Characteristics and determinants of community physiotherapy utilization and supply

Physiotherapists' attitudes, practice and barriers to sexual issues among stroke survivors in South-East Nigeria

BACKGROUND

Sexual issues post-stroke are common and can include difficulties related to arousal, orgasm, and decreased sexual desire, and satisfaction.

AIM

To determine the attitudes, practices, and barriers experienced by physiotherapists in addressing sexual issues among stroke survivors.

METHODS

This cross-sectional survey involved 72 practicing physiotherapists purposively recruited from selected tertiary hospitals in southeast Nigeria. Modified Physiotherapists' Attitudes on sexual issues, Physiotherapists' Performance Questionnaire in dealing with sexual issues, and Barriers to Discussing Sexual Issues Questionnaires were used to collect data that were analyzed using Statistical Package for Social Science (SPSS).

RESULTS

The results showed a significant association (p < 0.05) between the attitude and practice of physiotherapists in dealing with sexual issues of stroke survivors. Although most of the physiotherapists expressed confidence in their understanding of the need to address sexual issues of stroke survivors, only a quarter of them often or always assessed the patients' sexual function as well as included therapy for erectile dysfunction in their plan of care for stroke survivors. Patients' discomfort (88.9%) and insufficient knowledge and training (70.8%) were the most reported barriers. The majority (95.8%) indicated the need for a training program on the sexual issues, despite their area of specialization.

CONCLUSION

Although the studied physiotherapists understand the need to address these issues, the practical application remains limited due to varying barriers. There is a need for structured training programs focused on sexual health to bridge the gap between knowledge and practice, thereby enhancing the overall care and quality of life for stroke survivors.

Attractiveness and retention factors for employed physiotherapists in France: A multicentre survey

OBJECTIVES

The aim of this study was to investigate the factors influencing the attractiveness of employed physiotherapy, considering the shortage of physiotherapists in the salaried sector, previously unsuccessful measures.

METHODS

A survey was conducted using an online self-administered questionnaire. The primary outcome measure involved assessing respondents' agreement with each statement in key domains. Regarding the secondary outcome measures, the relationships between respondents' age and their responses, as well as the relationship between their profession and their responses, were examined.

RESULTS

The study included 448 participants in France, encompassing both primary and secondary care settings. The sample consisted of practicing physiotherapists (83.1%) and healthcare managers (16.9%). Respondents expressed significant concerns regarding the attractiveness of employed physiotherapy. For the primary outcome, the study identified potential solutions, including improving financial recognition, promoting continuous professional development, and enhancing inclusion in healthcare projects. For the secondary outcomes, statistically significant relationships were found between respondents' age and their answers for variables 16 (additional qualifications; p = 0.048), 24 (work-life balance; p = 0.010), and 25 (professional quality of life; p = 0.0005).

CONCLUSION

The findings underscore the need to enhance financial recognition, support continuous professional development, and increase inclusion in healthcare projects to effectively improve the attractiveness of employed physiotherapy. These results have significant implications for policymakers and healthcare institutions grappling with recruitment challenges. Further research and collaborative efforts are crucial to implementing the recommended measures and assessing their impact on the employed physiotherapy profession.

"Life has always been physical physical, now visual": an explorative study on the use of digital health technologies to promote physiotherapy home treatment programs among older people

BACKGROUND

There has been a recent rise in the use of technology for health promotional practices, which have begun to gain popularity among physiotherapists but not much research has been conducted to explore its many opportunities and challenges among older adults in developing countries.

OBJECTIVES

To explore Nigerian-based Physiotherapists' perspectives on how digital health technologies (DHT) can be utilized to promote physiotherapy home treatment programs among Nigerian older people.

METHODS

This is a one-on-one semi-structured interview of 12 geriatric physiotherapists (7 Male, 5 female) virtually in the Teams Meeting platform. Data generated were analyzed thematically using the latest version of NVivo software.

