Impact of Keeping a Personal Recovery Diary on Upper Extremity Disability

The Principal Investigator left the institution so the study was stopped before completing enrollment.

Primary null hypothesis: • Keeping a personal diary has no effect on upper-extremity disability (assessed w/ PROMIS [Patient Reported Outcome Measurement Information System] upper extremity) 8 weeks after injury. Secondary null hypotheses: Keeping a personal diary has no effect on avoidance of painful activities (assessed w/ PROMIS pain interference) 8 weeks after injury. Keeping a personal diary has no effect on symptoms of depression (assessed w/ PROMIS depression) 8 weeks after injury. There are no factors associated with upper-extremity disability 8 weeks after injury.

Recovery from injury can be counterintuitive and taxing. It is natural to feel protective and prepare for the worst. Healthy exercises can seem unwise. It can seem like things are taking too long or getting off track. We have noticed that small improvements such as being able to resume a cherished activity (e.g. knitting or swimming) or achieving some success with exercises (e.g. obtaining full supination after fracture of the distal radius), can help patients feel like things are going to be okay. That feeling seems to make it easier to do exercises and resume function activities. We wonder if awareness of this process (mindfulness) would help patients recover more rapidly. Keeping a journal is one method for encouraging mindfulness. It allows patients to express themselves and tell their stories. There is evidence that such "narrative medicine" can be healing. We anticipate that patients who perceive little or no progress will be able to look back on how they were feeling earlier on and appreciate that things are moving in the right direction. We also hope that their journal material might be useful for other patients that are having trouble seeing the "light at the end of the tunnel", so as part of this study, we will get permission to use their quotes anonymously in future patient care materials and future research. To our knowledge, research on the impact of keeping a personal diary/journal of recovery is scant, particularly pertaining to recovery from upper extremity trauma. Explanatory variables: Diary or no Diary Diagnosis (fracture, sprain, contusion, skin laceration, complex laceration [tendon, nerve]) Location (hand, wrist, forearm, elbow, arm, shoulder) Sex Age Education Work status Insurance (worker's compensation, private, public, other) Visit type Prior treatment received Other pain conditions Smoking status Marital status Physical or Occupational Therapy

Subjects that are randomized to the diary group will be told to keep a diary of their recovery. The study is focusing on the effect of keeping a diary on disability, rather than the content of the diary.

Inclusion Criteria: All new patients (>18 years) with an acute injury of the upper extremity (fracture, laceration, sprain, contusion) English fluency and literacy Able to take informed consent Exclusion Criteria: Pregnant women