwards elimination approach. RESULTS: Of the 2330 individuals in the MOST cohort at baseline, 576 had symptomatic knee OA and of these, 449 with complete fatigue values at baseline and follow-up were included in this analysis. Minimally important fatigue change (ie, worsening [≥1.13], no change [<0.82 or <1.13] and improvement [≥-0.82]) from baseline to follow-up were unequal within the population (34.5%, 26.9%, 38.5%; χ2 [2, N = 449] = 9.32, P = .009). The multiple linear regression showed that baseline fatigue (unstandardized coefficient [Β] = 0.435; 95% confidence interval [CI] 0.348-0.523, P < .001), slow gait speed (Β = -1.124; 95% CI -1.962 to -0.285, P = .009), depressive symptoms (Β = 0.049; 95% CI 0.024-0.075, P < .001) and higher numbers of comorbidities (Β = 0.242; 95% CI 0.045-0.439, P = .016) were significant predictors of greater fatigue at follow-up. CONCLUSION: Fatigue is strongly associated with physical- and mental-related health factors. Individualized treatments that include combined psychological and physical function rehabilitation might be modalities for fatigue management.

Reliability of ultrasound strain elastography in the assessment of the quadriceps and patellar tendon in healthy adults.

OBJECTIVE: To report the intra- and inter-operator reliability of ultrasound strain elastography measures in the assessment of quadriceps and patellar tendons. MATERIALS AND METHODS: Forty tendons were investigated of 20 healthy volunteers. Five anatomical sites were examined and analysed by three operators of differing levels of experience. Ultrasound was performed over two measures, employing three sonoelastography measurement techniques using a GE S8 with linear probe (L6-15 MHz). The percentage of exact agreement, Cohen's kappa and ICC2,1 were performed to assess intra- and inter-operator reliability. RESULTS: The patellar tendon is more reliably measured across all techniques compared to the quadriceps tendon, particularly the distal region. Colour scoring was the most reliable method of sonoelastography. Colour scoring intra- and inter-operator reliability was better for patella tendon sites across all operators (60-95% agreement range), and greatest for experienced operators. Elasticity index intra-operator reliability was greatest for the most experienced operator compared with the least (ICC range 0.35-0.72 and ICC 0.17-0.60). Elasticity ratio intra-operator reliability of the patella tendon was fair-excellent for the experienced operator (ICC range 0.43-0.91), excluding the mid patellar region (ICC 0.13). Poor-fair inter-operator reliability was observed for elasticity ratio (ICC range 0.0-0.54) and elasticity index (ICC range 0.0-0.57). CONCLUSIONS: Strain elastography of the patellar tendon is more reliable than the quadriceps tendon. Intra- and inter-operator reliability was better when undertaken by more experienced operators. Colour scoring was more reliable than elasticity ratio and index methods. Poor-fair intra- and inter-operator reliability of the elasticity ratio and elasticity index was observed.

Knowledge, Attitudes, and the Practice of Health Promotion among Physiotherapists in Nigeria.

Purpose: In spite of the growing epidemic of non-communicable diseases in Nigeria and the compelling need for the active participation of physiotherapists in health promotion activities around the world, there is no evidence that physiotherapists in Nigeria are engaged in health promotion activities. This study aimed to investigate the knowledge of, attitudes toward, and practice of health promotion among physiotherapists practising in Nigeria. Method: This was a cross-sectional study. We contacted members of the Nigeria Society of Physiotherapy (n = 368) by email; the message contained a link to an online questionnaire. Results: A total of 229 (62%) physiotherapists responded. Most demonstrated a good knowledge of health promotion (approximately 70%) and indicated that they often incorporated aspects of health promotion into their patients' treatment (63%). However, fewer than one-fifth strongly agreed that health promotion was taught in their entry-level programme and had equipped them with the necessary health promotion skills. Conclusions: The majority of the physiotherapists surveyed demonstrated good knowledge and often incorporated health promotion into their routine daily practice. Nevertheless, the respondents stated that their entry-level physiotherapy education had not sufficiently equipped them for health promotion practice. These findings provide a baseline reference that can be used to track capacity building for health promotion practices. The results also highlight important gaps in the physiotherapy entry-level curriculum and the health promotion training needs of physiotherapists in Nigeria.

Objectif : malgré l'épidémie croissante de maladies non transmissibles au Nigeria et le besoin pressant de compter sur la participation active de physiothérapeutes aux activités de promotion de la santé dans le monde, rien n'indique que les physiothérapeutes du Nigeria s'investissent dans la promotion de la santé. La présente étude visait à examiner les connaissances, les attitudes et la pratique des physiothérapeutes qui exercent au Nigeria en matière de promotion la santé. Méthodologie : le présent sondage transversal a été distribué aux membres de la société de physiothérapie du Nigeria (n = 368) dans un message courriel contenant un lien vers un questionnaire en ligne. Résultats : au total, 229 physiothérapeutes (62 %) ont répondu. La plupart ont démontré une bonne connaissance de la promotion de la santé (environ 70 %) et indiqué qu'ils en intégraient souvent des aspects au traitement de leurs patients (63 %). Cependant, moins du cinquième était fortement en accord avec l'affirmation selon laquelle leur programme de base leur avait inculqué les compétences nécessaires en promotion de la santé. Conclusions : la majorité des physiothérapeutes sondés ont démontré de bonnes connaissances en promotion de la santé, qu'ils intégraient souvent à leur pratique quotidienne. Les répondants ont tout de même indiqué que leur formation de base en physiothérapie ne les outillait pas suffisamment pour qu'ils exercent des activités de promotion de la santé. Ces constatations serviront de référence à des mesures de renforcement des capacités dans les pratiques de promotion de la santé. Elles démontrent également des lacunes importantes dans le programme de base et la formation en promotion de la santé des physiothérapeutes du Nigeria.

