How can we best identify and manage patients with persistent pain after wrist fracture?

A qualitative service evaluation and systematic review

Summary

It is normal to experience pain following a wrist fracture, but once the fracture has been managed through surgery or immobilisation in a cast, this pain should subside allowing the patient to begin to return to their usual activities. For some people the pain doesn't diminish but persists for longer than expected, meaning returning to work and leisure activities can be significantly delayed.
There is some evidence to suggest that identifying those people with persistent post fracture pain (PPFP) early on and referring them for rehabilitation with a physio/occupational therapist as well as to pain management and psychological services can significantly reduce their chances of developing a more chronic pain condition, such as the debilitating pain condition Complex Regional Pain Syndrome.
Currently very few hospital Trusts, including University Hospitals Bristol, have pathways in place that enable patients with PPFP to access all the necessary services and there are no validated tools available to help clinicians identify those patients most at risk of going on to develop PPFP.
I am a physiotherapist with over 10 years of experience working with wrist fracture patients. I would like to do a PhD in order to better understand which patients are most at risk of getting persistent pain after their fracture, and to investigate what is the best pathway of care for these patients. This preliminary work will look at how we can optimise the care received by patients at UH Bristol and also begin to define the key research questions for a PhD.