FACULTY OF CLINICAL SCIENCES
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Item Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries—A Systematic Review(Frontiers Media S.A., 2020) Ekechukwu, E. N. D.; Olowoyo, P.; Nwankwo, K. O.; Olaleye, O. A.; Ogbodo V. E.; Hamzat, T. K.; Owolabi, M. O.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 6min 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.Item Stroke Rehabilitation: Should Physiotherapy Intervention be Provided at a Primary Health Care Centre or the Patients’ Place of Domicile?(Informa Healthcare, 2014) Olaleye, O. A.; Hamzat, T. K.; Owolabi, M. O."Purpose: This randomized controlled trial compared the outcomes of physiotherapy intervention on selected indices of recovery for stroke survivors treated at a primary health centre group (PHCG) with those treated in their respective places of domicile group (DG). Methods: Participants were 52 individuals comprising 24 males and 28 females who had suffered a stroke and were recently discharged from two inpatient health facilities in Ibadan, Nigeria. They were randomly assigned into either the PHCG (n=25) or DG (n = 27) and treated twice weekly for 10 consecutive weeks using a physiotherapy intervention protocol comprising a battery of task- specific exercises. The outcomes measured were motor function, balance and handicap assessed using the modified motor assessment scale (MMAS), short-form postural assessment scale for stroke (SF-PASS) and reintegration to normal living index (RNLI), respectively, as well as walking speed which was assessed using a standard technique. Results: Between-group comparison using the General Linear Model revealed no statistically significant difference in both the pre- and post-intervention scores of the two groups on the MMAS, SF-PASS, RNLI and walking speed in both PHCG and DG (p>0.05). However, within-group comparison yielded a statistically significant difference in each of the indices of stroke recovery measured across the 10-week period in both groups. Conclusion: Physiotherapy intervention at the primary health care centre and respective homes of stroke survivors similarly improved clinical outcomes. Treatment at any of these locations may enhance access to physiotherapy after stroke in a low- income community like Nigeria. "Item Development and Evaluation of a Primary HealthCare-based Physiotherapy Intervention and its Effects on Selected Indices of Stroke Recovery(MA Healthcare Ltd, 2013) Olaleye, O. A.; Hamzat, T. K.; Owolabi, M. O.Aim: To develop a Primary Healthcare-Based Physiotherapy Intervention (PHCPI) that requires simple, inexpensive, easy-to-use equipment for stroke rehabilitation and evaluate its effects on selected clinical indices of recovery among post-acute stroke survivors over a 10-week period. Methods: Three databases (Medline, Pubmed and PEDro) were used to identify treatment approaches with proven efficacy. The authors synthesised these treatment approaches to develop the PHCPI, which was used in a repeated measure design involving 25 (mean age=60.6 ± 10.2 years) consenting individuals with first-incidence stroke. These individuals were treated at a primary health centre, twice weekly for 10 consecutive weeks. Outcomes were assessed using the Modified Motor Assessment Scale (MMAS), the Short Form Postural Assessment Scale for Stroke (SF-PASS) and the Reintegration to Normal Living Index (RNLI), before the intervention and fortnightly thereafter. Walking speed and quality of life were also assessed before the intervention and at week 10 of it. Results: Within-subject multivariate analysis, after controlling for gender, showed a significant increase in motor function, postural balance, walking speed and quality of life. Their community reintegration scores also improved over the period. Conclusion: The PHCPI resulted in improved motor function, community reintegration, walking speed, postural balance and quality of life among community-dwelling stroke survivors. This intervention can be used for stroke rehabilitation at primary health centres.Item Predictors of weight reduction in a Nigerian family practice setting(Ghana Medical Association, 2021) Ogunbode, A. M.; Owolabi, M. O.; Ogunbode, O. O.; Adebusoye, L. A.; Ogunniyi, A.Objectives: This study identified the predictors of weight reduction among adult obese patients in a Family Practice Setting and developed a statistical model to predict weight reduction. Design: A prospective cohort design. Setting: The Family Practice Clinic, University College Hospital, Ibadan, Nigeria Participants and study tools: Obese adults were recruited into a three-month weight reduction program. Patient Information Leaflets were used for counselling, while questionnaires were administered to obtain socio-demographic and lifestyle factors. Potential predictors were assessed using the Multidimensional Scale of Perceived Social Support, Zung Depression Scale, Rosenberg Self-Esteem scale, Garner’s Eating Attitude Test-26 (EAT-26), 24-hour dietary recall and International Physical Activity Questionnaire-short form. Anthropometric indices, blood pressure and Fast-ing Lipid Profile were assessed. Descriptive and inferential statistics were used for analysis with a significance set at α0.05. Results: Most 99(76.2%) of the 130 participants achieved weight reduction and had a median weight change of -2.3kg (IQR-4, -0.5), with 66 (66.7%) out of 99 attaining the weight reduction target of 10%. The regression model showed predictors of weight reduction to be Total Cholesterol [TC] (p=0.01) and Low-Density Lipoprotein Cholesterol [LDL-C] (p=0.03). The statistical model derived for Weight reduction = 0.0028 (LDL-C) -0.029 (TC)-0.053 (EAT-26) +0.041(High-Density Lipoprotein Cholesterol). The proportion of variance of the model tested was R2 = 0.3928 (ad-justed R2 = 0.2106). Conclusion: Predictors of weight reduction among patients were eating attitude score, Total Cholesterol, Low-Density Lipid and High-Density Lipoprotein Cholesterol levels. A statistical model was developed for managing obesity among patients.Item Factors associated with obesity and weight reduction among people with obesity: A systematic review(ScopeMed, 2020) Ogunbode, A. M.; Owolabi, M. O.; Ogunbode, O. O.; Ogunniyi, A.Introduction: Obesity is a non-communicable disease of huge public health importance with several multi-systemic complications. Weight reduction techniques are useful in the management of obesity. The aim of this review was to determine the risk factors, health risks of obesity as well as factors influencing weight reduction among individuals with obesity. Methods: Google, Google Scholar, and Pub Med databases were used to identify studies on obesity that assessed risk factors and complications of obesity plus factors influencing weight reduction among people with obesity. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used and 914 literature records were retrieved. These were limited to papers published in English up to 2019. We excluded 702 articles that did not match our theme and also excluded an additional 156 full articles due to incompleteness. The evidence available was critically appraised in line with our objectives. Results: Fifty-six articles were reviewed, and it was found that obesity increased with age and was more in women. Inadequate diet, physical inactivity, and metabolic disor¬ders were contributory factors, whereas the main factors associated with greater weight reduction were lower pre-treatment weight, lower waist circumference, doctors as role models, and absence of psychiatric co-morbidities. Conclusions: Proven weight reduction methods are vital for the cost-effective manage¬ment of patients as part of lifestyle modification.Item What’s in your hands? A systematic review of dietary assessment methods and estimation of food sizes in a Primary Care Clinic(Wolters Kluwer - Medknow, 2018) Ogunbode, A. M.; Owolabi, M. O.; Ogunbode, O. O.; Ogunniyi, A.Introduction: Many patients with noncommunicable diseases such as obesity are attended to in Family Practice Clinics where quick dietary assessment along with estimation of food sizes as part of lifestyle modification and appropriate intervention could be offered. We performed a systematic review to determine the dietary assessment methods with the best evidence that can be employed in a Family Practice Clinic. Methods: Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines were used to conduct a systematic review of PubMed, Google, and Google Scholar databases from 1992 to 2017. Results: We found 730 original research articles, case–control studies, review articles, proceedings, transactions, and textbooks. Thirty-seven articles were selected out of which two were secondary data, 12 were review articles, 10 were descriptive surveys, and one was a prospective cohort study. There were two randomized controlled trials, two mixed study designs, one working paper, and seven guides. Food portion size estimation using household objects and the hand guide, then the food pyramid guide along with the food-sized plate intervention was documented. Conclusion: In view of the busy nature of Family Practice Clinics in