Date Presented 04/6/21
This qualitative study illuminated components and intersections of cognitions, behaviors, and social environments that characterized and influenced the recovery process after distal radius fracture. Findings highlight the need for strategies to restructure clients' beliefs and change behaviors to promote health. Incorporating social cognitive elements as part of a holistic psychosocial perspective may be one way of demonstrating OT's value in musculoskeletal rehabilitation.
Primary Author and Speaker: Brocha Z. Stern
Contributing Authors: Farzaneh Yazdani, Tove Carstensen, and Tore Bonsaksen
PURPOSE: Biomedical models do not adequately explain complex variation in health after musculoskeletal hand injury. Clients’ beliefs and behaviors may contribute to clinical outcomes after distal radius fracture (DRF; Björk et al., 2020; Dewan et al., 2013). Exploring psychosocial aspects of individualized experiences of recovery is valuable in identifying clients’ needs for supportive care (Ayers et al., 2013; Eppler et al., 2019). This study applied a social cognitive perspective, which conceptualizes how reciprocal interactions between the person, behavior, and environment promote health. Specifically, the study aimed to describe the components and intersections of cognitions, behaviors, and social facilitation as experienced by clients after DRF.
METHOD: This qualitative study was guided by constructivist grounded theory techniques. Adults aged 45 to 74 with a unilateral DRF were purposefully sampled from therapy clinics and physicians’ offices. Study sessions took place 2 to 4 weeks after active wrist range of motion was initiated. One researcher engaged each participant in a single semi-structured interview using a guide developed for the study. All interviews were audio-recorded and then transcribed. Data analysis was ongoing throughout data collection and emphasized hierarchical coding with constant comparison. Open codes were supplemented by a priori codes derived from social cognitive theory to inform and focus the analysis. Memo writing, thick description, and audit trails were used to increase trustworthiness.
FINDINGS: The sample included 31 adults (90.3% female, 86.7% White, and 64.5% operative management). Participants 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 engaging in behaviors beyond medical management to address multidimensional sequelae of injury, including emotional distress and limited occupational performance. These cognitions and behaviors reciprocally interacted within a social context. For example, increased uncertainty restricted self-directed behaviors to return to everyday activity while the behavior of seeking information enhanced confidence to engage in exercise. Socially, cognitions and behaviors were supported and constrained by both health care providers and a broader circle of support.
CONCLUSION: The findings illuminated psychosocial elements that characterized and influenced the recovery process after DRF. As a component of the social environment, occupational therapy practitioners should explicitly consider means of supporting clients’ cognitions and behaviors to promote health. Early and ongoing education should extend beyond information transmission to addressing recovery expectations and restructuring pain-related beliefs that restrict participation and increase emotional distress. Additionally, strategies for behavior change, such as providing opportunities to practice functional tasks, may facilitate engagement in role management and restore occupational identity threatened by injury. Incorporating social cognitive elements as part of a holistic psychosocial perspective may be one way of demonstrating occupational therapy's unique value in DRF rehabilitation.
References
Ayers, D. C., Franklin, P. D., & Ring, D. C. (2013). The role of emotional health in functional outcomes after orthopaedic surgery: Extending the biopsychosocial model to orthopaedics. Journal of Bone and Joint Surgery, 95(21), Article e165. https://doi.org/10.2106/JBJS.L.00799
Björk, M., Niklasson, J., Westerdahl, E., & Sagerfors, M. (2020). Self-efficacy corresponds to wrist function after combined plating of distal radius fractures. Journal of Hand Therapy. https://doi.org/10.1016/j.jht.2020.01.001
Dewan, N., MacDermid, J. C., & Packham, T. (2013). Role of a self-efficacy-based model of intervention: The LEARN approach in rehabilitation of distal radius fracture. Critical Reviews in Physical and Rehabilitation Medicine, 25(3-4), 241–259. https://doi.org/10.1615/critrevphysrehabilmed.2013010110
Eppler, S. L., Kakar, S., Sheikholeslami, N., Sun, B., Pennell, H., & Kamal, R. N. (2019). Defining quality in hand surgery from the patient’s perspective: A qualitative analysis. Journal of Hand Surgery, 44(4), 311-320.e4. https://doi.org/10.1016/j.jhsa.2018.06.007
