The patients‘ perspective - a qualitative analysis of experiencing a fracture-related infection

Abstract

IntroductionFracture-related infection is a devastating complication confronting the patient with several challenges. To improve the management and to enhance the patients’ wellbeing the focus of this study was to understand the emotional impact and patients’ experiences during the process to identify challenges, difficulties, and resources. For this, a qualitative content analysis of semi-structured interviews according to Graneheim and Lundman was performed.MethodsIn total n = 20 patients of a German university orthopedic trauma centre specialized in bone and joint infections were recruited using a purposive sampling strategy. The patients were treated at the hospital between 2019 and 2021 and underwent at least one surgery. Individual in-person interviews were performed by one researcher based on a semi-structured guide, which was previously conceptualized. Content analysis according to Graneheim and Lundman was performed on the transcripts by two of the researchers independently.ResultsThe following major themes emerged: (i) the emotional and mental aspects highlighting the fact that FRI patients faced severe restrictions in their day-to-day life, which resulted in dependency on others and frustration, as well as future concerns showing that patients could not overcome a state of anxiety and fear even after successful treatment, (ii) socioeconomic consequences confronting patients with consequences on the job and in finances where they often feel helpless, and (iii) resources emphasizing the role of spirituality as a coping strategy and yoga exercises for keeping the positivity.ConclusionThis study emphasized the challenge of fracture-related infection management and associated consequences from the patients’ perspective. Not being well informed about possible negative outcomes or restrictions makes it harder for patients to accept the situation and patients expressed a need for better information and certainty. Also, patients developed constant anxiety and other psychological disturbances, highlighting the potential benefit of psychological support and patient-peer support to exchange experiences.

Managing more than bones: the psychological impact of a recurrent fracture-related infection

“…The patients reported that meditation and yoga practices served as valuable tools for them to maintain a positive outlook during recovery. 14 While the efficacy of such supplementary therapeutic approaches in FRI patients awaits validation, their incorporation into clinical practice could be a practical and cost-effective measure. In addition, it is well established that patients benefit from the incorporation of multidisciplinary teams, 12 , 31 and the results of this study emphasize the potential of and rationale for including a psychologist as a vital member of the treatment team.…”

“… 13 Moreover, the recurrence of FRI presents a particularly concerning scenario, potentially leading to greater morbidity, prolonged treatment courses, and heightened psychological distress. 14 Notably, a nationwide analysis conducted in Germany revealed that over 25% of all FRIs (1,893 out of 7,158 individuals) had a pre-existing secondary psychological comorbidity according to diagnoses of the International Classification of Diseases (ICD)-10 chapter F. 15 Further, it was observed that the number of patients with psychological comorbidities had increased by 24% over the past decade. 16 …”