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BACKGROUND: Each year, approximately one million older adults die in American ICUs or survive with significant functional impairment. Inadequate symptom management, surrogates’ psychological distress and inappropriate healthcare use are major concerns. Pioneering work by Dr. J. Randall Curtis paved the way for integrating palliative care (PC) specialists to address these needs, but convincing proof of efficacy has not yet been demonstrated. DESIGN: We will conduct a multicenter patient-randomized efficacy trial of integrated specialty PC (SPC) versus usual care for 500 high-risk ICU patients over age 60 and their surrogate decision-makers from five hospitals in Pennsylvania. INTERVENTION: The intervention will follow recommended best practices for inpatient PC consultation. Patients will receive care from a multidisciplinary SPC team within 24 hours of enrollment that continues until hospital discharge or death. SPC clinicians will meet with patients, families, and the ICU team every weekday. SPC and ICU clinicians will jointly participate in proactive family meetings according to a predefined schedule. Patients in the control arm will receive routine ICU care. OUTCOMES: Our primary outcome is patient-centeredness of care, measured using the modified Patient Perceived Patient-Centeredness of Care (PPPC) scale. Secondary outcomes include surrogates’ psychological symptom burden and health resource utilization. Other outcomes include patient survival, as well as interprofessional collaboration. We will also conduct prespecified subgroup analyses using variables such as PC needs, measured by the Needs of Social Nature, Existential Concerns, Symptoms, and Therapeutic Interaction (NEST) scale. CONCLUSIONS: This trial will provide robust evidence about the impact of integrating SPC with critical care on patient, family, and health system outcomes.

Background: Physical activity, sedentary behaviour and sleep are interrelated and may have a synergistic impact on health. This systematic review and meta-analysis of prospective cohort studies aimed to evaluate the combined influence of different combinations of these behaviours on mortality risk and incidence of cardiovascular disease (CVD), cancer, diabetes, and mental health. Methods: Four online databases were used to identify studies from database inception to 2022. Prospective cohort studies that examined how different combinations of physical activity, sedentary and sleep behaviours were associated with mortality and health outcomes were included. Random effects meta-analyses using the Der Simonian and Laird method were conducted.Results: Assessment of 4490 records result in twelve studies being included. Studies were qualitatively summarised and a sub-group of studies (n=5) were meta-analysed. The most frequent combination of behaviours was duration of leisure time physical activity and sleep (n=9), with all-cause mortality (n=16), CVD mortality (n=9) and cancer mortality (n=7) the most frequently examined outcomes. Meta-analysis revealed that relative to High physical activity & Mid sleep, High physical activity and Short sleep was not associated with risk of all-cause mortality (RR=1.05, 95% CI=0.97, 1.14), however Low physical activity and Short Sleep (RR = 1.42, 95% CI = 1.24, 1.63), Low physical activity and Mid Sleep (RR = 1.30, 95% CI = 1.12, 1.52), High physical activity and Long Sleep (RR = 1.16, 95% CI = 1.01, 1.32), and Low physical activity and Long Sleep were associated with risk of all-cause mortality (RR = 1.63, 95% CI = 1.21, 2.20).Conclusions: High levels of physical activity may offset all-cause mortality risks associated with short sleep duration. Low levels of physical activity combined with short sleep duration and any level of physical activity with long sleep duration appear to increase mortality risk. Currently there is limited evidence regarding how dimensions of physical activity, sedentary and sleep behaviours other than duration (e.g., quality, timing, type) are associated with future health status.

This study assessed attitudes of undergraduate healthcare students in Nigeria toward interprofessional practice. A cross-sectional survey of a convenience sample of 489 dental, medical, medical laboratory science, nursing, physiotherapy, and radiography students from a public university was conducted. The 14-item Attitudes Toward Healthcare Teamwork Scale was used to assess the students' attitudes. Data were summarized using descriptive statistics while differences in attitudes based on students' age, gender, year of study, and course of study were identified using inferential statistics. The findings showed that there were more (

