Main findings

• N = 6 morbidly obese
• The participants’ presentation would be deemed as complex cases with more than one decade of CO and with multiple chronic comorbidities since the onset of CO.
• Comorbidities included Chronic Obstructive Pulmonary Disease, obesity, congenital conditions such as Milroy’s Disease, Rothmund-Thomson Syndrome and diabetes (Type 1 and Type 2).

• Low adhering and/or disengaged patients have broadly been deemed as non-compliant [24], however, the findings of this pilot study have shown that can be an oversimplification. By exploring participants’ perspectives, this study has revealed multifactorial issues (enablers and barriers) that complicate adherence and attendance at the CO clinic.
• The current study has applied the theoretical framework COM-B model linked with TDF (Table 1) in understanding capability, opportunity and motivation factors as the lens for interpreting patient disengagement in therapy via perceived enablers and barriers. The study found that the enablers and barriers encompass physical, psychological and social factors impacting on the participants’ adherence to therapy. These factors entwined as complex multidimensional challenges that impacted participants adjusting to living with a chronic condition.
• Enablers included: participants’ knowledge of self-management strategies; positive health provider-patient relationship; access to medical appliances; and tailored program. Barriers included: decreased physical function; lack of medical practitioner knowledge; transport constraints; lack of appropriate personal clothing and footwear; and perceived lack of control over CO. Understanding these challenges has implications for developing a multidisciplinary approach aimed at enhancing patient engagement and participation in a physiotherapy CO program.