Health-related Quality of Life in Adult Patients With External Fixation Devices Seen at Kenyatta National Hospital and Aic Kijabe Hospital

Abstract

BACKGROUND; External fixation of bone involves placement of pins or wires inserted percutaneously through small skin incisions into bone then held externally with a framework of clamps and metal rods or rings. External fixators have been in use over the last 2 centuries. They have shown excellent outcomes in the management of fractures, bone deformities and bone loss. By contrast, these devices can potentially interfere with a patient’s daily life and ability to accomplish activities of daily living (ADLs). This can lead to a significant impact on the patient’s health-related quality of life (HRQOL). This may be due to their placement externally and prolonged treatment duration in indications such as deformity correction, bone loss management, and definitive fracture treatment. STUDY OBJECTIVES; To determine the perceived health-related quality of life (HRQOL) in patients with external fixation devices. METHODOLOGY; This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH) and AIC Kijabe Hospital. 78 patients were consecutively recruited. Data on patient demographics as well as HRQOL was collected using a structured questionnaire and the World Health Organization Quality of Life BREF (WHOQOL BREF) validated tool. Analysis was done using Statistical Package for Social Sciences (SPSS) Version 22. RESULTS; 78 patients were recruited. The mean age of the patients was 33.1±9.6. The majority of them were male (76.9%) with about half being unemployed. Their area of residence was equally distributed between rural and urban. 92% of the patients had the uniplanar external fixator with hybrid and circular external fixators being 4% each. About 1/3 of the patients had the external fixation device for <6 weeks with a further 1/3 having the device for between 6 and 12 weeks. The remaining 1/3 of patients had the device for >12 weeks. More than half of the patients rated their overall quality of life as poor or very poor with about 2/3 being dissatisfied with their overall health. All the WHOQOL BREF domain scores were low, corresponding to a low HRQOL (physical 24.5±11.9, psychological 48.2±14.2, social relationships 41.6±17.2 and environmental 36.7±11.4). There was no statistically significant xv association between HRQOL domain scores and the type as well as the duration of external fixation. (p-value >0.05 in all domains) CONCLUSION; Patients on management with external fixation devices have a low health-related quality of life. This study found no association between HRQOL and the type as well as the duration of external fixation. Due to the HRQOL impact of these devices, a multidisciplinary team approach should be employed in the management of these patients. Efforts should be made to avoid prolonging the duration of treatment with these devices and alternative forms of management should be considered where possible.