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PURPOSE: To explore the meaning of community reintegration and strategies for promoting community reintegration based on the lived experiences of individuals with spinal cord injury in northwest Nigeria. MATERIAL AND METHODS: Using a qualitative description, we purposively recruited people with spinal cord injury residing in Kano, Nigeria. Eight focus groups were conducted to gather relevant information about the meaning and strategies for community reintegration, based on the lived experiences of the participants. RESULTS: A total of 64 people aged 18-60 years completed the study. Most of the participants had lived with spinal cord injury for more than five years. The individuals perceived community reintegration as a multi-dimensional concept reflected by five major themes namely: living life as usual, gainful engagement, a basket of opportunities, courage and support, and acceptance of destiny. Furthermore, the participants considered education and awareness about spinal cord injury, supportive and enabling environment, equal opportunities, care and moral support, and accessible health and rehabilitation services as critical for promoting community reintegration. CONCLUSION: Community reintegration is a multidimensional process, and its promotion in northwest Nigeria requires a multisectoral approach.

Background: Quality of life (QoL) is an important outcome that is used to measure the success of healthcare interventions. Valid and reliable instruments are required to assess QoL. Hence, we conducted this study to adapt and validate the QoL Index (QLI) among Hausa-speaking people with spinal cord injury (SCI) in northwest Nigeria. Method: Using the International Society for Pharmacoeconomic and Outcome Research principles of good practice and the consensus-based standards for the selection of health measurement instruments guidelines, the QLI-SCI version was translated into Hausa language and tested for content validity, internal consistency, and test-retest reliability among people with SCI in northwest Nigeria. Result: The Hausa QLI (HQLI) demonstrated good content validity (CVI = 92.18%), internal consistency (Cronbach's alpha = 0.855), and test-retest reliability (ICC =0.949 [95% CI, 0.916-0.969]). Conclusion: The HQLI can be deployed to assess QoL among Hausa-speaking people with SCI, thus promoting robust measurement of QoL in an SCI population.

Background: Stroke and epilepsy are the most common neurological condition affecting individuals. The Short Form Six-Dimension Health Index (SF-6D is a preference-based measure of health developed to estimate utility values from the SF-36. This study estimated utility values for health states of Nigerian individuals with stroke or epilepsy using the SF-36. Methods: SF-36 responses from 125 and 69 individuals with stroke and persons with epilepsy, respectively were transformed into health state utility values using the SF-6D algorithm. The excel programme, developed by Brazier and colleagues was used to generate the SF-6D utility score estimated using a set of parametric preference weights. The health state utility values were determined using ordinal health state and standard gamble valuation techniques. Result: Mean (SD) ages of the stroke and epilepsy participants were 63.1 (11.1) and 39.6 (16) years respectively. The mean (SD) utility scores for stroke and epilepsy were 0.52(0.10) & 0.65(0.1) for standard gamble, 0.48(0.13) & 0.68(0.11) using the ordinal health state paradigm. The mean (SD) utility of stroke (Female = 0.46 (0.15); Male = 0.50 (0.12)) and epilepsy (Female = 0.65 (0.13), Male = 0.69 (0.11)) participants were reported. The mean (SD) annual episode seizure was 18.7(39). Conclusions: To our knowledge this is the first study to suggest that female with stroke and those with epilepsy considered their health to be poorer than that of their male counterparts. The significance of our findings is that they may be helpful for researchers, policy makers and clinicians by providing input to economic evaluations to facilitate resource allocation for stroke survivors and people living with epilepsy to improve their health outcomes and reduce the huge burden associated with the conditions.

