A qualitative study of patient experience of an open fracture of the lower limb during acute care

Tutton, Elizabeth; Achten, Juul; Lamb, Sarah E; Willett, Keith; Costa, Matthew L.

doi:10.1302/0301-620x.100b4.bjj-2017-0891.r1

Cited by 35 publications

(54 citation statements)

References 13 publications

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“…We have specifically focussed on the longer term (2–4-years postinjury) impact of these injuries and especially in those patients who were identified as having injuries on the ‘severe’ end of the spectrum. We found that the concept of embodied vulnerability,3 9 and endurance in early recovery,8 clearly identified in acute care, also extends into the longer term as participants struggle to recover, processing their loss, working to negotiate how they live and integrate changes within their self-identity. Our findings indicate that longer term clinical support is required to improve outcomes for mental health, function, management of pain and living with disability in patients with major trauma to the lower limbs.…”

Section: Discussionmentioning

confidence: 88%

“…This qualitative study adds to recent research on the patient experience of open fractures of the lower limb in acute care3 9 and postinjury4 by identifying the ongoing recovery undertaken by patients to process the impact of injury on their sense of being disempowered, being changed and being myself. We have specifically focussed on the longer term (2–4-years postinjury) impact of these injuries and especially in those patients who were identified as having injuries on the ‘severe’ end of the spectrum.…”

Section: Discussionmentioning

confidence: 99%

“…There is increasing evidence that the impact of open fracture of the lower limb can be life changing with prolonged periods of recovery. Embodied vulnerability conveys how patients with open fractures of the lower limb struggled to cope with their emotional distress, their changed body which included their wounds, body image, pain and the uncertain nature of their future life 3. Recovery can be slow and patients can find it hard to return to their preinjury lives even 2 years after an open fracture 4.…”

Section: Introductionmentioning

confidence: 99%

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Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting

et al. 2019

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ObjectivesTreatment of open fractures is complex and patients may require muscle and skin grafts. The aim of this study was to gain a greater understanding of patient experience of recovery from open fracture of the lower limb 2–4 years postinjury.DesignA phenomenological approach was used to guide the design of the study. Interviews took place between October 2016 and April 2017 in the participants’ own homes or via telephone.SettingEngland, UK.ParticipantsA purposive sample of 25 patients were interviewed with an age range of 26–80 years (median 51), 19 were male and six female, and time since injury was 24–49 months (median 35 months).ResultsThe findings identified a focus on struggling to recover as participants created a new way of living, balancing moving forward with accepting how they are, while being uncertain of the future and experiencing cycles of progress and setbacks. This was expressed through three themes: (i) ‘being disempowered’ with the emotional impact of dependency and uncertainty, (ii) ‘being changed’ and living with being fragile and being unable to move freely and (iii) ‘being myself’ with a loss of self, feeling and looking different, alongside recreation of self in which they integrated the past, present and future to find meaningful ways of being themselves.ConclusionThis study identified the long-term disruption caused by serious injury, the hidden work of integration that is required in order to move forward and maximise potential for recovery. Supportive strategies that help people to self-manage their everyday emotional and physical experience of recovery from injury are required. Research should focus on developing and testing effective interventions that provide support and self-management within a holistic rehabilitation plan.Trial registration numberCurrent Controlled Trials ISRCTN33756652; Post-results.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting

et al. 2019

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“…Open lower limb fractures can be life-changing injuries. Even when complication rates are low, a recent randomised multi-centre study has shown signi cant levels of patient reported disability throughout the rst 12 months post-injury (3,25,26). In this study of 427 patients who completed the trial, DRI scores improved from the mid-sixties at 3 months to mid-forties at 12 months.…”

Section: Discussionmentioning

confidence: 65%

Objective Measures of Functional Outcome in Recovery from Open Lower Limb Fractures – A Report from an Ortho-Plastic Research Clinic

