Cross-cultural adaptation and psychometric testing of the Yoruba lequesne algofunctional index of knee osteoarthritis among patients with knee osteoarthritis

BACKGROUND

The Lequesne Algofunctional Index of Knee Osteoarthritis (LAIKOA) is a widely used knee osteoarthritis (KOA) outcome measure and is recommended by many international authorities. It has been cross-culturally adapted to many languages, excluding indigenous Nigerian languages. The aim of this study was to cross-culturally adapt and validate the LAIKOA into Yoruba language.

METHODS

This was a validation study. Yoruba LAIKOA was translated and culturally adapted from English version following Beaton's guidelines (including cognitive debriefing). The Yoruba LAIKOA was psychometrically tested for test-retest reliability, standard error of measurements (SEM), smallest detectable change (SDC), internal consistency, and construct validity among 108 Yoruba-speaking patients with KOA recruited from selected hospitals in Ibadan, Nigeria. Participants completed the Yoruba and English versions of LAIKOA, and the Yoruba version of Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM).

RESULTS

The mean age of participants was 63.60 ± 11.77 years. Acceptable internal consistency was observed for the global index and function domain (α = 0.63-0.82) and good test-retest for items and domains (ICC = 0.81-0.995). Item-to-scale correlation was significant (r = 0.28-0.69). Its three domains demonstrated structural validity when subjected to confirmatory factor analysis (CFI = 0.99, TLI = 0.99, RMSEA = 0.02). Construct validity was supported by the correlation between Yoruba LAIKOA and IKHOAM (r = -0.39, p = 0.011). The overall scores and domain scores of the Yoruba and English versions of LAIKOA did not differ significantly. The Yoruba LAIKOA has no floor or ceiling effects.

CONCLUSION

The Yoruba LAIKOA is reliable and valid, and it is recommended for use in clinical settings in southwestern Nigeria and other Yoruba-speaking populations.

Normative scores for select neuropsychological battery tests for the detection of HIV-associated neurocognitive disorder amongst Nigerians

BACKGROUND

The study aimed to derive socio-demographic-corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross-sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla.

AIMS AND OBJECTIVES

To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing.

METHODS

Eligibility criteria were being HIV negative, aged 18-64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS-MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness.

RESULTS

All the participants were Nigerians aged 18-64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)-forwards, while education affected all expect IHDS-MS and DST-backwards. The cut-off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS-MS and DST.

CONCLUSIONS

With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV-associated dementia to a minimum. The lack of variability in the IHDS-MS and DST is unfavourable.

Nigerian physiotherapists’ perception of physiotherapy internship: perceived expectations, experience, and outcomes

Background

Physiotherapy internship in Nigeria was inaugurated in 1994 to allow continuous learning in the clinical setting, connecting theoretical knowledge and workplace practice. The internship program has not been evaluated over the years. The aim of study was to assess physiotherapists’ perceptions of the internship in Nigeria in terms of expectations, experiences, and outcomes.

Methods

A mixed method design of a cross-sectional survey and focus group discussion (FGD) was utilized. An adapted questionnaire was used for the survey. Data was assessed using descriptive statistics and content thematic analysis.

Results

The mean age of the physiotherapists who participated in the survey (147 males; 116 females) and FGD (7 males; 2 females) were 27.4 ± 2.5 and 28.8 ± 2.3 years, respectively. Most participants in the survey perceived their internship experience as good (97.7%), the supervision received as adequate (76%), and the outcomes of internship in terms of usefulness as useful (76%). The overall perception of physiotherapy internship in Nigeria was rated as good by 51% and fair by 47% of participants. However, responders in the FGD reported negative experiences including inadequate or lack supervision. They also reported that they were not formally prepared for internship by their training institutions or receiving health institutions before beginning internship.

Conclusion

Physiotherapy internship in Nigeria was perceived as deficient in structural organization and supervision of the interns. The outcome of internship program was perceived as good even though the experiences were negative.

Effects of aerobic exercise on quality of life of people with HIV-associated neurocognitive disorder on antiretroviral therapy: a randomised controlled trial

BACKGROUND

HIV-associated neurocognitive disorder (HAND) negatively impacts quality of life (QoL) of people living with HIV who are on antiretroviral therapy (ART). Behavioural intervention adjunct to ART may improve QoL of people with HAND. We determine the effect of a 12-week aerobic exercise programme on QoL in people with HAND who were receiving ART.

TRIAL DESIGN

This was a parallel-group, randomised controlled trial with concealed allocation and intention-to-treat analysis.

METHODS

We identified 73 participants diagnosed with HAND. Participants were sampled from an earlier study that examined the prevalence of HAND according to the Frascati criteria. Participants were randomised and allocated to an intervention of 12-weeks of aerobic exercise, comprising three 20-60 min sessions per week of moderate-intensity aerobic exercise using a cycle ergometer. The primary outcome was QoL, which was evaluated using the World Health Quality of Life Questionnaire (WHOQoL)-BREF.

