i) Participant characteristics
A total of 19 eligible participants were invited to participate in the study. Of these, 12 people completed an interview and 7 people did not (4 participants were unable to be contacted; 2 declined to participate; and 1 had difficulty hearing over the phone) (Table 1). Data saturation was reached by the 12th interview, confirmed by no new categories or concepts emergent from the analysis of interview transcripts. Participants had sustained a variety of injuries, including limb fractures, whiplash, rib fractures, sternum fractures or mild traumatic brain injury (mTBI). Psychological impacts such as anxiety, depression and post-traumatic stress disorder (PTSD) were reported.
ii) Overview of recovery experiences
Recovery experiences, trajectories and outcomes were diverse, reflecting the different types of injuries in the study cohort; pre-injury health status, and individual lifestyles and priorities.
Some participants fully recovered from their injuries:
P4 (Female, 70-74 years, fractured sternum)
‘I’ve always felt pretty good… [so]... once I got over the cracked sternum, my life carried on like usual’.
However, for other participants, their injury and recovery experience were life-changing, and resulted in major disruptions to their lives:
P10 (Female, 65-69 years, multiple arm fractures)
‘Well, it is all very traumatic having had many surgeries, which was terrifying. I would be in hospital, a long way away from the family… that was a real big problem… I lost my car; it was written off. So, the day that I had the accident I was going to my new unit I had just rented... so I paid rent for six months on a house I never lived in... so, it was all pretty crappy'.
The degree of disability reported by participants varied. One participant described major limitation in activities following bilateral soft tissue leg injuries, despite this being a ‘minor’ severity injury:
P5 (Female, 70-74 years, leg injuries)
‘I didn’t do hardly any chores or anything in the house because I couldn’t move properly. I had to learn to walk again. It took me all my time to - just to do my daily things, like getting up and walking, going to the bathroom to get up and have my shower’.
Recovery issues and priorities changed over time. In general, participants were most concerned with pain management and self-care during the acute recovery phase:
P6 (Female, 70-74 years, fractured ribs)
‘My GP said it’s [the fracture] on your ribs, they’ll just heal between six to eight weeks. And that’s what happened. I did go on a lot of medication; it was very painful... But then with the time that went by I got better’.
After the acute recovery phase had passed, participants’ priorities turned to resuming pre-injury daily life. Major barriers to further recovery at this time included chronic pain and persistent psychological symptoms.
iii) Perspectives and themes
Five themes were identified in relation to the ICF conceptual model: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support and positive personal approaches (Figure 1).
Theme 1: Recovery is regaining independence
Regaining independence in pre-injury activities was a major facilitator of self-perceived recovery. Challenges to independence differed between individuals, types of injury and recovery phase. The initial acute recovery phase was characterised by dependence on others for self-care, such as eating, getting dressed and walking unaided. In the post-acute phase, returning to regular activities, including driving, were perceived as indicators of recovery. Whilst frustration was expressed regarding driving restrictions, being back in a vehicle also presented challenges. Illustrative quotes for this theme are presented in Table 2.
Theme 2: Injury and disability in older age
Injury-related disability presented specific challenges in older age. Physical limitations and chronic pain had wide-ranging impacts on high-value activities such as caring for grandchildren, participation in weekly leisure and social activities and working life (which in some instances led to unplanned early retirement and financial concerns). The influence of older age on ongoing disability was raised. Illustrative quotes for this theme are presented in Table 3.
Theme 3: The burden of non-obvious disability
Late-onset physical disability, chronic pain and psychological injury were not readily apparent to others, but nonetheless had profound impacts on health and functioning (Table 4).
Theme 4: The importance of support
Practical and emotional support from family and friends was perceived as very helpful to recovery. Participants expressed a great deal of gratitude for the support they received from family, friends, community members and health care professionals. However, communication barriers with medical doctors were also mentioned. Participants who engaged with the compensation system had mixed experiences. Illustrative quotes for this theme are presented in Table 5.
Theme 5: Positive personal approaches
Positive personal and / or psychological resources were important facilitators of recovery that also served as coping mechanisms in managing the experience of the injury itself and the recovery process (Table 6). The most prominent resources from the participants’ perspectives were determination: both to recover and to not let the injury stop them from living life; resilience; pragmatism; active coping strategies, e.g. adoption of physical and psychological adaptations and ‘work-arounds’ in order to regain functioning; being physically active; focusing on incidental positive outcomes (e.g. moving closer to family); selflessness; stoicism; realistic optimism; not taking oneself too seriously; a good sense of humour; being goal-directed; taking responsibility for one’s own recovery and health, and a positive attitude towards life in general. Illustrative quotes for this theme are presented in Table 6.
iv) Summary of key findings
A summary of the key findings from the study are presented in Table 7.