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Allen Ingabire JC, Tumusiime DK, Sagahutu JB, Urimubenshi G, Bucyibaruta G, Pilusa S, Stewart A. Quality of life of survivors following road traffic orthopaedic injuries in Rwanda. Front Public Health 2024; 12:1405697. [PMID: 39100955 PMCID: PMC11295000 DOI: 10.3389/fpubh.2024.1405697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Background Road traffic injuries (RTI) pose a global public health threat, especially in low- and middle-income nations. These injuries typically cause orthopaedic problems that may negatively impair a person's physical and mental health and quality of life. Our study examined the quality of life of road traffic orthopaedic injuries (RTOI) survivors. Methods A cross-sectional study at five Rwandan referral hospitals, included 369 adult RTOI victims. Two years post-injury, participants completed the European Quality of life 5 Dimension 5 (EQ-5D-5L) and Visual Analogue Scale (VAS) Questionnaire between June 2 and August 31, 2022, with informed consent. Three EQ-5D-5L-VAS scores were used: low (0-40%), fair (41-60%), and excellent (61-100%). We used logistic regression analysis with a significance threshold of p < 0.05 to determine odds ratios (OR) and 95% CI. Results The RTOI victims had a mean age of 37.5 ± 11.26 years with sex ratio M:F:3:1. Usual activities (66.8%) and mobility (54.8%) were the most affected EQ-5D-5L dimensions. Residence, hospital stay, rehabilitation, and return to work affected mobility, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L/VAS score showed 34.95% poor QoL (0-40%) and 35.50% good QoL. Factors affecting QoL include level of education (OR = 1.66, p < <0.01), type of intervention (OR = 1.22, p = 0.003), rehabilitation (OR = 2.41, p < 0.01) and level of disability (OR = 196.41, p < 0.01). Mobility, self-care, usual activities, pain, comfort, anxiety, and depression vary moderately on Shannon's index. Conclusion The study highlights the significant impact of road traffic orthopaedic injuries (RTOI) on survivors' quality of life in Rwanda, revealing challenges in mobility and daily activities. Factors influencing quality of life include education level, medical intervention type, rehabilitation, and disability degree. The findings emphasize the need for tailored rehabilitation strategies and policy interventions to improve long-term outcomes for RTOI survivors.
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Affiliation(s)
- J. C. Allen Ingabire
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | | | | | | | - Georges Bucyibaruta
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Sonti Pilusa
- Physiotherapy Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Aimee Stewart
- Physiotherapy Department, University of the Witwatersrand, Johannesburg, South Africa
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Allen Ingabire JC, Stewart A, Sagahutu JB, Urimubenshi G, Bucyibaruta G, Pilusa S, Uwakunda C, Mugisha D, Ingabire L, Tumusiime D. Prevalence and levels of disability post road traffic orthopaedic injuries in Rwanda. Afr J Disabil 2024; 13:1251. [PMID: 38322752 PMCID: PMC10844983 DOI: 10.4102/ajod.v13i0.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/23/2023] [Indexed: 02/08/2024] Open
Abstract
Background Prolonged disability resulting from road traffic injuries (RTIs) contributes significantly to morbidity and disease burden. A good understanding of the prevalence and the level of disability of orthopaedic injuries in developing countries is crucial for improvement; however, such data are currently lacking in Rwanda. Objectives To determine the prevalence and levels of disability of 2 years post-road traffic orthopaedic injuries in Rwanda. Method A multicentre, cross-sectional study from five Rwandan referral hospitals of 368 adult RTI victims' sustained from accidents in 2019. Between 02 June 2022, and 31 August 2022, two years after the injury, participants completed the World Health Organization Disability Assessment Schedule (WHODAS 2.0) Questionnaire for the degree of impairment and the Upper Extremity Functional Scale and Lower-Extremity Functional Scale forms for limb functional evaluation. Descriptive, inferential statistics Chi-square and multinomial regression models were analysed using R Studio. Results The study's mean age of the RTOI victims was 37.5 (±11.26) years, with a sex ratio M: F:3: 1. The prevalence of disability following road traffic orthopedic injury (RTOI) after 2 years was 36.14%, with victims having WHODAS score > 25.0% and 36.31% were still unable to return to their usual activities. Age group, Severe Kampala Trauma Score and lack of rehabilitation contributed to disability. The most affected WHODAS domains were participation in society (33%) and life activities (28%). Conclusion The prevalence and levels of disability because of RTOI in Rwanda are high, with mobility and participation in life being more affected than other WHODAS domains. Middle-aged and socio-economically underprivileged persons are the most affected. Contribution This study showed that a good rehabilitation approach and economic support for the RTI victims would decrease their disabilities in Rwanda.