RESULTS

Participants in the exercise (n = 39) and control (n = 35) groups had similar sociodemographic characteristics (p > 0.05). Following the 12-week aerobic exercise programme, participants in the exercise group had improved physical (p < 0.001), psychological (p = 0.008) and environmental (p = 0.001) domains of the QoL (p = 0.001) and overall QoL (p = 0.001) relative to the control group. Similarly, participants in the exercise group had lower depression scores than participants in the control group. Depression scores in the exercise group were still lower 3 months post-intervention (p = 0.007). Only the improvements in physical (p = 0.02) and psychological (p = 0.007) domains of QoL were sustained at 3 months post-intervention.

CONCLUSIONS

Aerobic exercise improves the QoL of people with HAND. To ensure sustained benefits, people with HAND may need to engage in long-term physical exercise. Trial registration The trial is registered with the PAN African Trial Registry (PACTR). Date: 01/09/2020, ID: PACTR202009483415745.

Psychometric testing of Ibadan low back pain disability questionnaire

Background

The Ibadan Low Back Pain Disability Questionnaire (ILBPDQ) was developed to meet the need for a LBP treatment outcome measure that was appropriate for the Nigerian culture and environment. The objective of this study was to determine the psychometric properties of ILBPDQ.

Methods

This study used the validation design. One hundred and forty-two participants with LBP (LBPPs) and 142 age and sex-matched participants without LBP (NLBPPs) were included. The LBPPs were recruited consecutively from Physiotherapy clinics of selected tertiary hospitals in the six geopolitical zones of Nigeria. Both LBPPs and NLBPPs completed the ILBPDQ - the LBPPs completed the Numerical Pain Rating Scale (NPRS). The ILBPDQ was completed by 113 LBPPs two days after initial assessment. Sixty-four of the LBPPs received physiotherapy for 5-weeks, after which they were reassessed using ILBPDQ and NPRS.

Results

ILBPDQ score of LBPPs was significantly higher than that of NLBPPs (construct validity) and LBPPs NPRS score correlated significantly with their ILBPDQ score (r = 0.50) at baseline and post intervention (r =0.35) (divergent validity). ILBPDQ scores at baseline and 48 hours later for LBPPs correlated significantly (Intra Class Correlation =0.80) (test re -test reliability). Cronbach's α for ILBPDQ was 0.84 (internal consistency). The postintervention ILBPDQ and NPRS scores for LBPPs were significantly lower than their pre-intervention ILBPDQ scores (responsiveness) and NPRS scores. The changes in ILBPDQ and NPRS scores of the LBPPs correlated significantly (r =0.62) (responsiveness).

Conclusion

The ILBPDQ demonstrated evidence of validity, reliability and responsiveness.

Funding

University of Ibadan Senate Research Grant.

Femoral Anteversion Angles in Dry Bones of Adult Nigerians: A Comparison of Two Methods

BACKGROUND

Version describes the angle in the axial plane subtended by the femoral neck and the femoral shaft. Femoral version varies among various major geographic and racial populations. Femoral version plays a role in some orthopaedic operations. This study documented femoral version among Nigerians comparing two methods on dry femoral bones.

METHODOLOGY

This was a prospective descriptive study that involved measurements of femoral anteversion and retroversion angles on dry femoral bones using the Kingsley Olmsted (KO) method and digital measurement using a free software, IC Measure® from imaging source (The imaging source, Europe GmbH, Uberseetor 18, 28217 Bremen. Germany) Forty-eight (48) adult dry femoral bones were measured. The results obtained from these measurements were analyzed using Stata 13 (StataCorp, Texas, USA) RESULTS: The average value of anteversion angle using the Kingsley Olmsted (KO) method was 20.50 ± 5.50. The average anteversion angle using IC measure was 21.30 ± 6.00. The observed agreement was 16.67%. (Expected agreement was 5.21 %.) The measurements obtained from both KO method and digital photograph using IC measure showed high correlation with each other (r = 0.89, P < .0001).

CONCLUSION

The mean anteversion angle from this study was 20.50 ± 5.50 and 21.30 ± 6.00 using the KO and digital measurements respectively. These values further elaborated that the average anteversion angle is higher in Africans compare to other racial groups. Orthopaedic surgeons should be aware of this fact during surgical operations that involve proximal femur, such as femoral derotation, hemiarthroplasty and total hip replacement in Africans.

Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire

Background

Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment.

Objective

This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ).

Methods

Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version.

Results

The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP.

Conclusion

A scale for assessing disability in LBP is made available for use in Nigeria and similar populations.

Funding

None declared

Cross-cultural adaptatiion and validation of the stroke specific quality of life 2.0 scale into Hausa language

BACKGROUND

The Stroke Specific Quality of Life 2.0 (SS-QoL 2.0) is a widely used scale that has been cross-culturally adapted to many languages including Yoruba, one of the three major Nigerian languages. Non-availability of SS-QoL 2.0 in Hausa, the indigenous language of Northern Nigeria has restricted its use in Hausa stroke-survivors (SSV). This study was aimed at cross-culturally adapting SS-QoL 2.0 to Hausa and assessing validity and reliability of the Hausa version. The English version of SS-QoL 2.0 was cross-culturally adapted to Hausa following the American Association of Orthopaedic Surgeons' guideline. A final Hausa version (FHV) was produced through forward and back-translations, expert committee review, pretesting and cognitive debriefing interview. The FHV was investigated for test-retest reliability, internal consistency, convergent, construct and known-group validity on 86 consenting Hausa SSV. Hausa version of WHOQoL-BREF was used to assess convergent validity (n = 57) while English versions of SS-QoL was used to assess construct validity (n = 51) of FHV. The FHV was re-administered on 53 of the participants at 7-day interval to assess test-retest reliability. Each scale was administered in random order to eliminate bias. Data were analysed using Spearman correlation, Cronbach's alpha, Intra-class Correlation Coefficient (ICC), Independent t-test and One-way ANOVA at p < 0.05.