Persistent pain is a major public health issue—estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of ‘how pain works’ and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. Perspective: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public

Advances in healthcare and technology have led to increased survival rates after spinal cord injury (SCI). To facilitate recovery, regain function, and promote quality of life after SCI, rehabilitation in the acute care setting is of paramount importance. After discharge from acute care, there is difficulty in accessing appropriate intervention to facilitate community rein-tegration. This review examined the content, strengths, limitations, and effectiveness of existing community reintegration intervention programs after SCI to promote the adoption of the existing programs or the development of new interventions for individuals with SCI in a low-resource setting. We conducted a review of the literature using Arksey and O’Malley’s methodological framework. Six electronic databases were searched from the database inception to September 2022, including Medline, CINAHL, Web of Science, PsycINFO, Sabinet, and Global Health. A manual search of the selected references was also conducted. Seven articles met our inclusion criteria. Overall, 290 individuals participated in the included studies, 80% of the participants were males, and the majority of the participants had an injury at the thoracic level. The studies presented different interventional programs with varying contents addressing different aspects of community reintegration such as household duties, mobility, health maintenance, and recre-ation. All the identified programs have evidence of preliminary effectiveness in some domains of community reintegration (e.g., household duties, mobility, and health). However, most available programs are geared toward addressing a specific aspect of community reintegration and may not be suitable for individuals with complex needs. A robust program that encompasses all critical aspects of community reintegration (housing and household duties, mobility, recreation, health maintenance, pain management, sexuality, social support, and employment) may be required. Therefore, further d

Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public

Objectives: Although the Microsoft Kinect has compelling potential for gait analysis in medicine, data available to compare it with observational gait analysis (OGA) is scarce. This study compared the Microsoft Kinect and the OGA in assessing the gait parameters of apparently healthy adults. Methods: Ninety-seven apparently healthy young male adults participated in this comparative study. First, the participant’s age, height, weight, and body mass index were obtained. Afterward, gait parameters involving the number of steps, cadence, stride length, and step length were assessed concurrently following OGA standard procedures and the Microsoft Kinect during a 6-m walk down the hallway. The obtained data were analyzed using descriptive and inferential statistics. The significance level was set at P<0.05. Results: The Mean±SD walk time, steps, cadence, velocity, and stride length were 8.07±1.39 s, 14.0±2.96 counts, 72.9±11.9 steps/min, 0.8±0.13 m/s, and 0.77±0.13m, respectively. Step length was significantly higher (P<0.05) with Microsoft Kinect than OGA, whereas stride length and walk speed values were significantly (P<0.05) lower with Microsoft Kinect. A moderate but significant (P=0.001) positive correlation existed between Microsoft Kinect and OGA regarding walk speed. In contrast, regarding the step length, a weak but significant (P<0.05) positive correlation was found between Microsoft Kinect and OGA. Discussion: Step length values of Microsoft Kinect were significantly higher than OGA values, whereas stride length and walk speed values of Microsoft Kinect were significantly lower than OGA values. Walk speed and step length measured by Microsoft Kinect and OGA were positively correlated.

Introduction. Real-world evidence studies using routinely collected data, such as patient clinical records, are innovative ways of generating insight into the effectiveness of healthcare interventions. This study examined the effectiveness of vertical oscil-latory pressure (VOP) on selected clinical outcomes for patients with low back pain (LBP) using routinely collected data. Methods. Retrospective analysis was carried out on the medical records of patients diagnosed with LBP in a tertiary hospital in south-west Nigeria over a 10-year period. Clinical outcomes (pain intensity and functional disability) in patients who received VOP (n = 201) for their LBP were compared with controls that had traditional physiotherapy (TP) (n = 138) in a routine clinical setting. Total costs of intervention were estimated in terms of direct and indirect costs. Results. There were significant differences within group (from baseline to 4th and 8th week of intervention) for the VOP group in pain intensity (p = 0.001) and functional disability (p = 0.001). However, TP group showed no significant differences in pain intensity and functional disability across baseline and week 8 of the study. There was a significant difference in pain intensity (2.95 ± 1.38 vs. 4.16 ± 2.48; p = 0.013) between VOP and TP at week eight. A higher direct and indirect costs associated with VOP compared with TP (both p = 0.042). Conclusions. The findings of this study suggest that VOP is an effective intervention for LBP in the ‘real-world’. VOP is more effective compared to TP on its effect on pain intensity over time.

