Expert consensus on the minimum clinical standards of practice for Nigerian physiotherapists working in intensive care units: A modified Delphi study

BACKGROUND

Management of patients in intensive care units (ICUs) needs staff with a recommended level of expertise and experience owing to the life-threatening nature of illnesses, injuries and complications that these patients present with. There are no specific guidelines governing physiotherapy practice in ICUs in Nigeria. Hence, there is a need to have expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs as a first step to proposing/developing guidelines in the future.

OBJECTIVES

To assess the expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs in Nigeria.

METHODS

Physiotherapists with working experience in Nigerian ICUs were purposively recruited into the present study using a modified Delphi technique. A questionnaire comprising 222 question items on the role of physiotherapy in critical care was adopted and administered to the participants over three rounds of Delphi procedure (online). Participants checked either 'essential', 'not essential' or 'unsure' for each question item. For each question item to be considered 'essential' or 'not essential', a consensus agreement ≥70% had to be met. Questions without consensus were further modified by providing definition or clarification and presented in subsequent rounds. Data were analysed descriptively.

RESULTS

We recruited 26 expert physiotherapists who consented to the study and completed the first round of the study. The majority of the physiotherapists (n=24) remained in the study after the third round. A total of 178 question items were adjudged to be 'essential' after the first round, and a further 15 and three additional items were subsequently adjudged to be as 'essential' after modifying the outstanding question items during the second and third rounds, respectively. No consensus was reached for 24 items. None of the question items were ranked as 'not essential' after all the rounds.

CONCLUSION

Expert consensus was achieved for a substantial number of question items regarding knowledge and skills for assessment, condition and treatment items of the questionnaire by experienced critical care physiotherapists in Nigeria.

Relationships between respiratory parameters, exercise capacity and psychosocial factors in people with chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) affects respiratory functioning and psychosocial factors. However, little is known about perceived ability of people with COPD to engage in a regular exercise program. This study assessed respiratory parameters, exercise capacity, psychosocial factors and their relations in people with COPD.

METHODS

This cross-sectional study involved patients with COPD recruited from a Nigerian university teaching hospital. Respiratory parameters including forced expiratory volume in 1sec (FEV₁) and forced vital capacity (FVC) were assessed by using a spirometer and FEV₁/FVC ratio was calculated. Participants were sitting upright in a comfortable chair and wearing a nose clip for measurements. The procedure was performed in accordance with the American Thoracic Society criteria. Exercise capacity was assessed by the 6-min walk test (6MWT). Gait speed was assessed by the distance covered in 6min. Perceived exercise self-efficacy (PESE) and rating of perceived exertion (RPE) were assessed by exercise self-efficacy and Borg scales, respectively. Data were analysed using descriptive and inferential statistics. Alpha level was set at P<0.05.

RESULTS

The mean age of the 125 participants was 62.0±7.1years (60% male). The mean values for FEV₁, FVC and FEV₁/FVC were 1.8±0.6L, 2.4±0.5L and 58.0±8.8%, respectively, and the mean 6MWT and PESE values were 291.1±41.6m 63.1±11.2%. Exercise capacity was correlated with mean values for the respiratory parameters FEV₁ (r=0.29; P=0.035), FVC (r=0.32; P=0.045) and FEV₁/FVC ratio (r=0.37; P=0.007), and both exercise capacity and PESE were correlated with gait speed (r=0.96, P=0.001 and r=0.57; P=0.042) and RPE (r=0.42, P=0.050 and r=-0.44; P=0.032), but PESE was not correlated with respiratory parameter values (P>0.05).

CONCLUSION

Participants with COPD demonstrated reduced respiratory parameter values and low exercise capacity but moderate PESE. We found significant correlations between exercise capacity and respiratory parameter values, but PESE was correlated with only gait speed and RPE. The study has implications for respiratory health promotion and exercise adherence.

Effects of ultraviolet radiation (type B) on wound exudates, appearance and depth description

Purulent exudate is one of the clinical signs of decubitus ulcers; and it is indicative of infection. The greatest challenge is the decreasing sensitivity of infective micro-organisms to antibiotics. There appears to be paucity of data on the effect of Ultraviolet radiation on wound exudates and appearance. The main purpose of this study was to determine the effect of ultraviolet radiation (Type B) on wound exudates and appearance of decubitus ulcers. Ten (10) bed-ridden subjects with ascertained bilateral sore from unrelieved pressure in their lower extremities consented to participate in the study. The decubitus ulcers were treated with traditional saline-wet-to-moist (WM) wound dressing. The decubitus ulcers on the left lower extremities were the experimental limbs and were exposed to ultraviolet radiation as adjunct while the right lower limbs served as control and received only the saline-wet-to-moist (WM) wound dressing. The frequency of treatment was 3 times per week for 6 weeks. The type of exudates produced, amount of exudates, wound appearance and depth description were scored on a 5-point likert scale. The data was analyzed using descriptive statistics and non-parametric inferential statistics (Kruska-Wallis test). The result of the Kruskal Wallis test showed that there was significant improvement in the type of exudates produced by the decubitus ulcers of the experimental (left) limbs (X{2} = 33.71, p < 0.00) when compared with the control limbs. Similarly, there was significant reduction in the amount of exudates produced by the decubitus ulcers of the experimental limbs (X{2} = 30.58, p < 0.00) when compared with that of the control. Also, there was significant improvement in the appearance of the decubitus ulcers (X{2} = 33.01, p< 0.00) and depth description of the experimental (left) limbs compared to that of the control (right). This study concluded that Ultraviolet radiation (Type B) can significantly improve the appearance of decubitus ulcers. Also, it can significantly reduce the amount of purulent exudates and can hasten skin replacement of decubitus ulcers.