RESULTS

The SS-QoL 2.0 was successfully cross-culturally adapted to Hausa. Participants' mean overall score on SS-QoL 2.0 (145.30 ± 39.78) did not differ significantly from that of FHV (150.41 ± 40.45) p = 0.28. The mean domains score did not differ significantly except in self-care and work domains. There were weak to good correlations for 6 out of 8 similar domains on Hausa versions of SS-QoL and WHOQoL-BREF (r = 0.21-0.61; p = 0.001-0.006); and good to excellent correlations between Hausa and English versions of SS-QoL (r = 0.70-0.92; p = 0.001). The FHV showed high to excellent test-retest reliability (ICC = 0.86-0.99) and acceptable to excellent internal consistency (Cronbach's α = 0.71-0.90). No significant gender differences were demonstrated for any domains of FHV and for most domains across age groups.

CONCLUSION

The FHV is valid and reliable. The scale is recommended for assessing health-related quality of life among Hausa stroke survivors.

A comparative survey of Nigerian physiotherapists' familiarity with, knowledge of and utilisation of standard outcome measures: 10 years after initial survey

Background

The need for physiotherapists to use standardised outcome measures (SOMs) is recognised and recommended in clinical practice guidelines in many countries.

Aim

To evaluate changes in physiotherapy practice in Nigeria on the utilisation of SOMs and physiotherapists’ familiarity with and knowledge of SOMs over the past decade.

Methods

A comparative cross-sectional survey of present data with 2006 data was undertaken. The existing validated questionnaire of 2006 was used to assess physiotherapists’ familiarity with, knowledge of and utilisation of 16 SOMs.

Results

There was a noticeable change in familiarity with and utilisation of 16 SOMs in the current data and in knowledge. Between 52% and 90% of physiotherapists were not familiar with 14 SOMs in 2006, whereas 51.4% – 85.8% of physiotherapists were not familiar with 8 SOMs in 2016; 77% – 97% and 63.4% – 97.3% of physiotherapists were not utilising SOMs in the 2006 and 2016 data, respectively. The least utilised SOMs in 2006 were Western Ontario McMaster Osteoarthritis Index, Chedoke McMaster Stroke Assessment and SF-36 Health Survey; in 2016, it was only the Chedoke McMaster Stroke Assessment. The Visual Analogue Scale and Gross Motor Function Measure remained the most utilised in both data. Duration of practice, age and sex were significant factors for the utilisation of and familiarity with SOMs.

Conclusion

There was an improvement in the familiarity with, knowledge of and utilisation of SOMs over the past decade among Nigerian physiotherapists but the level of utilisation is unsatisfactory. Action is required if routine outcome measurement is to be achieved.

Clinical Implications

Utilisation of SOMs is part of core standards of physiotherapy practice for effective management of patients. Although the utilisation of SOMs improved over the past 10 years, it is very low. Therefore, studies directed at finding factors responsible for low utilisation of SOMs among Nigerian physiotherapists are warranted.

Factors influencing the use of outcome measures in knee osteoarthritis: A mixed method study of physiotherapists in Nigeria

Background: Osteoarthritis (OA) of the knee constitutes a significant proportion of musculoskeletal disorders managed in physiotherapy clinics worldwide. Best practice guidelines in the management of OA ensure the use of outcome measures. Aim: This study explored the factors influencing the use of outcome measures in management of patients with knee OA among physiotherapists in southwestern Nigeria. Methods: Mixed method design was used that involved a cross-sectional survey of 77 purposively selected physiotherapists and a focus group discussion with another 6 physiotherapists. Results: Participants (48 males, 29 females) were aged 35.3 ± 7.3 years. Fifty-two (67.5%) participants reported the use of outcome measures in the treatment of the patients with knee OA. The perceived barriers reported were lack of time/heavy workload (55.9%); lack of standardization of outcome measures (45%); lack of motivation (36.4%); and nonavailability of outcome measures in the clinic (36.4%). Reported perceived facilitators include interest/need to track patient's progress and ethical practice (87.1%); familiarity with outcome measures (87.0%); and understanding of the benefits of using outcome measures (87.0%). Conclusion: There is a need to establish good organizational structure focusing on the use of outcome measures in practice and development of a concessional toolkit of short and easily applicable instruments with user description.

Body Size Perceptions and Weight Status of Adults in a Nigerian Rural Community

Background:

Overweight and obesity are now recognized worldwide as increasing public health problems throughout the life course and wrong perception of one's body size may reduce the motivation for an overweight person to lose weight.

Aim:

This study was conducted to investigate how Nigerian rural dwellers perceive their body size and how their perception agrees with their body mass index (BMI).

Subjects and Methods:

A cross-sectional sample of 183 adults living in a rural community, South-West Nigeria was randomly recruited into the study. Their verbal and visual body size perceptions were assessed through structured questions and body images. Descriptive and inferential statistics were used to analyze the data.

