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Bredy TM, Glasgow C, Liddle J, Colwell S, Holding J, Swan S, Patterson F. Considering occupational performance during recovery of distal radius fracture: A scoping review. Aust Occup Ther J 2024. [PMID: 38803065 DOI: 10.1111/1440-1630.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Distal radius fracture (DRF) is one of the most common upper extremity fractures treated by hand therapists and can lead to chronic physical impairment and reduced occupational performance. This scoping review aimed to reveal what is currently known about occupational performance following DRF and to explore if and how occupational performance is defined and considered in the research. METHODS This review was guided by the PRISMA-Scoping review and the Joanna Briggs Institute (JBI) guidelines. Relevant databases were searched, and studies that addressed occupation performance in adult participants following DRF were included. The findings were summarised according to the components of occupational performance (person, occupation, and environment), and quality was measured using the Mixed Methods Appraisal Tool. RESULTS Forty-three articles met the eligibility criteria for inclusion. All of the studies discussed at least two components of occupational performance, while 25 recognised all three. The consideration of occupational performance was dominated by biomechanical issues associated with the person component (i.e. range of motion, strength). There was some acknowledgement of the psychosocial aspects of the person and, to a lesser extent, the environment, as well as the impact of both on return to occupational performance. CONCLUSION Despite occupational performance being at the core of occupational therapy theory, its consideration within the context of research on DRF appears to be focussed on the person component of occupational performance and on biomechanical issues. Further research is recommended to determine how much this reflects current clinical practice and if a more comprehensive consideration of occupational performance will improve rates of recovery following DRF. CONSUMER AND COMMUNITY INVOLVEMENT As part of the protocol development for this review, consumers and stakeholders were consulted. They provided feedback on clarity and importance of the research questions. PLAIN LANGUAGE SUMMARY A distal radius fracture happens when you break the bone on the thumb side of your wrist. This type of injury often occurs when you fall and land on an outstretched hand. It is one of the more common injuries that hand therapists see in their practice. For some people, recovering from this fracture can take a long time and come with a lot of pain, difficulty moving, and emotional stress. These problems can make it hard to do everyday things like driving, cooking, or getting dressed. It can also affect both paid and unpaid work as well as leisure and social activities, making life more difficult for everyone involved. The findings from this review suggest that the current research usually focuses on how the body physically heals from this type of injury, but it does not pay as much attention to the emotional and social impact on healing. Also, it does not always discuss the activities that are important to the person, or the environment where they live, work, and socialise. This may show a gap in the research regarding our full comprehension of recovery from distal radius fractures. Taking a broader view and approach to recovery, considering a person's emotions, social life, environment, and daily activities, could help people recover fully and get back to their previous life routines and roles after this type of injury.
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Affiliation(s)
- Terra M Bredy
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Celeste Glasgow
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
- Department of Occupational Therapy, Ipswich Hospital, Ipswich, Queensland, Australia
- Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jacki Liddle
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
- Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Jessica Holding
- Department of Occupational Therapy, Griffith University, Nathan, Queensland, Australia
| | - Sarah Swan
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Freyr Patterson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
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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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Bredy TM, Patterson F, Glasgow C. Current clinical practice patterns and perspectives of Australian hand therapists during the treatment of adults with distal radius fracture: A national survey. Aust Occup Ther J 2024; 71:265-278. [PMID: 38151897 DOI: 10.1111/1440-1630.12925] [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: 07/13/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Successful return to pre-injury occupational performance following distal radius fracture (DRF) may be influenced by person and environment factors such as pain, age, social support, and socioeconomic status. The primary aim of this study was to explore Australian hand therapists' current clinical practice and determine whether they consider these factors during the management of DRF. METHODS A mixed methods online survey was distributed to members of the Australian Hand Therapy Association. Descriptive statistics were used to examine the quantitative data, and the qualitative data were analysed by content analysis. RESULTS Of the 120 members who completed the survey, 68% were occupational therapists and 32% were physiotherapists with 74% in the private and 26% in the public health-care setting. Most factors perceived to influence recovery were consistent with person factors and a biomechanical approach. Other factors related to occupational performance, such as social and leisure skills, environment and culture were reported less often. When asked about defining occupational performance, the key categories identified through qualitative open responses were 'performing meaningful activities/occupations', 'performing work/employment', and 'completing activities/function'. CONCLUSION The data suggest that hand therapists in Australia primarily identify person factors as key to recovery after DRF. Context and environmental factors that influence occupational performance did not appear to be considered as often during treatment or when defining occupational performance. Further research is needed to explore the contextual and environmental factors that influence hand therapy intervention and determine whether they play a role in the successful return to pre-injury occupational performance following DRF. CONSUMER AND COMMUNITY INVOLVEMENT The survey was conceptualised by the research team, which included two experienced hand therapists and piloted with 10 consumers. Hand therapists (consumers) of various years of experience and discipline (i.e., occupational therapy and physiotherapy) provided feedback to improve the survey in terms of content, comprehensibility, and length. No clients/patients of hand therapists were involved in the development of the survey or the study, and the consumers of the study were considered hand therapists.
