Dangor Sabeeha, Jayaraman-Pillay Prithi, Maddocks Stacy, Chetty Verusia
Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa.
S Afr J Physiother. 2021 Jan 12;77(1):1501. doi: 10.4102/sajp.v77i1.1501. eCollection 2021.
Ankle fractures are a common injury because of an increase in levels of physical activity, as well as senescence worldwide. Ankle fractures often require surgical management for optimal stabilisation. Pre-operative physiotherapy is necessary to prepare patients for early mobilisation and home discharge. There is a lack of information on the influence of pre-operative physiotherapy on post-operative rehabilitation success, as well as timeous discharge, in patients with ankle fractures.
To explore the perceptions of patients receiving pre-operative physiotherapy care following a unilateral ankle fracture and the perceptions of nursing staff managing these patients at a tertiary hospital in South Africa.
A descriptive qualitative design, using semi-structured interviews, including both patients with unilateral ankle fractures and nurses caring for these patients, was adopted. Interviews were recorded and verbatim transcriptions were analysed utilising thematic analysis.
Four overarching themes emerged: the perceived benefits of pre-operative physiotherapy; inhibitors to physiotherapy rehabilitation; hidden enablers to pre-operative physiotherapy and future initiatives for rehabilitation.
The perceived benefits included improved functional independence and safety of patients, as well as reduced burden of care for nurses. Patients also believed that pain and fear were two inhibitors to physiotherapy. Furthermore, nurses identified that organisational limitations, such as short-staffing and inadequately trained staff, inhibited pre-operative physiotherapy and continuity of care. Early post-operative discharge was a crucial hidden enabler to the pre-operative physiotherapy protocol. Recommendations included improved health education; the potential role of nursing staff as facilitators in pre-operative rehabilitation and regular, pre-operative in-patient monitoring of physiotherapy intervention.
Health education was perceived to have improved patient safety and compliance which subsequently reduced patient safety incidences as well as served as a risk mitigation measure. Furthermore, gait training and muscle strengthening exercises was perceived to have resulted in safe, independent mobility to ensure prompt discharge home. Consequently, a reduced post-operative length of in hospital stay results in major cost savings per patient as well as improved access and bed availability. Future studies may need to explore the effects of pre-operative physiotherapy on post-operative success and return to pre-injury activity.
由于全球范围内身体活动水平的增加以及衰老，踝关节骨折是一种常见的损伤。踝关节骨折通常需要手术治疗以实现最佳稳定。术前物理治疗对于让患者为早期活动和出院回家做好准备是必要的。关于术前物理治疗对踝关节骨折患者术后康复成功以及及时出院的影响，目前缺乏相关信息。
探讨南非一家三级医院中接受单侧踝关节骨折术前物理治疗护理的患者的看法，以及护理这些患者的护理人员的看法。
采用描述性定性设计，通过半结构化访谈，访谈对象包括单侧踝关节骨折患者和护理这些患者的护士。访谈进行录音，并使用主题分析法对逐字记录进行分析。
出现了四个总体主题：术前物理治疗的感知益处；物理治疗康复的阻碍因素；术前物理治疗的潜在促进因素以及未来的康复举措。
感知到的益处包括患者功能独立性和安全性的提高，以及护士护理负担的减轻。患者还认为疼痛和恐惧是物理治疗的两个阻碍因素。此外，护士指出组织方面的限制，如人员短缺和员工培训不足，阻碍了术前物理治疗和护理的连续性。术后早期出院是术前物理治疗方案的一个关键潜在促进因素。建议包括改善健康教育；护理人员在术前康复中作为促进者的潜在作用以及对物理治疗干预进行定期的术前住院监测。
健康教育被认为提高了患者的安全性和依从性，从而降低了患者安全事件的发生率，并作为一种风险缓解措施。此外，步态训练和肌肉强化运动被认为带来了安全且独立的活动能力，以确保及时出院回家。因此，术后住院时间的缩短为每位患者节省了大量成本，并改善了就医机会和床位可用性。未来的研究可能需要探讨术前物理治疗对术后成功以及恢复伤前活动的影响。
