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Item Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: a scoping review(Frontiers Media SA, 2023) Barbosa dos Santos, R.; Fiedler A.; Badwal A.; Legasto-Mulvale J. M.; Sibley, K. M.; Olaleye, O. A.; Diermayr, D.; Salbach, N. M.Background: Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown. Purpose: To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke. Methods: A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool. Results: Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country. Conclusion: CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke.Item ‘We don’t have to do it together’: a qualitative study of Physiotherapists’ and patients’ perceptions about collaborative goal setting in Nigeria(Taylor & Francis, 2022) Olaleye, O. A.; Agoro, Z. B.Background: The adoption of Collaborative Goal Setting (CGS) is limited in most rehabilitation settings in Nigeria despite its recommendations in clinical practice guidelines. Objective: To explore the perceptions of physiotherapists and patients about CGS at a tertiary healthcare facility in Ibadan, Nigeria. Methods: We conducted focus group discussions among purposively selected physiotherapists (n = 8) and patients (4 stroke survivors, 3 patients with brain injury) to qualitatively explore their perceptions. Audio-taped discussions were transcribed verbatim and thematically analyzed. Results: We identified four themes around CGS which were: 1) paternalistic view of goal setting; 2) physiotherapists as goal setters; 3) perceived benefits of collaborative goal setting; and 4) barriers and facilitators to CGS. The physiotherapists articulated goals as expected outcomes from treat- ment and believed they were better poised and experienced to determine what patients could achieve during each phase of treatment. Patients' view of goal setting agreed with the physio- therapists', as they also opined that goal setting is the responsibility of physiotherapists. Time constraint, inadequate knowledge and the inability of patients to appropriately articulate their goals and expectations from treatment were barriers to CGS. Concerns about who to collaborate with when dealing with patients with impaired cognition and/or disorders of consciousness were raised by the physiotherapists. Participants in both groups indicated that education on how to set patient-oriented goals could facilitate CGS. Conclusions: Though rarely practiced, participants agreed that collaborative goal setting could be beneficial. Both the physiotherapists and patients require education on how to appropriately collaborate in setting goals of rehabilitation.Item Integrating Physiotherapy into Primary Health Care in Nigeria: Perceptions of Primary Health Care Practitioners(Taylor & Francis, 2022) Olaleye, O. A.; Abiodun, A. O.The perception of Primary Health Care (PHC) practitioners about integrating physiotherapy into PHC in Nigeria is still unknown. The aim of this study was to examine the knowledge and attitude of PHC practitioners in Nigeria regarding the integration of physiotherapy into PHC. The participants in this cross- sectional study were 183 PHC practitioners (physicians, nurses, and community health workers). A content-validated, semi-structured questionnaire was used to obtain information about history of exposure to physiotherapy, knowledge, and attitudes toward integrating physiotherapy into PHC. Data was analyzed using Pearson's product moment correlation and Analysis of Variance at a = 0.05. Participants were mostly females (n = 154; 84.2%) and aged 39.97 ± 9.38 years. The mean years of work experience was 14.41 ± 8.68 years. Participants had limited knowledge about the role and scope of physiotherapy but were willing to learn more about physiotherapy. Less than half of the participants however, had favorable attitude toward integrating physiotherapy into PHC. Knowledge differed significantly across healthcare professions (p < .05) and was significantly correlated with attitude (p < .01). Our findings underscore the importance of interprofessional education and teamwork among healthcare providers. This might enhance understanding, modify attitudes and facilitate the inclusion of physiotherapy into PHC in Nigeria. Additionally, this could improve access to physiotherapy services for Nigerians.Item Knowledge, perception and attitude of physiotherapy and medical undergraduates in Nigeria towards people with disability(College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria, 2022) Olaleye, O. A.; Sowemimo O. M.Background: Knowledge, perception and attitude of healthcare professionals could constitute barriers that could affect healthcare provision for, and social life of People with Disability (PWD). Knowledge, perception and attitude towards PWD was investigated among physiotherapy and medical undergraduates of the University of Ibadan, Nigeria using a mixed-method design. Methods: Knowledge and perception of first and final year physiotherapy and medical undergraduates about PWD were assessed using a validated questionnaire while attitude was assessed using the Attitude Towards Disabled Persons scales (Forms A and O). Focus Group Discussion (FGD) was held with eight purposively selected students from the survey sample. Data were analysed using Man- Whitney U test at p-value <0.05. Transcripts from the discussion were analysed thematically. Results: 187 undergraduates (106 males) aged 20.35+2.67years participated in the survey. Majority of the participants (≥88.0%) were knowledgeable about physical disabilities but had poor perception and negative stereotypes about PWD. Only 38(20.3%) of the participants reported that PWD