Objectives This study objective was to translate the HOOS into Yoruba language and determine its psychometric properties. Methods The first stage of this study involved translation of the English version of the HOOS into Yoruba language followed by the backward translation, reconciliation and harmonization of the reconciled items successively. Consequently, there was a panel review of the harmonized Yoruba version of the HOOS, followed by a pilot testing. Patients with Hip Osteoarthritis (Hip OA) were involved in the validity testing, and test-retest reliability of the tool. Yoruba versions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Back Belief Questionnaire (BBQ) were used to test the convergent and the discriminant validity of the Yoruba version of the HOOS. Data was analysed using descriptive statistics of mean, standard deviation, and percentages. Cronbach's Alpha, Intra-Class Correlation, and Pearson's Product Moment Correlation were used for reliability tests. Results Twenty participants with a mean age of 59.9 years participated in the study. For the concurrent validity, the correlation co- efficient score for the total HOOS was r = 0.813 and (p = 0.001), indicating a strong validity. A Cronbach’s alpha of 0.896 was found, indicating a high internal consistency. HOOS showed a significant correlation with WOMAC, which ranged from r=−0.801, p=0.001 for WOMAC pain to r=-0.432, and p=0.057 for WOMAC stiffness and r=-0.668 and p=0.001 for WOMAC function. The discriminant validity of the Yoruba version of the HOOS revealed no significant correlation with BBQ subscore (r=0.018, p=0.941), BBQ distractor (r=0.082,p=0.731) and BBQ total score (r=0.075,p=0.753). A high intraclass correlation co-efficient (ICC) which ranged from 0.969 to 0.994 (lowest to highest) was found on the retest of the subscales of HOOS. Conclusions The Yoruba version of the HOOS is valid and reliable for evaluating the outcomes of hip OA among Yoruba s

Objectives The 3-meter backward walk test (3-MBWT) is an important assessment tool used in evaluating neuromuscular control, proprioception, risk of fall and balance. On the other hand, the hand grip strength (HGS) test primarily is used to measure muscular strength or maximum tension generated by one’s forearm muscles. This study aimed to assess the relationship between 3-MBWT and HGS among community dwelling young-older adults. Methods Community-dwelling older adults participated in this study. 3-MBWT was measured using: a meter rule, to measure 3 meters on the ground, paper tape to mark out landmarks and a stopwatch to measure the time taken to complete the test. HGS was measured in line with the guideline of the American Society of Hand Therapists. Anthropometric variables were assessed following standard procedures. Descriptive statistics of mean and standard deviation were used to summarize data. Pearson’s correlation coefficient was used to verify the correlation between 3-MBWT and HGS test, as well as the influence of socio-demographic factors on both 3-MBWT and HGS. Alpha level was set at 0.05. Results Sixty-two participants with the mean age of 67.73 ± 1.96 years took part in the study. The mean values for 3-MBWT and HGS were 3.45 ± 0.80s and 29.58 ± 15.53kg, respectively. There was a significant correlation between 3-MBWT and HGS (r=-0.39; p = 0.002). However, there was no significant correlation between 3-MBWT and socio-demographic characteristics (p > 0.05). Similarly, there was no significant correlation between HGS and socio-demographic characteristics (p>0.05) except height and gender (p<0.05). Conclusions The 3-MBWT and HGS were significantly correlated with one another. Anthropometric characteristics did not influence the 3-MBWT. On the other hand, only height and gender showed a significant influence on HGS. Therefore, both 3-MBWT and HGS may serve as useful functional outcome measures for fall predictability and frailty in older adults.

