# Post-traumatic growth and rehabilitation adherence in lower extremity fracture patients: a parallel mediation model

## TL;DR

This study shows that psychological factors like post-traumatic growth and social support help patients with leg fractures stick to their rehabilitation exercises.

## Contribution

The study introduces a parallel mediation model explaining how post-traumatic growth influences rehabilitation adherence through self-efficacy and social support.

## Key findings

- Post-traumatic growth was positively linked to adherence to rehabilitation exercises.
- Self-efficacy and social support significantly mediated the relationship between post-traumatic growth and rehabilitation adherence.
- The model remained significant after adjusting for income and showed measurement invariance across genders.

## Abstract

Previous studies have shown that psychological factors such as post-traumatic growth (PTG), self-efficacy, and social support may be associated with rehabilitation behaviors in patients with musculoskeletal injuries. The mechanism underlying the relationship between PTG and adherence to rehabilitation exercises among patients with lower extremity fractures needs to be further investigated.

In total, 407 patients with lower extremity fractures were recruited from the Be Resilient to Fractures Cohort. Assessment tools measured post-traumatic growth, self-efficacy, perceived social support, and adherence to rehabilitation exercises. Bootstrap-based structural equation modeling was used to analyze data.

The structural equation model showed a good fit, with χ2/df = 2.879, RMSEA = 0.068, GFI = 0.933, CFI = 0.972, and AGFI = 0.900. Post-traumatic growth was positively associated with adherence to rehabilitation exercises (β = 0.149, 95%CI [0.014,0.289], p = 0.028). Both self-efficacy (β = 0.261, 95%CI [0.193,0.340], p < 0.01) and perceived social support (β = 0.176, 95%CI [0.087,0.271], p < 0.01) significantly mediated this relationship. Following adjustments for income, all paths remained significant. Measurement invariance was established across gender groups.

The findings underscore the importance of fostering post-traumatic growth, enhancing self-efficacy, and strengthening social support systems to improve rehabilitation outcomes for patients with lower extremity fractures.