RESULTS

Three overarching themes were conceptualized including the usage of DHT in Nigeria, challenges to DHT application, and strategies to improve DHT usage. These described a low awareness and usage of DHT despite its recognized need and advantages for promoting home program. The forms of DHT commonly being used are mostly mobile-based through calls or texts, which could be due to barriers to the use of DHT including older people's declining cognition, poverty, and low interest in technology. Some external problems included the physiotherapists' attachment to hands-on practice and low commitment from the informal caregivers.

CONCLUSIONS

These findings suggested ways to utilize the DHT in promoting physiotherapy home treatment programs among older people by encouraging technological innovations and raising awareness among physiotherapists, while the physiotherapists need to patiently educate both the older people and involve their informal caregivers.

Evaluation of the quality of physiotherapy service in university of Gondar comprehensive specialized hospital, northwest Ethiopia: A mixed method evaluation

BACKGROUND

Currently, the number of people with physical disability and impairment is increasing significantly in Ethiopia, especially in the northern part. In that regard, the Ethiopian government has been providing physical rehabilitation services to recover patients. However, due to the widespread problem of healthcare service and the increase in patients seeking physiotherapy service, the quality of the service might be compromised, and the evidence is limited. Thus, this study aimed to evaluate the quality of physiotherapy services at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia.

METHODS

A single case study with concurrent mixed method research design was conducted from June 02- August 10, 2022. The evaluation used patient-centeredness, timeliness, compliance and availability dimensions with 27 indicators. A total of 415 systematically selected patients who came for physiotherapy service for exit interviews, 9 service providers and managers for key-informant interviews, and 8 patients for in-depth interviews participated in the study. Approximately 176 patient medical charts were reviewed, and direct observation of 14 patient-provider interactions was performed. Binary logistic regression analysis was computed to identify factors associated with patient-centeredness. In the final model, variables with a p value < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistical significance. Thematic analysis for the qualitative data using OPEN CODE version 4.03 was performed. Finally, the dimensions and overall quality of physiotherapy service were judged using predetermined criteria.

RESULT

The overall quality of the physiotherapy service was found to be fair or intermediate (66.5%), computed from the availability of resources 63.4%, compliance of service providers 68.6%, timelines 64.2%, and patient centeredness 73.1%. Qualitative findings also revealed that insufficient staffing and heavy workload, lack of resources, inconvenient facilities, relocation of resources in the academic division of physiotherapy department, lack of training and continuous professional development opportunities, lack management attention and institutional support and nonexistence of multidisciplinary approaches leads to significant gaps in quality service delivery. Attending primary school (AOR = 3.22, 95% CI: 1.56, 6.61), secondary (AOR = 4.24, 1.91, 9.41), and higher education (AOR = 4.79, 1.94, 11.84) and being a private employee (AOR = 0.34, 95% CI: 0.16, 0.76) were significantly associated with patient centeredness.

CONCLUSION

The overall quality of physiotherapy service was deemed intermediate and needs further improvement. The required resources, such as clinical assessment tools, therapeutic exercise equipment, electrotherapy modalities and infrastructure, were not adequate. Educational level and occupation were significantly associated with patient centeredness.

Physiotherapy and its service in Nepal: implementation and status reported from facility surveys and official registers

BACKGROUND

Physiotherapy is a growing profession in Nepal. Despite efforts to promote strengthening and development, there are still challenges in providing equitable access and availability to services, particularly in underserved areas. Updated information is needed to address challenges to provide proper planning for resource allocation.

OBJECTIVE

To assess implementation of physiotherapy services and to explore plans, policies and the general status of physiotherapy in Nepal.

METHOD

Implementation was assessed with a cross-sectional survey conducted in Province III containing closed-ended questions addressing physiotherapy services, human resources, charging and record-keeping systems, and accessibility. Stratified purposive sampling was used to select eligible facilities from the list of Department of Health Services. Official records were explored through visits to governing institutions and by reviews of registers and reports to obtain data and information on status, plans and policy.

