What shapes beliefs about persisting symptoms after an isolated extremity injury? A qualitative study

Injury beliefs can affect how people navigate recovery and influence how they seek treatments. The aim of this study was to explore what influences beliefs about the cause(s) of persisting symptoms after an isolated extremity injury. Data were collected using semi-structured interviews. Participants (n = 12; 67% female) were purposively sampled from a cohort study exploring recovery trajectories after isolated extremity injuries. We used a descriptive approach to reflexive thematic analysis. Beliefs were formed through (1) expectations of what recovery entails (2) interactions with trusted others, (3) experience, and (4) prior knowledge and identity (Theme 1 and subthemes 1a–d). Persistent distress was understood as a normal response to an abnormal situation (Theme 2). Causal beliefs were influenced by concerns about judgement from others, particularly when symptoms did not match objective findings (Theme 3). Beliefs about the cause of persisting post-injury symptoms can be understood as a network of interrelated beliefs, moulded by individual experience and knowledge, but also interpersonal elements such as therapeutic alliance and fear of not being taken seriously by others. Causal beliefs were sometimes at odds with what patients were told by healthcare professionals, leading patients to seek alternate views. Acknowledging patients’ symptom experience and their concerns regarding what might be causing persistent symptoms after an isolated extremity injury may reduce feelings of invalidation, particularly when objective findings do not seem to match with patients’ experiencesShifting beliefs about persistent symptoms after extremity injuries- where necessary- may be facilitated by incorporating patient perspectives, involving friends or family or other support providers, using experiential evidence (e.g. facilitating movement) or by making information personally relevant to the patientClinicians should be supported in connecting patients who are experiencing prolonged distress to psychological care through psychological screening tools, clear referral pathways, and better access to mental health professionalsClinicians or pathways of care that are better resourced to support patients with complex persistent post-injury symptoms could be integrated into orthopaedic services Acknowledging patients’ symptom experience and their concerns regarding what might be causing persistent symptoms after an isolated extremity injury may reduce feelings of invalidation, particularly when objective findings do not seem to match with patients’ experiences Shifting beliefs about persistent symptoms after extremity injuries- where necessary- may be facilitated by incorporating patient perspectives, involving friends or family or other support providers, using experiential evidence (e.g. facilitating movement) or by making information personally relevant to the patient Clinicians should be supported in connecting patients who are experiencing prolonged distress to psychological care through psychological screening tools, clear referral pathways, and better access to mental health professionals Clinicians or pathways of care that are better resourced to support patients with complex persistent post-injury symptoms could be integrated into orthopaedic services