Objectives This study aimed to determine the convergent, divergent and known-group validity of the IKHOAM among patients with knee osteoarthritis (OA). Methods Patients with knee OA participated in this cross-sectional study. Convergent, divergent and known-group validity of the IKHOAM was determined using the Osteoarthritis Knee and Hip Quality of Life Questionnaire (OAKHQoL), Quadruple Visual Analogue Scale (QVAS), and socio-demographic characteristics (age and sex). Data was summarised using descriptive statistics. Inferential statistics of Pearson’s correlation and factor analysis to determine the sampling adequacy, test of sphericity and multi-collinearity of IKHOAM and OAKHoL was carried out. Results One hundred and three patients with a mean age of 58.07 years completed the study. There were significant correlations between each of IKHOAM’s activity limitation assistance (r=-0.458 - -0.892), activity limitations difficulty (r = -0.311 - 0.328), activity limitations domains (-0.311 - -0.364) and participation restrictions domain (r=-.364 - -0.367) with each domain of QVAS (p<0.05). There was significant correlation between IKHOAM’s activity limitations difficulty (r=0.398, p=.001), activity limitations domain (r=0.473, p=.001), participation restrictions domain (r=0.420, p=.001), and physical performance domains (r=-0.361, p=.009) with OAKHQoL’s physical activity dimension. There was significant correlation between IKHOAM’s activity limitation assistance (r=-0.202, p=.041), activity limitations difficulty (r=0.441, p=.001), activity limitations domain (r=0.278, p=.005), participation restrictions domain (r=0.238, p=.015), and physical performance domains (r=0.644, p=.001) with OAKHQoL’s mental health dimension. There was significant relationship between IKHOAM’s activity limitation assistance (r=-0.618, p=.001), activity limitations difficulty (r=0.681, p=.001), and activity limitations domain (r=0.223, p=.023) with OAKHQoL’s pain dimension. Conclusions The IK

Objectives This study aimed to assess the level and correlates of Physical Activity (PA) among Nigerian community-dwelling older adults. Methods Older adults who were 65 years and older participated in the cross-sectional study. Physical activity was assessed using the International Physical Activity Questionnaire for the Elderly (IPAQ-E) and Physical Activity Scale for the Elderly (PASE), respectively. Correlates of PA were assessed in terms of functional status (using Katz Index Independence of Daily Living Questionnaire), psychosocial variables (depressive symptoms and quality of life (QoL), using Older People Quality of Life-Brief Questionnaire and Geriatric Depression Scale) and socio-demographic factors (age and gender). Descriptive statistics was used to summarise data. Bivariate analysis of the Chi-Square test of association and Pearson’s correlation were used to determine correlations between variables, while logistic regression was used to predict PA from the selected correlates. Results A total of 246 respondents who were within the 66-75years (58.9%) and were mostly females (65%) participated in this study. Based on IPAQ-E, the mean PA for walking, moderate and vigorous activity were 1177.8 ± 1195.9 metabolic equivalents (METs), 1128.5 ± 1738.9METs, and 6.99 ± 51.71 METs respectively. Rates for low, moderate, and high levels of PA were 21.1%, 51.6%, and 27.2% respectively. However, based on PASE, the PA level by type were moderate (17.9%) and low (82.1%). The mean scores for QoL and depression were 45.72 ± 7.14 and 6.48±2.27. A majority (68.7%) of the respondents had higher QoL, and mild depression symptoms (54.1%). PA was significantly correlated with age (r=16.799,p=0.02) based on IPAQ-E, gender (r=3.842, p=0.050) based on PASE, QoL (ᵡ2= 9.817, p=0.010) and instrumental activity of daily living (ᵡ2=17.125,p=0.002) based on IPAQ-E. Conclusions Nigerian community-dwelling older adults engaged in low-to-moderate PA and had high QoL and mild depression sym

Objectives Stroke is a non-traumatic, focal vascular-induced injury of the central nervous system. Short Form (SF)-6D is a preference-based measure of health developed to estimate health utility values from the SF-36. This study was aimed to estimate utility scores using data from a preference-based SF-36 for stroke patients in Nigeria. Methods SF-36 responses from 125 individuals with stroke were transformed into utility values using the SF-6D algorithm developed by Brazier and colleagues. We used excel programme to generate the SF-6D utility scores estimated using a set of parametric preference weights obtained from a sample of stroke patients. The utility was determined using ordinal health state valuation. Results The mean age of the participants was 63.95 years. The average duration of stroke was 22 months. The mean (Standard Deviation (SD)) ordinal health state valuation for stroke patients was 0.48 (0.13). The mean (SD) utility for female and male participants were 0.46 (0.15) and 0.50 (0.12), respectively. Conclusions Our results suggest that the stroke survivors considered their health poorer than expected and particularly women more than men. Our findings will be helpful to inform cost-effectiveness analyses of interventions to facilitate resource allocation for patients for preventing and managing individuals with stroke to improve their health outcomes.