experienced disparities in accessing healthcare. First- year physiotherapy undergraduates had more positive attitudes towards PWD than first-year medical students (68.2% vs 35.0%, p<0.01) whereas final year medical students had more positive attitude that final year physiotherapy students (68.2% vs 52.6%, p=0.29) on form O. Participants in the FGD believed disability could be socially constructed and not just on account of physical impairments. They considered treating PWD as being more stressful than treating people without disability. Conclusion: Participants had good knowledge, ambivalent attitude and poor perception about PWD. Their perception and attitude could be improved through adequate exposure and contact with PWD.Item Sensorimotor function, balance and dual-task walking speed among stroke survivors with hemiparesis(Department of Physiotherapy, Ahmadu Bello University Teaching Hospital, 2022) Olaleye, O. A. A. O. Olaleye, O. A.|| Folorunsho, A. B. || Abiodun, A. O.; Folorunsho, A. B.; Abiodun, A. O.Background: Impaired dual-task ability increases the risk of fall and fall-related injuries among stroke survivors. It also limits the extent of community ambulation and overall reintegration into the community after rehabilitation. The aim of this study was to investigate the relationships among sensorimotor function, balance and dual-task walking speed of stroke survivors during a dual-task gait performance among stroke survivors with hemiparesis. Methods: Purposely recruited stroke survivors with hemiparesis who could ambulate independently for at least 10 metres, and who had a score of B20 on the Mini-Mental State Examination participated in this correlational cross- sectional survey. Motor and sensory functions were assessed using the Fugl-Meyer Assessment Scale while balance was assessed using the Berg Balance Scale. Walking speed while ambulating on a 10-meter walkway and button up and down shirts was also assessed. Data were summarized using descriptive statistics and analysed using Pearson's product moment correlation method at Coas Results: Forty-five stroke survivors (35 males) aged 52.5±10.23 years participated in this study. The mean sensory, motor function and balance scores were 10.76± 2.47, 67.09± 19.80 and 47.02 ± 7.24 respectively. There was a significant relationship between motor function and walking speed, as well as between balance and walking speed (p<0.05). Conclusion: Sensory, motor and balance functions are related to dual-task walking speed. Hence, dual-task gait training should be incorporated into the rehabilitation plans for stroke survivors.Item Relationship between post-stroke spasticity and functional ambulation among Nigerian stroke survivors(Nigeria Society of Physiotherapy, 2021) Olaleye, O. A.; Popoola, O. S.; Akosile, C. O.; Adegoke, B. O. A.Ambulation is a common goal of stroke rehabilitation that is often linked to lower limb spasticity. This study was conducted to investigate the relationship between paretic lower limb spasticity and functional ambulation after stroke. Thirty stroke survivors (19 males) aged 57.77 ± 9.52 years participated in this correlational cross-sectional study. Spasticity of the paretic lower limb was assessed using the Modified Tardieu Scale. Functional ambulation performance was assessed using the Emory Functional Ambulation Profile (E-FAP). Data were analyzed using Pearson's product moment correlation and stepwise regression analysis at p = 0.05. Spasticity was highest in the ankle plantaflexors (253.20 ± 32.62°). There was a significant relationship between spasticity of the affected lower limb and functional ambulation performance (r=0.61; p<0.05) Stepwise regression analysis indicated that only spasticity of the ankle plantaflexors predicted functional ambulation. Spasticity of the paretic ankle plantaflexors has discriminative power for predicting functional ambulation. This underscores the need for focused rehabilitation aimed at reducing spasticity of ankle plantaflexors for improved functional ambulation among stroke survivors.Item Expectations of Individuals with Neurological Conditions from Rehabilitation: A Mixed-Method Study of Needs(South African Society of Physiotherapy, 2021) Olaleye, O. A.; Zaki, D. A.; Hamzat, T. K.Background: Knowledge of the specific expectations of patients with neurological conditions (NCs) from rehabilitation helps in setting attainable goals. Such expectations may vary from situation to situation. There are no studies investigating rehabilitation expectations amongst individuals with NCs in Nigeria. Objectives: The aim of our study was to explore the rehabilitation expectations of individuals with NCs. Method: This convergent mixed-methods study comprised a cross-sectional survey of 105 individuals with NCs and two sessions of Focus Group Discussions (FGDS) amongst eight individuals with NCs. The modified Needs Assessment Questionnaire was used to assess rehabilitation needs as a proxy for rehabilitation expectations, whilst disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Quantitative data were summarised using descriptive statistics and analysed using inferential statistics at p < 0.05. Thematic analysis was conducted on the qualitative data. Results: Sixty-one (58.1%) stroke survivors, 33 (31.4%) individuals with spinal cord injury (SCI) and 11 (10.5%) with traumatic brain injury (TBI) aged 46.48 ± 15.91 were surveyed. The need for social/recreational activity was the most expressed need (100%) amongst the participants. Mobility was reported as an important need constituting a barrier to enjoying life by 93 (88.6%) participants. Individuals with SCI expressed the greatest needs compared with the other two