Exploring factors related to non-adherence to physiotherapy clinical attendance after traumatic fractures in children in Kwazulu-Natal : a caregiver perspective

Abstract

Background: Traumatic fractures (TF) are common in children and mainly result from falls and motor vehicles, amongst others. Traumatic fractures can be classified as closed or open fractures, and management depends on the type and degree of soft tissue involvement. Physiotherapy management commences as early as possible after the fracture has been reduced, and the aim is to improve function and return to the highest functional level. Returning to the highest functional level depends on patients’ good adherence to physiotherapy clinical attendance, as physiotherapy assists in the prevention of joint functional limitations and deformities. Several factors contribute to poor physiotherapy clinical attendance in children with traumatic fractures, and no studies explored these factors in this population. Aim: This study aimed to explore the factors related to non-adherence to physiotherapy clinical attendance after traumatic fractures in children between the ages of five and seventeen years. Method: A qualitative paradigm, using an exploratory and descriptive research design, was employed. A purposive sampling method was used to select caregivers of children with traumatic fractures who consulted in three selected provincial hospitals in KwaZuluNatal Province, South Africa. Ethical clearance and approval were granted (REC: 676/2020) by the University of Pretoria Health Sciences Research and Ethics committee. Permission to conduct the study was granted by the chief executive officers of the three hospitals. Gatekeeper’s permission was also obtained from the Provincial Department of Health in KwaZulu-Natal. Consent to participate in the study and recording of the interviews was sought verbally from parents of the children with traumatic fractures prior to conducting an interview. A pilot study of three participants was completed to check the quality of the interview questions. Phase one of data collection included reviewing records in the three hospitals to access the contact details of the caregivers of the children with traumatic fractures who did not adhere to physiotherapy clinical attendance from 2020 to 2021. Data reviewed from the file were patient name, diagnosis, age, parents and next of kin’s contact details and address. The researcher contacted each caregiver, read the information sheet, and verbally requested to interview and tape record the conversation. The researcher telephonically interviewed the caregivers of the children with traumatic fractures and probed for rich data. The interview was approximately 30 – 40 minutes per caregiver. As 8-15 participants are enough for a qualitative study to reach data saturation. Data were transcribed verbatim and analysed using Colaizzi’s seven steps. VII Results: Five main themes emerged from the conducted interviews. The themes were function and disability; hospital service; socio-economic factors; socio-political, and the value of physiotherapy. Conclusion: Caregivers identified insufficient knowledge about them coming back for physiotherapy sessions after discharge from the hospital as a major factor. They also had different opinions and beliefs on physiotherapy treatments and outcomes, influencing their adherence to the scheduled physiotherapy clinical attendances. Attitudes of physiotherapists towards children with traumatic fractures affected their interest in coming back for follow-up sessions. They also highlighted that their proximity made it difficult for them to pay for transport to the hospital. Thus, the study has demonstrated that children’s health conditions and how they are treated depend entirely on their caregivers’ beliefs and knowledge. Clinical implication of the study: Physiotherapists need to educate caregivers of children with traumatic fractures about the role of physiotherapy management in these patients. Also, physiotherapists need to change their attitudes towards caregivers as this was highlighted as a factor which made caregivers opt for alternative treatment methods or stay at home. For caregivers who stay far from the hospitals where they can access physiotherapy services, physiotherapists must consider making bookings on the same days as their reviews with medical doctors.