Barriers and facilitators to physiotherapy among adult orthopedic patients at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia: A cross-sectional study

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Figure 1
- Physiotherapy referral locations illustrating the highest referral location was the knee joint followed by shoulder.

Table 1

- Sociodemographic characteristics of adult orthopaedic patients (N=340).

Variables	n (%)
Age group
18 – 30 years	108 (31.8)
31 – 40 years	141 (41.5)
>40 years	91 (26.8)
Gender
Male	197 (57.9)
Female	143 (42.1)
Living area
Urban	280 (82.4)
Rural	60 (17.6)
Employment status
Employed	218 (64.1)
Unemployed	98 (28.8)
Retired	24 (7.1)
Educational level
Secondary or below	69 (20.3)
Bachelor’s degree	181 (53.2)
Diploma	53 (15.6)
Master’s degree	32 (9.4)
PhD	05 (1.5)
Reason for a physiotherapy referral
Post-surgery	152 (44.7)
Conservative treatment	188 (55.3)
Distance from home to physiotherapy location
5–15 minutes	66 (19.4)
16–30 minutes	168 (49.4)
>30 minutes	106 (31.2)
Level of importance of rehabilitation
Not important	22 (6.5)
Moderately important	138 (40.6)
Very important	180 (52.9)
Who do you see as part of your rehabilitation?
Physiotherapist	191 (56.2)
I do my own rehabilitation	130 (38.2)
Other	19 (5.6)
In what environment(s) did you see your rehabilitation provider?
Public hospital clinic	273 (80.3)
Private hospital clinic/center	52 (15.3)
Home	08 (2.4)
Other	07 (2.1)

Table 2

- Assessment of barriers and facilitators to physiotherapy among adult orthopaedic patients (N=340).

Statements	Mean ± SD
Barriers statement
Ongoing Pain	1.36 ± 0.68
Distance to center	1.35 ± 0.68
No means of transportation	1.33 ± 0.69
Crowded centers	1.32 ± 0.70
Not enough time to complete your rehabilitation	1.30 ± 0.64
The length and commitment of rehabilitation	1.29 ± 0.69
A lack of motivation and confidence to do your rehabilitation	1.29 ± 0.63
Being afraid of reinjuring	1.24 ± 0.58
Not having access to the facilities or equipment you needed	1.12 ± 0.79
Total barriers score	11.6 ± 3.52
Level of barriers, n (%)
Low	64 (18.8)
Average	183 (53.8)
High	93 (27.4)
Facilitators statement
Being given choice in what you do for rehabilitation	1.41 ± 0.65
Regular assessments of your progress and function	1.41 ± 0.62
Regular goal setting with your rehabilitation provider	1.41 ± 0.55
Enjoying the exercises provided to you	1.35 ± 0.68
Having exercises related to your daily life activities	1.33 ± 0.66
Having a good relationship with your rehabilitation provider	1.29 ± 0.69
Interacting with others with the same injury	1.25 ± 0.66
Having the support and encouragement of the people around you	1.23 ± 0.65
Total facilitators score	10.7 ± 3.16
Level of facilitators, n (%)
Low	41 (12.1)
Average	213 (62.6)
High	86 (25.3)

SD: standard deviation, Category responses were “not at all” coded with 0, “sometimes” coded with 1, and “a lot” coded with 2.

Table 3

- Differences in the score of barriers in relation to the sociodemographic characteristics of adult orthopaedic patients (N=340).

Factor	Barriers score (18) Mean ± SD	Z/H-test	P-value
Age group
≤35 years	11.6 ± 3.41	Z=0.172	0.863 ^a
>35 years	11.6 ± 3.68	Z=0.172	0.863 ^a
Gender
Male	11.7 ± 3.55	Z=0.840	0.401 ^a
Female	11.4 ± 3.48	Z=0.840	0.401 ^a
Living area
Urban	11.1 ± 3.32	Z=4.478	<0.001 ^** ^a
Rural	13.6 ± 3.75	Z=4.478	<0.001 ^** ^a
Employment status
Employed	11.5 ± 3.45	Z=0.647	0.517 ^a
Unemployed	11.8 ± 3.64	Z=0.647	0.517 ^a
Educational level
Diploma or below	12.0 ± 3.83	Z=1.824	0.068 ^a
Bachelor or higher	11.3 ± 3.32	Z=1.824	0.068 ^a
Reason for a physiotherapy referral
Post-surgery	11.5 ± 3.24	Z=0.130	0.896 ^a
Conservative treatment	11.6 ± 3.74	Z=0.130	0.896 ^a
Distance from home to physiotherapy location
5–15 minutes	11.4 ± 3.26	H=3.396	0.183 ^b
16–30 minutes	11.9 ± 3.88
>30 minutes	11.1 ± 3.01
Level of importance of rehabilitation
Not important	11.0 ± 2.67	H=20.186	<0.001 ^** ^b
Moderately important	10.6 ± 2.46
Very important	12.4 ± 4.05
Who do you see as part of your rehabilitation?
Physiotherapist	11.5 ± 3.29	Z=3.27	0.743 ^a
I do my own rehabilitation/Other	11.7 ± 3.79	Z=3.27	0.743 ^a
In what environment(s) did you see your rehabilitation provider?
Public hospital clinic	11.8 ± 3.64	Z=1.825	0.068 ^a
Non-public hospital clinic	10.8 ± 2.86	Z=1.825	0.068 ^a

Table 4

- Differences in the score of facilitators in relation to the sociodemographic characteristics of adult orthopaedic patients (N=340).

Factor	Facilitators score (16) Mean ± SD	Z/H-test	P-value
Age group
≤35 years	10.8 ± 3.17	Z=0.752	0.452
>35 years	10.5 ± 3.15	Z=0.752	0.452
Gender
Male	10.5 ± 3.15	Z=1.811	0.070
Female	10.9 ± 3.16	Z=1.811	0.070
Living area
Urban	10.3 ± 3.04	Z=5.338	<0.001^**
Rural	12.6 ± 3.01	Z=5.338	<0.001^**
Employment status
Employed	10.5 ± 3.19	Z=1.994	0.046^**
Unemployed	11.1 ± 3.07	Z=1.994	0.046^**
Educational level
Diploma or below	11.1 ± 3.22	Z=2.032	0.042^**
Bachelor or higher	10.4 ± 3.10	Z=2.032	0.042^**
Reason for a physiotherapy referral
Post-surgery	10.7 ± 3.02	Z=0.180	0.857
Conservative treatment	10.7 ± 3.28	Z=0.180	0.857
Distance from home to physiotherapy location
5–15 minutes	9.95 ± 3.04	H=11.999	0.002^**
16–30 minutes	11.4 ± 3.44
>30 minutes	10.0 ± 2.49
Level of importance of rehabilitation
Not important	8.82 ± 2.56	H=71.768	<0.001^**
Moderately important	9.14 ± 1.98
Very important	12.1 ± 3.31
Who do you see as part of your rehabilitation?
Physiotherapist	10.4 ± 2.83	Z=0.639	0.523
I do my own rehabilitation/Other	10.9 ± 3.53	Z=0.639	0.523
In what environment(s) did you see your rehabilitation provider?
Public hospital clinic	10.9 ± 3.28	Z=3.125	0.002^**
Non-public hospital clinic	9.57 ± 2.32	Z=3.125	0.002^**