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Affiliation(s)
- JC Allen Ingabire
- Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Aimee Stewart
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean Baptiste Sagahutu
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Rwanda,Kigali, Rwanda
| | - Gerard Urimubenshi
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Rwanda,Kigali, Rwanda
| | - Georges Bucyibaruta
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Imperial College London, United Kingdom
| | - Sonti Pilusa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carine Uwakunda
- Department of Surgery, Kibagabaga Level II Teaching Hospital, Kigali, Rwanda
| | - Didace Mugisha
- Department of Environmental, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leontine Ingabire
- Department of Nursing, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David Tumusiime
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Rwanda,Kigali, Rwanda
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Allen Ingabire JC, Stewart A, Uwakunda C, Mugisha D, Sagahutu JB, Urimubenshi G, Tumusiime DK, Bucyibaruta G. Factors affecting social integration after road traffic orthopaedic injuries in Rwanda. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1287980. [PMID: 38293289 PMCID: PMC10825670 DOI: 10.3389/fresc.2023.1287980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
Background Road traffic injuries (RTIs) leading to long-term disability present a significant public health challenge, causing immense personal and societal consequences. Every year, 50 million people are hurt, 1.2 million die, 30% are permanently disabled, and 14% cannot return to work due to road traffic accidents. However, in many developing countries, information on the social integration of patients post-RTI remains limited. This study aimed to identify factors contributing to social integration following road traffic-related orthopedic injuries (RTOI) in Rwanda. Methodology A multicenter, cross-sectional study included 369 adult Road traffic orthopedic injuries (RTOI) victims from five Rwandan referral hospitals. Participants completed the IMPACT-S Questionnaire between 2 June 2022, and 31 August 2022, two years after the injury. It measured social integration in terms of activities and paricipation. We used logistic regression statistical analysis with a significance level of p < 0.05 to estimate odds ratios (OR) and 95% confidence intervals (CI). The Institutional Review Board for Health Sciences and Medicine at the University of Rwanda College of Medicine ethically authorized this study. Participants signed a written consent form before participating in the study. The data was kept private and was used only for this study. Results The study's findings indicated that the mean age of RTOI victims was 37.5 ± 11.26 years, with a notable male predominance over females. Of the participants, 5.69% were unable to resume normal life activities. The overall mean score on the IMPACT-S scale was moderate, at 77 ± 17. Specifically, participants achieved an average score of 76 ± 16 for "activities" and a higher average of 84 ± 16 for "participation." Certain factors were associated with poor social integration compared to others, including belonging to the age group above 65 years (OR = 8.25, p = 0.02), female sex (OR = 3.26, p = 0.02), lack of rehabilitation (OR = 3.82, p = 0.01), and length of hospital stay >15 days (OR = 4.44, p = 0.02). Conclusion The majority of RTOI victims in Rwanda achieved successful reintegration into society; nevertheless, their mobility and community engagement were more significantly impacted compared to other aspects assessed by the IMPACT-S scale. The study emphasized the importance of early management, effective rehabilitation, and prompt patient discharge from the hospital in facilitating a successful return to everyday life after road traffic-related orthopedic injuries.