Objectives Musculoskeletal disorders (MSDs) are widespread in many countries and include a wide range of inflammatory and degenerative conditions. Digital health interventions are commonly used for individuals with MSDs, however, no study has synthesised the findings of cost effectiveness of these interventions. The aim of this study was to synthesise the cost-effectiveness of digital health interventions for people with MSDs. Methods Electronic databases including Medline, AMED, CIHAHL, PsycINFO, Scopus, Web of Science, and Centre for Review and Dissemination were searched for cost-effectiveness of digital health published between inception to May 2021 according to PRISMA guideline. References of all retrieved articles were checked for relevant studies. The quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data were synthesised through a narrative review. Results Ten studies from six countries met the inclusion criteria. The average percent of CHEERS checklist items reported was 70.4%. Included studies were on non-specific chronic low back pain (n = 4), chronic pain (n = 2), knee and hip osteoarthritis (n = 3) and Fibromyalgia (n = 1). The economic perspectives adopted in the included studies were societal (n = 4), societal and healthcare (n = 3) and healthcare (n = 3). Of the ten included studies 5 (50%) of them used quality-adjusted life years as the outcome measures. Except one study, all the included studies reported that digital health interventions were cost effective compared to the control group. Conclusions The findings of the review show that digital health interventions are cost-effective for the management of MSDs. This suggests that digital health intervention could help improve access to treatment for patients with the condition, and as a result improving their health outcomes. Clinicians and policy makers should consider the use of these interventions for patients wi

Objectives Epilepsy is the most common neurological condition affecting individuals of all ages. Short Form (SF) -6D is a preference-based measure of health developed to estimate utility values from the SF-36. This study estimated health utilities using data from a preference-based SF-36 for epilepsy patients in Nigeria. Methods SF-36 responses from 69 individuals with epilepsy were transformed into utility values using the SF-6D algorithm. The excel programme, developed by Brazier and colleagues, was used to generate the SF-6D utility score estimated using a set of parametric preference weights obtained from a sample of epilepsy patients. The utility was determined using ordinal health state valuation. Results Mean age of the participants was 39.6 years. The mean (Standard Deviation (SD)) annual episode seizure was 18.7(39). The mean (SD) ordinal health state valuation for epilepsy patients was 0.68 (0.11). The mean (SD) utility of female and male participants were 0.65 (0.13) and 0.69 (0.11), respectively. Conclusions The results of this study provide a quantitative estimate that suggest female epilepsy patients considered their health is poorer than male in Nigeria. Our findings will be helpful for researchers as an input in economic evaluations to facilitate resource allocation for patients with epilepsy to improve their health outcomes.

Objectives The increasing population of older adults and their specific characteristics show the need for the development of specific instruments to measure their quality of life (QoL) in this population. The study adapted and validated the original English version of the World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) to the Nigerian (IGBO) version (I-WHOQOL-OLD) module. Methods This was a cross-cultural adaptation and validation study in which the original English version of the WHOQOL-OLD was translated into I-WHOQOL-OLD language, synthesised, backward translated into English language, subjected to expert panel review and pretested. The final I-WHOQOL-OLD and the original English version were then administered to consecutively recruited 109 older adults from a conveniently selected community in Anambra State, Southeast Nigeria. Data were summarised using descriptive statistics. The instrument’s internal consistency was assessed using Cronbach’s alpha Results All the 24 items on the original WHOQOL-OLD were retained. The structure of the I-WHOQOL-OLD differed from that of the original WHOQOL-OLD. The I-WHOQOL-OLD displayed acceptable internal consistency (0.63-0.95), known-group validity (0.60-0.99), convergent validity and ceiling and floor effects. Conclusions The I-WHOQOL-OLD is a reliable and valid tool and thus can be used as for assessing QoL of Igbo-speaking older adults, thus helping to improve their health outcomes.

