Full Length Article| Volume 36, ISSUE 1, P148-157, January 2023

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“I didn't know what I could do”: Behaviors, knowledge and beliefs, and social facilitation after distal radius fracture

  • Author Footnotes
    1 Present Address: Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
    Brocha Z. Stern
    Corresponding author. Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, Chicago, IL, 60611, USA
    1 Present Address: Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
    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
    Search for articles by this author
  • Tsu-Hsin Howe
    Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
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  • 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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  • Author Footnotes
    1 Present Address: Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
Published:October 27, 2021DOI:


      • Self-management can frame how patients handle recovery after distal radius fracture
      • Behaviors extended beyond adherence to addressing daily living and emotions
      • Limited knowledge, naivete, and uncertainty interacted with behaviors
      • Multiple forms and sources of social support were relevant for recovery



      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.


      Describe the components of the self-management process after DRF from the patient's perspective.

      Study design

      Qualitative descriptive analysis.


      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.


      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.


      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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      JHT Read for Credit

      Quiz: # 936

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        Components of the self-management process include
        • a.
          social facilitation
        • b.
          knowledge and beliefs
        • c.
        • d.
          all of the above
      • # 2.
        Data were gleaned from
        • a.
          group discussions
        • b.
          Zoom meetings
        • c.
          semi-structured interviews
        • d.
          pre-determined questions style interviews
      • # 3.
        Typically patients reported
        • a.
          poor understanding of their condition
        • b.
          surprisingly good understanding of their situation
        • c.
          little interest in their prognosis beyond pain concerns
        • d.
          a childlike fascination with the medical-surgical management of their DRFx
      • # 4.
        The study design is
        • a.
        • b.
        • c.
          retrospective cohort
        • d.
          case series
      • # 5.
        The authors feel that therapists’ attitudes can have a significant impact on outcomes following DRFx
        • a.
          possibly true
        • b.
          absolutely true
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.