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Smith TO, Brown O, Baxter MA. Fear-avoidant beliefs and behaviours after upper limb fracture in older people: a systematic review and meta-ethnography. Osteoporos Int 2024; 35:939-950. [PMID: 38279074 DOI: 10.1007/s00198-024-07030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE This systematic review aimed to understand older people's perspectives of associated fear-avoidant beliefs following upper limb fracture. METHODS Published and unpublished literature databases were systematically searched from inception to 1st April 2023. Qualitative studies reporting the perspectives of fear-avoidant beliefs or behaviours in people who had sustained an upper limb fracture were eligible. Data extracted included characteristics of people interviewed, experiences and perceptions of fear, fear of falling, and fear-avoidant beliefs and behaviours. Data were synthesised using a meta-ethnography approach and the GRADE-CERQUAL tool. RESULTS Eight studies were eligible (n = 150 participants; 109 distal radial/41 humeral fracture). Three overarching themes were identified: (1) type of fear-avoidant experiences, (2) drivers of fear-avoidant beliefs and behaviours, and (3) consequences of fear-avoidant beliefs and behaviours. The themes generated were based on moderate confidence evidence. In summary, whilst some patients initially consider upper limb fractures to be relatively minor injuries, over time, the realisation occurs that they have wide-ranging consequences with longer-term perspectives on recovery. This often occurs following an initial period of reduced fear. Providing education and support immediately post-fracture to prevent or challenge initial health beliefs around fear of falls and fear of movement is imperative to recovery. CONCLUSIONS Fear-avoidant beliefs can impact heavily on certain older people's recovery, as well as their longer-term health and wellbeing. Consideration of fear avoidance and taking steps to mitigate against this in the acute upper limb trauma setting will better serve these patients in their ongoing recovery from injury.
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Affiliation(s)
- Toby O Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Oliver Brown
- Department of Trauma and Orthopaedic, St George's Hospital, London, UK
| | - Mark A Baxter
- Trauma and Orthopaedic Medicine, University Hospital Southampton, Southampton, UK
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Collis JM, Mayland EC, Kayes N, Signal N. Early Daily Activity: Development and description of an occupation-based intervention for surgically repaired distal radius Fractures. Clin Rehabil 2024:2692155241258296. [PMID: 38815992 DOI: 10.1177/02692155241258296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To describe the theoretical development and structure of an occupation-based intervention for people with a surgically repaired distal radius fracture. INTERVENTION DEVELOPMENT AND RATIONALE The Early Daily Activity (EDA) intervention uses the performance of strategically selected daily activities as the primary rehabilitative strategy. Occupation-based interventions are recommended for hand injury rehabilitation but are often poorly described and lack explicit theoretical underpinnings. The EDA-intervention was developed from exploratory research that informed the theory and structure. The theoretical principles are that daily activity performance is (i) safe within defined parameters (ii) appropriately self-determined (iii) produces high ranges and amounts of therapeutic movement, and (iv) builds psychosocial competencies. INTERVENTION DESCRIPTION The EDA-intervention is designed to be commenced within 2 weeks of surgery. There are three key components. The first is activity-specific education to emphasise the safety, benefits, and therapeutic actions of activity performance. A set of parameters for defining safe activities is described to support education. The second component is patient-therapist collaboration to select a range of daily activities that provide a 'just-right' challenge. Collaboration occurs at regular intervals throughout the rehabilitation period to incrementally increase the challenge of activities. The third component is performance of activities at-home targeted at improving range of movement and function. NEXT STEPS The EDA-intervention can be used by hand therapists, but it has not yet undergone effectiveness evaluation. A planned study will explore clinician readiness to adopt the EDA-intervention, inform iterative changes to the protocol and the design of feasibility and effectiveness studies.