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Affiliation(s)
- JC Allen Ingabire
- Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aimee Stewart
- Physiotherapy Department, University of the Witwatersrand, Johannesbourg, South Africa
| | - Carine Uwakunda
- Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Didace Mugisha
- Department of Environmental, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Baptiste Sagahutu
- Physiotherapy Department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gerard Urimubenshi
- Physiotherapy Department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David K. Tumusiime
- Physiotherapy Department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Georges Bucyibaruta
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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Cohen-Tanugi S, Reid R, Loeffler BJ, Gaston RG. The Prevalence of Depression and PTSD in Adults With Surgically Managed Traumatic Upper-Extremity Amputations. Hand (N Y) 2024; 19:169-174. [PMID: 35656852 PMCID: PMC10786098 DOI: 10.1177/15589447221093671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper-extremity limb loss has been associated with serious psychological sequelae. Despite advancements in surgical procedures and prostheses for upper limb amputees, it is critical to recognize the psychosocial component of these patients' care. Although the role of psychological factors in outcomes is increasingly acknowledged, little is known about the prevalence of depression and post-traumatic stress disorder (PTSD) in the civilian population after traumatic upper-extremity amputation. METHODS In this retrospective observational single-center study, adult patients evaluated for traumatic upper limb amputations from 2016 to 2019 completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual Analogue Scale, the Center for Epidemiologic Studies Depression Scale, and the Primary Care PTSD Screen during visits. All data underwent descriptive statistical analysis. RESULTS Thirty-nine adult patients treated for upper-extremity traumatic amputation completed patient-reported outcomes (PROs) questionnaires. The median final follow-up time for our cohort was 17 months from amputation. Twenty patients (51%) screened positive for depression and 27 (69%) for PTSD during follow-up. The median time from amputation to first positive screening was 6.5 months for depression and 10 months for PTSD. The physical component score of Veterans RAND 12-Item Health Survey (VR-12) was significantly worse for patients with depression. The Median DASH and mental component score of VR-12 were significantly worse for patients with PTSD. CONCLUSION Upper-extremity limb loss has a significant impact on mental health, which in turn affects PROs. The high prevalence of depression and PTSD in traumatic upper-extremity amputees underscores the necessity for screening and multidisciplinary treatment.
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Affiliation(s)
| | - Risa Reid
- Atrium Health, Department of Orthopaedics, Charlotte, NC, USA
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Hu W, Mehta D, Garg K, Patel S, Shukla S, Agrawal M, Thadani S. Post traumatic stress disorder following facial and dental trauma: preliminary findings from a study conducted in India. Oral Maxillofac Surg 2023; 27:297-303. [PMID: 35501526 DOI: 10.1007/s10006-022-01068-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/23/2022] [Indexed: 06/02/2023]
Abstract
This study was conducted to identify and study the prevalence of post traumatic stress disorder (PTSD) in patients, who had sustained traumatic facial and dental injuries along with other variables that may affect the psychological response. MATERIAL AND METHODS 241 patients suffering from traumatic facial and dental injuries presenting to the Ahmadabad Municipal Dental College and Hospital were included in the study. 110 patients (males - 87, females - 23) suffered disfiguring injuries and/or loss of multiple front teeth (DF). 131 patients (males - 102, females - 29) suffered no disfigurement (NDF). Assessment was carried out on day of discharge (D.O.D), 1 month, and 6 months. Impact of Event Scale (I.E.S-R) was used to assess the presence of post traumatic stress disorder in the patients. RESULTS Patients with DF injuries had statistically significant higher mean scores than patients suffering NDF injuries. Female patients had comparatively higher scores at D.O.D, 1 month, and 6 months. Patients treated with maxillomandibular fixation and between ages 18 and 40 years also had significantly higher scores. CONCLUSION Patients with DF facial injuries including multiple anterior teeth loss had significantly higher mean (I.E.S-R) scores for PTSD in comparison with patients with NDF facial injuries.