RESULTS

The survey included 25 urban and 4 rural facilities, covering hospitals and rehabilitation centres; both public (37.9%) and non-public (62.1%). Most facilities (79.3%) employed physiotherapists with bachelor's degrees. Average number of visits were 29.55 physiotherapy outpatients and 14.17 inpatients per day. Patient records were mainly paper based. Most (69%) used the hospital main card, while others (31%) had their own physiotherapy assessment card. Most referrals came from doctors. The most offered services were musculoskeletal, neurological, and paediatric physiotherapy. Daily basis charging was common. A single visit averaged 311 Nepalese rupees ≈ 2.33 US$. Convenience for persons with disabilities was reported as partial by 79% of outpatient departments. Official register data showed 313 master's and 2003 bachelor's graduates. Six colleges offered physiotherapy bachelor's degree, whereof one also offered a master's program. Government records revealed significant progress in physiotherapy in Nepal.

CONCLUSION

The study highlights variations in physiotherapy services within a province owing to type, size and location, but also unwarranted variations. Despite the progress, implementation of physiotherapy services in the perspective of official records imply a need of systems for proper planning and monitoring. Physiotherapy provision in underserved areas warrants further attention.

The Effect of COVID-19 Pandemic on Households' Utilization of Rehabilitation Services: National Evidence from Iran Health System

Background

The coronavirus disease-2019 (COVID-19) pandemic has affected the pattern of utilization of healthcare services. This study aimed to investigate the utilization of rehabilitation services before and after the COVID-19 pandemic in the health system of Iran.

Methods

This descriptive-analytical study used data from the Household Income and Expenditure Surveys of the Iran Statistics Center in 2018-2019 (before COVID-19) and 2020 (after COVID-19). The patterns of utilization and expenditures of rehabilitation services before and after this pandemic were investigated in different household sub-groups. The multilevel logistic regression model was used to investigate the effect of COVID-19 on the utilization of health services by households.

Results

Although 258 (0.66%) households used rehabilitation services before the COVID-19 pandemic, only 175 (0.47%) households utilized them after the pandemic. Additionally, the average total rehabilitation costs per utilized household were 3,438,185 Iranian Rials (IRR) in 2018-2019 and 2,996,511 IRR in 2020-2021. Sex, age, education, size of household, place of residence, health insurance coverage, and income significantly affected the utilization of rehabilitation services by households during the study period (p < 0.001). Furthermore, the average use of rehabilitation services decreased by 22% (odds ratio = 0.78, p < 0.01) after the pandemic.

Conclusion

In Iranian households, the utilization and average expenditure of rehabilitation services significantly decreased after the COVID-19 pandemic. These findings strongly recommend health system policymakers to develop comprehensive plans to address future shocks arising from pandemics and other emergencies.

Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people.

METHOD

We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect.

RESULTS

In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology's feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75-1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14-0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies.

CONCLUSIONS

Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people.

Effect of mixed and collective physical activity in chronic stroke rehabilitation: A randomized cross-over trial in low-income settings

BACKGROUND

The prevalence of physical inactivity after stroke is high and exercise training improves many outcomes. However, access to community training protocols is limited, especially in low-income settings.

OBJECTIVE

To investigate the feasibility and efficacy of a new intervention: Circuit walking, balance, cycling and strength training (CBCS) on activity of daily living (ADL) limitations, motor performance, and social participation restrictions in people after stroke.

METHODS

Forty-six community-dwelling individuals with chronic stroke who were no longer in conventional rehabilitation were randomized into an immediate CBCS group (IG; initially received CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG) that first participated in sociocultural activities for 12 weeks. In phase 2, participants crossed over so that the DG underwent CBCS and the IG performed sociocultural activities. The primary outcome was ADL limitations measured with the ACTIVLIM-Stroke scale. Secondary outcomes included motor performance (balance: Berg Balance Scale [BBS], global impairment: Stroke Impairment Assessment Set [SIAS] and mobility: 6-minute and 10-metre walk tests [6MWT and 10mWT] and psychosocial health [depression and participation]). Additional outcomes included feasibility (retention, adherence) and safety.

