Recovery from acute injury: Clinical, methodological and philosophical considerations

Abstract

Background. The foundational basis for rehabilitation of musculoskeletal injury as a profession rests upon the ability of an organism to recover from a deviation in homeostasis, and the clinician's ability to influence that process. Much work has been done in an effort to describe and predict recovery from acute injury, in particular soft tissue injuries of the spine (whiplash and low back pain). Recent reviews have identified inconsistencies in the criteria for identifying recovery in this literature that hamper attempts at knowledge translation.

Purpose. This article is intended to stimulate discussion around a new, standardised and acceptable set of criteria for discriminating between the injured individual who reaches a satisfying end to the experience of injury and the individual who does not reach that end.

Conclusions. Self-discrepancy theory and self-determination theory are used to frame the discussion. It is hoped that the introduction of a new paradigm will lead to the development of more standardised, acceptable and useful outcomes, and will facilitate data synthesis from studies on prognosis and intervention for acute musculoskeletal injury.

Keywords:

• Musculoskeletal
• recovery
• well-being

Acknowledgements

The authors are indebted to the following researchers and clinicians who provided comments and feedback on earlier versions of this manuscript: Dr. Harold Merskey, Dr. Doreen Bartlett, Ashley Smith PT, Neil Pearson PT, Lenerdene Levesque PT, Debbie Patterson PT, Hilary Reese PT and Lesley Singer PT. The primary author (DW) is supported by a Doctoral Fellowship from the Canadian Institutes of Health Research. The secondary author (JM) is supported by a New Investigator Award from the Canadian Institutes of Health Research. The authors disclose no conflict of interest, financial or otherwise, with the information contained herein.