Introduction Bedtime procrastination, the volitional delay of going to bed without any external circumstances causing the delay, is associated with poor sleep outcomes. Alleviating bedtime procrastination is an important target for interventions to promote adequate sleep, yet the social cognitive, biological, and behavioural determinants of bedtime procrastination are poorly understood. The present study aimed to conduct a systematic review, narrative synthesis, and meta-analysis of (1) the underlying determinants of bedtime procrastination, and (2) the strength and direction of the relationship between bedtime procrastination and sleep outcomes. Methods A database search was conducted through CINAHL, EMBASE, PsychINFO, PubMed, Scopus and Web of Science, using keywords related to procrastination, delay, bedtime and sleep. Results A total of 2087 records were identified, and 38 publications met the inclusion criteria. Random-effects meta-analysis for bedtime procrastination and sleep outcomes is ongoing. Preliminary findings suggest self-regulation, self-control and chronotype are the most prominent determinants. Conclusion Future research should expand focus to identify a broader range of determinants. Given that there are multiple benefits to a theory-based approach to behaviour change interventions, further research exploring determinants will be able to guide the development of interventions targeting bedtime procrastination. Support (If Any)

Background Poststroke balance impairment adversely affects stroke outcomes and addressing the impairment is expected to constitute an important focus of neurorehabilitation. Aims To examine the prevalence and factors associated with balance impairment after stroke. Methods Ninety-five stroke survivors undergoing neurorehabilitation at 2 government hospitals in Northern Nigeria participated in this cross-sectional study. Berg Balance Scale (BBS) was used to assess the presence of balance impairment (BBS score of 0-20). Prevalence of balance impairment was presented as frequency and percentage while demographic and stroke-related determinants of balance impairments were identified using logistic regression analysis. Results Thirty-five (36.8%) stroke survivors had balance impairment, and age, gender, and poststroke duration were statistically significant determinants. Stroke survivors aged less than 40 years (odds ratio [OR] = .14 [confidence interval [CI] = .20-.94]) and 40-59 years (OR = .23 [CI = .06-.81]) had a lower likelihood of having balance impairment compared to stroke survivors aged 60 years and above. Similarly, males had a lower likelihood of having balance impairment (OR = 1.60 [CI = .05-.55]) compared to females while those in the acute/subacute phase of stroke had a 7-fold likelihood of having balance impairment (OR = 7.74 [CI = 2.63-22.79]) compared to those with chronic stroke. Conclusions Poststroke balance impairment appears to be significantly influenced by stroke survivors’ age, gender, and poststroke duration. Hence, these variables should be considered when planning rehabilitation strategies for improving balance after stroke.

Introduction: Caring for stroke survivors may be burdensome with adverse consequences on caregivers' physical health. This study examined the prevalence of musculoskeletal symptoms and associated factors among family caregivers of stroke survivors in Nigeria. Methods: A hospital-based cross-sectional study involving 90 stroke caregiver and stroke survivor dyads was conducted. Data on the participants' demographics and post-stroke duration were obtained. Seven-day prevalence of musculoskeletal symptoms among the caregivers and level of stroke survivors' disability were respectively assessed using the Nordic Musculoskeletal Questionnaire and Modified Rankin Scale. Prevalence of musculoskeletal symptoms was presented as percentages while participants' characteristics associated with prevalence of musculoskeletal symptoms were examined using inferential statistics. Results: Mean (SD) age of caregivers and stroke survivors was 33.2 (10.7) years and 58.9 (9.7) years respectively. Majority of the caregivers were females (61.1%), and children of the stroke survivors (58.9%). Prevalence of musculoskeletal symptoms was 82.2%. The low back was the most affected body region (72.2%) followed by the upper back (40%) while musculoskeletal symptoms in the wrist was least prevalent (3.3%). Female caregivers, caregivers of female stroke survivors and spousal caregivers had significantly higher prevalence of musculoskeletal symptoms compared to other categories of caregivers. Only 5 (5.6%) caregivers had however received any training on safe care giving methods while only 21 (28.4%) caregivers with musculoskeletal symptoms had received treatment. Conclusion: With the high prevalence of musculoskeletal symptoms among family caregivers of stroke survivors, effective preventive strategies including training and education as well as timely access to treatment would be required.

