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\u27 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