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Affiliation(s)
- Julie M Collis
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Nicola Kayes
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
| | - Nada Signal
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Health & Rehabilitation Research Institute, Auckland, New Zealand
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Moos C, Abrahamsen C, Viberg B, Jensen CM. Adult patients' experiences after a distal radius fracture - A qualitative systematic review. Int J Orthop Trauma Nurs 2024; 54:101101. [PMID: 38640647 DOI: 10.1016/j.ijotn.2024.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Distal radius fractures are a common presentation in emergency departments. Synthesis of qualitative research of treatment, care and rehabilitation this fracture presents from the patient perspective could improve clinical practice and care. The purpose of this systematic review was to synthesize the qualitative literature on patient experiences after sustaining a distal radius fracture. METHODS We searched Embase, MEDLINE, CINAHL, Psycinfo and CINAHL to identify qualitative studies published from database conception to May 2023. All studies were screened, extracted, analysed and quality assessed by two blinded reviewers. A thematic synthesis approach was used to analyse the findings from included studies. RESULTS A total of 9 studies interviewing 160 unique patients were included. We identified 3 themes in relation to patient experiences after sustaining a distal radius fracture: 1) Concerns about dependency, 2) Fear and pain and 3) Motivators for recovery. The themes did not exist as sharply demarcated topics but were intertwined with patients reflecting that more information and knowledge could assist in managing expectations and the recovery period. CONCLUSION Our synthesis highlighted that adult patients with DRF experience a lack of information about the care and treatment inhibiting independence and successful management of expectations due to pain, fear and lack of motivation. Our findings can inform orthopaedic units and assist in tailoring information to patient needs.
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Affiliation(s)
- Caroline Moos
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Charlotte Abrahamsen
- Department of Orthopaedic Surgery, Kolding Hospital, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Charlotte Myhre Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
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Mohrsen A, Sørensen T, Lund H, Rasmussen SZ, Jensen A, Skov KB, Rathleff MS. "I Feel Like I Have Lost Part Of My Identity" - A Qualitative Study Exploring The Impact Of Chronic Ankle Instability. Int J Sports Phys Ther 2024; 19:316-325. [PMID: 38439771 PMCID: PMC10909303 DOI: 10.26603/001c.92908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Lateral ankle sprain is the most common ankle injury and up to 40% of those who sustain a lateral ankle sprain will develop chronic ankle instability (CAI). The aim of this study was to explore the thoughts and expectations of CAI-patients concerning their condition and expectations of care in an orthopedic setting. . Study Design Qualitative study. Methods Nine semi-structured one-to-one interviews were conducted with CAI-patients who were referred to an orthopedic setting. Interviews were recorded, transcribed, and analyzed using systematic text condensation with an inductive goal free approach. . Results Seven themes emerged. The themes were Injury history and symptoms (Lateral ankle sprain during sport, pain and instability), Information from health professional (conflicting information about management and prognosis), Management (mental and physical challenges), Expectation and hope (explanation of symptoms, prognosis and imaging to provide clarification of condition), Activity and participation (restriction in sport and daily life and feelings of uncertainty), Support (support from family/friends) and Identity (low ability to participate in sport and social life result in loss of identity). . Conclusion The impact of CAI exceeds an experience of pain and instability. Patients experienced loss of identity, having to manage uncertainty regarding their diagnosis and prognosis and had hopes of being able to explain their condition. . Level of Evidence Not applicable.
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Affiliation(s)
- Anders Mohrsen
- Department of Health Science and Technology Aalborg University
| | - Thomas Sørensen
- Department of Health Science and Technology Aalborg University
| | - Henrik Lund
- Department of Health Science and Technology Aalborg University
| | | | - Asger Jensen
- Department of Health Science and Technology Aalborg University
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Kukizaki W, Ohno K, Maruta M, Shimokihara S, Iida H, Tabira T. Effect of Occupation-Based Intervention Using the ADOC-H Combined With Physical Function-Based Intervention on Patients With Distal Radius Fractures: A Retrospective Case-Control Study. Hong Kong J Occup Ther 2023; 36:101-109. [PMID: 38027053 PMCID: PMC10680855 DOI: 10.1177/15691861231187240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/26/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Occupation-based intervention (OBI) involves daily and meaningful activities for evaluation and intervention. Recently, the "aid for decision-making in occupation choice for hand" (ADOC-H) was developed to facilitate OBI in patients with hand injuries. We aimed to examine the efficacy of OBI using the ADOC-H combined with physical function-based interventions (PBI) for patients with distal radius fractures (DRF). Material and methods Patients with DRF were retrospectively allocated to two groups, ADOC-H group (n = 14) and PBI group (n = 14), and compared. Results Improvements in the Pain Catastrophizing Scale magnification and Hospital Anxiety and Depression Scale and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were significantly higher in the ADOC-H group than in the PBI group (p < .05). The groups showed no differences in measure of physical function, such as range of motion and grip strength. Conclusion OBI using the ADOC-H combined with PBI is clinically useful for patients with DRF as it promotes use of the injured hand for daily activities in a step-by-step approach, improving psychological difficulties in using the hand.