Objectives The EQ-5D is a self-administered questionnaire which necessitates its existence and adaptation in different languages. This study aimed to translate, cross-culturally adapt, and determine the reliability and validity of the Yoruba version of the EQ-5D questionnaire. Methods Following the International Quality of Life Assessment (IQOLA) project guidelines, the EQ-5D-5L questionnaire was first translated from the English version following a sequence of forward translation, reconciliation and harmonization, backward translation, reconciliation of problematic items. A total of 113 individuals with musculoskeletal disorders were recruited to test the validity of the Yoruba translated version of the EQ-5D-5L (EQ-5D-Yor). A seven-day test-retest reliability of the EQ-5D-Yor was carried out among 109 of the respondents. Convergent and discriminant validity of the EQ-5D-Yor were determined using the Yoruba version of the SF-12 (SF-12-Y) and Visual Analogue Scale (VAS). Data was analyzed using descriptive and inferential statistics of Pearson/Spearman correlation, Intra-Class Correlation, Cronbach alpha and multi trait scaling analysis. Alpha level was set as p < 0.05. Results The construct validity of the EQ-5D-Yor yielded Spearman rho ranging from 0.438 to 1.000, with the EQ-VAS having the highest co-efficient (r = 1.000; p = 0.001). The convergent validity of the EQ-5D-Yor index with SF-12-Y yielded no significant correlations (p < 0.05), except the physical functioning scale (r = -0.709, p = 0.001). On the other hand, the divergent validity of the EQ-5D-Yor index with VAS yielded a weak correlation, (r = 0.016). The Intra-class Correlation Coefficient and Cronbach alpha for the test-retest reliability of the EQ-5D-Yor were 1.000 and 0.968. The confirmatory factor analysis showed the factor loadings were poor when including VAS in the model. Conclusions The EQ-5D-Yor has acceptable validity and reliability and can be used as a valid tool in economic evaluation s

Objectives This study evaluated the clinical and cost effectiveness of a clinic-based McKenzie therapy (CBMT), mobile-phone based McKenzie therapy (TBMT) and virtual-reality based McKenzie therapy (VRGMT) in patients with long-term low back pain (LBP). Methods One hundred twenty consenting patients with long-term LBP were randomised into CBMT; n = 43; TBMT; n = 36; VRGMT; n = 41 and completed the study. The intervention was applied thrice weekly for eight weeks. Outcomes were assessed in terms of Pain Intensity (PI), Back Extension Muscles’ Endurance (BEME), Activity Limitation (AL), Participation Restriction (PR), Fear Avoidance Belief (FAB), Kinesiophobi (Kp), General Health Status (GHS) and resource use questionnaire. Data were analysed using descriptive and inferential statistics. Economic evaluation estimates were the incremental cost effectiveness ratios. Results The mean of age of the participants was 42.9 ± 12.1years. There was a significant difference (p < 0.05) within group comparison across baseline, 4th and 8th week for all the variables. However, there were no significant differences (p > 0.05) across the groups at 4th week, except for CBMT. Across group analysis showed there were significant differences in the mean change for ODI, FABQ-P, FABQ-W, TSK, and all GHS domains except for MH (all p < 0.05). Similarly, there were significant differences in across the groups at the end of the eight weeks in mean change for ODI, FAB-P, and all domains of GHS (all p < 0.05) except for RLM (p > 0.05). Compared to CBMT, BEVRG and TBMT were dominant interventions. Conclusions The findings of the study indicate that CBMT and its digital variants are effective for reducing pain and disability and improving psychosocial outcomes and GHS in patients with chronic LBP. However, BEVRG and TBMT compared to CBMT were cost effective as they offer the lowest cost and highest health benefits in this patient group.

