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W.A. Wanunda1,2, N.T. Ndune2, N.B. Mlenzana1,2
1University of the Western Cape, Physiotherapy, Cape Town, South Africa, 2Kenyatta National Hospital, Physiotherapy, Nairobi, Kenya
Background: Osteoarthritis is a degenerative chronic musculoskeletal disorder. The condition causes disability that arises from pain and loss of function, affecting quality of life and increasing the probability of further morbidity. Global studies have reported the positive effects of implementation of rehabilitation programs in the management of osteoarthritis. Despite this, the Kenyan patients affected with osteoarthritis exhibit low adherence towards their rehabilitation programs.
Purpose: To discover the perceived barriers and facilitators towards adherence to rehabilitation programs in patients with osteoarthritis.
Methods: The study was conducted in urban Kenya. Mixed methods with a partial mixed sequential dominant status-qualitative design was used. Participants were patients with osteoarthritis and physiotherapists with experience in osteoarthritis management.
Quantitative phase: Patients with osteoarthritis on rehabilitation programs a year before the study commenced participated. Patients with rheumatoid arthritis, septic arthritis, gout arthritis, and ankylosing spondylitis were not allowed to participate in the study.
A data capture sheet and a standardized AIMS2 questionnaire were administered to the patients to determine their clinical profile. Consecutive sampling procedure whereby 114 files of patients affected with Osteoarthritis on rehabilitation programs were sampled. The information collected was recorded on data capture sheets.
Afterward, for capturing data on the AIMS2 questionnaire, Cochrane’s formula was used to calculate a sample size that was 138. Purposive sampling method was then utilized thereafter to identify 138 participants. Descriptive statistics were employed to analyze the categorical variables (age, gender, marital status) of respondents in the form of frequencies and percentages to come up with socio-demographic characteristics of the participants. Also, sections of the standardized questionnaire were analyzed using descriptive statistics in the form of frequencies and percentages to produce the clinical profile of the participants.
Qualitative stage: Patients with osteoarthritis and physiotherapists experienced in the management of the condition were purposively selected to participate in this stage. One on one interviews’ with probes that were audio-taped lasting 30-40 minutes was conducted to nine patients and seven physiotherapists. Participants expressed their perceptions on patient adherence towards rehabilitation programs. The Braun and Clark stages of thematic analysis were used to analyze data.
Quantitative phase: Patients with osteoarthritis on rehabilitation programs a year before the study commenced participated. Patients with rheumatoid arthritis, septic arthritis, gout arthritis, and ankylosing spondylitis were not allowed to participate in the study.
A data capture sheet and a standardized AIMS2 questionnaire were administered to the patients to determine their clinical profile. Consecutive sampling procedure whereby 114 files of patients affected with Osteoarthritis on rehabilitation programs were sampled. The information collected was recorded on data capture sheets.
Afterward, for capturing data on the AIMS2 questionnaire, Cochrane’s formula was used to calculate a sample size that was 138. Purposive sampling method was then utilized thereafter to identify 138 participants. Descriptive statistics were employed to analyze the categorical variables (age, gender, marital status) of respondents in the form of frequencies and percentages to come up with socio-demographic characteristics of the participants. Also, sections of the standardized questionnaire were analyzed using descriptive statistics in the form of frequencies and percentages to produce the clinical profile of the participants.
Qualitative stage: Patients with osteoarthritis and physiotherapists experienced in the management of the condition were purposively selected to participate in this stage. One on one interviews’ with probes that were audio-taped lasting 30-40 minutes was conducted to nine patients and seven physiotherapists. Participants expressed their perceptions on patient adherence towards rehabilitation programs. The Braun and Clark stages of thematic analysis were used to analyze data.
Results: Severe pain, lack of funds, long distance to health facility and inadequate patient education by the attending Physiotherapists were identified as significant barriers towards adherence to rehabilitation programs. Alternatively, improvement of the clinical and functional patients’ outcomes, psycho-social support from Physiotherapists, family members and other patients were factors perceived to be contributing positively towards patients’ adherence to rehabilitation programs.
Conclusion(s): Clinical and socioeconomic barriers greatly affect adherence to rehabilitation programs of patients with osteoarthritis in Kenya. Alternatively, psycho-social support positively affects adherence. Future research will seek a broad population in rural settings to ensure the results are not generalized due to the diversity of the Kenyan populace.
Implications: We recommended that policy makers should come up with long term solutions that will assist in mitigating the effects of socioeconomic constraints experienced by a majority of the participants due to the burden of health care costs and improving availability of health facilities in Kenya.
Funding, acknowledgements: No funding.
Keywords: Adherence, Rehabilitation, Osteoarthritis
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: University of the Western Cape, Cape Town, South Africa
Committee: Biomedical Research Committee
Ethics number: BM 18/8/18
All authors, affiliations and abstracts have been published as submitted.