Prediction of functional capacity during six-minute walk among patients with chronic heart failure

BACKGROUND

Formulae for predicting functional capacity during 6-minute walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations.

AIMS

The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 2 ) in Chronic Heart Failure Patients (CHF) during exercise.

METHODS

Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated.

RESULTS

The result showed that the distance covered was highly correlated with the VO2 (0.65, p< 0.01). The regression analysis revealed that a linear equation model developed was a good predictor of V0 2 for the group.

CONCLUSION

The study concluded that in situation where sophisticated equipments are lacking, this equation might be useful during exercise supervision for patients with CHF. [VO2 (mlkg-1 min-1) = 0.0105 x distance (m) + 0.0238 age (yr) - 0.03085 weight (kg) + 5.598].

Obesity prevalence in adult residents of Ile-Ife, Nigeria

BACKGROUND AND PURPOSE

Few data on obesity exist on Sub-Sahara population in Africa. This study investigated the prevalence of obesity and Body Mass Index (BMI) percentile and quartiles in accordance with sex and age in adult residents of the historic ancient semi-urban community of Ile-Ife, South-West, Nigeria.

MATERIALS AND METHODS

2097 adults aged 21 years and above were recruited into the door-to-door survey through a multi-stage cluster sampling technique. The World Health Organization (WHO) criteria based on BMI was used in the definition of overweight and obesity. Height and weight were measured using standardized procedures.

RESULTS

The mean age and BMI of the participants were 44.2 years and 24.2 Kg/m2 respectively. Although age-matched; the females had higher BMI values compared to males (23.8 vs. 24.5 Kg/m2). The overall crude prevalence of overweight (25.0-29.9 Kg/m2) and obesity (>30 Kg/m2) were 20.3% and 12.5% respectively. The rates of overweight (17.9 vs. 22.1 Kg/m2) and obesity (9.7 vs. 14.5 Kg/m2) were both higher in women than men. Obesity increased across age gradient from young to old adults; peaking in the 60-69-year age group. The first to fourth BMI quartiles were = 20.4 Kg/m2, 20.5-24.1 Kg/m2, 24.2-25.2 Kg/m2, = 25.3 Kg/ m2 respectively in the study population. At all ages; more females (32.4%) than males (24.7%) were placed within fourth BMI quartile. The 95th percentile BMI in the study population was 33.4 Kg/m2.

CONCLUSION

Overweight and obesity are common in Nigerians, particular among females and elderly. The prevalence estimates of overweight and obesity in Nigerians is comparable with prevalence among Blacks in other populations.

The effect of histamine iontophoresis on the heart rate and blood pressure of female subjects

The main purpose of this study was to determine the effect of histamine iontophoresis on the Blood Pressure (BP), and heart rate (HR) of female subjects. Twenty apparently healthy female undergraduates of Obafemi Awolowo University, Ile-Ife (average age 24.2 +/- 2.9) participated in the study. An automated electronic sphygmo-manometer that monitors both BP and HR was used to measure the Systolic Blood Pressure(SBP) and diastolic Blood Pressure (DBP) over the left brachial artery. The histamine gel used in this study contained 1 percent histamine dihydro-chloride. The gel was applied to the right biceps brachii and active was applied below the cubital fossa. The current intensity Interrupted Direct Current (IDC) was gradually increased and subjects were instructed to indicate immediately they experienced tingling sensation under the electrode. The same procedure was carried out the second time on the subjects with the same intensity of IDC current but without histamine for each subject. The treatments were administered on different days but within a two-week interval. The cardiovascular response was monitored five minutes before the administration, twenty minutes during the administration and five minutes after the termination of each treatment. Blood Pressure and heart rate did not change significantly from the baseline during the histamine iontophoresis and direct currents treatments (P > 0.05). The findings suggest that the subjects' BP and HR were not affected by histamine iontophoresis during the twenty minutes treatment. It was concluded that local administration of 1 percent histamine dihydrochloride into the subcutaneous tissue of females' right upper arm with the aid of direct current did not appreciably affect the blood pressure and heart rate after 20 minutes of treatment.

Reliability and concurrent validity of visual analogue scale and modified verbal rating scale of pain assessment in adult patients with knee osteoathritis in Nigeria

The objective of this study was to determine the reliability and concurrent validity of two pain rating scales - Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). The verbal rating scale was modified by translating the English description of subjective pain experience into vernacular (Yoruba) equivalents and rating the knee pain when the patient was  standing with the knee  flexed . Twenty seven patients who were clinically and radiologically diagnosed with osteoarthritis (OA) and with knee pain were purposively selected for the study. Two testers (physiotherapists) independently rated the pain experienced by patients, when bearing full weight while standing on the affected leg with slight knee flexion, over a period of several days. For each patient pain was rated with the VAS and the modified VRS (MVRS). There were significant correlations between VAS and MVRS by the same tester (tester 1 and tester2) (r=0.92, p<0.01; r = 0.89,            p<0.01respectively,)) and between VAS and MVRS between tester 1 and tester 2 (r=0.91,p<0.01). There were no significant differences between VAS for tester 1 and VAS for tester 2, and between MVRS for tester 1and MVRS for tester 2 (p> 0.01).  According to this study, the two pain rating scales for knee OA are reliable. Our use of VAS and MVRS togetherwith the procedure involving the flexed knee posture is, therefore, recommended for wider clinical trials.