Occupational needs of chronic orthopedic trauma patients
Authors:   , Shea Lemoins Samantha Nicole 
Published: September 2024

Millions of orthopedic trauma injuries occur yearly in the U.S., requiring surgical intervention and hospital admission. These orthopedic injuries are a leading cause of death and disability in the United States, with lower-extremity injuries being the leading cause of trauma hospitalizations among people under 65 (Archer et al., 2009; Jarman et al., 2021). Healthcare providers address the patient's immediate needs in the acute orthopedic setting, stabilizing the patient's medical status and addressing life-threatening issues in the event of trauma. Additionally, early ambulation and activity are prescribed in the orthopedic setting to combat common symptomology of orthopedic injury, including pain and infection. Emphasis on early activity and ambulation is rooted in evidence of decreased infection rates and length of stay (Castella et al., 2020; de Vries et al., 2012; Fukumoto et al., 2013; Kamel et al., 2003; Lei, 2021; Shakil-ur-Rehman, 2012). However, this emphasis on mobility is often done in a way that deemphasizes functional outcomes of other meaningful activities, e.g., participation in physical exercise, education, sexual activity, home management, social roles, and participation. While mobility is important for overall health, engagement in other meaningful activities, e.g., childcare and employment, is also central to health, well-being, and quality of life for adults with orthopedic injuries. Over 50 percent of adults with musculoskeletal conditions, which include orthopedic injuries, report decreased participation in activities of daily living (ADL; selfcare activities such as dressing, bathing, grooming, etc.), even with an emphasis on mobility and activity within the acute setting (Haider et al., 2020; Herrera-Escobar et al., 2018). These self-reported limitations in ADL are common and negatively impact one's quality of life. Basic activities of daily living are addressed in the acute care setting; however, not extensively and are not carried out post-acute due to the interruption of one's continuum of care, i.e., meeting basic OT goals in the acute setting with no referral to post-acute OT services. The impact of orthopedic injuries on mobility and ADL is well-documented in peer-reviewed literature. However, engagement in other meaningful tasks outside of ADL has yet to be explored and measured to investigate the potential benefits of prolonging the individual's care post-orthopedic event to address ongoing needs in the post-acute setting outside of mobility alone (Falvey, 2021; Gabbe et al., 2012). Given the known impact of orthopedic injuries on ADL participation, it is plausible that limitations also extend to other meaningful activities, e.g., instrumental activities of daily living (IADL) and social participation, which may impact community reintegration, health, and overall quality of life. Therefore, increased focus on exploring the prevalence of these other potential deficits, the need for continued care post-acute, and their impact on quality of life is warranted. Additionally, there is a need to explore the impact of the patient's biopsychosocial contexts and how one's mental health contributes to or is influenced by decreased occupational participation. Objective: (1) Explore chronic (>3 months) activity participation and mental health changes and quality of life in persons who experience a traumatic orthopedic injury; (2) Determine the feasibility and acceptability of the Cognitive Orientation to Daily Occupational Performance to enhance performance and participation in meaningful occupations through a feasibility study. Methodology: Aim 1 of this study was an exploratory cross-sectional study to evaluate the adult orthopedic lower-extremity patient's ongoing needs, including instrumental activities of daily living, social roles and participation, and perceived quality of life. The initial cross-sectional study was followed by a pilot study (Aim 2) to assess the feasibility and acceptability of the planned intervention.