Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Dr. Joy C MacDermid


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.

Summary for Lay Audience

Shoulder fracture is a common cause of disability among older adults. This injury may happen as a result of a simple fall in people with low bone density. Although people have moved past the bone healing stage, recovery can be slow and long after this injury. People might be unable to dress, bathe, or eat by themselves. To date, there is no study about the real-life problems from people’s point of view in the recovery course. In this thesis, my goals were to find factors that increase the likelihood of recovery or non-recovery, and to know how people with this injury describe recovery. Since exercise is an important part of care after injury, I wanted to understand what things help or stop them from exercising. In the first study, I found 23 factors with positive or negative impact on future outcomes in shoulder fracture. Most of the factors leading to poor or non-recovery were health-related either in the past or post-fracture like shoulder surgery. Factors with positive impact on recovery were rehabilitation, general good health, and exercise. The second and third studies were done at St. Joseph Hospital-Hand and Upper Limb Center. In a survey, 59 patients with shoulder fracture aged 45-94 answered questions about their important outcomes, problems in daily life and exercising. In the third study, I interviewed 14 patients and asked them to describe in detail about their recovery expectations, and might help them recover faster. The results of the survey and interviews showed that although recovery may simply means “being able to run a normal life”, but ways to running a normal life are different from one to another. This thesis was the first step to give voice to patients in the first year of shoulder fracture. The main messages of this study are paying more attention to patient’s needs and preferences, and see what is more important for them in the course of recovery. Care and treatment plans for older adults needs to be more holistic, and adjustable to their condition.