A recurrent stroke increases the rates of mortality and morbidity after an initial stroke. There is, however, a dearth of data on the prevalence of recurrent stroke in Nigeria.A secondary analysis of the data obtained from 100 stroke survivors undergoing physiotherapy at 2 health facilities in Nigeria was carried out to document the prevalence of recurrent stroke. The association between recurrent stroke and selected socio-demographic and clinical factors of the participants was explored using logistic regression analysis.Thirty-two (32%) participants had had a recurrent stroke. Employment status and educational level were significantly associated with recurrent stroke. The outcome of the logistic regression analysis further showed that participants who were employed (OR = 0.08; P0.001; 95% CI = 0.02-0.32) and who had no formal education (OR = 0.22; P = 0.03; 95% CI = 0.05-0.87) were significantly less likely to present with recurrent stroke compared to the unemployed participants and those who had tertiary educational qualification, respectively.Approximately 1 in 3 stroke survivors undergoing rehabilitation had experienced stroke recurrence. The finding of this study buttresses the urgent need to emphasize and aggressively pursue secondary stroke prevention. Further studies are, however, required to explore those potentially modifiable factors that are associated with recurrent stroke, and having more representative samples.

Background: Falls and fall-related injuries rank among the most common complications after stroke, and are characterised by high rates of morbidity and mortality. This study examined the proportion, and the socio-demographic and clinical characteristics of those who fell among stroke survivors attending physiotherapy facilities in selected hospitals in Nigeria.Methods: Socio-demographic, clinical and falls data were obtained using a researcher-designed questionnaire while the modified Rankin scale (mRS) was used to assess functional ability of the participants. Descriptive statistics of frequencies, percentages, mean and standard deviation were used to summarise all data. Pearson's Chi square statistic was used to identify significant socio-demographic and clinical characteristics of those who fell.Results: One hundred stroke survivors participated in the study with a majority of males (67%). Mean ± SD age of the stroke survivors was 55.97 ± 9.56 years (range = 33–85 years). Thirty-three (33%) stroke survivors fell within the 3 months prior to the study and a significant proportion were older (p < .001) and had more diminished functional ability (p < .001).Conclusion: A considerable proportion of the stroke survivors fell, especially those in the older age-group and those with diminished functional ability. These findings suggest that improving functional ability after stroke may prevent falls while older stroke survivors would also require intensive falls prevention strategies to reduce their susceptibility to falls post stroke. Longitudinal studies on the incidence and frequency of falls among stroke survivors in Nigeria, and clinical trials on appropriate falls prevention strategies are however urgently required.

BACKGROUND Functional independence is often compromised after stroke and its restoration is one of the goals of stroke rehabilitation. OBJECTIVE This study assessed the impact of balance on functional independence after stroke. METHODS Ninety-five stroke patients undergoing physical rehabilitation at two health institutions in Nigeria participated in the study. Balance and functional independence were respectively assessed with the Berg Balance Scale and the Barthel Index. Binary logistic regression analysis was conducted to examine the independent impact of balance on functional independence while controlling for participants' age, sex, side of hemiparesis and post-stroke duration. RESULTS Mean±SD age of the participants was 58.4±13.1 years and females were more (f = 48; % = 50.5). The regression model from the binary regression analysis explained 73.2% (Nagelkerke R2 = 0.732) of the variance in functional independence. Good balance function was found to independently and significantly (P < 0.01) increase the likelihood of being functionally independent after stroke (Odds ratio = 1.33; 95% CI = 1.11 to 1.58). CONCLUSION The goal of attaining functional independence after stroke may depend to a significant extent on good balance function irrespective of the stroke survivor's age, sex and post-stroke duration.

Background Leisure provides pleasure and relaxation, and has health benefits even after a stressful and life-changing event such as a stroke. Objective This study examined leisure participation among a sample of community-residing stroke survivors in Nigeria. Methods Fifty-five stroke survivors undergoing rehabilitation were consecutively recruited from two government hospitals in Northern Nigeria. Data on pre- and post-stroke participation, and socio-demographic (age, sex, marital, employment, and educational status) and clinical (level of disability, post-stroke duration, stroke type and side of hemiplegia/hemiparesis) attributes of the stroke survivors were obtained. Leisure participation was assessed in four domains of recreational, social, cognitive, and productive/creative activities. Associations between leisure participation and the socio-demographic and clinical variables were examined using bivariate analysis. Results Mean (SD) age of the stroke survivors was 53.55 (14.39) years. Prevalence of leisure participation was 89.1%. Participation in specific leisure domains however varied thus: social (83.6%), cognitive (60%), recreational (41.8%), productive/creative activities (30.9%). Significant associations were observed between participation in cognitive, productive/creative, and recreational leisure activities, and specific socio-demographic and clinical attributes. Conclusions Leisure participation was high in a general sense but marginal in recreational and productive/creative activities. The observed socio-demographic and clinical associations with post-stroke leisure participation may assist in providing effective leisure rehabilitation strategies.

