Hearing loss, gait and balance impairments and falls among individuals with sub-acute stroke: A comparative cross-sectional study

Background

The impact of hearing loss in stroke is less explored. This study aimed to compare hearing loss in patients with sub-acute stroke with healthy controls and evaluate its association with gait and balance impairments and falls.

Methods

This study involved 78 ambulant sub-acute stroke patients and 78 age-sex-matched controls. Hearing loss was assessed with pure tone average, while gait and balance impairments were assessed with the Timed Up and Go test, Berg Balance Scale, Functional Gait Assessment and 10-m walk test (gait speed). Fall occurrence was evaluated by a self-report questionnaire.

Results

The prevalence of hearing loss (pure tone average of >25 dB) was higher in stroke patients than in controls (64.1% vs. 35.9%; p < 0.001). The mean pure tone average of stroke patients showed a significant positive correlation with Timed Up and Go test (r = 0.357; p = 0.001) and fall occurrence (r = 0.253; p = 0.025), and a significant negative correlation with Berg Balance Scale (r = -0.299; p = 0.008) and Functional Gait Assessment (r = -0.452; p < 0.001). There was a non-significant negative correlation with gait speed (r = -0.166; p = 0.147). Multiple regression showed that mean pure tone average was associated with Timed Up and Go test (B = 0.096; 95%CI: 0.010, 0.183) and Functional Gait Assessment (B = -0.087; 95%CI: -0.157, -0.017), but not with gait speed (B = -0.003; 95%CI: -0.007, 0.001) and Berg Balance Scale (B = -0.058; 95%CI: -0.165, 0.049).

Conclusion

Hearing loss is more prevalent among patients with sub-acute stroke compared with age-sex-matched controls. Hearing loss is also associated with gait and balance impairments and falls among sub-acute stroke patients. We recommend that hearing screening and rehabilitation be incorporated into post-stroke rehabilitation programmes as part of strategies to improve balance and gait and reduce or prevent falls.

Comparative effects of burst mode alternating current and resisted exercise on physical function, pain intensity and quadriceps strength among patients with primary knee osteoarthritis

Background and objective: The benefi cial effect of Resisted Exercise (RE) in Knee Osteoarthritis (OA) rehabilitation is often hamstrung by the presence of other comorbidities affecting exercise implementation, hence the need for comparative alternative therapies. This study compared the effect of Burst Mode Alternating Current (BMAC) and RE in the management of patients with knee OA. Methods: Forty-seven consenting patients with primary knee OA participated in this study. The participants were recruited from the outpatient physiotherapy department of a Nigerian teaching hospital. The participants were randomly assigned into either RE plus BMAC (RBMAC) or RE Only (REO) groups. The effects of intervention were assessed in terms of physical function, pain intensity and quadriceps strength at the 4th and 8th week of intervention. Descriptive and inferential statistics were used to analyze data at p<0.05 alpha level. Result: RBMAC and REO led to signifi cant mean changes in physical function (RBMAC – p=0.001: REO – p=0.001), pain intensity (RBMAC − p=0.001: REO – p=0.001), and muscle strength (RBMAC − p=0.001: REO – p=0.001) scores. However, there was no signifi cant difference in the mean change in physical function, pain intensity or muscle strength scores between RE plus BMAC and RE only groups (p>0.05). Conclusion: In conclusion, resisted exercise alone had signifi cant effects on physical function, pain intensity and quadriceps strength in patients with knee osteoarthritis. However, burst mode alternating current did not show additional effects.

Joint predictability of physical activity and body weight status on health-related quality of life of patients with hypertension