Study Design. Non-randomised longitudinal observational study. Objective. To evaluate the association between baseline pain duration and medium-to-long term clinical outcomes, in low back pain (LBP) patients enrolled on the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP). Summary of Background Data. The NERBPP is based upon National Institute for Health and Care Excellence (NICE) guidelines. These guidelines no longer differentiate management of LBP patients based on pain duration. Medium-to-long term data from the NERBPP is lacking. Methods. Between May 2015 and December 2019, 786 and 552 LBP patients from the NERBPP returned 6-month and 12-month follow-up outcome measures, respectively. Outcomes included pain (Numerical rating scale), function (Oswestry Disability Index) and quality-of-life (EuroQol five-dimension, five-level questionnaire), analysed using a series of covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration: <3 months, ≥3 to <6 months, ≥6 months to <12 months, ≥12 months. Results. Patients with <3 months duration demonstrated clinically important improvements on all outcomes, at both follow-ups. The improvements in outcomes from this group were larger than those in the ≥12 month's duration group (p < 0.05), these group differences in change, in some cases surpassed our threshold for clinical relevance. Functional improvements in those with ≥12 month's duration were not clinically relevant at either follow-up. All patients, regardless of baseline pain duration, reported similar levels of readiness to self-manage at the 12-month follow-up. Conclusions. Baseline pain duration would appear to be of clinical importance. Patients with shorter baseline pain duration demonstrated better outcomes. Those with ≥12 month's duration of pain may need additional support during their management to achieve clinically relevant functional improvements in the medium-to-long term. These findin

STUDY DESIGN: Cultural adaptation and psychometric analysis. OBJECTIVE: This study determined the test-retest reliability, acceptability, internal consistency, divergent validity of the Yoruba pain self-efficacy questionnaire (PSEQ-Y). It also examined the ceiling and floor effects and the small detectable change (SDC) of the PSEQ-Y among patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA: There are various indigenous language translations of the PSEQ and none adapted to African language. However, translations of the PSEQ into Nigerian languages are not readily available. METHODS: The validity testing phase of the study involved 131 patients with LBP, while 83 patients with LBP took part in the reliability phase. Following the Beaton recommendation for cultural adaptation of instruments, the PSEQ was adapted into the Yoruba language. The psychometric properties of the PSEQ-Y determined comprised: internal consistency, divergent validity, test-retest reliability, and SDC. RESULTS: The mean age of the participants was 52.96 ± 17.3 years. The PSEQ-Y did not correlate with the Yoruba version of Visual Analogue Scale (VAS-Y) scores (r = -0.05; P = 0.59). The values for the internal consistency and the test-retest reliability of the PSEQ-Y were 0.79 and 0.86, with the 95% confidence interval of the test-retest reliability ranging between 0.82 and 0.90. The standard error of measurement (SEM) and the SDC of the PSEQ-Y were 1.2 and 3.3, respectively. The PSEQ-Y had no floor or ceiling effect, as none of the respondents scored either the minimal or maximal scores. CONCLUSION: This is the first study in Nigeria to culturally adapt PSEQ. The PSEQ-Y showed adequate psychometric properties similar to existing versions. Therefore, the tool can be used to assess pain self-efficacy in clinical and research settings and help to improve the health outcomes of patients chronic LBP.Level of Evidence: 3.

