A reason to recover: A qualitative study of recovery after traumatic chest wall injury requiring intensive care admission.

Abstract

Patients surviving major traumatic injury involving the chest wall experience unpredictable recovery trajectories, typically extending over 12 months or more. While some recover well, others experience ongoing physical and mental health difficulties and reduced quality of life. A nuanced understanding of the meaning and process of recovery is needed to inform the development of interventions to enable patients to access the right help, at the right time. Hence, we examined the experience of recovery and the bio-psycho-social factors shaping recovery in the months after traumatic injury resulting in admission to intensive care. This qualitative inquiry was underpinned by philosophical pragmatism, an approach which promotes development of knowledge that can be applied to solve problems. Participants recruited from a tertiary hospital completed semi-structured interviews encompassing perceived recovery, health as reflected in the EQ-5D-5 L, and factors influencing recovery. Qualitative data were analysed using the framework approach enabling the team to focus on matters pertinent to participants while addressing research questions. EQ-5D-5 L data were analysed descriptively. Fourteen participants including 13 men, aged 19 to 67 years were interviewed by telephone, video-conference or in-person four- to seven-months post-injury. Duration of interviews was, on average, 50 min. Participants understood recovery as a non-linear process with progress assessed against pre-injury 'normal'; some acknowledged the need to develop and adapt to a new 'normal'. Engagement in the recovery process ranged along a spectrum anchored by passivity and proactivity, with approach taken reflecting the participant's characteristic way of being, and investment in a 'reason to recover'. Recovery was a function of interlinked factors categorised as 'pre-injury life circumstances', 'recovery mindset', 'recovery behaviours' and 'recovery resources'. While EQ-5D-5 L scores indicated substantial impairment across domains, participants generally regarded themselves as recovering well 'given the circumstances'. Findings highlight the need for care to be grounded in an appreciation of the 'person' of the patient because pre-injury circumstances inexorably shape approach to recovery, engagement in recovery behaviours and access to resources. The model of recovery developed in this study can guide clinicians undertaking the comprehensive assessment that is fundamental to provision of personalised care, and ongoing evaluation of recovery, potentially using patient-generated outcome measures.