Pallister

Handley

Maggs

et al. 2020

Preprint

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BACKGROUNDOpen lower limb fractures are serious, potentially life-changing injuriesrequiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery.Our hypothesis was that objective measures combining strength, agility and balance would better reflect recovery than isolated parameters (e.g. range of motion) and would compare well to patients’ perceived recovery.METHODSAdultopen lower limb fracture patients were followed-up at 6 and 12 weeks, 6, 9 and 12 months post-injury. The mechanism,injurypattern, age, gender and treatment were recorded. Isolated parameter objective functional outcome measures (OFOMs)(range of movement and MRC strength grade) were compared to combined OFOMs(timed up and go (TUAG), comfortable and fast gait speed (CGS and FGS), Edgren Side Step Test(ESST) and Single Leg balance. Patient reported outcomes were recorded (Global Perceived Effect (GPE) scoreand Disability Rating Index (DRI)). RESULTS68 patients (54 male) with a medianage of 45 years (range 20-75). Neither range of movement,strength nor Single Leg balance consistently improved with time. TUAG, ESST, CGS, FGS and GPE scoresshowed consistent improvement, with TUAG and FGS showing highest proportion of improving results at each time-point. Patients’ estimation of recovery paralleled these measures with all but 2 patients achieving the minimum clinical important difference in DRI by 12 months compared to baseline. However, the GPE score compared favourably withthe DRI having a higher proportion of improving responses at each time-point. DISCUSSIONFunctional recovery is a key determinant in patients returning to work, providing for themselves and their family or resuming independent living for older patients. This study has demonstrated time-related improvements in combined OFOMs measuringmobility, strength, agility and balance paralleling patients’ perception of recovery in the 12 months after open lower limb fractures. Over the same time-frame, the simple GPE score compared favourably with the DRI. Such parameters could become part of a defined core outcomes set. Focussing rehabilitation towards these combined OFOMs may help hasten recovery.Trial registrationSouth West Wales REC 06/WMW02/10)

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“…The first was to examine patient experience of traumatic injury, in this case open-fracture of the lower limb. This experience is reported separately [ 5 , 6 ]. The second is reported here and describes the patient experience of being part of a trial in the context of emergency interventions.…”

Section: Introductionmentioning

confidence: 99%

Participation in a trial in the emergency situation: a qualitative study of patient experience in the UK WOLLF trial

Tutton

Achten

Lamb

et al. 2018

Trials

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BackgroundPatients can struggle to make sense of trials in emergency situations. This study examines patient experience of participating in the United Kingdom, Wound management of Open Lower Limb Fractures (UK WOLLF) study, a trial of standard wound management versus Negative Pressure Wound Therapy (NPWT).MethodsThe aim of the study was to understand the patient’s lived experience of taking part in a trial of wound dressings. Interviews drawing on Phenomenology were undertaken with a purposive sample of 20 patients, on average 12 days into their hospital stay from July 2012–July 2013.ResultsThe participants were vulnerable due to the emotional and physical impact of injury. They expressed their trial experience through the theme of being compromised identified in categories of being dependent, being trusting, being grateful and being without experience. Participants felt dependent on and trusted the team to make the right decisions for them and not cause them harm. Their hopes for future recovery were also invested within the expertise of the team. Despite often not being well enough to consent to the study prior to surgery, they wished to be involved as much as possible. In agreeing to take part they expressed gratitude for their care, wanted to be helpful to others and considered the trial interventions to be a small component in relation to the enormity of their injury and broader treatment. In making sense of the trial they felt they could not understand the interventions without experience of them but if they received NPWT they developed a strong technological preference for this intervention.ConclusionsPatients prefer to be involved in studies within the limits of their capacity, despite not being able to provide informed consent. A variety of sources of knowledge may enable participants to feel that they have a better understanding of the interventions. Professional staff need to be aware of the situated nature of decision making where participants invest their hopes for recovery in the team.Trial registrationCurrent Controlled Trials, ID: ISRCTN33756652. Registered on 24 February 2012.

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A qualitative study of patient experience of an open fracture of the lower limb during acute care

Cited by 35 publications

References 13 publications

Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting

Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting

Objective Measures of Functional Outcome in Recovery from Open Lower Limb Fractures – A Report from an Ortho-Plastic Research Clinic

Participation in a trial in the emergency situation: a qualitative study of patient experience in the UK WOLLF trial

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