This study investigated the predictability of physical activity (PA) and body weight status (BWS) on health-related quality of life (HRQoL) of patients with hypertension. A cross-sectional study involved 250 patients with hypertension (≥140/90≤179/109 mmHg) selected from government hospitals in Osun State, Nigeria. Purposive sampling technique was used to select participants. Socio-demographic characteristics and cardiovascular parameters were recorded. PA and HRQoL were assessed using the International Physical Activity Questionnaire and Short Form health survey questionnaire respectively. Sufficient PA equals ≥150 min/wk while BWS was defined using body mass index classification. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. Of all participants, 63.6% reported sufficient PA and 78.4% was either overweight or obese. The HRQoL of participants become poorer in all domains with higher body weight. The HRQoL including role limitation due to physical health (RLdPhp) and emotional problems (RLdEmp) had worst scores. Participants in the categories of normal and overweight/obese with sufficient PA demonstrated higher (better) HRQoL in all domains than those with insufficient PA (P<0.05). When adjusted for body weight, significant differences were found in all domains of HRQoL except in RLdPhp, RldEmp, and bodily pain (P>0.05). There were significant correlations between PA and all domains of HRQoL except in RldEmp, emotional well-being and bodily pain (P>0.05). Regression models established PA as a significant predictor of HRQoL. Sufficient PA is a better predictor of HRQoL among patients with hypertension irrespective of BWS. Regular PA is recommended for improving HRQoL among patients with hypertension.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association between exercise-induced asthma and parental socio-economic status among school-aged adolescents in a semiurban community in Nigeria

This study investigated the prevalence and association between exercise-induced asthma (EIA) and parental socio-economic status (PSES) among school-aged adolescents in a semiurban community in Nigeria. Three hundred and eighty-five adolescents (185 male and 200 female adolescents) whose ages ranged between 10 and 19 years participated in this cross-sectional study. Participants were recruited from four government approved secondary schools in Ido-Ekiti using a multistage sampling technique. Peak expiratory flow rate (PEFR) was assessed at baseline and after 6-min run test (6-MRT) on a level playing ground using a standard peak flow meter. PEFR measurements were repeated at 5th, 10th, 15th, and 20th min post 6-MRT. Participants who had >15.0% PEFR fall were considered to have EIA. PSES was assessed using a validated socio-economic status questionnaire. Descriptive and inferential statistics were used to analyze data. Alpha level was set at P<0.05. The mean ages of males and females were 13.9±2.0 and 13.8±1.6 years, respectively. More than half of the participants, 58.2% had EIA (>15.0% PEFR scores) while 53.5% belonged to middle PSES class. There was no significant difference between PEFR scores of male and female participants at baseline and 5th min post 6-MRT. However, male participants had significant higher PEFR than the female counterparts at 10th (t=2.090, P=0.037), 15th (t=2.162, P=0.031), and 20th min (t=2.978, P=0.003). There was significant association between EIA and PSES (χ²=152.4; P=0.001). The prevalence of EIA is very high among school-aged adolescents in Nigeria and was significantly associated with PSES.

Relationships among exercise capacity, dynamic balance and gait characteristics of Nigerian patients with type-2 diabetes: an indication for fall prevention

This study investigated the relationships among exercise capacity (EC), dynamic balance (DB), and gait characteristics (GCs) of patients with type-2 diabetes (T2D) and healthy controls (HCs). This observational controlled study involved 125 patients with T2D receiving treatment at a Nigerian university teaching hospital and 125 apparently healthy patients' relatives and hospital staff recruited as controls. EC maximum oxygen consumption (VO2max) was estimated following a 6-min walk test. DB and GC were assessed using the Time Up to Go Test and an accelerometer (BTS G-Walk) assessing gait speed, step length, stride length, and cadence respectively during a self-selected walk. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. The mean ages of patients with T2D and HCs were 57.6±6.6 and 60.0±7.0 years, respectively. All physical characteristics were comparable (P>0.05). There were significant differences in the VO2max and DB between patients with T2D and HCs; 7.6±0.6 mL/kg/min vs. 9.6±0.6 mL/kg/min (t=-16.6, P=0.001) and 14.2±2.1 sec vs. 10.4±1.5 sec (t=-6.37, P=0.001), respectively. Furthermore, significant differences were found in GC between patients with T2D and HCs; gait speed: 0.7±0.1 m/sec vs. 1.2±0.1 m/sec (t=-16.60, P=0.001), step length: 0.6±0.2 m vs. 0.9±0.3 m (t=-7.56, P=0.001) and stride length: 0.9±0.1 m vs. 1.1±0.5 m (t=-6.09, P=0.001). There were significant correlations between EC and gait speed in both groups (T2D: r=-0.26, P=0.032 and HCs: r=0.51, P=0.003). In conclusion, patients with T2D demonstrated lower EC, unstable DB, and altered GCs compared with HCs. Exercise interventions to improve EC and gait balance are recommended.

