Study interventions
pain
The interventions commenced immediately after baseline assessments and randomisation. Participants in the PE plus MCE group received PE followed by stretching, MCE and aerobic exercise. Participants in the PE alone group received PE followed by stretching and aerobic exercise, whereas those in the MCE received stretching followed by MCE and aerobic exercise. The PE was administered once a week for 8 weeks (8 sessions), whereas stretching and MCE were administered twice a week for 8 weeks (16 sessions). Participants were treated on alternate days to minimise cross-contamination between groups. All exercises except aerobics (non-supervised continuous overground walk or bicycling) were supervised by physiotherapists. All the participants were advised to refrain from receiving other interventions such as herbal preparations and treatment from traditional bonesetters to prevent contamination of outcome. However, prescribed pain tablets were permissible as it would be unethical to withhold medication. They were encouraged to perform exercises consistent with their group treatment at home. To enhance self-management, participants were given a booklet (translated into Hausa) according to the group they were assigned. Participants in the PE plus MCE received a booklet containing key information about the PE programme (including picture models of postural hygiene and relaxation positions) and picture models of stretching and MCE resembling rural northern Nigerian dwellers. Participants in the PE alone group received a booklet consisting of the aforementioned components but without the MCE programme. Those in the MCE alone group however received a booklet containing only the stretching and MCE programme. All participants were encouraged to continue with home exercises at the end of the study to sustain self-management. The researcher kept in touch with the participants through phone calls to remind them of their follow-ups from time to time.