Background. Low back pain (LBP) is a major cause of disability and the most common work-related musculoskeletal disorder among physiotherapists. This study examined the prevalence of low back pain among students undergoing training to become physiotherapists. Methods. Participants were 207 undergraduate clinical physiotherapy students at three universities in Nigeria. A modified version of a questionnaire used in a previous study was utilized to obtain demographic, educational activities, and LBP data. Prevalence of LBP was examined with descriptive statistics while factors associated with prevalence were explored using chi-square statistics. Results. More male students (53.1%) and those in the penultimate year of study (53.1%) participated in the study. Lifetime, 12-month, 1-month, and 7-day prevalence of LBP were 45.5%, 32.5%, 17.7%, and 11.5%, respectively. Prevalence of LBP was not significantly associated with any of the demographic variables. Educational activities, namely, “having techniques practiced on self for ≤10 hours” and “treating patients for ≥30 hours,” a month prior to the study were significantly (P<0.05) associated with higher 1-month and 7-day LBP prevalence, respectively. Conclusions. Although the prevalence of LBP was comparatively low, its association with educational activities emphasizes the need to incorporate effective LBP preventive strategies in the training of physiotherapy students.

Introduction: Social support has often been identified as a key determinant of important stroke outcomes such as health-related quality of life (HRQoL). Information on the influence of the specific sources of social support on poststroke HRQoL is however scarce. This study examined the influence of social support received from family, friends and significant others on stroke survivors’ HRQoL. Methods: One hundred consenting stroke survivors were purposively recruited from two tertiary hospitals in Northern Nigeria into this cross-sectional study. Data on the stroke survivors’ sociodemographic and stroke-related attributes were obtained. Perceived support from friends, family and significant others was assessed using the Multidimensional Scale of Perceived Social Support (MSPSS) while HRQoL was assessed using the Stroke-Specific Quality of Life-12 (SS-QoL-12) measure. Hierarchical regression analysis was used to identify the independent influence of the

Background: Hypertension is regarded as a silent killer especially because it may remain undiagnosed. This study examined the prevalence of undiagnosed hypertension among staff of a University in Nigeria. Methods: A cross-sectional survey of junior and senior staff of a University in Northern Nigeria was conducted. Demographic, blood pressure, and body mass index (BMI) data were obtained using appropriate instruments. Prevalence of undiagnosed hypertension was presented as percentages while Chi-square statistic was used to assess differences in the prevalence among participants in the senior and junior cadres globally, and by gender and BMI at a significance level of α = 0.05. Results: There were 441 participants comprising 258 (58.5%) senior and 183 (41.5%) junior staff while mean age of participants was 40±8.5 years. Prevalence of undiagnosed hypertension was 36.1%. Differences in the prevalence were statistically significant only between obese male senior and junior staff, and obese female senior and junior staff, with higher proportions of senior staff having undiagnosed hypertension in both cases. Conclusions: Approximately one-third of the participants had undiagnosed hypertension with a higher prevalence among obese male and female senior staff. Institution-based hypertension prevention and awareness strategies including routine blood pressure and risk factor screening are advocated.

