Bridges and Barriers: Physiotherapy and the Physiotherapist's experience of treating Musculoskeletal Disorders in Western Ecuador. A qualitative study.
Abstract: BACKGROUND: Ecuador is a Spanish speaking country located in northwestern South America with an approximate population of 16 million people. It is considered a developing country. The public healthcare system is divided into three branches and there are also private services available. Musculoskeletal disorders are overly represented in the developing world, especially where poverty and rural living are factors. Physiotherapy is included in the health care system but there is a lack of literature describing physiotherapy practice or the physiotherapist’s experience of working with musculoskeletal disorders in Ecuador. AIM: This study aims to describe a group of physiotherapists’ work as well as the experiences of their work in the rehabilitation of musculoskeletal disorders in Ecuador. METHOD: This qualitative study used semi-structured interviews and a content analysis method. Seven Ecuadorian physiotherapists participated in face-to-face, semi-structured interviews (Index I). Interviews lasted between 35-60 minutes and audio was digitally recorded. The interviews were transcribed and coded in Spanish. Prevalent and common themes from each interview were compiled and further organized into main themes and subthemes. RESULTS: The results of the study were first grouped into two main categories; that which describes physiotherapy in Ecuador and that which describes the physiotherapists’ experience. Patient groups, access to healthcare, patient referral, physiotherapy process and specific techniques and equipment are described. The physiotherapists’ experience was described as a balance of bridges and barriers. Three aspects which cause difficulty in their practice were identified: (1) Limitations to autonomy (2) Economical and political factors (3) Access to continuing education. Three aspects which support and facilitate their work were also recognized: (1) Professional satisfaction (2) Physiotherapists’ role and identity (3) Development of profession. CONCLUSION: While the participating PTs were faced with many challenges in their physiotherapy practices, there was a pervasive tone of satisfaction, optimism, and inspiration for progress and a better future.
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