Results:

Thirty-five percent (64/183) of participants were classified as either overweight or obese by BMI. More than half of the participants perceived themselves as normal weight. More women perceived themselves to be obese than men in both verbal and visual perceptions. Based on BMI classification, 43% (79/183) and 54% (98/183) of participants misperceived themselves in verbal and visual perception, respectively. Underestimation of body size was higher in men (38.3%, 36/94) while overestimation was higher in women (9.0%, 8/89). Men had consistently higher values of kappa coefficient which indicate greater agreement than women in both types of perception.

Conclusion:

We found considerable gender differences in body weight perception of adults in the Nigerian rural community. A large proportion of these rural dwellers could not appropriately classify their weight status; and over 30% (64/183) and nearly 50% (92/183) of them underestimated their own body weight in verbal and visual perceptions respectively.

A randomized controlled trial of the effects of aerobic dance training on blood lipids among individuals with hypertension on a thiazide

PURPOSE

Hypertension is associated with dyslipidemia. Thiazides adversely affect serum lipid levels in hypertensives. There is currently a dearth of information on benefits of aerobic exercise training on serum lipid levels in individuals on thiazides and this study aimed at bridging this gap in knowledge.

METHODS

This randomized-controlled trial involved 120 newly-diagnosed adults with essential hypertension (≥65 years). They were treated with 50 mg of hydrochlorothiazide + 5 mg of hydrochloride amiloride and 5 or 10 mg of amlodipine for 4-6 weeks before they were randomly assigned into exercise group (EG) and control croup (CG). Only EG underwent 12-week aerobic dance training at 50-70 % of heart rate reserve three times per week. Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglyceride and total cholesterol were measured and recorded at baseline and post-study.

RESULTS

Eighty-eight (45 in EG and 43 in CG) of 120 participants randomly assigned to groups completed the study. Systolic (p = 0.370) and diastolic (p = 0.771) blood pressures (BP) were similar between the two groups at baseline. Systolic (p < 0.001) and diastolic (p < 0.001) BPs reduced significantly in exercise and control groups. LDL-C (from 120.10 ± 33.41 to 110.50 ± 31.68 mg/dl; p = 0.037) and triglyceride (from 117.49 ± 45.12 to 100.63 ± 35.42 mg/dl; p = 0.002) decreased in EG post-study but no significant between-group differences were observed.

CONCLUSIONS

Although, LDL-C and triglyceride are reduced after aerobic dance training, they were not any more than without it. Aerobic dance training has favorable effects on LDL-C, triglyceride, and systolic and diastolic BP in individuals with hypertension on a thiazide.

Sexual dysfunction in Nigerian stroke survivors

BACKGROUND

Over three-quarters of stroke survivors experience disruption of sexual functioning. Studies reporting poststroke sexual function of Nigerian patients are few.

OBJECTIVES

This survey reports sexual dysfunction in Nigerian stroke survivors, and determines the influence of sociodemographic, clinical and psychological factors on the dysfunction.

METHODS

Participants were 77 stroke survivors (60 males; 17 females) recruited consecutively from a teaching hospital. Participants completed the Beck Depression Inventory, Stroke Specific Quality of Life Scale and post-stroke sexual function questionnaire. Participants' motor ability was rated on the Modified Motor Assessment Scale. Data were analysed using Chi square test and Mann-Whitney U test (alpha level set at 0.05).

RESULTS

Participants were aged 55.2 ± 10.8 (28-79) years. Most (94.8%) participants reported a dysfunction in sexual function. Decline in libido and coital frequency were reported by >70% and in erection, ejaculation and orgasm by >60% of participants. Participants' with erectile dysfunction were significantly older than those without (U=267.0; p=0.02). Depression, quality of life, willingness to have sex, general attitude to sex and ability to express sexual feelings had significant influence on sexual dysfunction reported by participants (p<0.05).

CONCLUSION

Our findings suggest that sexual dysfunction is common among Nigerian stroke survivors and it is mostly associated with psychological factors.

Relationship between post-stroke functional recovery and quality of life among Nigerian stroke survivors

AIMS AND OBJECTIVES

This study explored relationship between post-stroke functional recovery and QoL among Nigeria SSv with first-ever stroke.

PATIENTS, MATERIALS AND METHODS

This Study involved 65 (33 males and 32 females) individuals diagnosed of first-ever episode of stroke in the University College Hospital, Ibadan, Nigeria. The National Stroke Severity scale was used to assess their stroke sequeles. Their functional performance and QoL was assessed using the combination of the standard values of Barthel Index and Frenchay Activities Index, and the Stroke-Specific QoL questionnaire respectively. They were assessed at 14 days and fortnightly for 12 months post-stroke. Data were analysed using the Pearson's Moment Correlation and paired t-test at p=0.05.

RESULTS

Fifty-five (84.61%) out of the 65 SSv completed this study while 10 (15.39%) died. Participants' age was 58.1±15.7 years with majority (90.6%) of them between 40 years and 79 years. Mean QoL score increased significantly at day 14-day through 6-month and non-significantly through 12-month post-stroke. Mean functional performance significantly increased from 3.2±2.1 at day 14 to 66.3±14.2 at 6-month but non-significantly from 6-month to 76.14±12.1 at 12-month post-stroke. Their functional recovery had direct positive relationship with their QoL scores during the 12 months follow-up.

