System-level barriers account for non-compliance to physiotherapy among persons with Parkinson's disease at the Korle Bu Teaching Hospital, Ghana: an explanatory mixed-method study.

Background: Despite the increasing importance of physiotherapy and robust evidence, there is still limited studies assessing compliance rates and barriers to physiotherapy appointments for Persons with Parkinson disease (PwPD) especially in low-resource settings such as Ghana. Objective: To assess compliance rates and identify barriers to adhering to physiotherapy appointments among PwPD receiving physiotherapy management at a tertiary hospital in Ghana. Methods: A sequential explanatory mixed method design was used. The quantitative part involved a retrospective survey of health records of PwPD who reported at the Korle-Bu teaching hospital physiotherapy PD-clinic from 2013-2021. The qualitative part involved semi-structured telephone interviews among defaulters from the year with highest clinic attendance. Quantitative data was descriptively analyzed. For the qualitative data, a deductive qualitative content analysis of the transcribed audiotaped interviews was conducted. Results: Eighty-six PD records (56 males) were included. Overall mean (SD) age was 67(±11) and ranged from 38-90 years. The year 2014 recorded the highest number of attendees (n=20/86; 23%). Overall, 88% of the participants had stopped physiotherapy. Six PwPD participated in the interviews. System-level barriers were mainly recorded as the reasons for patients defaulting physiotherapy. Conclusion: The majority of PwPD had stopped physiotherapy and system-level barriers were the key reasons.