Exposure to Meta-Analysis During Graduate and Postgraduate Trainings Predicts the Good Knowledge and Use of Randomized Controlled Trials, Systematic Reviews, and Meta-Analyses Among Nigerian Physiotherapists

Background Evidence-based practice (EBP) is essential for physiotherapy as an integral part of the multidisciplinary rehabilitation team. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses are the gold standard in the hierarchy of evidence. However, the extent of knowledge, attitudes, and professional use of RCTs and meta-analyses among physiotherapists in Nigeria remains unclear. Therefore, this study aimed to describe and explore the predictors of Nigerian physiotherapists' knowledge, attitudes, and professional behaviors toward RCTs, systematic reviews, and meta-analyses. Methods In this observational study, an electronic version of an adapted questionnaire assessing the knowledge, attitudes, and professional use of RCTs and meta-analyses was shared across electronic platforms of Nigerian physiotherapy professional organizations. Results We found good overall knowledge (76 {80.8%}) and attitude (83 {88.3%}) toward the use of RCTs, systematic reviews, and meta-analyses for evaluating health interventions. Exposure to meta-analysis during graduate and postgraduate training (odds ratio {OR}, 7.102; 95% CI, 1.680-30.021; p = 0.008) and the presence of a medical library at the workplace (OR, 0.264; 95% CI, 0.070-0.997; p = 0.049) were significant predictors of good knowledge of RCTs, systematic reviews, and meta-analyses. Self-rated (OR, 56.476; 95% CI, 1.356-2357.430; p = 0.034) and overall levels of knowledge (OR, 0.013; 95% CI, 0.000-0.371; p = 0.011) predicted the good use of RCTs, systematic reviews, and meta-analyses among respondents. Discussion To equip physiotherapy practitioners with the requisite skill in using RCTs, systematic reviews, and meta-analyses, graduate and postgraduate trainings should prioritize education on the use of RCTs, systematic reviews, and meta-analyses to inform clinical decisions and practice, while capable workplaces may set up medical libraries to ease access and enhance the use of RCTs, systematic reviews, and meta-analyses.

The Association Between Shoulder Pain and Disability Among Saudi Office Workers

Background and objective Shoulder pain stands out as the most prevalent musculoskeletal issue that office workers face. This type of pain has been observed to be linked to various aspects of one's job. To address this concern, the current research endeavors to examine the impact of digital device use on the intensity of shoulder pain and the extent of disability experienced by office employees in Saudi Arabia. This study is driven by two principal objectives. Firstly, it aims to assess the overall occurrence of shoulder discomfort and functional limitations among the Saudi office worker population. Secondly, it seeks to draw comparisons between the parameters of the shoulder pain and disability scale and the amount of time spent using electronic screens. Methodology This cross-sectional descriptive study was conducted in Riyadh, Saudi Arabia. We recruited 150 participants to measure shoulder pain and disability among office workers. The study was carried out to determine the general frequency of shoulder discomfort and impairment by using the Shoulder Pain and Disability Index (SPADI). The survey was conducted online in June 2022 via Google Forms. The survey questions included data regarding age, sex, year of study, exercise, and duration of computer time per day (hours).  Results This study recruited 150 participants to measure shoulder pain and disability among office workers. The mean age of the cohort was 42.56 ± 2.56 years. Among the total participants, 90 (60%) were male, and 60 (40%) were female. We observed that pain parameters had a negative correlation of -0.008 with screen time. The participants who had high shoulder pain and disability scores were older in age and spent less than two hours on screens, which affects the correlation results, and hence we recommend performing a study involving the younger population working on screen for more than four hours to find the better correlation. At the same time, the shoulder disability score reported a correlation of 0.05, and the overall correlation between SPADI and screen time was observed to be 0.04. Based on these findings, the present study observed a weak correlation between SPADI and screen time. Conclusion These results suggest that while there may be some association between screen time and shoulder pain and disability, it is not substantial. Therefore, it is unlikely that screen time alone significantly contributes to the occurrence or severity of shoulder pain and disability among office workers. Additional factors and variables may need to be explored in future research to gain a more comprehensive understanding of this issue.

Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study

OBJECTIVE

This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital.

PATIENTS AND METHODS

Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence.

RESULTS

778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications.

CONCLUSIONS

In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Retro walking treadmill training reduces C-reactive protein levels in overweight and obese young adults: A randomized comparative study

Background and Aims

Retro walking has been shown to acquire a greater metabolic cost, placing a higher cardiopulmonary demand on the body, when compared with forward walking at a similar speed. The aim of this study was to compare the effect of retro walking with that of forward walking on C-reactive protein (CRP) levels, body mass index (BMI) and blood pressure (BP) and to understand the influence of independent factors namely systolic blood pressure (SBP), diastolic blood pressure (DBP) and BMI on CRP in untrained overweight and obese young adults.

Methods

This was a randomised controlled trial whereby 106 participants underwent either retro walking (n = 53) or forward walking (n = 53) treadmill training four times a week for 12 weeks before and after which CRP, BMI, and BP levels were measured. Comparison of the measured values before and after intervention and between the groups was done and influence of BMI and BP on CRP levels was determined.

Results

Both groups recorded a significant decrease (p < 0.001) in CRP, BMI, and BP levels postintervention. The participants who underwent retro walking training showed a significantly (p < 0.001) higher decrease in all the outcomes as compared with the forward walking group. C-reactive protein levels were seen to be influenced by BMI and DBP.

Conclusion

Retro-walking training leads to greater decrease in CRP, BMI, and BP when compared with forward walking, and CRP levels are influenced by BMI and DBP. Retro walking treadmill training can be used preferentially to bring about reduction in cardiovascular risk factors.

Comparing the effects of retro and forward walking on serum adiponectin levels in obese young adults

Objectives

Retro walking or backward walking expends greater energy and places less stress on joints compared with forward walking at a similar speed. This study conducted in obese young men was primarily aimed at comparing the effects of backward walking with forward walking on adiponectin levels. The secondary aim was to describe the effects of concomitant factors, namely C-reactive protein, body mass index (BMI), waist to height ratio, and waist to hip ratio, on adiponectin levels in obese young men.

Methods

In this randomized comparative study, 102 participants underwent either retro walking or forward walking treadmill training four times a week for 12 weeks before and after which adiponectin, C-reactive protein, BMI, waist to height ratio, and waist to hip ratio were measured. Comparison of the measured values before and after intervention and between the groups was done, and the influence of C-reactive protein, BMI, waist to height ratio, and waist to hip ratio on adiponectin levels was determined.

Results

Adiponectin levels were significantly increased (p < 0.001) and C-reactive protein, BMI, waist to height ratio, and waist to hip ratio were significantly decreased (p ≤ 0.001) post-intervention. The participants who underwent retro walking training showed a significantly higher change in C-reactive protein levels, BMI, and waist to hip ratio compared to the forward walking group (p < 0.001). Adiponectin levels were influenced by BMI (p < 0.001).

Conclusion

Retro walking training leads to a greater increase in adiponectin and reduction in C-reactive protein, BMI, waist to height ratio, and waist to hip ratio compared to forward walking, and adiponectin levels are influenced by BMI. Retro walking treadmill training can be preferentially used to decrease cardiovascular risk factors.