Relationship between functional capacity and health-related quality of life of patients with type-2 diabetes

AIMS

Physical function is a determinant of survival in chronic diseases, however, little is known about functional capacity (FC) and self-reported health status of patients with type-2 diabetes (T2D). This study investigated the relationship between FC and health related quality of life (HRQoL) of patients with T2D.

MATERIALS AND METHODS

This cross-sectional survey recruited 150 patients with T2D from a Nigerian university teaching hospital using purposive sampling technique. Socio-demographic and physical characteristics were assessed. FC and HRQoL including physical and mental health component summary (PCS and MCS) were assessed using the six minute walk test (6MWT) and Short-Form (SF-12) questionnaire respectively. Maximum oxygen consumption (VO₂ max) was estimated, pre and post 6MWT cardiovascular parameters and fasting blood glucose (FBG) were assessed. Data were analyzed using descriptive and inferential statistics. Alpha level was set at p<0.05.

RESULTS

There were 83(55.3%) women, means of age and FBG of participants were 64.2±8.7years and 7.4±2.4mmol/L respectively. The means of 6-min walk distance (6-MWD) and estimated VO₂ max were 341.55±41.82m and 9.2±0.7mL/kg/min respectively. Significant differences were found between pre and post HR (t=-44.71; p=0.001), SBP (t=-38.38; p=0.001) and DBP (t=-38.58; p=0.001) following 6MWT. The means of PCS and MCS of HRQoL were 48.67±5.51 and 58.39±2.86 respectively. There were significant correlations between FC and each of PCS (r=0.678; p=0.001) and MCS (r=0.211; p=0.009).

CONCLUSION

Patients with T2D demonstrated low functional capacity and reduced HRQoL. Significant relationship exists between FC and physical and mental component summary of HRQoL. Exercise intervention to improve FC and HRQoL were recommended.

Assessment of functional capacity and sleep quality of patients with chronic heart failure

Background:

Adequate sleep improves physical and mental alertness. However, there is a dearth of empirical data on functional capacity (FC) and sleep quality (SpQ) in patients with chronic heart failure (CHF).

Objective:

This study investigated the relationship between FC and SpQ of patients with CHF and apparently healthy controls (HCs).

Methods:

This case-control study recruited 50 patients with CHF whose left ventricular ejection fraction (LVEF) was <40%, attending cardiac clinics of selected government hospitals in Osun State. Furthermore, 50 age- and sex-matched healthy individuals were recruited as controls. Socio-demographic characteristics and cardiovascular parameters were assessed. The FC (VO₂ max) and SpQ were assessed using the 6-minute walk test (6-MWT) and Pittsburgh Sleep Quality Index (PSQI), respectively. Data were analysed using descriptive and inferential statistics. Alpha level was set at p < 0.05.

Results:

Patients had a significantly lower FC and poorer SpQ than HCs, 4.6 ± 0.5 versus 11.3 ± 1.6 mL/kg/min (t = −3.452; p = 0.001) and 8.74 ± 1.6 versus 3.8 ± 1.3 (t = −5.371; p = 0.001), respectively. HCs were about five times more likely to walk longer distance [odds ratio (OR), 4.8; confidence interval (CI), 2.0–11.1] and had a better heart rate (OR, 2.8; CI, 1.4–5.3) than patients. SpQ had a significant negative correlation with FC of patients (r = −0.362; p = 0.001) but a significant positive correlation with HCs (r = 0.481; p = 0.041). Furthermore, there were significant correlations between FC and body mass index in both groups (CHF: r = 0.247, p = 0.022; HCs: r = 0.321, p = 0.040).

Conclusion:

Patients with heart failure demonstrated lower functional capacity and poorer sleep quality.

Knowledge, attitude and practice of exercise for plasma blood glucose control among patients with type-2 diabetes

AIMS

Exercise plays significant role in the health outcomes of patients with diabetes, however, little is known about patients' knowledge of exercise for plasma blood glucose control among patients with type-2 diabetes (T2D). This study investigated knowledge, attitude and practice (KAP) of exercise for plasma blood glucose control among patients with T2D.

