Understanding patient experience of distal tibia or ankle fracture: a qualitative systematic review

Nathan A Pearson; Elizabeth Tutton; Stephen E Gwilym; Alexander Joeris; Richard Grant; David J Keene; Kirstie L Haywood

doi:10.1302/2633-1462.43.BJO-2022-0115.R1

Understanding patient experience of distal tibia or ankle fracture: a qualitative systematic review

Bone Jt Open. 2023 Mar 15;4(3):188-197. doi: 10.1302/2633-1462.43.BJO-2022-0115.R1.

Authors

Nathan A Pearson¹, Elizabeth Tutton^{2

3}, Stephen E Gwilym², Alexander Joeris⁴, Richard Grant⁵, David J Keene^{2

6}, Kirstie L Haywood¹

Affiliations

¹ Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK.
² Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
³ Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴ AO ITC, Clinical Science, AO Foundation, Strettbacherstrausse 6, 8600, Dubendorf, Switzerland.
⁵ National Institute for Health Research, Applied Research Collaboration, West Midlands; Warwick Medical School, User Teaching and Research Action Partnership; Fragility Fracture Network; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁶ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.

PMID: 37051834
PMCID: PMC10031546
DOI: 10.1302/2633-1462.43.BJO-2022-0115.R1

Abstract

To systematically review qualitative studies of patients with distal tibia or ankle fracture, and explore their experience of injury and recovery. We undertook a systematic review of qualitative studies. Five databases were searched from inception to 1 February 2022. All titles and abstracts were screened, and a subset were independently assessed. Methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. The GRADE-CERQual checklist was used to assign confidence ratings. Thematic synthesis was used to analyze data with the identification of codes which were drawn together to form subthemes and then themes. From 2,682 records, 15 studies were reviewed in full and four included in the review. A total of 72 patients were included across the four studies (47 female; mean age 50 years (17 to 80)). Methodological quality was high for all studies, and the GRADE-CERQual checklist provided confidence that the findings were an adequate representation of patient experience of distal tibia or ankle fracture. A central concept of 'being the same but different' conveyed the substantial disruption to patients' self-identity caused by their injury. Patient experience of 'being the same but different' was expressed through three interrelated themes, with seven subthemes: i) being proactive where persistence, doing things differently and keeping busy prevailed; ii) living with change including symptoms, and living differently due to challenges at work and leisure; and iii) striving for normality, adapting while lacking in confidence, and feeling fearful and concerned about the future. Ankle injuries were disruptive, draining, and impacted on patients' wellbeing. Substantial short- and longer-term challenges were experienced during recovery. Rehabilitation and psychosocial treatment strategies may help to ameliorate these challenges. Patients may benefit from clinicians being cognisant of patient experience when assessing, treating, and discussing expectations and outcomes with patients.