Sale Joanna E M, Frankel Lucy, Thielke Stephen, Funnell Larry
Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
Rheumatol Int. 2017 Aug;37(8):1317-1322. doi: 10.1007/s00296-017-3761-y. Epub 2017 Jun 20.
Our objective was to examine the experience of pain after a fracture beyond the conventional healing duration of 6 months. We conducted a phenomenological study in participants who were deemed high risk for future fracture and recruited through an urban fracture clinic in Toronto, Canada. In-depth interviews were conducted with questions addressing the experience of pain, the status of recovery from the fracture, ways in which the fracture affected one's daily activities, and interactions with health care providers. Two researchers coded the transcripts within the phenomenological perspective to develop a structure of the pain experience, promoting rigour through the use of multiple analysts, searching for negative cases, and supporting claims with direct quotations from participants. We interviewed 21 participants who had sustained fractures of the wrist (n = 4), hip (n = 6), vertebrae (n = 2), and multiple or other locations (n = 9). All patients were ambulatory, had a range of socioeconomic status, and lived in the community. Eleven of the 21 participants reported persistent pain at the site of the fracture. Of the 10 participants who reported no pain, four indicated they had ongoing difficulties with range of motion and specific activities and two others described persistent pain from a previous fracture or reliance on a scooter for mobility. Our study demonstrated that over two-thirds of older adults reported fracture-related pain and/or limitations at, or beyond, 6 months post-fracture. We suggest that health care providers ask questions about post-fracture pain and/or limitations when assessing fracture status beyond 6 months.
我们的目标是研究骨折后超过传统6个月愈合期的疼痛经历。我们对被认为未来骨折风险较高的参与者进行了一项现象学研究，这些参与者是通过加拿大多伦多的一家城市骨折诊所招募的。我们进行了深入访谈，问题涉及疼痛经历、骨折恢复状况、骨折对日常活动的影响方式以及与医护人员的互动。两名研究人员从现象学角度对访谈记录进行编码，以构建疼痛经历的结构，通过使用多名分析人员、寻找反例以及引用参与者的直接言论来支持观点，从而确保研究的严谨性。我们采访了21名骨折患者，其中手腕骨折4例，髋部骨折6例，脊椎骨折2例，多处或其他部位骨折9例。所有患者均能行走，社会经济地位各异，居住在社区。21名参与者中有11人报告骨折部位持续疼痛。在报告无疼痛的10名参与者中，4人表示他们在活动范围和特定活动方面仍存在困难，另外2人描述了先前骨折带来的持续疼痛或依靠踏板车行动。我们的研究表明，超过三分之二的老年人在骨折后6个月及更长时间报告有与骨折相关的疼痛和/或活动受限。我们建议医护人员在评估骨折6个月后的状况时，询问有关骨折后疼痛和/或活动受限的问题。