Health-related quality of life (HRQoL) of stroke survivors can be described as an important and holistic index of stroke outcome. To enhance this all encompassing construct, information on its predictors at different phases of stroke is required.This study sought to identify consistent determinants of HRQoL over the course of 1 year after stroke in Nigeria.Information on socio-demographic, clinical, and functioning attributes of 55 consecutive individuals with first-ever stroke were obtained during acute admission and at 1, 3, 6, and 12 months post-stroke. Attributes of functioning namely, motor performance, functional activity, and participation were assessed using the Simplified Fugl-Meyer Assessment, the motor-Functional Independence Measure, and the London Handicap Scale, respectively. HRQoL was also assessed with the Health-Related Quality of Life in Stroke Patients-40 scale at 1, 3, 6, and 12 months. Attributes that were associated with HRQoL at these time points were identified using bivariate and multivariable regression analyses.Among the independent variables, concurrently assessed participation was the sole significant (P 0.0001) determinant of HRQoL at 1, 3, and 6 months, respectively accounting for 70%, 64%, and 75% variance in HRQoL. At 12 months, participation (P 0.0001), and functional activity (P 0.05) accounted for 83% variance in HRQoL, with better functional activity and participation associated with better HRQoL.The outcome of this study indicates that optimizing post-stroke functional activity and participation through proven and effective rehabilitation strategies may result in better HRQoL in stroke survivors.

Background: Stroke is a major cause of mortality and morbidity worldwide and primary prevention, through adequate knowledge of its risk factors and attendant risk factor control/modification, remains the best solution. This study assessed knowledge of stroke risk factors among individuals diagnosed with two of the most common modifiable risk factors of stroke namely hypertension and diabetes. Methods: A consecutive sample of 200 clients diagnosed with hypertens ion and/or diabetes was recruited into this cross - sectional survey from a university teaching hospital in northern Nigeria between January and March 2011. Clinical, socio - demographic, and knowledge of stroke risk factors data were obtained through face - to - face interview using researcher - developed

Background and purpose A stroke event is often characterized by a number of debilitating consequences that may impact negatively on the health-related quality of life (HRQL) of survivors. This study examined the impact of poststroke fatigue (PSF), a persistent and prevalent stroke consequence, on HRQL of Nigerian stroke survivors. Methods One hundred stroke survivors were recruited from the physiotherapy outpatient departments of two tertiary hospitals in Northern Nigeria. The Fatigue Severity Scale and Health-Related Quality of Life in Stroke Patients-26 were respectively used to assess PSF and HRQL. The independent impact of PSF on overall and domain-specific HRQL was examined using hierarchical regression analyses. Results Mean age of the stroke survivors was 55.32 years (SD 13.9 years). The majority were males (66%), had suffered ischemic stroke (70%) and presented with moderately severe disability (42%). After controlling for demographic and stroke-related variables, PSF was found to be significantly and independently associated with all the domains of HRQL albeit at varying degrees. While the influence of PSF on the emotional domain was the most pronounced and uniquely contributed to 15% of the variance in the domain, its influence on the cognitive domain was the least prominent. PSF also solely accounted for 9% of the variation in overall HRQL with higher levels of PSF related with lower HRQL. Conclusions Being a potentially treatable condition, PSF's significant impact on HRQL has implications for successful stroke care and rehabilitation. For instance, addressing PSF through appropriate interventions may assist in enhancing HRQL of stroke survivors.

Objective: Submissions on recovery of post-stroke motor performance vary, especially in relation to increasing time after stroke. This study examined the trajectory of motor performance over the first 12 months after stroke.Methods: Consecutive first-incidence stroke survivors (N = 83) were recruited within 1 month of onset from a tertiary health institution in Nigeria. Simplified Fugl Meyer scale (S-FM) was used to assess motor performance at monthly intervals. Changes in overall motor performance, and differences between the affected upper and lower extremities, were examined using Friedman's ANOVA and paired t-tests, respectively.Results: Significant improvement in motor performance was observed across 12 months (p < .001), with the proportion of stroke survivors with severe impairment at onset (53.3%) decreasing to 20% by 12 months. Lower extremity motor performance scores were significantly higher than for the upper extremity from 1 to 12 months (p p < .05 at the remaining months).Conclusions: The potential for long-term improvement in motor performance after stroke was observed, suggesting that this can be harnessed by long-term rehabilitation efforts. The comparatively poorer outcome in the upper extremity indicates the need for extra rehabilitation strategies to enhance upper-extremity motor recovery in the first year of stroke.

