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Background: Obesity has become a public health challenge worldwide with significant health and economic impacts. This study aimed to assess the current published literature on clinical and economic burden associated with obesity in low- and middle-income countries (LMICs). Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. CINAHL, MEDLINE, PubMed, Web of Science and Scopus databases were systematically searched for studies published from inception to October 17, 2023. Costs of illness for all included studies were converted to 2023 United States (US) dollars, using country-specific gross domestic product inflators. Conversion to US dollars was based on purchasing power parities (PPP). Quality assessment of all included studies was performed using Newcastle-Ottawa quality assessment scale. Results Of the total 676 studies identified, five studies reported prevalence-based estimate, four studies based on survey and the remaining three studies presented model based. These studies published data from Brazil, Ghana, China, South Africa, Mexico, and Thailand. Out of the 12 studies, three studies reported the indirect costs. Methodological quality was deemed moderate. The annual direct and indirect costs associated with obesity for a population in LMICs ranged from USD 0.2 billion to USD 12.56 billion and USD 223 million to USD 227.5 million, respectively. Hospitalisation was the main cost driver in five of the included studies. Average length of stay (days) for obesity-related diseases in Brazil for men and women 7.9 and 6.8. Conclusion: There was a considerable clinical and economic burden of obesity on individuals and the healthcare systems and may require appropriate prevention and management strategies. However, the included studies employ varied approaches and many of them have methodological shortcomings. Thus, future studies should consider adopting standardised cost of illness meth

Background: Recent advances in technology have made possible the delivery of health services to patients remotely, and telerehabilitation for stroke survivors has emerged as a promising intervention. This systematic review assessed the clinical effectiveness of telerehabilitation (TR) programmes on quality of life (QoL) of stroke survivor compared to standard care. Methods: MEDLINE, CINAHL, AMED, Web of Science and Scopus databases were searched from inception to 10th of June 2022. Studies were considered eligible for inclusion if they fulfilled the following criteria: assessed the efficacy of different telerehabilitation models in poststroke patients, employed randomised controlled trial, and non-randomised design, stroke survivor adults age ≥ 18 years, health related quality of life outcome, and full text available. Data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed among trials presenting with similar clinical characteristics. Results: A total of 11 eligible studies that met the inclusion criteria were included in the review. These studies were conducted in Brazil (n=1), Italy (n=2), Netherland (n=1), South Korea (n=1), Taiwan (n=1), United Kingdom (n=1) and United States (n=4) between 2004 and 2020. Except for blinding of participants to study group allocation, all the studies were (> 50%) at low risk of bias to considering adequate sequence generation, allocation concealment, blinding of trial personnel or outcome assessors, evaluation of incomplete outcome data, and lack of selective reporting. The meta-analysis (n = 5) included 306 individuals with duration of follow up ranged between 4 weeks and 12 weeks. We found that there was no statistically significant difference (SMD = 0.089, confidence interval (CI) 95% = -0.184 to 0.362, p = 0.522) for Stroke Impact Scale between the interventions and the control. Conclusion: The review provides ev

Background: Missed appointments (MAs) is a significant challenge to efficient running of physiotherapy departments and it has cost implications. In this study, wait time and the pattern and impact of MAs on cost, efficiency, and patient outcome was assessed among Nigerian patients receiving physiotherapy. Method: In this retrospective study a total of 3243 physiotherapy appointments booked between 2009 and 2019 at an Outpatient Physiotherapy Clinic in Nigeria. were conducted. Data were gleaned on socio-demographic and patient outcomes related to MAs. The total revenue loss due to MAs was calculated as a product of the total of MAs and per treatment cost. Results: MAs constituted 1701 (52.5%) of all appointments and the average wait time for the first appointment was 9.6 ± 23.2 days. The proportion of MAs was higher among females (50.2%), patients who were not residents within the same location as the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from an orthopaedic surgeon (32.8%). Females, those who live far within the city, and those with neurological/medical conditions were 1.68, 1.24, and 1.52 times more likely to have MAs compared with males (OR = 1.68, CI = 1.44 – 1.96, p = < 0.001), and those who live outside the city (OR = 1.24, CI = 1.05 – 1.46, P = 0.01), and have orthopaedic conditions (OR = 1.52, CI = 1.20 – 1.93, p = <0.001), respectively. Using per treatment schedule cost of N1000 (an equivalent of $2.31), a 52.5% MAs rate resulted in lower efficiency of 76.6% with an efficiency ratio of 0.23. Further, a 52.5% MAs rate could potentially impact patient recovery by 3402 days if MAs slow a patient recovery process by 2 days. Conclusions: MAs for physiotherapy treatment pose a significant challenge in terms of costs, efficiency, and patient outcomes. Thus, an innovative reminder system may help reduce patients’ non-attendance to physiotherapy and its consequences.

Background: Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy. Objectives: To evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder. Methods: This is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up. Discussion: This will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice. Trial Registration: Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022.

