Patient-perceived barriers and facilitators to weight-bearing with a lower-limb circular external fixator
Date
2024
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Abstract
External fixators have been used throughout history to immobilise broken bones and correct orthopaedic deformities. The use of circular external fixators has increased owing 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 the earlier removal of the external fixator, less complications and improved patient outcomes.
Purpose
Although literature suggests that patients can fully weight-bear immediately postoperatively, empirical evidence, both globally and locally, shows that many patients do not. As a result, the factors that hinder early weight-bearing need to be addressed. This study aimed to determine the patient-perceived barriers and facilitators to full weight-bearing with a circular external fixator.
Method
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 had been 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 were generated. Data saturation was reached after nine interviews. Results Four themes were generated from the data that was collected from the interviews. The first deals with the participants’ pain, the pain experience, as well as the measures to relieve pain, swelling and injury. Theme 2 presents the participants’ state of mind, which has a significant impact on their ability to mobilise and weight-bear. Although a number of participants were negative, there were indeed participants who presented with a positive state of mind. The effects of their surgical history and complications iv influenced their current state of mind. 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 3 represents the physical factors pertaining to the human body and the external fixator equipment that play a role in the participants’ ability to mobilise and weight-bear. Lastly, Theme 4 delves into the medical and non-medical support systems that played a key role in both the physical and psychological state of the participants. Both of these act as facilitators or barriers to weight-bearing. Furthermore, the demographics showed that there are certain factors that increase the participants’ chances of developing complications. In fact, with complications, the participants are unable to weight-bear.
Conclusion
The findings are in line with the available literature sources on external fixators. Since the relevant literature sources are few and far-between, the research results add to the limited body of knowledge. They show that there are both physical and psychological factors that are barriers and facilitators to full weight-bearing. Pain was found to be the major influence in weight-bearing. The medical team, as well as the level of support at home, also played a role in this respect. Clinical Implications The barriers and facilitators to full weight-bearing with a circular external fixator that were identified in this study should provide for a better understanding among the clinicians managing these patients. With these results as a guideline, further studies should be conducted on the implementation of solutions in the field of general physiotherapy practice around circular external fixators.
Description
A research report submitted in partial fulfilment of the requirement for the degree of Master of Science in Medicine (Physiotherapy) to the Faculty of Health Sciences, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, 2023
Keywords
External fixators, Broken bones, Orthopaedic deformities