Musculoskeletal clinicians practice behaviour for non-traumatic wrist disorders in the UK: a qualitative study

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Abstract
Objectives Though non-traumatic wrist disorders (NTWD) are common, little is known about how clinicians direct their management. In this study, we aimed to explore clinical decision-making and practice behaviour in managing those with non-traumatic wrist disorders. Design This is a qualitative study using semi-structured, face-to-face and remote interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis Setting UK-based clinicians from across private and public healthcare settings were selected through involvement in a previous online survey. Participants Data were collected from 15 clinicians using semistructured interviews (April–August 2024). Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Results We analysed the data into five overarching themes. The first theme, ‘listening and acknowledging concerns’, described the concentration, empathy and attention involved with initial interactions. The second theme, ‘What this means to me’, described how clinicians interpreted and communicated information about a patient’s wrist condition, often co-constructing explanatory narratives with patients through the use, modification or deliberate avoidance of diagnostic labels. Clinicians differed in the value they attributed to specific diagnoses, with some viewing them as essential for guiding management and others favouring function-based explanations. In the third theme, ‘having an honest conversation’, clinicians expressed the need to reach a shared and realistic understanding of what was achievable going forwards. The fourth theme, ‘managing what matters’, reflected the pragmatic sentiment held by clinicians in working towards clear functional goals that really matter to the individual patient. The final theme, ‘sitting with uncertainty’, encompassed the importance of allowing people to find their own ways of coping and how explaining certain uncertainties may be of value to patients. Conclusions This study provides the first description of UK clinicians’ practice behaviour regarding NTWD across professional groups and healthcare settings. The findings reveal that effective care is driven by a sophisticated blend of professional integrity, relational skills and clinical pragmatism, particularly when faced with diagnostic uncertainty and resource limitations.

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