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Affiliation(s)
- Weihsin Hu
- Department of Oral & Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College & Hospital, Phd Sc, Gujarat University, Khokhra, Ahmedabad, India.
| | - Deval Mehta
- Department of Oral & Maxillofacial Surgery, College of Dental Science & Research Centre, Phd Guide, Gujarat University, Ahmedabad, India
| | - Krati Garg
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Ahmedabad, India
| | - Shweta Patel
- Department of Oral & Maxillofacial Surgery, Ahmedabad Municipal Dental College & Hospital, Ahmedabad, India
| | - Shreedhar Shukla
- Department of Oral & Maxillofacial Surgery, Ahmedabad Municipal Dental College & Hospital, Ahmedabad, India
| | - Mohit Agrawal
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Ahmedabad, India
| | - Sandeep Thadani
- Smile Train Cleft Lip and Palate Project, Indus Hospital, Sabarmati, Ahmedabad, India
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Tan AC, Allen SK, Aziz I, Mercado M, Nanthakumar K, Syed F, Champion GD. Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study. Injury 2022; 53:3201-3208. [PMID: 35843753 DOI: 10.1016/j.injury.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. METHODS This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery. RESULTS The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039). CONCLUSIONS Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.
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Affiliation(s)
- Aidan Christopher Tan
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
| | - Samantha Kate Allen
- Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia.
| | - Iqra Aziz
- Royal North Shore Hospital, Sydney, NSW, Australia.
| | | | | | - Faisal Syed
- Wollongong Hospital, Sydney, NSW, Australia.
| | - G David Champion
- School of Women's and Children's Health, Department of Pain, University of New South Wales, Sydney, Level 7 Bright Alliance Building, High Street, Randwick, NSW 2031, Australia.
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Yang CL, Yin YR, Chu CM, Tang PL. Does category of strength predict return-to-work after occupational injury? BMC Public Health 2022; 22:1472. [PMID: 35918669 PMCID: PMC9344704 DOI: 10.1186/s12889-022-13817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Occupational accidents may lead laborers to lose their working capacities, affecting their physical and mental health. Occupational rehabilitation helps improve the ability of patients with occupational accidents and suggests appropriate jobs to avoid second injuries. This study aimed to identify whether any of the functional capacity evaluation (FCE) strength subtests predicted successful return to work. Methods Data were collected of 84 patients receiving government-subsidized occupational rehabilitation between September 2016 and December 2018. A structured questionnaire was employed for pre- and post-training assessment, including basic information, information of the occupational accident, status of the laborer at the opening of the injury case, physical requirement for the job, and physical capacity. Eight subtests of strength were included in the physical capacity evaluation, i.e., carrying, lifting to several levels, power grip, and lateral pinch, to explore the association between the strength tests and return to work. Results The unadjusted model showed that for every additional kilogram in bilateral carrying strength before work hardening training, the odds of successful return to work increased (crude odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.01–1.24, p = 0.027). After adjustment for basic demographic information and pre-accident physical functional elements of work, the odds of successful return to work increased (adjusted OR = 1.27, 95% CI = 1.04–1.54, p = 0.02) for every additional kilogram in the pre-training bilateral carrying strength. There were no statistically significant differences observed in the other seven subtests. Conclusion Through thorough evaluation and work hardening training provided in the occupational rehabilitation, patients’ physical capacity can be understood and improved. However, a full evaluation of functional capacities is prolonged and time-consuming. This study provides evidence that pre-work-hardening bilateral carrying strength may be a promising predictor of return to work and we recommend to consider it as a prioritized test to assist in determining appropriate advice regarding return to work. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13817-2.
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Affiliation(s)
- Chia-Lin Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Yan-Ru Yin
- Department of Occupational Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Chuan-Man Chu
- Department of Occupational Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC). .,Department of Health-Business Administration, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC). .,College of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC).
