Patient-perceived barriers and facilitators to full weight-bearing with a lower-extremity circular external fixator: a qualitative study

Abstract

Background: Circular external fixators are commonly used in orthopaedics to immobilise fractured bones and correct deformities. Early weight-bearing with circular external fixators has been shown to enhance bone growth and improve patient outcomes. However, many patients do not fully weight-bear after surgery, indicating the presence of barriers to early weight-bearing that need to be addressed. The objective was to identify the barriers and facilitators to full weight-bearing with a circular external fixator.

Method: Patients with lower-limb circular external fixators in Pretoria, South Africa, were invited to participate in a qualitative exploratory study, using semi-structured interviews. The interviews were audio-recorded, transcribed verbatim, and analysed using thematic content analysis. Data saturation was reached after nine interviews.

Results: Four themes were obtained. These included pain/pain management, participants’ state of mind, physical factors, and medical/non-medical support systems. The interviews revealed that pain, swelling, and the history of the injury influenced the participants’ ability to bear weight, and their state of mind. Physical factors related to the human body and external fixator equipment also played a role, as did the availability of medical and non-medical support systems. Complications and fear of refracturing or falling were additional factors affecting mobilisation and weight-bearing.

Conclusion: The findings of this study emphasise the importance of addressing physical and psychological factors affecting rehabilitation. While identifying the barriers and facilitators is beneficial, the study’s limitations may reduce the generalisability of the findings. Further research on the implementation of solutions to address these factors in physiotherapy practice are warranted in this context.

Level of evidence: 3