Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Collaborative Specialization

Musculoskeletal Health Research

Supervisor

Dr.Joy Mac Dermid

Abstract

Background: Distal radius fracture (DRF) is a common upper extremity fracture that causes significant impairment and leads to difficulties in fulfilling important life roles such as indoor and outdoor cleaning, meal preparation, grocery shopping, caring for others, and earning and managing family income. However, clinicians do not routinely address home and family life roles after a DRF. Patient and rehabilitation factors are crucial in addressing home and family work roles (HFWRs). The HFWR questionnaire consists of tasks that are typically performed at home.

Objective: The overarching objective of this thesis is to explore the role of patient and rehabilitation factors in the recovery of HFWRs following DRF.

Methods: The first manuscript was an exploratory factor analysis (EFA) of the HFWR questionnaire to determine the structural validity in the DRF population and compare the HFWR by gender. The second manuscript was an observational longitudinal cohort study that explored HFWRs performed one week before (retrospective rating) and recovery of those roles three months after fracture. The third manuscript was a qualitative study that explored patients' and clinicians’ perceptions of integrating HFWRs into rehabilitation.

Results: An EFA of 115 participants (women 73%; men 27%; mean age = 56 years; 18 to 89 years) yielded a three-factor solution, namely: traditionally masculine roles, traditionally feminine roles, and caregiving roles. Men performed a greater proportion of items 2, 5, 6, and 12 (outdoor cleaning, home repairs, yard work, and maintaining vehicles), and women performed a greater proportion of item 3 (laundry). The second study showed that the proportion of HFWR performed decreased significantly one week after the fracture (n = 115) and returned to pre-fracture level at three months (n = 50). Marital and employment status had a significant influence on HFWRs. Finally, the semi-structured interview of eighteen patients and eleven clinicians provided an in-depth understanding of patients’ and clinicians’ perceptions of integrating HFWRs into rehabilitation. The patient interview yielded five themes: (ⅰ) a positive rehabilitation experience (ⅱ) a predetermined expectation of rehabilitation; (ⅲ) varying patient needs for addressing HFWRs; (ⅳ) the determination to return to valued activities driving behavioural choices; and (ⅴ) incorporating HFWRs into rehabilitation is perceived as beneficial. The clinician interview yielded five themes: (ⅰ) there are challenges in integrating HFWR into rehabilitation; (ⅱ) HFWR is addressed when brought up by a patient; (ⅲ) working context and referral sources influence the rehabilitation plan; (ⅳ) rehabilitation is not explicitly tailored according to sex and gender, and (ⅴ) utilizing HFWR as a rehabilitation strategy is perceived as beneficial.

Conclusions: The HFWR questionnaire has demonstrated three-factor structure validity in the DRF population. DRF has a significant short-term impact on HFWR and recovers in three months. Clinicians and patients acknowledge that integrating HFWR into rehabilitation is beneficial but was not a major focus for either the clinician or the expectation of the patients. However, there are challenges in integrating HFWRs into rehabilitation due to the unfavourable working environment, the financial constraints of the patient, and limited time.

Keywords: activities of daily living, function, clinicians, distal radius fracture, sex, gender, factor analysis, life roles.

Summary for Lay Audience

A wrist fracture is a common upper limb fracture, leading to difficulties in fulfilling life roles, especially caring for family members, meal preparation, indoor and outdoor cleaning, doing laundry and earning income.

This thesis aimed to understand the impact of wrist fractures on home and family work roles (HFWRs) and the recovery of those tasks following a wrist fracture. Additionally, Patients and clinicians were interviewed to explore their experiences and opinions on addressing and incorporating HFWRs into rehabilitation.

Initially, an exploration of the HFWR questionnaire was conducted to understand the applicability of the questionnaire to people with wrist fractures. A total of 115 people with broken wrists completed the HFWR questionnaire. The analysis of the completed HFWR questionnaire revealed that the questionnaire measures three main roles: traditionally masculine, traditionally feminine, and caregiving roles. The second study aimed to examine the impact of wrist fractures on HFWRs and recovery following a fracture. The patient's ability to perform HFWRs decreased substantially immediately after a wrist fracture. However, the patients were able to resume their HFWRs at three months. Interviews with patients who had wrist fractures showed that patients had a positive rehabilitation experience; they had a view of what to expect in a rehabilitation session and did not expect clinicians to teach them about managing HFWRs. However, some patients with broken wrists may need advice on family tasks, while others were determined to return to the activities they enjoyed. The interviews with clinicians revealed that it can be hard to include household and family tasks in the rehabilitation plan, and they are only addressed when patients bring them up. The workplace and the source of referral can affect the rehabilitation plan. The patients and the clinicians suggest that addressing HFWRs in rehabilitation is beneficial but not the primary focus of clinicians.

The questionnaire can inform healthcare providers and researchers about the effect of wrist fractures on life roles. A wrist fracture can temporarily impact household tasks, but most patients recover in three months. Although both clinicians and patients agree that addressing HFWRs in rehabilitation is beneficial, unfavourable working environments, patient budget constraints and limited time are hindrances in addressing HFWRs in rehabilitation.

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