CONCLUSION

Stroke has negative impact on both the functional performance and quality of life of stroke survivors. Quality of life of stroke survivors increases with improvement in functional recovery.

Development of the tibiofemoral angle in a cohort of Nigerian children during the first 3 years of life

PURPOSE

Findings from cross-sectional studies of knee angle development in Nigerian children vary in values and in the age at which the varus angle changes to the valgus angle. This study was conducted to describe knee angle development and to determine the age when the knee angle changes from the varus to the valgus angle.

METHODS

This was a longitudinal survey of 152 Nigerian children recruited within 3 weeks of life and followed up monthly until age 3 years. Their knee angle was measured using clinical methods.

RESULTS

The mean tibio-femoral/varus knee angle (13.2 ± 3.8°) at birth-3 weeks of life decreased sharply to 5.6 ± 0.7° at 9 months, increased slightly to 6.3 ± 1.1° at 13 months, and then decreased again up to age 18 months (0.3 ± 2.1°). The mean valgus knee angle increased from -2.4 ± 2.5° at 19 months of life to -8.5 ± 2.5° at 27 months and then decreased to -7.7 ± 2.2° at 36 months. Intercondylar/intermalleolar distances (ICD/IMD) showed a similar pattern, changing from an extreme varus knee (ICD) at birth-3 weeks of life (2.5 ± 0.7 cm), decreasing to 0.6 ± 0.2 cm at 9 months, increasing to 0.8 ± 0.5 cm at 12 months, and decreasing to 0.1 ± 0.4 cm at 15 months. The mean IMD increased from -0.1 ± 0.8 cm at 16 months of life to -2.0 ± 1.5 cm at 29 months and then decreased up to 36 months. Our tri-modal analysis showed that the transition from the varus to the valgus angle was between 18 and 19 months.

CONCLUSION

Our findings suggest that the developmental pattern of the knee angle in Nigerian children is at maximal varus at birth, neutral at 18 months of life, and valgus at 19 months, with the valgus angle continuing to increase up to 36 months.

Effects of aerobic exercise and drug therapy on blood pressure and antihypertensive drugs: a randomized controlled trial

BACKGROUND

Although aerobic exercise has been shown to lower blood pressure (BP) in human beings, its additive BP-reducing effect on antihypertensive drug therapy seems to have been investigated in only laboratory animals.

OBJECTIVES

This study investigated the effects of aerobic dance combined with antihypertensive drugs on BP and number of antihypertensive drugs in individuals with hypertension.

METHODS

This open label randomised-controlled trial involved new-diagnosed male and female individuals with mild-to-moderate essential hypertension after at least four weeks of treatment. They were randomly assigned to drug therapy (Normoretic: Hydrochlorothiazide + amiloride hydrochloride, and Amlodipine) (control: n=33) and aerobic dance combined with drug therapy (exercise: n=30) groups. Intervention in each group lasted 12 weeks. BP was measured at baseline and during and pos-intervention. Number of antihypertensive drugs was recorded post-intervention.

RESULTS

There were significant reductions in SBP at some periods of the intervention in the exercise group (p=0.000 to 0.002) and control group (p=0.001 to 0.002), and significant difference in DBP at some periods of the intervention in exercise group (p=0.000 to 0.003) and control group (p=0.000 to 0.001). SBP (p=0.066) and DBP (p=0.100) did not differ between the two groups post-12-week intervention. The BP control rates were similar between the exercises (56.7%) and control (35.5%) groups (p=0.075). Similarly, between-group difference in the number of drugs was not significant (p=0.511).

CONCLUSION

This preliminary report demonstrates the tendency of aerobic dance to enhance BP control in individuals on two antihypertensive drugs without BP control.

Perceived body image and weight: discrepancies and gender differences among University undergraduates

BACKGROUND

Body image (BI) is a multidimensional construct that includes perceptual, attitudinal, behavioural components, and feedback from other people's perception of oneself. The feedback from others and the degree to which one accepts or rejects it can determine self evaluation and perception. Body weight perception is a strong determinant of nutritional habits and weight management among adolescents. One of the barriers to reducing rise in obesity prevalence could be its cultural acceptability in some developing countries.

OBJECTIVE

To explore the gender influences on perception of self- and opposite-sex body images (BI), perceived body weight and the actual body weight categories at which discrepancies occur among the perceived BIs in undergraduates.

METHODS

This was a survey of perceptual dimension of BI, perceived body weight and actual body weight carried out in 121 undergraduates aged 21-29 years.

RESULTS

Discrepancies occurred between self-perceived BI and each of actual body weight (p= 0.00 at 0.00-0.02 confidence interval (CI)), perceived body weight (p= 0.01 at 0.000-0.02 CI) and self-ideal BI (p= 0.03 at 0.000-0.05 CI) of normal-weight males. Self-perceived BI and perceived body weight also differed in normal-weight females (p= 0.02 at 0.000-0.04 CI). Discrepancies (p= 0.02 at 0.00-0.04 CI) occurred between self-perceived BI and self-ideal BI, and between self-perceived BI and desired BI (p= 0.02 at 0.00-0.04 CI) in overweight females. Gender differences occurred for self-ideal BI (p= 0.00 at 0.00-0.02 CI), ideal image for the opposite sex (IBIOS) (p= 0.02 at 0.00-0.04 CI) and desired BI (p= 0.00 at 0.00-0.02 CI).

