PATIENT PERCEIVED BARRIERS AND FACILITATORS TO WEIGHT-BEARING WITH A LOWER LIMB, CIRCULAR, EXTERNAL FIXATOR

M.D. Crouse¹, S. Lord¹, M.M. Keller¹

¹University of Witwatersrand, Physiotherapy, Johannesburg, South Africa

Background: External fixators have been used throughout history to immobilise broken bones, and correct deformities. The use of circular external fixators has increased due to the versatility of the fixator and the allowance of early weight-bearing. Early weight-bearing can significantly improve bone growth in most types of fractures. This may result in earlier removal of the external fixator, less complications and improved patient outcomes.

Purpose: Although literature suggests that patients can fully weight-bear immediately post-operatively, empirical evidence shows that many do not, making this a fundamental study both in South Africa and Internationally. Therefore, factors that hinder early weight-bearing need to be addressed. This study aimed to determine the patient perceived barriers and facilitators to early weight-bearing with a circular external fixator.

Methods: A qualitative exploratory study was conducted using semi-structured one-on-one interviews. Patients that had a lower limb, circular, external fixator applied in Pretoria, South Africa and were referred for physiotherapy were invited to participate. Participants were requested to complete a demographic questionnaire prior to the interview. Once the questionnaire was completed the interview commenced. The interviews were audio – recorded and transcribed verbatim. Thematic content analysis was used to analyse the data. Codes and categories were identified, and themes emerged. Data saturation was reached after nine interviews.

Results: Four themes emerged from the data collected from the interviews. The first was the participants’ experience of pain as well as the measures to relieve pain, swelling and injury. Theme two denotes the participants’ state of mind, which had a significant impact on their ability to mobilise and weight-bear. Some were positive, and others negative, and the effects of their surgical history and complications influenced their current state of mind as well. The fear of falling or refracturing their leg also had an influence on their attempt to mobilise or weight-bear without their assistive devices. Theme three represents the physical factors pertaining to the human body and the external fixator equipment that played a role in the participants’ ability to mobilise and weight-bear. Lastly, theme four delves into the medical and non-medical support systems, that played a key role in both the physical and psychological state of the participants.

Conclusions: The results obtained show that there are both physical and psychological factors that are barriers and facilitators to full weight-bearing. Pain was the major influence in weight-bearing. The medical team as well as the level of support at home also played a role. Furthermore, the demographics showed that there were certain factors that increased the participants’ chance of having complications. When there were complications, the participants could not weight-bear. Findings were in line with available literature on external fixators, which is scarce, therefore it adds to the limited body of knowledge.

Implications: These results reveal the barriers and facilitators to weight-bearing with an external fixator. This may provide a better understanding for clinicians when managing these patients. Further studies should be conducted on the implementation of solutions, with these results as a guideline, for general circular external fixator physiotherapy practice.

Funding acknowledgements: This study was partially funded by the South African society of physiotherapy

Keywords:
External fixator
Weight-bearing
Barriers and facilitators

Topics:
Orthopaedics
Disability & rehabilitation
Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: University of Witwatersrand

Committee: University of Witwatersrand Human Research Ethics Committee (Medical)

Ethics number: M210723