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Fear-avoidant beliefs and behaviours after upper limb fracture in older people: a systematic review and meta-ethnography

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Abstract

Purpose

This systematic review aimed to understand older people’s perspectives of associated fear-avoidant beliefs following upper limb fracture.

Methods

Published and unpublished literature databases were systematically searched from inception to 1st April 2023. Qualitative studies reporting the perspectives of fear-avoidant beliefs or behaviours in people who had sustained an upper limb fracture were eligible. Data extracted included characteristics of people interviewed, experiences and perceptions of fear, fear of falling, and fear-avoidant beliefs and behaviours. Data were synthesised using a meta-ethnography approach and the GRADE-CERQUAL tool.

Results

Eight studies were eligible (n = 150 participants; 109 distal radial/41 humeral fracture). Three overarching themes were identified: (1) type of fear-avoidant experiences, (2) drivers of fear-avoidant beliefs and behaviours, and (3) consequences of fear-avoidant beliefs and behaviours. The themes generated were based on moderate confidence evidence. In summary, whilst some patients initially consider upper limb fractures to be relatively minor injuries, over time, the realisation occurs that they have wide-ranging consequences with longer-term perspectives on recovery. This often occurs following an initial period of reduced fear. Providing education and support immediately post-fracture to prevent or challenge initial health beliefs around fear of falls and fear of movement is imperative to recovery.

Conclusions

Fear-avoidant beliefs can impact heavily on certain older people’s recovery, as well as their longer-term health and wellbeing. Consideration of fear avoidance and taking steps to mitigate against this in the acute upper limb trauma setting will better serve these patients in their ongoing recovery from injury.

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Data availability

The data that support the findings of this study may be available from the corresponding author (TS) upon reasonable request.

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Author information

Authors and Affiliations

  1. Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

    Toby O. Smith

  2. Department of Trauma and Orthopaedic, St George’s Hospital, London, UK

    Oliver Brown

  3. Trauma and Orthopaedic Medicine, University Hospital Southampton, Southampton, UK

    Mark A. Baxter

Authors
  1. Toby O. Smith
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  2. Oliver Brown
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  3. Mark A. Baxter
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Corresponding author

Correspondence to Toby O. Smith.

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PROSPERO international prospective register of systematic reviews (Ref: CRD42023411173).

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Smith, T.O., Brown, O. & Baxter, M.A. Fear-avoidant beliefs and behaviours after upper limb fracture in older people: a systematic review and meta-ethnography. Osteoporos Int (2024). https://doi.org/10.1007/s00198-024-07030-7

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