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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
    Correspondence
    Corresponding author. Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, Chicago, IL, 60611, USA
    Footnotes
    1 Present Address: Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
    Affiliations
    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
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  • Tsu-Hsin Howe
    Affiliations
    Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
    Search for articles by this author
  • Janet Njelesani
    Affiliations
    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:https://doi.org/10.1016/j.jht.2021.09.003

      Highlights

      • 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

      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.

      Keywords

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