COMMENTARY about Self-management following distal radius fracture

Barbara SHANKLAND

BSc (OT), MSc (Rehab Sci) McGill University

”SELF-MANAGEMENT IN ADULTS AFTER DISTAL RADIUS FRACTURE: A MIXED METHODS EXPLORATION”

Brocha Z. STERN, MOT, OTR, CHT. Submitted in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy in the Steinhardt School of Culture, Education, and Human Development, New York University (NY), USA, 2020

Dr. Brocha Stern, PhD, OTR, CHT, completed her doctoral research at the Steinhardt School of Culture, Education and Human Development at New York University in 2020. Her work has contributed to our understanding of the importance of a more holistic approach to upper extremity rehabilitation by specifically examining self-efficacy, self-management and perceived health outcomes for clients who have sustained a Distal Radius Fracture (DRF). The following will provide a very brief overview of her dissertation.

Study Purpose (Stern, 2020, p. 7).

1. Understand self-management as experienced after DRF.

2. Explore associations between self-efficacy for managing injury and perceived health after DRF.

3. Generate a more comprehensive conceptualization of how the self-management process relates to perceived health after DRF within the context of risk and protective factors.

The study utilized a conceptual framework of self-management following DRF that was developed by the author and informed by social cognitive theory, individual and family self management theory and the World Health Organization tripartite model of health. It demonstrated reciprocal interactions between self-management, knowledge, beliefs, social facilitators and behaviors within a context of risk and protective factors (Stern et al., 2021a).

Study Design

This study used a convergent mixed-methods design.

Sample

The sample size of n=31 was adequate for an 80% power level. Participants were adults between the ages of 45-74 years who sustained a unilateral DRF, with or without a fracture of the ulna, and managed either conservatively or with open reduction and internal fixation. Participants entered the study when they were 2-4 weeks post full-time immobilization.

Outcome Measures

A semi-structured interview guide was developed for the qualitative component. Quantitative measurement was carried out using a demographic questionnaire, the Patient Rated Wrist Evaluation (PRWE) and the Newest Vital Sign (health literacy). Short forms of the Patient Report Outcome Measurements Information System (PROMIS) were used to evaluate selfefficacy (managing symptoms, managing emotions and managing daily activities), pain interference, depression, anxiety and social participation.

Methods

Individuals who met the inclusion/exclusion criteria participated in one session, at a location of their choice, during which time they completed all of the self-report, quantitative outcome measures. The Newest Vital Sign was administered verbally. A semi-structured interview was then conducted using the interview guide. Results from the quantitative questionnaires were also clarified and probed. Following the interview, the author completed a reflective memo. Constructivist grounded theory techniques were used in the qualitative analysis and bivariate non-parametric correlational analyses and descriptive statistics were used for the quantitative analyses (Stern, 2020; Stern et al., 2021b).

Key Findings

• Transitioning from “hurting to healing” (Stern, 2020, p. 164) involved participants learning from the injury, working and hoping towards healing and getting back to their “normal self”.

• Self-efficacy for managing symptoms, emotions and daily activities was significantly associated with self-reported physical health and social health.

• Self-efficacy for managing symptoms and emotions was significantly associated with selfreported mental health.

• Participants with lower self-efficacy demonstrated poorer self-reported physical, mental and social health compared to participants with higher self-efficacy.

• Self-efficacy was linked to the participants’ self-reported health and the self-management process.

Clinical Implications

The author suggests that therapists who treat DRF should consider a holistic approach that includes evaluation of behavioral and cognitive factors such as self-efficacy and fear avoidance. Therapists can support clients in the self-management of their injury by using multimodal education that includes carefully selected language, mind-body based interventions and occupational based interventions that promote successful experiences. Clients may also benefit from using methods to self-track their progress.

Reference

Stern, B. Z. (2020). Self-Management in Adults after Distal Radius Fracture: A mixed methods exploration (Doctoral dissertation, New York University) (pp. 1-297). Ann Arbor, MI: ProQuest.

Stern, B.Z., Howe, T.H. & Njelesani, J. (2021a). “I didn’t know what I could do”: Behaviors, knowledge and beliefs, and social facilitation after distal radius fracture. J Hand Ther, e1-e9 https://doi.org/10.1016/j.jht.2021.09.003

Stern, B.Z., Njelesani, J. & Howe, T.H. (2021b). Transitioning from hurting to healing: selfmanagement after distal radius fracture. Disabil Rehabil, 13, e1-e10. https://doi.org/10.1080/09638288.2021.1962990