CONCLUSION

Normal-weight males perceived their BI differently from their actual body weight, perceived body weight and self-ideal BI whereas normal-weight females perceived their BI differently from only their perceived body weight. Discrepancies occur between self-ideal BI and self-perceived BI, and between self-perceived BI and desired BI in overweight females. There are differential perceptions of self-ideal BI, IBIOS and desired BI between males and females.

Prevalence, pattern and impact of depression on quality of life of stroke survivors

Abstract Objective. This study documented the incidence, pattern and impact of depression on QoL of stroke-survivors within 6-month post-stroke. Methods. This study involved 65 stroke survivors consecutively recruited at ictus from a tertiary health institution in Nigeria. The National Institute of Health Stroke-Scale, Stroke-Specific Quality-of-Life (SSQOL), international classification of diseases (tenth edition) and Center for Epidemiological Scale-Depression (CES-D) were administered at ictus to assess stroke-severity, QoL and depression respectively. The SSQOL, ICD-10 and CES-D were subsequently administered every other week for 6 months. Data were treated using Spearman's correlation coefficient, Mann-Whitney U-test and multivariable stepwise linear regression analysis (P=0.05). Results. Participants were age 58.1±15.7 years; 38 and 27 hemorrhagic and ischaemic stroke respectively. Twenty-six (40%) and 60.0% had moderate and severe stroke, respectively. The QoL at post-stroke periods were significantly influenced (P<0.05) by depression, age, marital status, spouse supports, stroke-severity, and educational-attainment. Depression determined (P<0.05) poor QoL in stroke-survivors. Co-morbidity with stroke severity was a determinant (P<0.05) of poor QoL and death. The haemorrhagic stroke survivors had significantly higher (P<0.05) QoL at post-stroke periods. Conclusion. Depression is associated with stroke. It is common within the first 6 months post-stroke and has negative impact on quality of life of stroke-survivors.

Adiposity and quality of life: a case study from an urban center in Nigeria

OBJECTIVE

To determine relationship between adiposity indices and quality of life (QOL) of residents of a housing estate in Lagos, Nigeria.

DESIGN

Cross-sectional survey employing multistep random sampling method.

SETTING

Urban residential estate.

PARTICIPANTS

This study involved 900 randomly selected residents of Abesan Housing Estate, Lagos, Nigeria.

MAIN OUTCOME MEASURES

Body mass index (BMI); waist circumference (WC); waist-to-hip ratio (WHR); triceps skin-fold thickness (TSFT); and abdominal skin-fold thickness (ASFT) were measured using International Standard of Anthropometric Assessment methods. QOL was assessed using Short Form-20.

ANALYSIS

Data were analyzed using the Pearson product moment correlation coefficient and multiple regression analysis.

RESULT

The mean age of participants was 37.7 +/- 14.3 years, with a range of 20 to 80 years. The mean values of adiposity indices were 24.1 +/- 4.3 kg/m(2) (BMI), 11.5 +/- 5.3 mm (TSFT), 18.5 +/- 6.2 mm (ASFT), 81.8 +/- 11.2 cm (WC), and 0.89 +/- 0.1 (WHR). Although the overall mean QOL score was 72.02 +/- 11.9, women had significantly (P < .05) lower scores (70.1 +/- 5.2) than men (73.5 +/- 11.3). There was inverse correlation between QOL and each of the age and adiposity indices.

CONCLUSION AND IMPLICATIONS

Quality of life of the urban-dweller Nigerians decreased with increasing body adiposity and age. This finding suggests the need to further educate the Nigerian public on the association between high body fat and poor health.

Validity and internal consistency of a Hausa version of the Ibadan Knee/Hip Osteoarthritis Outcome Measure

BACKGROUND

The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed for measuring end results of care in patients with knee or hip OA in Nigeria. The purpose of this study was to validate a Hausa translation of IKHOAM in order to promote its use among the Hausa populations of Nigeria and other West African countries.

METHODS

Sixty-seven patients with knee OA, literate in Hausa and English, recruited consecutively from all government hospitals in Kano were assessed on both English and Hausa versions of IKHOAM. The order of assessment with the versions was randomized and separated by 24 hours. Participants also rated their pain intensity on the Visual Analogue Scale. Data was analyzed using the Spearman Rank Order correlation and Cronbach's alpha.

RESULTS

The participants (17 males, 50 females) were aged 55.7 +/- 13.4 years. Participants' scores on the Hausa version correlated significantly with the original version (r = 0.67, p = 0.000) and with pain intensity scores on the Visual Analogue Scale (r = -0.24, p = 0.005). The Cronbach's alpha for correlation on the different parts of the Hausa version ranged between 0.28 and 0.95.

CONCLUSION

The Hausa version of IKHOAM meets the criteria for validity and internal consistency and may be used in the Hausa speaking parts of Nigeria and other West African countries.

Comorbidity and impact of chronic spinal pain in Nigeria

STUDY DESIGN

A cross-sectional survey of households selected using multistage stratified sampling.