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Affiliation(s)
- Wataru Kukizaki
- Master’s Program of Occupational Therapy, Graduate School of Health Sciences, Kagoshima University, Sakuragaoka, Kagoshima, Japan
- Department of Hand Therapy, Medical Corporation, Kojinkai, Iida Hospital, Miyakonojo, Miyazaki, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Science, Tokyo University of Technology, Ota, Tokyo, Japan
| | - Michio Maruta
- Department of Health Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Suguru Shimokihara
- Doctoral Program of Occupational Therapy, Graduate School of Health Sciences, Kagoshima University, Sakuragaoka, Kagoshima, Japan
| | - Hiroyuki Iida
- Department of Orthopaedic Surgery, Medical Corporation, Kojinkai, Iida Hospital, Miyakonojo, Miyazaki, Japan
| | - Takayuki Tabira
- Graduate School of Health Sciences, Kagoshima University, Sakuragaoka, Kagoshima, Japan
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Guo Y, Zhao P, Zeng B, Su M, Zhou Y, Liu X, Zhou Y. Current status and influencing factors of self-management in knee joint discomfort among middle-aged and elderly people: a cross-sectional study. BMC Geriatr 2023; 23:612. [PMID: 37773113 PMCID: PMC10541685 DOI: 10.1186/s12877-023-04334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND This study aims to identify the current status and factors influencing self-management of knee discomfort in middle-aged and elderly people in China. METHODS A stratified multistage cluster sampling method was used to select participants from communities in China from January 15 to May 31, 2020. A cross-sectional survey was conducted using the general information questionnaire and the Knee Joint Discomfort Self-management Scale. Univariate analysis and a generalized linear model were used to analyze the factors influencing self-management. RESULTS The prevalence of knee discomfort was 77%. Moderate to severe discomfort accounted for 30.5%. The average item score of self-management in 9640 participants was 1.98 ± 0.76. The highest and lowest levels were: 'daily life management' and 'information management'. Gender, ethnicity, education level, economic source, chronic disease, knee pain in the past month, and the degree of self-reported knee discomfort were significant predictors of self-management. CONCLUSION The self-management of knee discomfort in middle-aged and elderly people is poor, and the degree of discomfort is a significant predictor. Healthcare providers should consider socioeconomic demographic and clinical characteristics to help these individuals improve their self-management skills. Attention should also be given to improving their ability to access health information and making them aware of disease risks.
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Affiliation(s)
- Yabin Guo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
- Xiang Ya Nursing School, Central South University, Changsha, China
| | - Peipei Zhao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Biyun Zeng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Manman Su
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Yang Zhou
- Xiang Ya Nursing School, Central South University, Changsha, China
| | - Xiaotong Liu
- Xiang Ya Nursing School, Central South University, Changsha, China
| | - Yang Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.
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Collis JM, Mayland EC, Wright-St Clair V, Rashid U, Kayes N, Signal N. An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study. J Hand Ther 2023; 36:593-605. [PMID: 35953335 DOI: 10.1016/j.jht.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/07/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. RESULTS Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. CONCLUSIONS ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.
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Affiliation(s)
- Julie M Collis
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand.
| | - Elizabeth C Mayland
- Western Sydney University, School of Health Sciences, Campbelltown, New South Wales, Australia
| | | | - Usman Rashid
- Auckland University of Technology, Health & Rehabilitation Research Institue, Auckland, New Zealand
| | - Nicola Kayes
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
| | - Nada Signal
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
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Stern BZ, Howe TH, Njelesani J. Self-Efficacy for Managing Injury After Distal Radius Fracture: A Mixed Methods Exploration. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:170-179. [PMID: 35426346 DOI: 10.1177/15394492221086232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Self-efficacy for managing injury may contribute to variation in clients' support needs after distal radius fracture (DRF). This study aimed to (a) explore associations between self-efficacy for managing injury and self-reported health and (b) compare qualitative descriptions of the self-management process and outcome between high and low self-efficacy groups. In this cross-sectional convergent mixed methods study, 31 adults aged 45 to 72 with a unilateral DRF completed patient-reported outcome measures and a semi-structured interview 2 to 4 weeks after discontinuing full-time wrist immobilization. Higher self-efficacy was moderately associated with better physical, mental, and social health. The High-Self-Efficacy group described self-directed behaviors to manage injury sequelae and more confidence in their ability to use their injured hand. They also described less disruptive physical and emotional symptoms and fewer participation restrictions compared with the Low-Self-Efficacy group. Findings suggest that occupational therapy practitioners should assess and address self-efficacy for managing DRF sequelae to support recovery.