MATERIALS AND METHODS

This cross-sectional study recruited 299 patients with T2D (male=105; female=194) from selected government hospitals in Osun State, Nigeria using purposive sampling technique. Validated questionnaires were used to assess of exercise for plasma blood glucose control and socioeconomic status (SES) of the patients. Data were analysed using descriptive and inferential statistics. Alpha level was set at <0.05.

RESULTS

The mean age of respondents was 51.9±9.8 years. A majority, 245(81.9%) were married individuals and more than half, 195(65.3%) were in the low SES. One hundred and forty-eight (49.5%) had good knowledge of exercise whilst 269(90.0%) had negative attitude to exercise practice. Less than a third, 82(27.4%) engaged in exercise practice for plasma blood glucose control. There was significant association between knowledge and practice of exercise ((2)=12.535; p=0.002). Furthermore, significant associations were found between knowledge and gender ((2)=11.453; p=0.003), and socioeconomic status ((2)=29.127, p=0.001) but not associated with attitude towards exercise (p>0.05).

CONCLUSION

Patients with demonstrated good knowledge of exercise for plasma blood glucose control but reported negative attitude and poor practice of exercise.

Knowledge, attitude and techniques of breastfeeding among Nigerian mothers from a semi-urban community

BACKGROUND

Mothers' poor knowledge and negative attitude towards breastfeeding may influence practices and constitute barriers to optimizing the benefits of the baby-friendly initiative. This study assessed breastfeeding knowledge, attitude and techniques of postures, positioning, hold practice and latch-on among Nigerian mothers from a Semi-Urban community.

METHODS

Three hundred and eighty three consenting lactating mothers who have breastfed for 6 months and up to two years volunteered for this cross-sectional survey, yielding a response rate of 95.7%. A self-administered questionnaire that sought information on maternal socio-demographic variables, knowledge, attitudes and breastfeeding techniques of mothers was employed.

RESULTS

Based on cumulative breastfeeding knowledge and attitude scores, 71.3% of the respondents had good knowledge while 54.0% had positive attitude. Seventy one point three percent practiced advisable breastfeeding posture. Sitting on a chair to breastfeed was common (62.4%); and comfort of mother/baby (60.8%) and convenience (29.5%) were the main reasons for adopting breastfeeding positions. Cross-cradle hold (80.4%), football hold technique (13.3%), breast-to-baby (18.0%) and baby-to-breast latch-on (41.3%) were the common breastfeeding techniques. A majority of the respondents (75.7%) agreed that neck flexion, slight back flexion, arm support with pillow and foot rest was essential during breastfeeding. There was no significant association between breastfeeding posture practice and each of cumulative breastfeeding knowledge score levels (X2 = 0.044; p = 0.834) and attitude score levels (X2 = 0.700; p = 0.403).

CONCLUSION

Nigerian mothers demonstrated good knowledge and positive attitude towards breastfeeding. Most of the mothers practiced advisable breastfeeding postures, preferred sitting on a chair to breastfeed and utilized cross-cradle hold and baby-to-breast latch-on.

Relationship between socioeconomic status and metabolic syndrome among Nigerian adults