OBJECTIVE

This paper investigates the prevalence of chronic spinal pain, its profile of comorbidity, and its impact on role disability in Nigeria.

SUMMARY OF BACKGROUND DATA

Study was conducted in 21 states representing 57% of the national population. A probability sample (n = 2143) was interviewed.

METHODS

Self-reports of chronic spinal pain, other pain conditions, as well as comorbid medical conditions were obtained. Composite International Diagnostic Interview, version 3, was used to evaluate mood, anxiety, and substance use disorders. Functional role impairment was assessed with questions about days out of role.

RESULTS

Chronic spinal pain was present in 16.4% (95% confidence interval, 14.5%-18.5%) of the sample. Prevalence increased with age of respondents, with 1 in 3 persons 60 years of age and older reporting chronic spinal pain. Persons with chronic spinal pain were at elevated risk to have chronic pain at other anatomic sites, to have a range of medical comorbidities, and to have mood and substance use disorders. Even though about one third of the decrement in functional role performance associated with chronic pain condition was attributable to demographics and comorbid conditions, chronic spinal pain was independently associated with significant role impairment.

CONCLUSION

Chronic spinal pain is a common problem in the Nigerian community, and persons 60 years of age and older may be at particularly elevated risk. Chronic spinal pain is associated with increased probability of comorbid physical and mental disorders. These comorbid conditions partly but do not fully explain the disability associated with chronic spinal pain, which therefore constitutes a substantial health burden on the society.

Validation of a Yoruba translation of the World Health Organization's quality of life scale--short form among stroke survivors in Southwest Nigeria

The World Health Organization's quality of life scale - short form (WHOQOL-BREF) is a well-validated, cross-cultural tool for measuring quality of life (QOL) of patients with chronic diseases. It has been translated into over 20 languages, none of which is an indigenous Nigerianlanguage. The aim of this study was to investigate the validity of a Yoruba translated version of the WHOQOL-BREF Yoruba is the indigenous language of southwestern Nigeria. The English version of the WHOQOL-BREF was translated into Yoruba and it went through two rounds of back-translation. The English and Yoruba versions of WHOQOL-BREF were completed by 41 stroke survivors, literate in both languages. Participants were recruited through purposive sampling method from physiotherapy clinics of all tertiary health institutions in southwestern Nigeria between April and August, 2004. Data was analyzed using Spearman rank order correlation and paired t- test with the alpha level set at 0.05. Participants (24 males, 14 females) were aged 55 +/- 10.7 years and have had stroke for 28.4 +/- 6.7 months. Participants' domain scores on the Yoruba translated version of WHOQOL-BREF correlated significantly with those on its English version (r = 0.695-0.859; p = 0.000). This Yoruba version is a valid translation of the English WHOQOL-BREF and may be used for assessing QOL of stroke survivors in southwestern Nigeria.

Familiarity with, knowledge, and utilization of standardized outcome measures among physiotherapists in Nigeria

Measurement tools that assess changes in patients' clinical status are called outcome measures and their integration into clinical practice promotes objective assessment and evidence-based practice. Healthcare providers' knowledge andfamiliarity with outcome measures are pertinent to their utilization. The purpose of this descriptive survey study was to determine the levels offamiliarity, knowledge and utilization of 16 standardized outcome measures (SOM) among physiotherapists in Nigeria. A 3-part questionnaire was administered (N = 236). Part 1 elicited demographic information, Part 2 assessedfamiliarity and utilization and Part 3 assessed knowledge of the SOM. Results indicated that over 60% of the respondents had never used and were not familiar with 14 out of the 16 SOM, indicating low levels of utilization and familiarity among respondents. Respondents' knowledge about the SOM was low (3.1 +/- 2.5), and correlated positively and significantly (p < 0.05) with their levels offamiliarity with and utilization of the SOM. Working experience had a positive influence on knowledge about SOM, but influence of work setting on familiarity, utilization, and knowledge about SOM was inconclusive. This study suggests that physiotherapists in Nigeria have poor knowledge, seldom utilize, and are unfamiliar with SOM and that the use of SOM should be promoted among them.

Validity and internal consistency of a Yoruba version of the Ibadan knee/hip osteoathritis outcome measure (Yoruba IKHOAM)

The Ibadan Knee Hip osteoarthritis Outcome measure (IKHOAM) was developed for patients with Knee/Hip Osteoarthritis in the Nigerian and similar environments. The Yoruba Version was developed to encourage its use in the Southwestern region of Nigeria. The IKHOAM was translated into Yoruba in four separate processes of translation, back translation, committee review and pre-testing. It was administered to a cohort of 164 outpatients with symptomatic OA of the knee and or Hip who attended physiotherapy units in selected hospitals from Southwestern region of Nigeria. The IKHOAM (English Version) was correlated with the Yoruba version and Visual analogue scale (VAS). The Validity of the Yoruba IKHOAM was found to be satisfactory and comparable to the original version (r = 0.67, p = 0.005) for the criterion-related validity and r = -0.31 (p = 0.005) for construct validity. The items in the Yoruba IKHOAM correlated well with each other with Cronbach's alpha coefficient ranging between 0.69 and 0.99. The correlation on the different parts of the Yoruba IKHOAM was satisfactory (alpha = 0.52-0.87). The Yoruba IKHOAM like the original version is a reliable consistent and valid instrument that can be considered for use in the Nigeria environment for evidence based quality healthcare promotion in Knee/Hip OA patients.