Background. Stroke may negatively affect social participation in survivors. Aims. This study assessed the pattern of social participation in a sample of Nigerian stroke survivors across the first 12 months after stroke. Methods. Stroke survivors were consecutively recruited while on admission at a tertiary health institution. The London handicap scale was used to assess social participation at 1, 3, 6, 9, and 12 months at the homes of the stroke survivors. Overall and domain-specific patterns of social participation were examined independently and also in relation to initial stroke severity. Results. Overall social participation significantly improved over 12 months (), while significant improvements were observed only in the mobility, physical independence, and work and leisure domains at P equals 0.04, 0.04, and 0.05, respectively. In spite of the improvement in the work and leisure domain, the domain recorded the lowest level of participation. Social participation also differed by initial stroke severity with severe stroke survivors having the lowest level of participation across 12 months after stroke. Conclusions. The poor outcome in the work and leisure domain of social participation and in individuals with initial severe stroke has implications for planning and provision of appropriate long-term stroke rehabilitation.

Participation which entails involvement in life situations and represents a higher level of functioning can be severely restricted after a stroke. This study investigated the impact of social support on participation of stroke survivors in Nigeria.Ninety-six community-residing stroke survivors were recruited from physiotherapy outpatient departments of two tertiary care hospitals in Northern Nigeria. Socio-demographic, clinical, participation (London Handicap Scale), and social support (Multidimensional Scale of Perceived Social Support) data were obtained. The impact of social support on global and domain-specific participation was examined using bivariate analyses and multiple regression analyses.Mean (SD) age of the stroke survivors was 56.6 (12.0) years. Social support was a significant (β = 0.41, p 0.0001) and independent determinant of the economic self-sufficiency domain of participation (p 0.0001) in a regression model that accounted for 27% of the variance in the domain (R(2) = 0.27). Social support, however, had no independent effect on overall participation and the other participation domains namely mobility, physical independence, occupation, social integration, and orientation.The impact of social support was significant only in the economic self-sufficiency domain of participation with higher availability of social support related to better economic self-sufficiency. This finding provides additional information on the importance of social support post-stroke.

Background Caregivers play important roles in the collaborative efforts that characterize successful stroke rehabilitation, and their quality of life (QoL) may have implications for outcome of care. Aim This study explored the QoL of caregivers of community-dwelling stroke survivors in north-eastern Nigeria. Methods Fifty-nine caregivers of community-dwelling stroke survivors attending physiotherapy out-patients departments of two government hospitals in the city of Maiduguri participated in the study. Information on participants' age, gender, employment status, educational background, relationship with the stroke patient, and time after onset of stroke were obtained through interview, while their QoL was assessed with WHOQoLBREF questionnaire. Demographic and QoL data were summarized with descriptive statistics, and influence of caregivers and care recipients' factors on QoL was analysed using Kruskal–Wallis test. Results Majority of caregivers were males (55.9%) and provided care for their parents (69.5%) who had suffered stroke within 1 year prior to study (72.9%). Mean scores on all QoL domains were above average with the physical domain recording the lowest scores. Caregivers' factors of age, educational background and employment, and duration poststroke onset were significantly associated with domains of QoL. Conclusion Although QoL of stroke caregivers was fair across domains, the physical domain recorded the lowest mean scores. Older age, lack of formal education, unemployment and caring for stroke patients within the second year poststroke were associated with lower QoL scores. Information from this study may aid in identifying those caregivers who require support programmes and care the most.

Background Attitudes of students of health care professions, such as physiotherapy, toward persons with disability may influence their attitude and practice post-qualification. Objective To examine attitudes toward persons with disability among undergraduate physiotherapy students in Universities in Nigeria. Methods The 30-item Attitudes toward Disabled Persons – Form A (ATDP-A) scale was used to assess the attitudes of penultimate and final year physiotherapy students in 3 Nigerian universities. Overall and item-by-item analyzes of responses to the ATDP-A scale were carried out. Differences in attitude by sex, age, year and university of study were also examined using independent t-test and one-way ANOVA. Results One hundred and sixty-nine students with a male majority (56.2%) participated in the study. Mean score on the ATDP-A was 94.95 ± 17.50 with more students (60.4%) having a score >90 which depicts positive attitude. Item-by-item analysis of responses to the 30 items on the ATDP-A showed that negative attitudes were preponderant on items relating to the emotional component of the personality of persons with disability. Only age of students and their university of study however resulted in statistically significant differences in attitudes and older students reported better attitudes toward persons with disability. Conclusions Although the overall attitude of the physiotherapy students was positive, negative stereotypes and discriminatory tendencies were observed in issues relating to the perceived emotional capacity of persons with disabilities. Educational strategies capable of effecting more positive attitudes in physiotherapy students in Nigeria toward persons with disability are urgently needed.