several countries, in performing dietary assessment, food portions can be estimated using household measures and the hand portion guide. The pyramid guide and the portion-sized plate can then be used for intervention.Item What’s in your hands? A systematic review of dietary assessment methods and estimation of food sizes in a Primary Care Clinic(Wolters Kluwer - Medknow, 2018) Ogunbode, A. M.; Owolabi, M. O.; Ogunbode, O. O.; Ogunniyi, A.Introduction: Many patients with non-communicable diseases such as obesity are attended to in Family Practice Clinics where quick dietary assessment along with estimation of food sizes as part of lifestyle modification and appropriate intervention could be offered. We performed a systematic review to determine the dietary assessment methods with the best evidence that can be employed in a Family Practice Clinic. Methods: Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines were used to conduct a systematic review of PubMed, Google, and Google Scholar databases from 1992 to 2017. Results: We found 730 original research articles, case–control studies, review articles, proceedings, transactions, and textbooks. Thirty-seven articles were selected out of which two were secondary data, 12 were review articles, 10 were descriptive surveys, and one was a prospective cohort study. There were two randomized controlled trials, two mixed study designs, one working paper, and seven guides. Food portion size estimation using household objects and the hand guide, then the food pyramid guide along with the food-sized plate intervention was documented. Conclusion: In view of the busy nature of Family Practice Clinics in several countries, in performing dietary assessment, food portions can be estimated using household measures and the hand portion guide. The pyramid guide and the portion-sized plate can then be used for intervention.Item Weight control, alcohol reduction, smoking cessation, health promotion, exercise and diet (WASHED)’: a mnemonic for lifestyle modification in obesity(Department of Family Medicine, University College Hospital, Ibadan, 2015) Ogunbode, A. M.; Owolabi, M. O.; Ogunniyi, A.; Ogunbode, O. O.Item Bell's palsy in pregnancy and the puerperium: a report of five cases(College of Medicine, University of Ibadan, 2010) Fawale, M. B.; Owolabi, M. O.; Ogunbode, O.The incidence of idiopathic facial nerve palsy is higher during pregnancy and the puerperium than in non-pregnant women of childbearing age. An important association also exists between Bell’s palsy and hypertensive disorders of pregnancy. We describe three patients with idiopathic facial nerve palsy in pregnancy and two in the puerperium. Two of these were associated with hypertensive disorder of pregnancy. This case report illustrates the fact that Bell’s palsy is common in pregnancy and in the puerperium and often associated with hypertensive disorders of pregnancy. Association also exists between Bell’s palsy and hypertensive disorders of pregnancy [1].The clinical manifestation is the same in pregnancy as in the general population, although, it tends to run a more severe course in the former [5]. Rarely, patients have recurrent Bell’s palsy in successive pregnancies [5]. Short course of steroids early in the course of the disease has been used with some evidence of benefit [7]. We present a crop of five cases of Bell’s palsy who we saw in quick succession within a few months at the Neurology Unit of the Department of Medicine, University College Hospital, Ibadan.Item Data resource profile: Cardiovascular H3Africa Innovation Resource (CHAIR)(Oxford University Press, 2018-12) Owolabi, M. O.; Onoja, M. A.; Made, F.; Adebamowo, S. N.; Ojo, A.; Dwomoa, A.; Motala, A. A.; Bongani, M.M.; Ovbiagele, B.; Adebamowo, C.; Bamidele, T.; Rotimi, C.; Akinyemi, R.; Gebregziabher, M.; Sarfo, F.; Wahab, K. W.; Parekh, R. S.; Engel, M. E.; Chisala, C.; Peprah, E.; Mensah, G.; Wiley, K.; Troyer, J.; Miche` le, R.Low- and middle-income countries (LMIC) constitute the majority of the world’s population and bear more than 80% of the global burden of cardiovascular disease (CVD).1,2 The recent increases in CVD globally are also reflected in LMIC, where the prevalence of overall deaths from CVD was 28% in 20013 and premature CVD mortality was 37% in 2015.4 The paucity of data regarding the drivers of the CVD epidemic and contextualized solutions is, in part, because less than 10% of the global research resources and facilities for implementation are found in LMIC.5,6 Therefore LMIC are particularly disadvantaged in dealing with the CVD burden with...