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Affiliation(s)
- Terra M Bredy
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Freyr Patterson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Celeste Glasgow
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
- EKCO Hand Therapy, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Philip S, MacDermid J, Rushton A, Parikh P, Seens H. Patients' and therapists' perspective of integrating home and family work roles into rehabilitation following distal radius fracture. Disabil Rehabil 2024:1-11. [PMID: 38284803 DOI: 10.1080/09638288.2024.2305297] [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: 06/02/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To explore distal radius fracture (DRF) patients' and hand therapist/occupational therapist/physiotherapists' perceptions of integrating home and family work roles (HFWR) into rehabilitation. METHODS Eighteen patients and eleven therapists completed a semi-structured telephone interview three months after DRF. Reflexive thematic analysis of the interviews and triangulation of patients' and therapists' themes was performed. RESULTS The patient interview yielded five themes: the experience of rehabilitation; predetermined expectations of rehabilitation; incorporating HFWR into therapy sessions; varying patient needs for addressing HFWR; and determination to return to valued activities drives behavioral choices. The therapists' interview yielded five themes: The challenges in integrating HFWR into rehabilitation; HFWR addressed when brought up by a patient; working context and referral sources influence the rehabilitation plan; rehabilitation is not explicitly tailored according to sex and gender; and utilizing HFWR as a rehabilitation strategy is perceived beneficial. CONCLUSIONS Patients have predetermined rehabilitation expectations primarily focused on mobility and strengthening exercises. Therapists and patients agree that adapting home and family work roles is beneficial but was not a major focus for either therapists' or patients' expectations during therapy. An unfavourable environment, patient budget constraints, and limited time were identified as challenges to integrating family roles.
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Affiliation(s)
- Sheena Philip
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Joy MacDermid
- Health and Rehabilitation Sciences, Western University, London, Canada
- School of Physical Therapy, Western University, London, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Canada
| | - Pulak Parikh
- School of Physical Therapy, Western University, London, Canada
| | - Hoda Seens
- Health and Rehabilitation Sciences, Western University, London, Canada
- Windsor University, School of Medicine, Cayon, St Kitts & Nevis
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Boel S, Vinther A, Hansen AØ, Juhl CB, Landgren M, Jacobsen NS, Paulsen CP, Jørgensen CT, Kristensen HK. Factors influencing functioning after volar locking plate fixation of distal radius fractures: a scoping review of 148 studies. Acta Orthop 2023; 94:280-286. [PMID: 37293983 PMCID: PMC10253938 DOI: 10.2340/17453674.2023.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE A better understanding of factors that influence functioning may improve the identification of patients with distal radius fractures (DRFs) who need hand therapy. The purpose of this scoping review was to provide a comprehensive overview of factors that have been evaluated for their influence on hand functioning following volar plate fixation of DRFs. MATERIAL AND METHODS 6 databases were searched from 2005 to 2021 for publications regarding surgical treatment for a DRF with a volar locking plate. Included studies evaluated demographic, perioperative, and postoperative factors within the 6 weeks post-surgery for their influence on functioning at least 3 months post-surgery. Functioning was assessed with patient-reported outcome measures. The factors were categorized into themes and mapped to the International Classification of Functioning, Disability and Health (ICF). RESULTS 148 studies were included. 708 factors were categorized into 39 themes (e.g. pain) and mapped to the ICF components. The themes were primarily mapped to "body functions and structures" (n = 26) and rarely to "activities and participation" (n = 5). Fracture type (n = 40), age (n = 38), and sex (n = 22) were the most frequently evaluated factors. CONCLUSION This scoping review identified an extensive number of factors evaluated within 6 weeks after surgery for their influence on functioning at least 3 months after volar plate fixation of a DRF and the existing research has primarily evaluated factors related to "body functions and structures," with limited focus on factors related to "activities and participation."
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Affiliation(s)
- Susanne Boel
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Clinical Research, University of Southern Denmark, Odense; Centre for Innovative Medical Technology, Odense University Hospital, Odense.
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Hospital Secretariat and Communications, Research, Herlev and Gentofte, Copenhagen University Hospital
| | - Alice Ø Hansen
- Department of Clinical Research, University of Southern Denmark, Odense; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Carsten B Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense
| | - Marcus Landgren
- Department of Orthopedic Surgery, Hand Surgery Unit, Herlev and Gentofte, Copenhagen University Hospital; Department of Evidence-Based Medicine (EBM), Danish Health Authority, Copenhagen
| | - Nicolaj S Jacobsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Camilla P Paulsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | | | - Hanne Kaae Kristensen
- Department of Clinical Research, University of Southern Denmark, Odense; Centre for Innovative Medical Technology, Odense University Hospital, Odense; Health Sciences Research Centre, UCL University College, Odense, Denmark
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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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