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Almeida I, Teixeira JM, Magalhães T. The impact of major occupational injuries on professional reintegration. A Portuguese medico-legal contribution. J Forensic Leg Med 2022; 90:102391. [PMID: 35716592 DOI: 10.1016/j.jflm.2022.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022]
Abstract
Occupational injuries represent an enormous economic impact for victims, respective families, involved institutions and all the community due to professional outcomes. Thus, it is of the utmost importance that medico-legal personal injury assessment and the posterior follow-up of these victims, may allow their concrete damage repair, considering the victims' needs fulfilment and professional reintegration, whenever possible. The main objective of this study is to reflect on the role that legal medicine can play in promoting the professional reintegration of victims of major occupational accidents through the analysis of occupational injuries cases considering the medico-legal examinations performed. A retrospective study was conducted using medico-legal major occupational injuries cases (Partial Permanent Disability ≥40%). Data were collected from two medico-legal assessment moments: (a) personal injury assessment homologated by a labour court 4.8 years on average after occupational injury; (b) medico-legal follow-up for needs and/or Partial Permanent Disability adjustments performed 18.9 years on average after occupational injury. The final sample includes 103 cases. The results showed that in major occupational accidents, permanent long-term outcomes were principally associated with neurological (62.1%) and orthopaedic (52.4%) sequelae. Permanent professional damage parameters assigned by the labour court included Partial Permanent Disability (23.3%), Permanent Absolute Disability for Regular Work (41.7%) and Permanent Absolute Disability for Any Work (35%). Three-dimensional methodology is helpful in predicting Partial Permanent Disability and Permanent Absolute Disability for Any Work. However, three-dimensional methodology did not reveal correlations with Permanent Absolute Disability for Regular Work, and currently 65% of the victims who were considered able to work by the labour court are not professionally active. Thus, these major cases deserve a more detailed medico-legal approach based on concrete information about the professional reality of each victim, especially cases with an eventual Permanent Absolute Disability for Regular Work. Medico-legal Injury Assessment must be based on concrete aspects of the victim's professional reality and not only on permanent disability tables. This calls for an articulation between all institutions working with the victim of occupational injuries and legal medicine to promote recovery and the necessary measures to assure professional rehabilitation.
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Affiliation(s)
- Isabel Almeida
- CINTESIS, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal; CRPG - Centro Reabilitação Profissional de Gaia, Av. João Paulo II, 961, 4410-406, Arcozelo, Vila Nova de Gaia, Portugal.
| | - José Manuel Teixeira
- Porto Healthcare Unity - Accidents, Fidelidade - Insurance Company, Rua Direita de Campinas 324, 4100-207, Porto, Portugal
| | - Teresa Magalhães
- CINTESIS, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal; Porto Healthcare Unity - Accidents, Fidelidade - Insurance Company, Rua Direita de Campinas 324, 4100-207, Porto, Portugal; IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, Rua do Paço 5, Penafiel, Gandra, Portugal
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Baig MR, Beck RD, Wilson JL, Lemmer JA, Meraj A, Meyer EC, Mintz J, Peterson AL, Roache JD. Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study. Mil Med Res 2020; 7:46. [PMID: 33032657 PMCID: PMC7545554 DOI: 10.1186/s40779-020-00278-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 09/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Selective serotonergic reuptake inhibitors (SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder (PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury (mTBI) is problematic since SSRIs could exacerbate post-concussion syndrome (PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy. METHODS We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of mTBI. DISCUSSION We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full- scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans. TRIAL REGISTRATION NCT04280965 .