groups. Needs were significantly correlated with severity of disability (p < 0.05). Four overarching themes (physical health, financial, healthcare services/rehabilitation and emotional/social) representing major areas of needs emerged from the FGD data. Conclusion: Individuals with NCs in Nigeria have specified expectations of rehabilitation. Disability was a major driver of these expectations, irrespective of NC subtype. Clinical implications: Rehabilitation programmes for individuals with NCs should target expressed needs or expectations of each patient cohort and minimise disabilities associated with these conditions.Item Early Mobilisation of Patients with Acute Stroke: A survey of knowledge, attitude and practice health care professionals in South-west, Nigeria(African Journals Online., 2020) Olaleye, O. A.; Amusan, O. I.; Adeyinka, A. O.BACKGROUND: Early mobilisation of acute stroke survivors has been associated with fewer deaths and better clinical outcomes. Yet, there are conflicting reports about the knowledge, attitude and practice of early mobilisation among clinicians. We investigated the knowledge, attitude and practice of early mobilization among health care professionals in South-West, Nigeria. MATERIALS AND METHODS: All the 159 health care professionals comprised 68(42.8%) nurses, 45(28.3%) physicians and 46(28.9%) physiotherapists involved in acute stroke care were surveyed using a content-validated questionnaire. Pearson’s Product Moment correlation and ANOVA were used to analyse data at p < 0.05. RESULTS: Most (n=147; 92.5%) of the participants agreed that early mobilization reduces complications of immobility. Majority of the HCPs were knowledgeable and had positive attitude towards early mobilisation (n=139; 87.4%). Attitude differed significantly across different healthcare professions (p=0.02). Most health care professionals (n=149; 93.7%) reported practicing early mobilization of acute stroke patients. There was a significant relationship between years of work experience and each of knowledge and attitude (p<0.05) CONCLUSIONS: Although, many health care professionals expressed concerns about the risks of early mobilization, including possibility of death, they reported practicing early mobilisation. It may be necessary to conduct a risk-benefit analysis of early mobilisation and provide appropriate practice guidelines to promote implementation. This could further enhance the health care professionals’ confidence in practicing early mobilisation and improve stroke care.Item Effect of Aerobic Exercise on Post-Stroke Cognitive Function: A Systematic Review(MA Healthcare Ltd, 2020) Abba, M. A.; Olaleye, O. A.; Hamzat, T. K.Background/Aims: Literature suggests that aerobic exercise improves cognitive impairments post stroke. This systematic review was conducted to analyse evidence on the effectiveness of aerobic exercise in improving post-stroke cognitive impairments. Methods: Online databases (PubMed, EMBASE and Web of Science) were systematically searched from inception until 13 July 2017 using the keywords stroke/exercise/cognition. Clinical trials that met the inclusion criteria were assessed for methodological quality using the PEDro scale. Extracted data were synthesised for evidence. Results: A total of seven studies met the inclusion criteria. Participants in most of the studies were aged over 60 years and the majority had ischaemic stroke. The most commonly used measure for assessing cognition was the Mini Mental State Examination. The majority of studies included moderate to high intensity exercise (50–70% of VO2max) for 30–60 minutes three to five times per week. There is moderate evidence that aerobic exercise enhances global cognitive function, attention and working memory. Evidence that aerobic exercise improves memory, levels of brain-derived neurotrophic factor and executive function is conflicting and limited. Conclusions: Aerobic exercise is moderately effective in improving post-stroke cognitive impairments. More clinical trials are needed in view of the methodological limitations and paucity of existing studies.Item Effects of over-ground walking and cognitive rehabilitation on cognition, brain-derived neurotrophic factor, participation and quality of life among stroke survivors: a study protocol(Taylor & Francis, 2020) Abba, M. A.; Olaleye, O. A.; Hamzat, T. K.Background: Cognitive rehabilitation (CR) is an important component of stroke rehabilitation. Most of the strategies used for this purpose are not readily affordable. This is the protocol of a trial to investigate the effects of over-ground walking (OGW) exercise and CR on cognitive function among stroke survivors. Methods: This is a three-centre, single blind, randomised controlled trial (RCT). Fifty-seven stroke survivors with mild to moderate cognitive impairments will be recruited from three healthcare facilities and randomly assigned into three groups. Group A will receive moderate intensity OGW exercise. Group B will receive CR using an adapted cognitive intervention comprising an attention and a memory tasks. Group C will receive combine OGW and CR exercise. All interventions will be thrice weekly for 8 weeks. Outcomes to be assessed at baseline, 4th and 8th week of interventions are cognition, brain-derived neurotrophic factor (BDNF), quality of life and participation using Mini-Mental State Examination, Melsin brand ELISA kit, stroke-specific quality of life and London Handicap Scale, respectively. Friedman and Kruskal–Wallis tests will be used for within-group and between-group comparison of data. Discussion: This trial is the first to examine the effect of OGW exercise on cognition and BDNF among stroke survivors.