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

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

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

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

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

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

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

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