Today, the proven medical treatments for hip fracture's physical breaks are not equaled by knowledge of how survivors seek to heal the fractured connection to valued communities and cultural identities after injury - although we have learned that such psychosocial and cultural reconnections are needed to thrive over the long term. The need is great: only 34 percent of the 351,000 yearly hip fracture (HF) patients regain full function; mortality nears 50 percent after one year. Men, stereotypes aside, now incur 1 in 3 HF. Yet we lack basic knowledge of the nature of desired community reintegration and lack adequate insight into the relationships between individuals and their communities (of identity and affiliation) which is essential to long-term social acceptance and inclusion of people with disabilities. The return to a valued life with disability is neglected in a literature dominated by studies of the acute injury phase. The proposed goal is to identify the forms, modes, and meanings of community engagement and identities perceived as meaningful after HF.
Specific aims and working hypotheses are examined using a cross-sectional design that will select 144 adults after HF to explore how pathways into HF relate to the nature of meaningful community reintegration afterward. The major group conditions provided for study will represent: HF DURATION: New (n=72), Long-Term (n=72); RESIDUAL IMPAIRMENT: Low (n=36), High (n=36); then PRE-HF IMPAIRMENT: No-Prior (n=18), Prior (n=18) men and women. Methods include structured, narrative, and standardized measures. Analyses include qualitative content and narrative methods, basic statistics, and qualitative hypotheses. Notably, the project combines concepts and methods of anthropology, and clinical medicine and rehabilitation. It contributes data and new concepts of cultural dimensions of loss and reintegration into meaningful cultural communities and the impact of impairment levels. This addresses a high NIH, public and scientific priority (IOM 1997) and meets the WHO (2002) call to identify the community conditions that predict the long-term success at sustaining a meaningful community life after disability. ? ? ? ?
| Luborsky, Mark R; Sankar, Andrea P (2009) The interrogative imperative: state, community, and individual as bodies and subjectivities. Med Anthropol Q 23:89-90 |