The study determined the diastolic and systolic pressure, anthropometric parameters, serological parameters comprising fasting blood glucose (FBG), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C) as well as the socio-economic status (SES) of inhabitants of Ilora with a view to providing information on impact of SES on metabolic syndrome (MetS). One hundred participants (54 males and 46 females) whose ages ranged from 30 and 70 years, participated in the study. Participants were recruited from the three wards of the town using multi-stage random sampling procedure. Subjects' weights, height, blood pressure, waist circumference (WC) were measured using standard instruments. Fasting blood glucose (FBG) was measured using a glucometer on participants' blood samples taken after at least 8h of fasting. Serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were analyzed using enzyme colometric assay kits in the laboratory. SES of the participants was determined by using a questionnaire, which sought information on annual income, occupation and education. Participants who had MetS were determined using the new International Diabetes Foundation definition of MetS. Both descriptive and inferential statistics were used to analyze the data. The mean scores for the males and females systolic blood pressure (SBP) were 123.20 ± 20.72 mmHg and 117.78 ± 14.64 mmHg, and the diastolic blood pressure (DBP), 78.63 ± 11.72 mmHg and 75.98 ± 13.06 mmHg, respectively. The mean of serological variables scores for the males and females, respectively, were FBG (4.95 ± 0.81 mmol/L and 4.84 ± 1.36 mmol/L), TG (1.28 ± 0.75 mmol/L and 1.35 ± 1.05 mmol/L), HDL-C (1.26 ± 0.21 mmol/L and 2.32 ± 7.34 mmol/L). The mean SES scores for the males and females were 14.35 ± 4.75 and 13.13 ± 4.66, respectively. The prevalence of MetS was 43.5% in females and 9.3% in males. Significant differences were found in SBP and FBG across the three SES groups (F=3.148 and 3.862, respectively, p<0.05). The high SES group was found to have significantly higher SBP and FBG than the low and middle SES groups. There were significant correlations between SES scores and SBP (r=0.255; p<0.05), FBG (r=0.270; p<0.01), and BMI (r=0.210; p<0.05). Also, significant relationships were found between weight and TG (r=0.282; p<0.05), waist circumference (WC) and FBG (r=0.264; p<0.05), and WC and TG (r=0.414; p<0.01). The study concluded that SES has significant relationship with metabolic syndrome components such as SBP and fasting blood glucose among adult population in Nigeria.

Knowledge and use of Transcutaneous Electrical Stimulation (TENS) among Nigerian physical therapists

AIMS AND OBJECTIVE

The purpose of this study was to evaluate the knowledge and the use of Transcutaneous Electrical Nerve Stimulation (TENS) by Nigerian physical therapists.

METHODS

A cross sectional study design was carried out among Nigerian physical therapists. Eighty-six physical therapists participated in this study and data were collected using a structured and validated questionnaire. Copies of the questionnaires were distributed by hand and by mail (with self addressed envelopes) to various hospitals, clinics, universities that offer physical therapy services/programmes across Nigeria. Data were analyzed using descriptive statistics.

RESULTS

Academic staff constituted 10.5% while 89.5% were clinicians. First degree holders constituted 61.6% while 38.4% had postgraduate degrees. Majority of physical therapists, 90.7% use TENS, 83% of those who use TENS are aware of the different types of TENS; 98.72% use TENS for 30 minutes or less, 48.7% use it for 15 minutes or less. The frequency commonly use is between 1-30 Hz and about 12.8% of those using this frequency believed that TENS relieves pain through the pre-synaptic inhibition, endogenous pain control, and direct inhibition of abnormally excited nerve and restoration of afferent input. Furthermore, 12.8% calibrated their TENS devices. Only 6.4% have published TENS related papers in the last five years while 29.5% have attended TENS related seminar in the past. Majority, 88.5% considered TENS to be cost effective.

CONCLUSION

This study concluded that TENS is widely used among Nigerian physical therapists and tend to have adequate knowledge of TENS and its application in the management of pain.

Assessment of exercise capacity in African patients with chronic heart failure using six minutes walk test

Background:

The purpose of this study was to assess the functional capacity during a 6-minute corridor walk and a 6-minute bicycle ergometry exercise in patients with chronic heart failure (CHF).

Method:

Thirty five patients with stable CHF were recruited for the study. Each subject performed six minutes corridor walk and 6-minute bicycle ergometry testing. The 6-minute walk required the subjects to walk at a self selected speed on a 20 meter marked level ground for 6-minute. All the subjects also performed a 6-minute exercise on a stationary bicycle ergometer with initial resistance of 20 watts and increased by 10 watts after 3-minutes. The perceived rate of exertion was assessed using a modified Borg Scale after each exercise mode. The maximum oxygen consumption was derived using American College of Sport Medicine equations.

Results:

Result showed high positive correlation between distance walked in the 6-minute and the maximum volume of oxygen (VO₂ max) (r = 0.65, P < 0.01). The average distance walked was 327 m ± 12.03 m. The VO₂ max estimated during bicycle ergometry was higher (13.7 ± 1.9 L) than during the six minutes walk (8.9 ± 1.2 L).

Conclusion:

Six minutes walk could be useful to evaluate exercise tolerance in patients with chronic heart failure, while the bicycle ergometer could be more appropriate in the assessment of maximum functional capacity in these patients.