An Exploration of the Influence of Activity and Occupation on Recovery from a Surgically Treated Distal Radius Fracture
Collis, Julie Margaret
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A distal radius fracture is a common injury of the upper limb. Distal radius fractures can result in wrist stiffness, sensorimotor impairment, and activity limitations that can persist for weeks or months following injury. For fractures that are treated surgically, it is common practice to commence mobilisation within two weeks to restore movement and prevent such sequelae. Traditional postoperative rehabilitation relies on range of motion exercises to restore wrist and hand movement. Hand therapists may also use performance of daily activities to enhance rehabilitation, but purposeful activities are not a routine component of early mobilisation regimes. Understandings of how activities and occupation are currently used and how they bring about improvements after surgery is limited. The research aimed to explore how daily activities and occupation influences recovery after surgical treatment of distal radius fractures. The research used a mixed methodology design informed by a critical realist paradigm and is presented in manuscript format. Two systematic reviews examined firstly the influence of purposeful activities on upper extremity motor performance and secondly how daily activities are recommended in early mobilisation regimes. Results from the first review suggested that upper extremity movement quantity and quality were enhanced when performed during purposeful conditions. The second review showed that performing daily activities was commonly recommended as part of early mobilisation and suggested better functional and biomechanical outcomes for people who commence mobilisation prior to two weeks. Patient perspectives on the influence of activity and occupation on recovery from a surgically repaired distal radius fracture were then explored in an Interpretive Description qualitative study. Results suggested that purposeful activities facilitate recovery by potentiating motivation, wellbeing, and optimism, restoring normal body schema, and by facilitating wrist movement. A randomised crossover study was subsequently conducted in which wrist movement during purposeful activities was evaluated using electrogoniometry and compared with movement during active range of motion exercises. The study provided novel data demonstrating that significantly greater volumes of movement are produced by performing purposeful activities than previously understood; as much, or more than exercise routines. Findings from the studies suggest that activities and occupation are highly influential in facilitating the recovery of movement and function in the early weeks after surgical treatment of a distal radius fracture. The research indicated that performing purposeful activities facilitates recovery by eliciting high volumes of active movement of the wrist, and by building psychosocial resources. The research challenges the reliance on exercise approaches and suggests the potential of activity and occupation as an early postoperative rehabilitative strategy. Based on the research findings, a proposal for an occupation-based postoperative approach that harnesses the unique remediating mechanisms of activity and occupation is presented.