Chronic musculoskeletal (MSK) pain, specifically low back pain (LBP) and osteoarthritis (OA), are a major cause of global disability, reduced quality of life and high socioeconomic burden. Research in high income countries suggests MSK pain is often comorbid with other long-term conditions / non-communicable diseases (NCDs) including diabetes, hypertension, and cardiovascular disease. However, the epidemiology of comorbid NCDs and MSK pain in low- and middle-income countries (LMICs) is unclear. This systematic review aims to describe the prevalence and pattern of comorbid NCDs in adults with MSK pain in LMICs. Nine databases were searched for epidemiological studies in LMICs (World Bank categories). Paired researchers independently identified studies, extracted data, and completed critical appraisal using Hoy risk of bias tool. Random-effect meta-analysis was used to estimate prevalence of NCDs comorbid with MSK pain. From 2112 citations; 14 studies (n=6093 adults with MSK pain, mean age=46.9years) were included. Overall prevalence of MSK pain with comorbid NCDs was 46.1% (95%CI 32.3 - 59.9). Systemic hypertension had the highest comorbid prevalence with MSK pain (42.6%, 95%CI 25.6-59.6), followed by diabetes (26.7%, 95%CI 16.1-37.3) and mental health conditions (anxiety/depression; 24.9% 95%CI 11.5-38.4). A high proportion of patients with MSK pain in LMICs experience comorbid NCDs. Variable data/population samples, and under-reporting limit accurate capture of prevalence estimates. Understanding the true burden of MSK pain (specifically lower back pain and hip/knee osteoarthritis) and comorbid NCDs is critical to informing effective treatment strategies. The health systems implications of these findings are imperative towards person-centred care, organisation of care and efficient resource utilisation in LMICs.

Objective: The 3-meter backward walk (3MBW) test is an outcome performance measure to assess backward walking mobility, balance, and risk of fall. However, the lack of baseline values is a potential limitation for its use as a rehabilitation target value or predictor of outcomes. This study aimed at ascertaining a gender- and age-reference value of 3MBW and determining its correlation with sociodemographic and anthropometric variables. Methods: A total of 1,601 Nigerian healthy adults participated in this cross-sectional study. 3MBW was measured following standardized procedure on a marked 3-m floor. Anthropometric and sociodemographic parameters were taken. Data were summarized using the descriptive statistics of mean, standard deviation, and percentile (less than the 25th, between the 25th and 75th, and above the 75th percentiles were regarded as low, average, and high 3MBW, respectively). Results: From this study, less than 2.23 s and 2.60 s were regarded as low risk of fall for males and females, respectively; 2.23–3.00 s and 2.60–3.50 s were regarded as average risk of fall for males and females, respectively, while greater than 3.00–3.9 s and 3.50–3.90 s were regarded as high risk of fall for males and females, respectively. 3MBWT was significantly associated with age (r = 0.51, p = 0.001), sex (r = 0.315, p = 0.001), weight (r = 0.14, p = 0.001), BMI (r = 0.28, p = 0.001), but not height (r = −0.03; p = 0.250). Conclusion: This study provided a reference set of values according to age and gender for 3MBW in healthy individuals. Males have shorter 3MBW than females, and the time taken to accomplish 3MBW increases with age.

Objectives: Poor adherence to home exercise programs (HEPs) is a significant barrier to continuity of care and eventual outcomes, thus requiring innovative mitigating approaches. This study aimed to develop and test the feasibility of a remote support application (RSA) designed to encourage adherence to HEPs. Methods: Using standard computer programing, an RSA with administrator and user interfaces was developed for mobile phone or tablet. Consenting patients receiving physiotherapy for musculoskeletal conditions (n=19) were randomly assigned into the experimental group (n=10) or the control group (n=9). The experimental group received their customized HEP reminders via the RSA, whereas the control group used conventional paper handouts for HEPs. Adherence to HEPs was assessed over 4 weeks. The feasibility of the RSA was assessed using the Mobile Application Rating Scale and System Usability Scale (SUS) questionnaires. Data were summarized using descriptive and inferential statistics. Results: The adherence rate of patients in experimental group was significantly higher than that of patients in the control group after 2 weeks [median diff.=−6.0, 95% confidence interval (CI): −8.0 to −5.0; U=5.00; Z=−3.304; P=0.001; r=0.75] and 4 weeks (median diff.=−7.0, 95% CI: −8.0 to −5.0; U=0; Z=−3.695; P<0.001; r=0.84) of intervention. The RSA had a mean SUS score of 82.53±9.04 (out of 100) and a mean app quality rating score of 75.95±4.98 (out of 95). Conclusions: The use of an RSA to improve adherence to HEPs is feasible for patients with musculoskeletal conditions.

Objective: To determine the feasibility and validity of Goniometer Records (GR), a mobile app goniometer for knee joint range of motion (ROM). Material & Methods: A total of 72 undergraduate physiotherapy students participated in this study. Knee flexion and extension was taken simultaneously with the Universal goniometer (UG) and GR, and the Mobile Application Rating Scale (MARS) and System Usability Scale (SUS) were used to assess the feasibility of GR. Results: The mean age of participants was 22.2 ± 1.6 years. There was a weak but significant correlation between UG and GR (r = 0.251; p = 0.030) for knee flexion but not for extension (r = 0.105; p = 0.37). The feasibility ratings of GR on MARS for all the sections were 17.6±2.7 (out of 25), 15.4±2.0 (out of 20), 11.4±1.3 (out of 15), 25.4±2.6 (out of 35), 14.8±2.2 (out of 20) and 21.2±2.1 (out of 30) for engagement, functionality, aesthetics and information respectively. Based on SUS statements about app usage, 63.9% of the respondents rated the App low. Conclusion: GR showed weak validity in knee flexion assessment but none with extension compared to UG. GR for knee ROM assessment had moderate feasibility but low usability rating.