Introduction
Methods
Design
Sampling and recruitment
Data collection
Qualitative analysis
Stakeholder meetings
Results
Participant interviews
Participant ID | Gender | Type of reconstruction | Reason for reconstruction | Length of time since reconstructive surgery |
---|---|---|---|---|
P01 | M | Frame (external) | Sporting injury | 2 months |
P02 | M | Frame (external) | Congenital | 18 months |
P03 | F | Frame (external) | Sporting injury | 6 months |
P04 | M | Frame (external) | Fall | 1 month |
P05 | F | Frame (external) | Osteomyelitis and Charcot joint | 8 months |
P06 | M | Frame (external) | Road traffic accident | 6 months |
P07 | M | Frame (external) | Aggravated an old knee injury | 24 months |
P08 | M | Frame (external) | Ongoing issues following a previous accident | 20 months |
P09 | M | Frame (external) | Congenital, curved arches | 9 months |
P10 | F | Frame (external) | Sporting injury | 3 months |
P11 | F | Plate (internal) | Old sporting injury- nonunion | 8 months |
P12 | M | Frame (external) | Fall | 1 month |
P13 | M | Frame (external) | Accident- heavy load at work | Not recorded |
P14 | F | Frame (external) | Sporting injury | 19 months |
P15 | M | Frame(external) | Fall | 5 months |
P16 | M | Frame (Second frame after previous infection) (external) | Sporting injury | 17 months |
P17 | M | Frame (external) | Sporting injury | 18 months |
P18 | M | Frame (external) | Road traffic accident | 18 months |
P19 | M | Frame and internal fixation (external and internal) | Heavy load incident at work | 30 months |
P20 | M | Frame (external) | Fall | 3 months |
P21 | M | Frame (external) | Sporting injury | 18 months |
P22 | M | Intermedullary nails (internal) | Accident- heavy load at work | 3 months |
P23 | F | Frame (external) | Fall | 7 months |
P24 | F | Frame (external) | Fall | 2 months |
P25 | M | Frame (external) | Fall | 13 months |
P26 | F | Frame (external) | Road traffic accident | 6 months |
P27 | F | Frame (external) | Fall | 11 months |
P28 | F | Plates (internal) | Fall | 12 months |
P29 | M | Frame and plates (external and internal) | Fall | 4 months |
P30 | M | Frame (external) | Accident- heavy load at work | 4 months |
P31 | F | Nail (internal) | Fall | 5 months |
P32 | F | Frame (external) | Road traffic accident | 31 months |
Participant ID | Job role |
---|---|
HCP01 | Physiotherapist |
HCP02 | Consultant surgeon |
HCP03 | Consultant surgeon |
HCP04 | Physiotherapist |
HCP05 | Consultant surgeon |
HCP06 | Physiotherapist |
HCP07 | Physiotherapist |
HCP08 | Consultant surgeon |
HCP09 | Physiotherapist |
HCP10 | Consultant surgeon |
HCP11 | Physiotherapist |
HCP12 | Frame Nurse specialist |
HCP13 | Consultant surgeon |
HCP14 | Frame Nurse specialist |
HCP15 | Consultant surgeon |
HCP16 | Frame Nurse specialist |
HCP17 | Physiotherapist |
HCP18 | Physiotherapist |
HCP19 | Physiotherapist |
HCP20 | Physiotherapist |
HCP21 | Physiotherapist |
HCP22 | Frame Nurse specialist |
Domain | Summary | Quotes |
---|---|---|
Pain | All patients experienced pain at some point during their recovery. However, for most this reduced as they recovered. Pin site infections were a concern for frame patients but they found they got used to managing these and being able to recognise the onset of infection early | “Sometimes the pain went but then sometimes it could sky rocket, it could. It was ridiculous … there were days where I couldn’t literally put my foot down.” P19 |
“I got an infection in my pin site, it was hell. They said actually it’s just a very sore and irritated one but they gave me the antibiotics, so thank god it wasn’t infected. But all I can say, if that wasn’t infected Christ knows what it must feel like when they are infected.” P10 | ||
Perception-of-self | Impact on sense-of-self varied between patients greatly, with some feeling as though they lost what made them ‘them’ through the loss of hobbies and work. Whereas others did not feel at all affected. Some patients were concerned about their appearance due to scars or the frame and would avoid wearing shorts due to this or avoided busy places | “I’m one of those 60 year olds that will get up and do anything scary. I mean my grandchildren say, I dare you to do that grandma, I’d do it but now I can’t… I’m just like a disabled lady walking with one leg high and one leg low.” P23 |
