Lower limb chronic edema management program: Perspectives of disengaged patients on challenges, enablers and barriers to program attendance and adherence

Linda A M Khong; Amma Buckley; Wendy Johnson; Vinicius Cavalheri

doi:10.1371/journal.pone.0219875

Lower limb chronic edema management program: Perspectives of disengaged patients on challenges, enablers and barriers to program attendance and adherence

PLoS One. 2019 Nov 25;14(11):e0219875. doi: 10.1371/journal.pone.0219875. eCollection 2019.

Authors

Linda A M Khong^{1

2}, Amma Buckley³, Wendy Johnson¹, Vinicius Cavalheri^{4

5}

Affiliations

¹ Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
² Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
³ Media, Cultural Studies and Social Inquiry, Curtin University, Perth, Western Australia, Australia.
⁴ School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
⁵ Allied Health, South Metropolitan Health Service, Perth, Western Australia, Australia.

Abstract

Background: Chronic edema (CO) is a progressive, physically disfiguring and currently incurable condition. A multifaceted program has been recommended to manage the swelling. However, there is little evidence investigating patients' perspectives following the program, particularly for those who have poor adherence and/or are disengaged.

Aim: To investigate the perceived challenges faced by disengaged participants with lower limb CO by identifying their enablers and barriers to participating in a Physiotherapy CO program.

Method: An exploratory qualitative approach was used. A purposive sampling strategy was adopted to recruit participants. Those with more than three months swelling and who had low adherence and/or attendance (disengaged) to the CO program were invited to participate. Semi-structured interviews with six participants from a CO clinic in a tertiary hospital were conducted. Data were thematically analyzed and findings in terms of enablers and barriers were subsequently reflected in the light of a theoretical framework.

Results: All six participants were morbidly obese (BMI 47 ± 4 kg/m2) with multiple chronic comorbidities. Enablers and barriers detected included physical, psychological and social factors that interplay to present multidimensional challenges that influence the participants' adjustment to managing their CO. For the disengaged participants in this study, their under-managed lower limb CO was a progression towards being housebound and having a gradually increasing level of disability.

Conclusion: This study has identified the multidimensional challenges faced by low adherent and/or disengaged participants with lower limb CO to participating in a hospital-based CO program. Perceived enablers and barriers included physical, psychological and social factors. These were mapped using a health behavior change theoretical framework. Understanding these challenges has implications for developing a multidisciplinary approach aimed at enhancing patient engagement and participation in the physiotherapy CO program.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chronic Disease
Cohort Studies
Comorbidity
Disease Management
Edema / epidemiology
Edema / psychology*
Edema / therapy*
Female
Humans
Interviews as Topic
Lower Extremity
Male
Middle Aged
Obesity, Morbid / epidemiology
Patient Compliance / psychology
Patient Participation / psychology
Physical Therapy Modalities / psychology
Pilot Projects
Qualitative Research

Grants and funding

LK is supported by the Sir Charles Gairdner and Osborne Park Health Care Group Research Advisory Committee 2017Small Grant. The funding organization had no role in the study design, data collection and analysis nor in preparation of the manuscript. VC is supported by the Cancer Council Western Australia Postdoctoral Research Fellowship.