Transitioning from hurting to healing: self-management after distal radius fracture.

PURPOSE: Chronic pain and disability after musculoskeletal trauma support the need for non-biomedical perspectives to frame experiences of recovery. Self-management is a specific holistic lens with implications for improving health outcomes. This qualitative study explored how adults made meaning of self-management after distal radius fracture (DRF). METHODS: Thirty-one individuals aged 45-72 with a unilateral DRF participated in a semi-structured interview 2-4 weeks after discontinuing full-time wrist immobilization. Interviews were audio-recorded and transcribed, and constructivist grounded theory techniques were used to analyze the data. RESULTS: Participants made meaning of self-management as a process of "transitioning from hurting to healing," which occurred via three underlying processes. "Learning because of my injury" included gaining information for empowerment and understanding by physically living through the experience. "Working and hoping toward healing" involved taking active steps to recovery in the face of uncertainty. "Getting back to my normal self" comprised reconnecting to one's body and identity after injury. CONCLUSIONS: Participants' lived experiences overlapped with those of self-managing chronic conditions, highlighting the need to consider how individuals actively engage in their recovery after DRF. Findings suggest using supportive interventions to facilitate patients' understanding, activation, and engagement in meaningful activity after DRF.Implication for rehabilitationTo maximize health outcomes after distal radius fracture, clinicians should move beyond impairment remediation to supporting multiple dimensions of recovery, including emotional distress and functional limitations.Clinicians should routinely provide early and ongoing information, such as expected symptoms and recovery time frames, to minimize loss of control related to uncertainty.Clinicians should emphasize active interventions, such as collaborative goal setting and functional tasks, that engage patients in their own healing.Clinicians should support patients' early return to meaningful activity to maintain or restore connection to the body and identity.

Expanding Self-Management Support From Chronic to Acute Care: Implications for Value.

In this article, I advocate the expansion of self-management support from chronic to acute care as a means of increasing the value of services and highlighting the value of occupational therapy. Like people with chronic conditions, clients with acute conditions (1) need to participate in their own care, (2) require support for participation, (3) engage in care outside of traditional medical behaviors, and (4) benefit from a focus of care that extends beyond discrete episodes. Self-management support can facilitate adherence, promote holistic conceptualizations of health, and address long-term outcomes and costs. Given that self-management support aligns with occupational therapy's philosophical roots, expansion of self-management support to acute care highlights the profession's contribution to health promotion in this practice area.