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Fractures following trauma affect physical and mental health for working-age persons, and the International Classification of Functioning, Disability, and Health (ICF) can help therapists understand the fractures' impact on daily lives. To examine self-reported functioning and outcomes six months after upper and lower body fractures and compare limitations using the ICF. Data were collected from 160 patients with fractures as part of a prospective cohort study. The primary outcome measure was the Short Musculoskeletal Function Assessment questionnaire that covers all domains of the ICF. Moreover, sick leave, sense of coherence, and physical activity were reported. Six months after the injury, function had improved significantly, but patients reported problems on all domains in the ICF with few differences between the upper and lower body groups. Leisure activities caused problems for 63 (38.8%) of the patients and bothered 86 (53.8%). Problems performing work bothered 63 (39.4%) with no significant difference between the groups, although a significantly higher proportion in the upper body group had returned to work within two months (p <.001). Six months after fractures, adults reported problems on all ICF domains, especially on the participation dimension, which therapists should address in the rehabilitation process. [ABSTRACT FROM AUTHOR]

The aim of this classic grounded theory study was to develop a substantive theory explaining variations in patients' expectations of physiotherapists when contacting a clinic. The study was nested in a survey cohort study, and data constituted a single open-ended question: State what you expect the physiotherapist to help you with. Responses were obtained from patients before attending the clinic. Statements were analysed using classic grounded theory with open, selective, and theoretical coding. The authors concurrently used memos and constant comparison until theoretical saturation was achieved, categories were identified, and a theoretical model was developed. Based on 292 statements from patients primarily suffering from musculoskeletal problems, the theory grounded in data Expectations as a continuum was developed. Four typologies created the theory: (1) Doing something, so it is again possible to..., (2) Finding out what is wrong with me, (3) Relieving/getting rid of symptoms, and (4) Help to self-help. The theory Expectations as a continuum illuminates that patients' expectations range from helplessness to being competent to act and reflect the social cognitive theories health locus of control and self-efficacy. Patients' abilities for self-management are different, and physiotherapists should carefully adjust the requirements for self-management. [ABSTRACT FROM AUTHOR]

• It is difficult for patients to anticipate the consequences of fractures on everyday life during their admission after accidents. • Patients' expectations about everyday life after fractures do not predict outcomes regarding recovery or return to work. • The predictive validity of patients' expectations on recovery and other aspects of everyday life is low. • General health, the Short Musculoskeletal Function Assessment bother index, and plans about work assignments predict early return to work. • Long-term sick leave is associated with poor general health and much bother by problems in everyday life. Recovery after fractures due to accidents relates to all aspects of the biopsychosocial model. Therefore, it is difficult for the patients to foresee the consequences of the fractures. This study aimed to examine 1) patients' expectations regarding the impact of the injury on everyday life, 2) predictive validity of their expectations after six months, and 3) factors that predict a return to work. Patients were 18–64 years old and hospitalized with simple or compound/multiple fractures due to an accident. During admission, structured interviews were conducted with a questionnaire covering working conditions, expectations regarding recovery, sports, economy, family, household, and return to work. Additionally, mental and physical status were covered with Short Musculoskeletal Function Assessment questionnaire (SMFA) and Short Form 36, and working conditions were uncovered too. After six months, telephonic interviews were conducted with the 164 available patients to elucidate the impact of the fractures on everyday life, their health status, and sick leave. Likelihood ratios, post-test probabilities, and logistic regression analysis were performed to establish if patients' expectations predicted recovery, economy, sports, family, household, and return to work. Few patients' baseline expectations about everyday life were met. The likelihood ratios were small, and the post-test probabilities for expectations consistent with outcomes were between 18% and 68%, with recovery as the lowest and participation in sports as the highest. In the multivariate analysis, patients' expectations did not predict short-term (less than two months) or long-term sick leave (more than three months). Self-rated health and the bother index of SMFA were significant short-term and long-term predictors for sick leave. Additionally, vitality, pain, and decision latitude at work predicted sick leave of less than two months. A few days after the accident, patients' expectations about everyday life are not associated with outcomes six months later. Likelihood ratios indicate difficulties for the patients in predicting fractures' consequences on various aspects of everyday life. Return to work was associated with self-rated health and the bother index of SMFA. Future research should examine if fracture patients can benefit from comprehensive, individual counseling during admission to set appropriate expectations. [ABSTRACT FROM AUTHOR]

Physical activity is important for health but injuries might affect the level of activity. The aim of this study was to evaluate change in physical activity after fracture and to determine predictors for return to a previously high/moderate level of physical activity at 6 months following injury. A cohort study was conducted that included 201 people aged 18–64 years who suffered fractures. Participants reported their level of physical activity prior to the injury and perceived change after six months (n = 164). Subgroup analysis of 95 preinjury physical active participants was performed with logistic regression analysis and odds ratio (OR). Totally, 27.4% (n = 45) returned to their previous level of physical activity and for the 95 pre-injury physically active participants it was 27.3% (n = 26). Low income OR 3.15 (95% CI 1.78–28.05), not receiving rehabilitation OR 0.09 (95% CI 0.02–0.37), and sustaining upper limb fractures compared to lower limb fractures OR 0.09 (95% CI 0.02–0.51) were positively associated with return to preinjury physical activity levels at 6 months after controlling for significant factors. Fracture affects physical activity at six months even for pre-injury active individuals. Therapists should pay attention to guiding patients to perform physical activities despite their injury. [ABSTRACT FROM AUTHOR]

To investigate how accidents leading to fracture affect sense of coherence and health-related quality of life 6 months later and the association between the two phenomena. A cohort study including 201 patients admitted to hospital with fractures was conducted. Data were based on structured interviewing a few days after admission and 6 months later. Sense of coherence was evaluated with a nine-item scale and health-related quality of life was examined with the subscales of Short Form-36 (SF-36). Follow-up comprised 164 patients (81.6%), mean age 47 years. Sense of coherence changed to be either stronger (43%) or weaker (41%) and was stable for 15.9% of the participants. Health-related quality of life changed positively after 6 months but did not reach normative values. Strong sense of coherence was significantly associated with the SF-36 subscales emotional role functioning, social functioning, vitality, and mental health. Accidents leading to fracture can be stressful life events that could influence an individual's sense of coherence to be stronger or weaker. The association between sense of coherence and health-related quality of life emphasises the importance of therapists supporting the patients' personal resources and promote a salutogenic focus. An injury may change an individual's sense of coherence to be stronger or weaker. For patients who sustain fracture, sense of coherence should be included in therapists' analysis of personal resources and support a salutogenic perspective. Health-related quality of life is especially for younger individuals affected by an accident and its consequences and need a guided and meticulous rehabilitation course. [ABSTRACT FROM AUTHOR]