Utilization of physiotherapy services and associated factors among patients with lower back pain at Mubende Regional Referral Hospital, Uganda

Abstract

Background: Low back pain (LBP) still remains the commonest cause of musculoskeletal disorders related to work status and condition globally. Many people in rural Africa and Uganda continue to live with physical disabilities due LBP. Physiotherapy is a widely used treatment for gaining relief from low back pain. In Mubende regional referral hospital (MRRH), physiotherapy services are provided at a free cost to help improve function and quality of life LBP patients. However, many people with LBP do not utilize the service and the reasons are not clear. Therefore, the study assessed utilization of physiotherapy services and associated factors among patients with lower back pain in MRRH, Uganda. Methods: A mixed method cross sectional study using explanatory sequential approach was conducted among 125 LBP patients. Data was collected for three months from April to June of 2021. A pre-tested questionnaire was used to collect quantitative data. Key informant interviews to explore barriers and facilitators to physiotherapy utilization were conducted among purposively selected health workers from the rehabilitation team. Descriptive analysis was done and modified poisson regression was used to determine factors associated with utilization physiotherapy using STATA Version 14.0. Thematic analysis was used to analyze qualitative data. Results: The study revealed 60.0% utilization of physiotherapy services among LBP patients at MRRH. Middle income status (APR 1.61, 95% CI: 1.06-2.44), occupation (APR 0.51, 95% CI: 0.26-0.97), pain relief by physiotherapy (PR 0.58, 95% CI: 0.36-0.95) and physiotherapy first time user (APR 1.64, 95% CI: 1.09-2.47) at a p<0.05 were significantly associated with the utilization of physiotherapy services among LBP patients. Reported facilitators to physiotherapy utilization by LBP patients were; Health facility (availability of free physiotherapy services at the unit), Patient related (availability of transport and pain patients with LBP feel), and Health care provider (good customer care and experience of a physiotherapist). Barriers to physiotherapy utilization included health facility barriers (Long waiting time and lack of outreach programmes for LBP), Patient related barriers (long distance to health facility, lack of awareness about physiotherapy services and use of traditional methods of managing LBP). Conclusion: The study revealed 60.0% prevalence of physiotherapy utilization among LBP patients at MRRH. Factors that were significantly associated with utilization of physiotherapy service included; income status, occupation, pain relief and physiotherapy first time user. Health facility, Health care provider and Patient related barriers and facilitators to utilization of physiotherapy services were reported. Therefore, the government and other relevant stakeholders should prioritize sensitization and increasing awareness of physiotherapy services, its availability and importance to LBP patients, health professionals and general public in order to improve on physiotherapy service utilization.