Nigerian back school model: development and effect on industrial workers' knowledge of back pain and back care

Back schools are health education programmes on back pain. Many back schools have been developed for different populations since 1969 when the first one was developed in Sweden, but none for the Nigerian setting. The need to develop a back school that would be appropriate for the Nigerian environment was therefore identified. As a step towards its development, this preliminary study was carried out to determine the effect of a back school model (BSM) on some Nigerian industrial workers' knowledge of low back pain and back care. The subjects were 110 workers of a soap industry in Lagos, Nigeria. Apre-test, post-test quasi-experimental design was used. The BSM consisted of two 45 minute teaching sessions on structure and functions of the back, epidemiology and causes of back pain, correct postures and demonstration of exercises that may prevent/alleviate back pain. Data on demographic information, low back pain (LBP) experience, knowledge of back structure and back care were collected using a questionnaire with closed ended questions, which was completed before, immediately after and 8-weeks after BSM administration. The results showed that the subjects' mean knowledge score increased significantly from an initial value of 16.1 + 5.3 to 24.0 + 5.6 (p < 0.05) immediately after and 23.1 + 3.9 (p < 0.05) 8 weeks after BSM administration. Educational attainment had no influence on subjects' knowledge scores before or 8 weeks after BSM administration. Reported experience of LBP and duration on the job had no significant influence on subjects' knowledge scores before, immediately or 8-weeks following BSM administration. It was concluded that the BSM was effective in improving the workers' knowledge of LBP and back care. We believe that this findingjustifies the effort to develop the Nigerian model of back school.

Normal values of knee angle, intercondylar and intermalleolar distances in Nigerian children

There is little data on the range of variation of knee angle, intermalleolar and intercondylar distances in African children. Such measurements are needed to assist determining whether a child legs are normal or not. Knee angle intermalleolar and intercondylar distances were measured in 2166 Nigerian children aged one year to 10 years to establish normal values for these measurements. In the study we discovered that knees were maximally bowed at ages 1-3 years and reduced to neutral of 0 degrees at age five (5 years) in girls and age seven (7) in boys. Both sexes had no bowing after age (7 years) in boys. Both sexes had no bowing after age of 7 years. The valgus angle was found to be constant at about 11 degrees between ages 1-10 years in both sexes. Mean intercondylar distance was 0.2 cm at 1 year of age and did not vary significantly at 10 years of age. The greatest intermalleolar distances of 2.5 cm and 2.2 cm were noted between the ages of 2 and 4 years. Normograms of these measurements are presented as diagnostic aids in clinical settings.

Correlative study of 3 pain rating scales among obstetric patients

The relationship between pain scores obtained on the Visual Analog Scale (VAS) the Box Numerical Scale (BNS) and Verbal Rating Scale (VRS) was studied. The subjects were 35 volunteer female patients who had their babies through caesarian section 1-3 days prior to the study. Demographic data and pain scores were collected through a questionnaire, which was available in both English and Yoruba, the two most commonly spoken languages in Ibadan where the study was carried out. Data were analysed using Pearson Product, Moment Correlation Coefficient, and One-way Analysis of Variance. Results indicated that there was no significant difference between the pain scores obtained on the 3 pain rating scales. Significant correlations existed between pain scores obtained on the VAS and VRS (r = 0.48, p = 0.003); VAS and BNS (r = 0.74, P = 0.000); BNS and VRS (r = 0.74, P = 0.000). High educational attainment improved correlation between the scales in this study. It was concluded that the three pain rating scales measure the same construct, and could be used for pain measurement in obstetrically related conditions in this environment.

Responses of the African hypertensive to exercise training: preliminary observations

The aim of the study was to investigate the effect of exercise on blood pressure in hypertension. Ten hypertensives served as study subjects, and ten as controls. The study subjects (mean age 55.7 years) exercised for 42 minutes, three times a week for 12 weeks. The training intensity was 60-70% of heart rate reserve. Controls (mean age 57.2 years) were not subjected to exercise training. Blood pressure was measured at rest and during submaximal exercise test on the bicycle ergometer. The exercise heart rate of the study subjects was significantly reduced after exercise training. There were small but significant reductions in resting and exercise systolic blood pressure and exercise diastolic blood pressure of the study group following the exercise training. There was no significant change in the resting and exercise blood pressure of the control group. The significant blood pressure reductions in the study group were attributed to the exercise training programme. The response of the African hypertensive is similar to those reported in other racial groups, notably Caucasians.

Range of lumbar flexion in chronic low back pain

Thirty low back pain (LBP) patients, and thirty normal controls without any back pain or disease were the subjects for this study. Lumbar flexion was measured using the skin-marking method, a MacRae and Wright's modification of Schober's method. The mean lumbar flexion for the LBP patients (5.25 +/- 2.12 cm) was significantly lower (P 0.05) than that for normal subjects (6.96 +/- 2.0 cm). The normal males had higher value of lumbar flexion than the females. There is also the tendency for lumbar flexion to decrease with advancing age. Measurement of lumbar flexion using skin-marking technique is therefore an objective method of monitoring patients with low back pain.