Successful implementation of multidisciplinary healthcare approach may among other things depend on students' education and knowledge of the roles of healthcare professions other than their own. This study investigated medical students' awareness of the role of physiotherapists in multidisciplinary healthcare teams.One hundred and ninety-eight medical students of the University of Maiduguri, Nigeria, participated in this study. Each student completed a self-administered questionnaire that obtained information on demographics, awareness of role of physiotherapists and educational sources of information as well as suggestions about other sources of information about physiotherapy. Chi-square test was used to analyze differences in awareness by gender and year of study.Although rates of awareness regarding some physiotherapy roles were high, many of the medical students were unaware that physiotherapists can practice on first-contact basis and autonomously. About 60% of the students also viewed the role of physiotherapists in the health team as one of providing assistance for medical work. Clinical ward round was the most common source of information on physiotherapy although many of the students suggested classroom lecture as a preferred means of obtaining information. Year of study resulted in significantly different level of awareness (p 0.05) with a higher proportion of final year students exhibiting awareness of physiotherapists' roles.Clinical ward rounds facilitated the students' awareness of the role of physiotherapists. Interprofessional education involving lectures and clinical ward rounds may assist in building medical students' level of awareness and appreciation of the physiotherapy profession.

To investigate the sensitivity and responsiveness of the Health-Related Quality of Life in Stroke Patients-40 (HRQOLISP-40) scale in evaluating stroke patients from onset to 12 months.Fifty-five patients with first-incidence stroke were followed-up for 12 months. The HRQOLISP-40 scale was used to assess health-related quality of life (HRQOL) while stroke severity was assessed with the Stroke Levity Scale. Sensitivity to change was assessed by analyzing changes in the HRQOLISP-40 scores between pairs of months with paired samples t-test. Standardized effect size (SES) and standardized response mean (SRM) were used to express responsiveness.Overall HRQOL and domains in the physical sphere of the HRQOLISP-40 were sensitive to change at different time intervals in the first 12 months post-stroke. Marked responsiveness (SES and SRM0.7) was demonstrated by the overall scale, and the physical, psycho-emotional and cognitive domains at varying time intervals. For instance, SRM was greater than 0.7 between 1 and 6, 3 and 12, 1 and 9, and 1 and 12 months for both the physical and psycho-emotional domains.The HRQOLISP-40 is a sensitive and responsive stroke-specific quality of life measure that can be used to evaluate the outcome of stroke rehabilitation.Enhancing the health-related quality of life (HRQOL) of stroke survivors can be regarded as the ultimate goal of stroke rehabilitation. Sensitive and responsive stroke-specific HRQOL measures are required for use in evaluative studies, and clinical trials and practice. The Health-Related Quality of Life in Stroke Patients-40 (HRQOLISP-40) is a sensitive and responsive stroke-specific scale.

Background: Abdominal obesity is a risk factor for many life-threatening and life changing chronic conditions. A survey was conducted to determine the prevalence of abdominal obesity among stroke survivors undergoing rehabilitation. Methods: Ninety stroke survivors attending three outpatient physiotherapy clinics in a metropolitan city in Nigeria participated in this cross-sectional survey. Abdominal obesity was determined with the measurement of waist circumference. Data on participants’ personal factors namely age, gender, post-stroke duration and level of disability (Modified Rankin Scale) were also obtained and the prevalence of abdominal obesity was explored in relation to these factors using Chi-square statistics. Results: Mean (SD) age of participants was 58.9 (9.7) years, and male stroke survivors were in the majority (62.2%). Twenty-two participants were observed to have abdominal obesity giving a prevalence rate of 24.4%. Females had a significantly higher prevalence (44.1%) compared to males (12.5%). No other personal factors however resulted in significantly different prevalence rates. Conclusion: Approximately one in four stroke survivors in this study was observed to have abdominal obesity with a significantly higher prevalence among female stroke survivors. Further studies would be required to document outcomes of abdominal obesity after stroke and identify effective preventive and intervention strategies to address abdominal obesity among stroke survivors.