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Affiliation(s)
- Muhammad R Baig
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA. .,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA. .,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Robert D Beck
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Jennifer L Wilson
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Jennifer A Lemmer
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Adeel Meraj
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
| | - Eric C Meyer
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Central Texas Veterans Healthcare System, Waco, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L Peterson
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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10
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Devlin A, Casey S, Williams S, Giummarra MJ. Association of fear-avoidance and self-efficacy on pain disability in individuals with co-morbid post-traumatic stress and chronic pain. J Health Psychol 2020; 27:188-198. [DOI: 10.1177/1359105320947819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated relationships between post-traumatic stress symptoms (PTSS) and pain disability. Fifty people with chronic pain (probable PTSD, n = 22) completed measures assessing pain interference, PTSS, fear avoidance, and pain self-efficacy. We hypothesized that people with probable PTSD would have higher fear avoidance and lower pain self-efficacy; and that PTSS would be indirectly associated with pain disability via fear avoidance and self-efficacy. People with probable PTSD had higher fear avoidance, but there were no differences in self-efficacy, pain severity or disability. There was an indirect association between PTSS and pain disability via fear avoidance, but not via self-efficacy.
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Affiliation(s)
- Anna Devlin
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
- Psychology Department, Epworth HealthCare, Melbourne, Australia
| | - Sara Casey
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Scott Williams
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Melita J Giummarra
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Melbourne, Australia
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11
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Lau G, Gabbe BJ, Collie A, Ponsford J, Ameratunga S, Cameron PA, Harrison JE, Giummarra MJ. The Association Between Fault Attribution and Work Participation After Road Traffic Injury: A Registry-Based Observational Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:235-254. [PMID: 31820220 DOI: 10.1007/s10926-019-09867-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose To characterise associations between fault attribution and work participation and capacity after road traffic injury. Methods People aged 15-65 years, working pre-injury, without serious brain injury, who survived to 12 months after road traffic injury were included from two Victorian trauma registries (n = 2942). Fault profiles from linked compensation claims were defined as no other at fault, another at fault, denied another at fault, claimed another at fault, and unknown. Claimant reports in the denied and claimed another at fault groups contradicted police reports. Patients reported work capacity (Glasgow outcome scale-extended) and return to work (RTW) at 6, 12 and 24 months post-injury (early and sustained RTW, delayed RTW (≥ 12 months), failed RTW attempts, no RTW attempts). Analyses adjusted for demographic, clinical and injury covariates. Results The risk of not returning to work was higher if another was at fault [adjusted relative risk ratio (aRRR) = 1.67, 95% confidence interval (CI) 1.29, 2.17] or was claimed to be at fault (aRRR = 1.58, 95% CI 1.04, 2.41), and lower for those who denied that another was at fault (aRRR = 0.51, 95% CI 0.29, 0.91), compared to cases with no other at fault. Similarly, people had higher odds of work capacity limitations if another was at fault (12m: AOR = 1.49, 95% CI 1.24, 1.80; 24m: 1.63, 95% CI 1.35, 1.97) or was claimed to be at fault (12m: AOR = 1.54, 95% CI 1.16, 2.05; 24m: AOR = 1.80, 95% CI 1.34, 2.41), and lower odds if they denied another was at fault (6m: AOR = 0.67, 95% CI 0.48, 0.95), compared to cases with no other at fault. Conclusion Targeted interventions are needed to support work participation in people at risk of poor RTW post-injury. While interventions targeting fault and justice-related attributions are currently lacking, these may be beneficial for people who believe that another caused their injury.
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Affiliation(s)
- Georgina Lau
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, SA2 8PP, UK
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - James E Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, SA, Australia
| | - Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC, Australia.