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Affiliation(s)
- Brocha Z Stern
- New York University, New York, NY, USA.,Kessler Rehabilitation Center, Howell, NJ, USA
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Karimi D, Houkjær L, Skive A, Holmenlund C, Brorson S, Viberg B, Abrahamsen C. Exploring patient experiences after treatment of humeral shaft fractures: A qualitative study. Int J Orthop Trauma Nurs 2022; 46:100957. [PMID: 35921741 DOI: 10.1016/j.ijotn.2022.100957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Humeral shaft fracture treatment can induce serious morbidities, and it is unclear how these morbidities impact patients. To gain in-depth knowledge, we explored how patients experience humeral shaft fractures and the subsequent treatment course. METHOD A qualitative study was performed using semi-structured individual interviews. A purposive sampling approach was conducted to recruit patients with traumatic isolated humeral shaft fractures; the patients' ages, genders, primary treatments, and complications varied. Data saturation was met after the data of 12 patients were analyzed using Malterud Systematic Text Condensation. RESULTS Eight women and four men with a median age of 48.5 years (range: 22-83 years) were interviewed. The median time from injury to interview was 12.5 months (range: 8-18 months). Ten out of twelve patients were treated non-surgically; of those ten, four patients experienced major complications from the primary treatment. During the analysis, five overarching themes appeared: expectations, physical changes, support and independence, psychological impact, and the specific treatment and recovery. CONCLUSION First, patients with humeral shaft fractures expressed frustration with treatment in the emergency department. Second, gross fracture movement and pain were central symptoms that led to the loss of basic capabilities. Third, patient preferences were included in the treatment decision-making process and could change throughout the treatment course. Fourth, patients required massive support to perform basic activities of daily living.
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Affiliation(s)
- Dennis Karimi
- Department of Orthopedic Surgery, Lillebaelt Hospital, Kolding Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark Campusvej 55, 5230, Odense, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | - Line Houkjær
- Department of Orthopedic Surgery, Zealand University Hospital, Køge Lykkebækvej 1, 4600 Køge, Denmark
| | - Anders Skive
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Camilla Holmenlund
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Stig Brorson
- Department of Orthopedic Surgery, Zealand University Hospital, Køge Lykkebækvej 1, 4600 Køge, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery, Lillebaelt Hospital, Kolding Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark Campusvej 55, 5230, Odense, Denmark
| | - Charlotte Abrahamsen
- Department of Orthopedic Surgery, Lillebaelt Hospital, Kolding Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark Campusvej 55, 5230, Odense, Denmark
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Stern BZ, Howe TH, Njelesani J. "I didn't know what I could do": Behaviors, knowledge and beliefs, and social facilitation after distal radius fracture. J Hand Ther 2021; 36:148-157. [PMID: 34756488 DOI: 10.1016/j.jht.2021.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Biomedical models have limitations in explaining and predicting recovery after distal radius fracture (DRF). Variation in recovery after DRF may be related to patients' behaviors and beliefs, factors that can be framed using a lens of self-management. We conceptualized the self-management process using social cognitive theory as reciprocal interactions between behaviors, knowledge and beliefs, and social facilitation. Understanding this process can contribute to needs identification to optimize recovery. PURPOSE Describe the components of the self-management process after DRF from the patient's perspective. STUDY DESIGN Qualitative descriptive analysis. METHODS Thirty-one adults aged 45-72 with a unilateral DRF were recruited from rehabilitation centers and hand surgeons' practices. They engaged in one semi-structured interview 2-4 weeks after discontinuation of full-time wrist immobilization. Data were analyzed using qualitative descriptive techniques, including codes derived from the data and conceptual framework. Codes and categories were organized using the three components of the self-management process. RESULTS Participants engaged in medical, role, and emotional management behaviors to address multidimensional sequelae of injury, with various degrees of self-direction. They described limited knowledge of their condition and its medical management, naive beliefs about their expected recovery, and uncertainty regarding safe movement and use of their extremity. They reported informational, instrumental, and emotional support from health care professionals and a broader circle. CONCLUSIONS Descriptions of multiple domains of behaviors emphasized health-promoting actions beyond adherence to medical recommendations. Engagement in behaviors was reciprocally related to participants' knowledge and beliefs, including illness and pain-related perceptions. The findings highlight relevance of health behavior after DRF, which can be facilitated by hand therapists as part of the social environment. Specifically, hand therapists can assess and address patients' behaviors and beliefs to support optimal recovery.
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Affiliation(s)
- Brocha Z Stern
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA; Kessler Rehabilitation Center, Howell, NJ, USA.
| | - Tsu-Hsin Howe
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Janet Njelesani
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
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