The Occurrence of Knee Stiffness in Patients with fractures of femurs attending physiotherapy out-patient services at Moi teaching and referral hospital, Eldoret, Uasin gishu county, Kenya

Abstract

Abstract: Study Background: Management of knee stiffness includes both operative and nonoperative. In both cases, physical therapy is important. nonoperative treatments include physical therapy and home exercise programs. These are used to treat and minimize the flexion and extension deformities. Physiotherapy may include manual stretching, prolonged stretching using a tilt table, sandbag or weight over the distal femur, mechanical traction, passive range of motion exercises and joint mobilization techniques. The effectiveness of a given treatment to reduce stiffness is a function of applied torque, as well as the duration and frequency of the treatment. Objectives: To describe the characteristics of patients, to determine the prevalence, and to establish the management factors associated with knee stiffness in patients with fractures of femurs attending physiotherapy out-patient services at Moi Teaching and Referral Hospital (MTRH), Eldoret, Uasin Gishu County, Kenya. Methods: The study was carried out in the Physiotherapy out-patient clinic at MTRH. A descriptive retrospective audit of 48 patients’ folders (14 Females, 34 Males) during the period of July 2021 and June 2022 that fulfilled inclusion criteria was conducted, after approval by Institutional Research and Ethics Committee and Hospital Administration. Data was collected using prevalidated tool, and then analysis for the study variables was done using the Statistical Packages for Social Science (SPSS) computer software. The preliminary data was analyzed using descriptive statistics in the form of frequencies, means, and percentages and presented in the form of tables, pie charts and graphs. Results: Males (70.8%) exhibited higher prevalence of femoral fractures than females (29.2%) due to occupational hazards and high-risk activities. Middle-aged individuals (30-50 years) were most affected, primarily due to physically demanding jobs, while older patients (>50 years) experienced prolonged recovery due to degenerative changes and comorbidities. Road traffic accidents were the leading cause of fractures in younger patients, while occupational hazards and falls were predominant among older individuals. Prevalence was 17.78%. Delayed physiotherapy initiation and lower education levels were linked to increased knee stiffness, particularly among patients from remote areas with limited healthcare access. The length of hospitalization and the number of days between occurrence of injuries and medical and surgical intervention played a significant role in the development of knee stiffness among patient and subsequent outcomes. Conclusion: Early surgical intervention, timely physiotherapy, and adherence to rehabilitation programs significantly improved recovery. Socioeconomic factors, including education and healthcare access, play a crucial role in rehabilitation outcomes. Recommendations: Public health educations on injury prevention, improved access to physiotherapy, and targeted fall prevention strategies for older adults are essential. Strengthening hospital efficiency, implementing workplace safety policies, and promoting multidisciplinary care can further enhance patient recovery and reduce knee stiffness incidence