An Analysis of Work-Related Musculoskeletal Disorders Among Butchers in Kano Metropolis, Nigeria.

BACKGROUND: Butchering is often associated with high rates of work-related musculoskeletal disorders (WRMSDs). However, published work on the prevalence of WRMSDs among butchers in Nigeria is scarce. This is important because meat processing practices differ across geographical and cultural locations. This study was therefore aimed at analyzing WRMSDs among butchers in Kano metropolis. METHODS: Sociodemographic and work-settings information was obtained from 102 male cattle butchers (age, 37.49 ± 11.68 years) through survey. Information on the prevalence and pattern of musculoskeletal disorders was obtained from the respondents using the Standardized Nordic Questionnaire. Additional information on health seeking practices was also obtained using a pro forma. Associations between the prevalence of WRMSDs and each of the sociodemographic data and work settings were explored using Chi-square analysis. The level of significance was set at p < 0.05. RESULTS: The 12-month and point prevalence rates of WRMSDs among butchers in this study were 88.2% and 74.5%, respectively. Whereas lower back complaints (66.7%) were the overall and lower body quadrant's most commonly reported WRMSDs among the butchers surveyed, wrist/hand complaints were the leading upper quadrant's (45.1%) most commonly reported WRMSDs among the respondents. There were significant associations between age and majority of WRMSDs in the body regions. Only 23.3% of the 90 individuals who had WRMSD visited the hospital to seek redress for their WRMSD. CONCLUSION: The prevalence of WRMSDs is high among butchers in Kano Metropolis. Few individuals with WRMSD utilize healthcare facilities. Age is a major risk factor in this setting.

Translation of the fear avoidance beliefs questionnaire into Hausa language.

BACKGROUND: Self-report measures of fear-avoidance beliefs are widely used in clinical practice and research. To date there is no Hausa version of the Fear Avoidance Beliefs Questionnaire (FABQ). This is important as the Hausa language is a widely spoken language in West Africa. OBJECTIVES: The purpose of this study was to translate and validate the Hausa version of the FABQ in patients with non-specific neck pain. METHODS: Two independent bilingual Hausa translators translated the English version of the FABQ into Hausa which was thereafter back translated by one independent bilingual translator. A professional expert panel revised the translations to produce a consensus version. The psychometric testing of the final translated instrument was investigated by surveying 54 Hausa speaking patients with chronic non-specific neck pain. Cross-sectional construct validity was evaluated by comparing Hausa Fear Avoidance Beliefs Questionnaire (FABQ-H) with the English version of the FABQ. Internal consistency of the FABQ-H was examined by Cronbach alpha by comparing the scores between the FABQ-H and its subscales. Test-retest reliability was evaluated by administering the Hausa version twice. RESULTS: The translated Hausa version of FABQ proved to be acceptable. The FABQ-H showed strong correlations (r=0.94, p=0.000) with the original English version. There was also high internal consistency between the FABQ-H and its subscales (physical activity component-alpha=0.88, p=0.000 and work component- alpha=0.94, p= 0.000). The FABQ-H also showed a high test-retest reliability (intra-class correlation coefficient =0.98). CONCLUSION: The FABQ-H demonstrated excellent psychometric properties similar to other existing versions. The FABQ-H is recommended for clinical practice.

Point-of-choice prompts to reduce sitting time at work: a randomized trial.

BACKGROUND: Prolonged sitting is prevalent in the workplace and is associated with adverse health markers. PURPOSE: Investigate the effects of point-of-choice (PoC) prompting software, on the computer used at work (PC), to reduce long uninterrupted sedentary periods and total sedentary time at work. DESIGN: Assessor-blinded, parallel group, active-controlled randomized trial. SETTING/PARTICIPANTS: A convenience sample of office workers from Glasgow, United Kingdom. Data were collected April to June 2010, and analyzed October 2010 to June 2011. INTERVENTION: The education group (n=14) received a brief education session on the importance of reducing long sitting periods at work. The PoC group (n=14) received the same education along with prompting software on their PC for 5 workdays, which reminded them to stand up every 30 minutes. MAIN OUTCOME MEASURES: Sitting time was measured objectively using the activPAL™ activity monitor for 5 workdays at baseline and 5 workdays during the intervention. The number and time spent sitting in events >30 minutes' duration were the main outcome measures. RESULTS: At baseline, participants spent 5.7±1.0 hours/day (76%±9%) of their time at work sitting. Of that time, 3.3±1.3 hours/day was spent sitting in 3.7±1.4 events >30 minutes. There was a significant difference between the groups in the change (intervention to baseline) of both the number (ANCOVA; -6.8%, p=0.014) and duration (-15.5%, p=0.007) of sitting events >30 minutes. During the intervention, compared with baseline, the PoC group reduced the number (paired t-test; -0.11 events/hour, p=0.045) and duration (-12.2%, p=0.035) of sitting events >30 minutes. However, there was no significant difference in total sitting time between groups (-4.4%, p=0.084). CONCLUSIONS: Point-of-choice prompting software on work computers recommending taking a break from sitting plus education is superior to education alone in reducing long uninterrupted sedentary periods at work. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.govNCT01628861.