RESULTS

ADL capacity significantly improved pre to post CBCS training (ACTIVLIM-stroke, +3,4 logits, p < 0.001; effect size [ES] 0.87), balance (BBS, +21 points, p < 0.001; ES 0.9), impairments (SIAS, +11 points, p < 0.001; ES 0.9), and mobility (+145 m for 6MWT and +0.37 m/s for 10mWT; p < 0.001; ES 0.7 and 0.5 respectively). Similar improvements in psychosocial health occurred in both groups. Adherence and retention rates were 95% and 100%, respectively.

CONCLUSION

CBCS was feasible, safe and improved functional independence and motor abilities in individuals in the chronic stage of stroke. Participation in CBCS improved depression and social participation similarly to participation in sociocultural activities. The benefits persisted for at least 3 months after intervention completion.

PROTOCOL REGISTRATION NUMBER

PACTR202001714888482.

Patients' satisfaction with physiotherapy management of chronic mechanical neck pain in physiotherapy departments of public hospitals in Ibadan, Nigeria: A mixed-method study

INTRODUCTION

The study was aimed at determining patients' satisfaction level with physiotherapy in the management of chronic mechanical neck pain (CMNP) in physiotherapy departments of the 3 public hospitals in Ibadan, Nigeria.

METHODS

A mixed-method design that involved 51 and five both purposively selected participants for the cross-sectional survey (CSS) and qualitative study, respectively. For the CSS, data was collected using the MedRisk instrument and analyzed using the Chi-square test at p ≤ .05. For the qualitative study, patients' satisfaction was explored through a focus group discussion (FGD) and analyzed using thematic analysis.

RESULTS

For CSS, 49.0% and 7.8% of the participants reported excellent and fair satisfaction, respectively, with physiotherapy in the management of CMNP. There was no significant association of patients' satisfaction level with: age (p = .588); sex (p = .851); and marital status (p = .409). For the FGD, three themes (patients' experience with physiotherapists; patient satisfaction with physiotherapy services; patient satisfaction with other health care services) that emerged further explained that participants were satisfied with physiotherapy management of their CMNP. However, they were not satisfied with the attitude of the record officers, constancy of the same treating physiotherapists, and unavailability of resources.

CONCLUSION

Patients with CMNP are satisfied with the physiotherapy care they received.

Adverse events in the treatment of motorcycle-related isolated limb injuries at a regional hospital in Uganda: a prospective clinical analysis

PURPOSE

Although motorcycle accidents are a leading cause of limb injury in Uganda, little is known about injury care quality at regional hospitals. This study measured the incidence of clinical adverse events (CAEs) and identified associated treatment barriers surrounding motorcycle-related isolated limb injuries at a regional hospital.

METHODS

A prospective descriptive study was conducted among patients with motorcycle-related isolated limb injuries at a Ugandan regional hospital between September 2017 and February 2018. Patients were surveyed upon admission and monitored throughout their course of treatment. Weight-bearing status and quality of life measures (EQ-5D) were assessed at four and 12 weeks.

RESULTS

One hundred twenty-four participants enrolled. Of the total participants, 12% refused definitive treatment. Among 108 treated patients, six experienced CAEs: four wound infections, one amputation, and one death. At 12 weeks follow-up, the majority of patients had no difficulty with mobility, pain/discomfort, or self-care, but 51% endorsed challenges completing certain daily chores, and 40% of patients could ambulate without an assistive device with restoration of pre-fracture gait. Both longer hospital stays and poorer 12-week functional recovery were seen among patients sustaining open fracture (p < 0.001).

CONCLUSION

Treatment of isolated limb injuries at a Ugandan Regional Hospital was associated with minimal short-term CAEs. However, patients with more severe injuries may be at risk for delayed post-operative recovery. Future studies measuring long-term functional outcomes should be performed to better understand and optimize injury care in this population.

Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis

BACKGROUND

Musculoskeletal conditions are common and cause high levels of disability and costs. Physical therapy is recommended for many musculoskeletal conditions. Past research suggests that referral rates appear to have increased over time, but the rate of accessing a physical therapist appears unchanged.

