Abstract
Importance:
The optimal duration of occupational therapy after distal radius fracture remains uncertain. Occupational therapy practitioners focus on objective indicators such as range of motion and grip strength, whereas patients prioritize subjective daily activity difficulties.
Objective:
To identify objective and subjective factors influencing decisions to continue occupational therapy from therapists’ and patients’ perspectives.
Design:
Prospective observational cohort study.
Setting:
Multicenter.
Participants:
Patients (N = 143) who underwent open reduction and internal fixation for distal radius fracture were enrolled. The number of participants analyzed at Postoperative Weeks 4, 8, 12, and 24 was 143, 138, 114, and 82, respectively, because of attrition and incomplete data.
Outcomes and Measures:
Objective assessments included range of motion and grip strength, whereas patient-reported outcomes were assessed using the Hand20 questionnaire. Therapists and patients evaluated the necessity for continued occupational therapy. Statistical analyses included Cohen’s κ for agreement, Lasso regression for variable selection, and generalized linear models for significance testing.
Results:
Therapists prioritized objective measures (range of motion, grip strength), whereas patients emphasized subjective difficulties with daily activities. At Postoperative Week 8, Hand20 scores significantly affected the decisions of both groups, more closely aligning with perceptions. By Postoperative Week 12, therapists reverted to objective measures, renewing discrepancies.
Conclusions and Relevance:
Discrepancies exist between therapists’ objective assessments and patients’ subjective recovery requirements regarding therapy continuation. With limited evidence supporting therapy beyond 12 wk, integrating patient-reported outcomes into shared decision-making may enhance functional recovery and satisfaction, particularly during the first 8 wk postoperation.
Plain-Language Summary
This study investigated how patients and occupational therapists decide whether to continue or discontinue therapy after a wrist fracture. Therapists focus on movement and strength, whereas patients care more about how their hand feels during daily activities. Early after surgery, their views were different; however, by 8 weeks, similarities were observed. Subsequently, differences reemerged. The results suggest that listening to patients’ experiences, especially during the first 8 weeks, may improve therapy plans and recovery outcomes.
This study investigated how patients and occupational therapists decide whether to continue or discontinue therapy after a wrist fracture.
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