“After having the frame off I still feel quite nervous about going outside. I’ve not been wearing shorts because I’ve got scars galore on my leg now and I think the scars caused by the frame, as I say, have set me back a little bit.” P18 | ||
Work and Finances | Impact on work depended on the patient’s job. Those who did manual labour jobs were more likely to take longer to return to work and some had to find new jobs. Those who could work from home were likely to return to work more quickly. However, some patients said they did not feel in the right mindset to work during this time even though they could have done. The loss of work and worries about financial stability increased as patients’ recovery time increased | “Work wise is a nightmare because I can’t go back to construction and I’m kind of looking at office jobs at the moment but that’s never been me, so work kind of worries me to be honest….I’ve never worked since the accident. I’m looking for work now but before I was literally on crutches for 2 years so I couldn’t get about. I couldn’t drive anywhere so I was just restricted really but now I’m quite a bit more mobile, I’m looking for work now.” P19 |
“No, I’ve just put that to the back of my mind. I’m not worrying about the financial thing aspect of it all. I’ve got enough to worry about without that. So no I’m not.” P03 | ||
Daily lifestyle and functioning | Physical functioning, hygiene and dressing, socialising and hobbies, and sleep were impacted by the reconstruction and were general areas of frustration for patients. Limits to physical functioning negatively impacted other daily activities that required mobility. The impact of this usually reduced as patients recovered and became more mobile and independent | “I’m just generally worried that it’s not…. I want it to go back to how it was, and I was told when the frame was fitted that there was no reason why it won’t be as strong as it was before, and I am starting to doubt that. I’m starting to sort of think am I ever going to run? Am I ever going to play football with my daughter? Am I ever going to go on the trampoline again?” P27 |
“I am absolutely exhausted. At 4 o’clock I am exhausted and when I’m sleeping, I’m out for the count.” P10 | ||
Emotional well-being | Patients were likely to experience some episodes of low mood during their recovery. This was often related to frustrations at their lack of independence, being in pain and not being able to engage in their usual pastimes. This tended to improve as recovery progressed and patients regained their independence and self-efficacy. For those with extra complications or who took longer than expected to recover this was impacted for longer | “Being bleak about it, honestly soul destroying. It really kind of took me….I’d say I’m still recovering from it because it was hard having a cage on and looking after my little boy, expecting to try and walk around with him and I couldn’t and there were days when I didn’t want to get out of bed and there were days where I didn’t want to be here anymore.” P18 |
“Your independence you miss it. Miss to be able to walk and get something.”P29 | ||
Support | Support was important to all patients and could be from health professionals (both in the acute period and longer term), from family and friends and from work. Feeling informed and in control of their recovery pathway was also important to patients. Feeling informed and supported mediated the impact the other domains had on patients’ quality of life | “I don’t want to sound big headed but I’ve only been able to do that [rehabilitated well] because of the team what looked after me originally. They said you could ring up at any time and it was immediate and when I went to see [name] on three occasions he just said, carry on, you know. So I knew I was doing right.” P16 |
“She’s [patients wife] my private nurse really. She’s very observant, you know, she sees that….because when I had the cage on it’s a 360 degree system and she was very knowledgeable, became very knowledgeable about what was improved and what was going backwards. She did all my dressings every day.” P09 |