Background and Objective: Explosion in information technology knowledge and utilization among young people, referred to as digital natives, seems less explored in the health sector and training. This study was aimed to assess awareness, attitude and expectations of physiotherapy students on telerehabilitation. Methods: This cross-sectional survey employed systematic probability sampling technique to recruit 200 physiotherapy students. A self-developed questionnaire which was tested for its face and content validity was used to obtain data. Data was analysed using descriptive and inferential statistics. Alpha level was set at p < 0.05. Results: The mean age of the respondents was 21.2 ± 2.04 years. There was higher prevalence of moderate awareness (43%) and positive attitude towards telerehabilitation (39%). Majority of the respondents (62%) had high expectation towards future telerehabilitation products and services. There was significant association between level of awareness of telerehabilitation and age (X2 = 7.119; p = 0.001). Discussion: The responding students in this study are by age in the class of digital natives, who should be conversant with technology. This could account for the higher moderate level of awareness of telerehabilitation. However, the higher rates of negative attitude towards telerehabilitation could be attributed to prevailing barriers to its utilization in Nigeria. Nonetheless, a large percentage of the students had high expectations for the future of telerehabilitation. Conclusion: Nigerian physiotherapy students have moderate awareness and high expectation for future telerehabilitation applications. However, a larger number of them hold negative attitude towards it use.

Background. Short Form 12 (SF-12) health survey has found its utility in clinical and research settings because of its short length that spares time. Though several translations into other languages do exist there is none available in Yoruba language. Hence, this study’s objective was to culturally adapt and determine the reliability and validity of the Yoruba translated version of the SF-12. Methods. Forward and backward translations of SF-12 into Yoruba version of SF-12 (Y-SF-12) were done using the International Quality of Life Assessment Project Guidelines. Healthy participants were assessed using both English and Yoruba versions of SF-12 for the validation phase, and two weeks later were reassessed with the Y-SF-12 for the reliability phase. Results. Participants were 225 males and 171 females. The mean scores for each scale range from 73.4 to 86.1, with no gender difference. All scale and domain scores evidenced a negative skew and ranges from -1.79 to -0.62. Concurrent validity (0.879 – 0.938) and convergent validity (0.786 – 0.907) appeared to be good as reflected by their correlation values. The internal consistency of Y-SF-12 was good as Cronbach’s Alpha ranged between 0.899 and 0.968, while the Intraclass Correlation Coefficient (ICC) ranged between 0.775 and 0.949. Conclusion. This is the first study to assess the psychometric properties of the Y-SF-12. It appears to be valid and may be an appropriate tool for assessing health-related quality of life among Yoruba population. The tool may help to improve the health outcomes of individuals, and redress health inequalities in low and middle-income countries.

Objectives: The use of animated cartoons for pain management is an emerging area, however, in no study has it been explored as a digital platform for the rehabilitation of low-back pain (LBP). This study was aimed to develop and evaluate the feasibility of an animated cartoon-based self-care (ACBSC) app for LBP, and to examine the correlation between the app rating parameters and patients’ pain. Methods: This 2-phase study comprised development and feasibility testing components. Development of the ACBSC app was based on Mckenzie’s Mechanical Diagnosis and Therapy (MDT) extension protocol plus back hygiene following standard it-eration and prototyping process. Twenty-eight consecutive patients with chronic non-specific LBP with ‘direction Preference’ for extension based on the MDT screening algorithm participated in the feasibility phase. The participants utilised the car-toon-based app thrice weekly for 2 weeks. Outcomes were assessed in terms of usability, satisfaction and user experience ap-plying the system usability and mobile application rating scales. The Quadruple Visual Analogue Scale (QVAS) was used to assess the participants’ pain intensity. Results: On a unified scale up to 20, functionality (15.4 ± 2.41) and aesthetics 14 ± 2.00 had highest and least objective quality rating on the app parameters. Total objective and subjective quality rating of the app was 16.9 ± 1.97 and 15.6 ± 2.42, respectively. The total impact and usability scores were 24.1 ± 3.39 (out of 30) and 27.8 ± 3.09 (out of 50). Participants re-ported that the cartoon app for back care mostly affected mindfulness/meditation/relaxation (42.9%), increasing happiness/ well-being (46.4%), leading to behavioural changes (60.7%), while targeting physical health (100%). There was no significant correlation between participants’ pain characteristics and app rating parameters (p>0.05). Conclusion: The animated cartoon-based self-care LBP app has moderate to high usability, functionality, aesthetic