OBJECTIVE

Our retrospective cohort study describes the rate of physical therapy use after referral for a variety of musculoskeletal diagnoses while comparing users and non-users of physical therapy services after referral.

METHODS

The study sample included patients in the University of Utah Health system who received care from a medical provider for a musculoskeletal condition. We included a comprehensive set of variables available in the electronic data warehouse possibly associated with attending physical therapy. Our primary analysis compared differences in patient factors between physical therapy users and non-users using Poisson regression.

RESULTS

15 877 (16%) patients had a referral to physical therapy, and 3812 (24%) of these patients accessed physical therapy after referral. Most of the factors included in the model were associated with physical therapy use except for sex and number of comorbidities. The receiver operating characteristic curve was 0.63 suggesting poor predictability of the model but it is likely related to the heterogeneity of the sample.

CONCLUSIONS

We found that obesity, ethnicity, public insurance and urgent care referrals were associated with poor adherence to physical therapy referral. However, the limited predictive power of our model suggests a need for a deeper examination into factors that influence patients access to a physical therapist.

Social determinants of health are associated with physical therapy use: a systematic review

OBJECTIVE

The purpose of this systematic review is to identify and summarise the social determinants of health (SDH) cited in the literature and evaluate their association with individuals using physical therapy services.

DESIGN

A systematic review using qualitatively synthesised information to describe the association between SDH and physical therapy use.

DATA SOURCES

The electronic databases Medline, Embase and Scopus were searched from inception to February 2021, identifying observational and qualitative studies.

ELIGIBILITY CRITERIA

Published studies included all adults, aged 18 or older, who independently sought to use physical therapy, in all practice settings from all geographical locations.

RESULTS

Of the 9248 studies screened, 36 met the inclusion criteria for the review. The participants represented 8 countries and totaled 2 699 437. The majority of the papers reported moderate strength of association for each SDH. Female gender, non-Hispanic white race/ethnicity, increased education attainment, urban environment, access to transportation, employment, high socioeconomic status and private insurance were associated with higher likelihood of physical therapy use.

CONCLUSION

This systematic review identifies predisposing and enabling factors impacting physical therapy usage among adults in different countries and across physical therapy settings. The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.

Understanding Telerehabilitation Technology to Evaluate Stakeholders' Adoption of Telerehabilitation Services: A Systematic Literature Review and Directions for Further Research

OBJECTIVES

To examine the adoption of telerehabilitation services from the stakeholders' perspective and to investigate recent advances and future challenges.

DATA SOURCES

A systematic review of English articles indexed by PubMed, Thomson Institute of Scientific Information's Web of Science, and Elsevier's Scopus between 1998 and 2020.

STUDY SELECTION

The first author (N.N.) screened all titles and abstracts based on the eligibility criteria. Experimental and empirical articles such as randomized and nonrandomized controlled trials, pre-experimental studies, case studies, surveys, feasibility studies, qualitative descriptive studies, and cohort studies were all included in this review.

DATA EXTRACTION

The first, second, and fourth authors (N.N., W.I., B.N.) independently extracted data using data fields predefined by the third author (M.B.). The data extracted through this review included study objective, study design, purpose of telerehabilitation, telerehabilitation equipment, patient/sample, age, disease, data collection methods, theory/framework, and adoption themes.

DATA SYNTHESIS

A telerehabilitation adoption process model was proposed to highlight the significance of the readiness stage and to classify the primary studies. The articles were classified based on 6 adoption themes, namely users' perception, perspective, and experience; users' satisfaction; users' acceptance and adherence; TeleRehab usability; individual readiness; and users' motivation and awareness.

RESULTS

A total of 133 of 914 articles met the eligibility criteria. The majority of papers were randomized controlled trials (27%), followed by surveys (15%). Almost 49% of the papers examined the use of telerehabilitation technology in patients with nervous system problems, 23% examined physical disability disorders, 10% examined cardiovascular diseases, and 8% inspected pulmonary diseases.

CONCLUSION

Research on the adoption of telerehabilitation is still in its infancy and needs further attention from researchers working in health care, especially in resource-limited countries. Indeed, studies on the adoption of telerehabilitation are essential to minimize implementation failure, as these studies will help to inform health care personnel and clients about successful adoption strategies.

Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review

Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.

The Clinical and Cost-Effectiveness of Telerehabilitation for People With Nonspecific Chronic Low Back Pain: Randomized Controlled Trial

BACKGROUND

Telerehabilitation can facilitate multidisciplinary management for people with nonspecific chronic low back pain (NCLBP). It provides health care access to individuals who are physically and economically disadvantaged.

OBJECTIVE

This study aimed to evaluate the clinical and cost-effectiveness of telerehabilitation compared with a clinic-based intervention for people with NCLBP in Nigeria.

METHODS

A cost-utility analysis alongside a randomized controlled trial from a health care perspective was conducted. Patients with NCLBP were assigned to either telerehabilitation-based McKenzie therapy (TBMT) or clinic-based McKenzie therapy (CBMT). Interventions were carried out 3 times weekly for a period of 8 weeks. Patients' level of disability was measured using the Oswestry Disability Index (ODI) at baseline, week 4, and week 8. To estimate the health-related quality of life of the patients, the ODI was mapped to the short-form six dimensions instrument to generate quality-adjusted life years (QALYs). Health care resource use and costs were assessed based on the McKenzie extension protocol in Nigeria in 2019. Descriptive and inferential data analyses were also performed to assess the clinical effectiveness of the interventions. Bootstrapping was conducted to generate the point estimate of the incremental cost-effectiveness ratio (ICER).

RESULTS

A total of 47 patients (TBMT, n=21 and CBMT, n=26), with a mean age of 47 (SD 11.6) years for telerehabilitation and 50 (SD 10.7) years for the clinic-based intervention, participated in this study. The mean cost estimates of TBMT and CBMT interventions per person were 22,200 naira (US $61.7) and 38,200 naira (US $106), respectively. QALY gained was 0.085 for TBMT and 0.084 for CBMT. The TBMT arm was associated with an additional 0.001 QALY (95% CI 0.001 to 0.002) per participant compared with the CBMT arm. Thus, the ICER showed that the TBMT arm was less costly and more effective than the CBMT arm.

CONCLUSIONS

The findings of the study suggested that telerehabilitation for people with NCLBP was cost saving. Given the small number of participants in this study, further examination of effects and costs of the interventions is needed within a larger sample size. In addition, future studies are required to assess the cost-effectiveness of this intervention in the long term from the patient and societal perspective.

Activity and participation in stroke survivors in a low-income setting: A cross-sectional study

OBJECTIVES

To describe patients' activity and participation levels and to compare these levels across different groups of stroke survivors according to their walking speed (WS).

METHODS

In this cross-sectional study, 67 stroke survivors (43 men, mean age: 58.4 ± 12.9 years old) were assessed using the stroke impairment assessment set (SIAS), ACTIVLIM-Stroke, 10-m walk test (10MWT), 6-min walk test (6MWT) and Reintegration to Normal Living Index (RNLI). The sample was afterwards split into three WS sub-groups (<0.4 m/s, 0.4-0.8 m/s and >0.8 m/s) based on 10MWT scores.

RESULTS

ACTIVLIM-Stroke, 10MWT and 6MWT mean scores (±SD) were, respectively, 69.4 ± 20.2%, 0.9 ± 0.6 m/s and 282.1 ± 182 m. RNLI median score (range) was 5 (0-20). Sub-group analyses indicated that 26.9% (n = 18) obtained WS < 0.4 m/s, 13.4% (n = 9) WS between 0.4 and 0.8 m/s, and 59.7% (n = 40) WS > 0.8 m/s. Significant differences (p < .001) were found between WS sub-groups for both activity and participation.

CONCLUSION

Stroke survivors in Kinshasa presented a good performance for basic-activities of daily life (basic-ADLs). However, some of them still had difficulties with some community activities. Differences in WS seemed to discriminate well stroke survivors in terms of activity and participation, since the higher WS, the more they performed in basic-ADLs, walking distance and participation, and inversely.