Rates of obesity, Type 2 diabetes and cardiovascular disease are high among Pacific people in New Zealand. Physical activity is recommended in the prevention and management of these conditions. Community-based, 'small-sided game' group activities may be an effective and culturally appropriate way to promote physical activity within Pacific communities.To assess the effectiveness of small-sided games-based exercise on fitness and health parameters among Pacific adults over four weeks.Twenty untrained (13 female) Pacific adults were randomised to intervention or control. Intervention participants were offered 45 minutes of small-sided games three times per week for four weeks. Control participants were offered one-month gym membership after the trial. Primary outcomes included cardiorespiratory fitness (VO₂peak) and leg strength (maximal concentric force of quadriceps at 60°/second) measured at baseline and four weeks. Secondary outcomes included glycaemia, lipid profile, blood pressure (BP), and inflammatory markers. Multivariable regression models were used to assess differences between groups, adjusting for baseline values, age and gender.At baseline, mean age was 34.8 years (SD 12.6), BMI 36.3 (6.7), systolic BP 127.7 mmHg (12.1), HbA1c 6.1% (1.9), VO₂peak 2.5 L/min (0.6) and leg strength 170.0 N.m (57.4). Sixteen participants completed the trial. Change in outcomes were greater in intervention than control participants in absolute VO₂peak (0.9 L/min (p=0.003)), leg strength (17.8 N.m (p=0.04)) and HDL (0.12 mmol/L (p=0.02)). There were no other significant differences.Small-sided games appear to be a promising means for improving the health and cardiorespiratory fitness and reducing the risk of diabetes and cardiovascular disease in Pacific adults.

Background: Awareness of stroke warning signs is considered a vital prerequisite for seeking emergency stroke care. This study assessed awareness of stroke warning signs and its associations among individuals at risk of stroke. Methods: A cross-sectional design was utilized to obtain information on awareness of stroke warning signs among 200 individuals diagnosed with hypertension and/or diabetes at a tertiary hospital in Nigeria. Data were obtained using researcher-developed questionnaire. Descriptive and bivariate analyses were used to respectively summarize data and examine associations between awareness of warning signs and selected participants’ attributes. Results: Mean age of the participants was 49.7 ± 16.3 years. 73.5% of the participants identified at least one stroke warning sign. The most reported sign was headache (57%) followed by weakness of the limbs and/or face (34.5%) and dizziness (34.5%) while disturbance of vision was the least (6.5%) identified warning sign. Significant associations were observed between level of awareness of warning signs and family history of stroke (P = 0.049), and employment (P = 0.047). A higher proportion of those with a family history of stroke (39.1%) were aware of 3 or more stroke warning signs compared to those without (19.4%). More civil servants (37.8%) and retired civil servants (29.4%) were also able to mention ≥3 warning signs compared with those in other occupational categories. Conclusions: Awareness of stroke warning signs appeared to be generally high with headache being the most known sign. Efforts at improving awareness of more distinct and less easily ignored warning signs may however be required.

Background: Availability of social support has been identified as an important prerequisite for positive outcomes after stroke. There is however, little information on variables that influence the availability of social support after stroke. Aim: This study explored the influence of selected sociodemographic and clinical variables on social support of stroke survivors in Nigeria. Subjects and Methods: One hundred stroke survivors undergoing rehabilitation at two tertiary‑care hospitals in Northern Nigeria participated in the study. Data on age, gender, living arrangement, marital, education and prestroke employment status, and time after stroke were obtained through interview, while poststroke disability was evaluated with the modified Rankin Scale. Social support was assessed with the multidimensional scale of perceived social support (MSPSS). Univariate and multiple linear regression analyses were conducted. A P value of less than 0.05 is considered as significant. Results: Univariate analysis showed that gender, education, and prestroke employment status were significantly associated with the availability of social support. In a regression model that accounted for 11 % of the variance in social support, prestroke employment was the only variable that independently influenced availability of social support (β = −0.33, P < 0.01) with previously employed stroke survivors having higher MSPSS score (5.28 [0.98]) compared to the unemployed (4.57 [0.82]). Conclusion: Employment is a known significant contributor to social network and was also found to influence significantly, the availability of poststroke social support in this study. Further studies are required to identify factors that more substantially influence the availability of social support after stroke.Keywords: Nigeria, Social support, Stroke, Stroke survivors