The impact of self-efficacy and sense of coherence on hand disability during the first year after distal radius fracture surgery—a prospective cohort study

BACKGROUND: Distal radius fractures are among the most common surgically treated fractures in adults. While many patients recover well after surgery, a substantial number continue to experience pain, stiffness, and limitations in hand function that affect daily life and well-being. These difficulties are not always explained by physical healing alone. Psychological responses such as worry, low motivation, or reduced confidence in recovery are often observed in clinical encounters. Two psychological constructs, sense of coherence and self-efficacy, have been associated with outcomes in musculoskeletal rehabilitation. However, their contribution to recovery after distal radius fracture has not been fully established. This study aimed to explore how sense of coherence and self-efficacy are associated with hand disability during the first year after surgical treatment. METHODS: This prospective cohort study included adults (18-74 years) with surgically treated distal radius fractures. Data were collected at cast removal and at three months, six months, and one year post-surgery. Outcome measures included hand disability (DASH), sense of coherence (SOC-13), task-specific self-efficacy, pain, grip strength, and range of motion. Nonparametric statistics were used. Group differences were analyzed with Mann-Whitney U and chi-squared tests. Logistic regression explored associations between psychological factors and disability. RESULTS: 74 patients completed the three-month follow-up, and 61 remained at one year. Sense of coherence scores were stable and not associated with disability at any time point. Self-efficacy was generally high. At six months, higher self-efficacy for goal fulfilment was associated with lower disability, but no associations were found at three months or one year. Median DASH scores improved from 12 at three months to 2 at one year. Pain at rest was normalized by one year, while pain during activity remained. Grip strength and volar flexion had not fully recovered at 12 months. Supination, pronation, and radial/ulnar deviation returned to near normal by six months. CONCLUSION: Neither sense of coherence nor self-efficacy consistently predicted outcomes after a surgically treated distal radius fracture across all time points. However, our exploratory results contribute to the overall understanding of the multifactorial nature of recovery in this patient population.