Recovery Following Proximal Humerus Fracture
Abstract
There is currently a glaring gap in the existing knowledge to address individuals’ experiences while recovering from a proximal humeral fracture (PHF). The main objective of this dissertation was to understand better how recovery is perceived by individuals after PHF. This overarching objective aligned well with the broad conceptualization of the issue at hand as those provided by the International Classification of Functioning, Disability and Health (ICF). Three inter-linked studies were conducted to provide a broader picture of recovery after PHF. The first study was a systematic review of prognostic factors predicting recovery after PHF in adults. This review demonstrated the complexity of recovery through a range of multi-factorial biopsychosocial factors that are inter-connected. To describe recovery after PHF as well as facilitators/barriers and preferences to exercise from individuals’ perspectives, two studies were performed: a descriptive cross-sectional survey and a semi-structured interview. A convenience sample of 59 individuals with PHF aged ≥45 participated in the survey study and completed three self-reported validated questionnaires. The most important outcomes for participants were tapped into the daily activities and social roles. Forty-seven out of 59 participants rated themselves ‘unable’ to perform recreational activities after PHF. The main facilitators and barriers to exercise belonged to the contextual (person-environment) factors. The semi-structured interview study provided an in-depth understanding of recovery as well as facilitators and barriers to exercise through interviewing 14 individuals with PHF as a subset of those who participated in the survey. Thematic analysis used to analyze participants’ narratives revealed two core concepts: self and social connectedness. The interpretation process of interviews provided a deeper understanding of the experience of recovery, what it means and why it matters to individuals themselves. The integration of quantitative and qualitative data provided insight into the perceived recovery expectations, and a number of contextual factors that are involved in the process of recovery perceptions. One key message from this work was that person-environment factors deeply influence individuals’ perceptions on recovery, and what facilitators and barriers to exercise are through their eyes.