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12
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Giummarra MJ, Lau G, Grant G, Gabbe BJ. A systematic review of the association between fault or blame-related attributions and procedures after transport injury and health and work-related outcomes. ACCIDENT; ANALYSIS AND PREVENTION 2020; 135:105333. [PMID: 31863937 DOI: 10.1016/j.aap.2019.105333] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/07/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
Attributions of fault are often associated with worse injury outcomes; however, the consistency and magnitude of these impacts is not known. This review examined the prognostic role of fault on health, mental health, pain and work outcomes after transport injury. A systematic search of five electronic databases (Medline, Embase, CINAHL, PsycINFO, Cochrane Library) yielded 16,324 records published between 2000 and January 2018. Eligibility criteria were: adult transport injury survivors; prospective design; multivariable analysis; fault-related factor analysed; pain, mental health, general health or work-related outcome. Citations (n = 10,558, excluding duplicates) and full text articles (n = 555) were screened manually (Reviewer 1), and using concurrent machine learning and text mining (Reviewer 2; using Abstrackr, WordStat and QDA miner). Data from 55 papers that met all inclusion criteria were extracted, papers were evaluated for risk of bias using the QUIPS tool, and overall level of evidence was assessed using the GRADE tool. There were six main fault-related factors classified as: fault or responsibility, fault-based compensation, lawyer involvement or litigation, blame or guilt, road user or position in vehicle, and impact direction. Overall there were inconsistent associations between fault and transport injury outcomes, and 60% of papers had high risk of bias. There was moderate evidence that fault-based compensation claims were associated with poorer health-related outcomes, and that lawyer involvement was associated with poorer work outcomes beyond 12 months post-injury. However, the evidence of negative associations between fault-based compensation claims and work-related outcomes was limited. Lawyer involvement and fault-based compensation claims were associated with adverse mental health outcomes six months post-injury, but not beyond 12 months. The most consistent associations between fault and negative outcomes were not for fault attributions, per se, but were related to fault-related procedures (e.g., lawyer engagement, fault-based compensation claims).
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Affiliation(s)
- Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC, Australia.
| | - Georgina Lau
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Genevieve Grant
- Australian Centre for Justice Innovation and Faculty of Law, Monash University, Clayton, VIC, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
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13
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Rissanen R, Liang Y, Moeller J, Nevriana A, Berg HY, Hasselberg M. Trajectories of sickness absence after road traffic injury: a Swedish register-based cohort study. BMJ Open 2019; 9:e031132. [PMID: 31371302 PMCID: PMC6677943 DOI: 10.1136/bmjopen-2019-031132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Despite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns' interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity. DESIGN A register-based prospective cohort study. SETTING Administrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data. PARTICIPANTS Individuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL. RESULTS Three distinct patterns of SA were identified; 'Stable', 'Quick decrease' and 'Gradual decrease'. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable. CONCLUSION The study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.
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Affiliation(s)
- Ritva Rissanen
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Yajun Liang
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Jette Moeller
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Alicia Nevriana
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Hans-Yngve Berg
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
- Swedish Transport Agency, Borlänge, Sweden
| | - Marie Hasselberg
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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14
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Nayak SS, Kamath AT, Gupta K, Roy A, Roy S, Chatterjee A. Posttraumatic stress disorder among patients with oral and maxillofacial trauma in a South Indian population. SPECIAL CARE IN DENTISTRY 2019; 39:399-405. [DOI: 10.1111/scd.12383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/18/2019] [Accepted: 04/21/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Sunil S. Nayak
- Department of Oral and Maxillofacial SurgeryManipal College of Dental Sciences Manipal Karnataka India
- Manipal Academy of Higher Education Manipal Karnataka India
| | - Abhay T. Kamath
- Department of Oral and Maxillofacial SurgeryManipal College of Dental Sciences Manipal Karnataka India
- Manipal Academy of Higher Education Manipal Karnataka India
| | - Kripa Gupta
- Department of Oral and Maxillofacial SurgeryManipal College of Dental SciencesManipal Academy of Higher Education Manipal Karnataka India
| | - Anubhav Roy
- Department of Oral and Maxillofacial SurgeryManipal College of Dental SciencesManipal Academy of Higher Education Manipal Karnataka India
| | - Sreea Roy
- Department of Oral and Maxillofacial SurgeryManipal College of Dental Sciences Manipal Karnataka India
- Manipal Academy of Higher Education Manipal Karnataka India
| | - Abhirup Chatterjee
- Department of Oral and Maxillofacial SurgeryManipal College of Dental Sciences Manipal Karnataka India
- Manipal Academy of Higher Education Manipal Karnataka India
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15
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Duckworth MP, Iezzi T. Motor Vehicle Collisions and Their Consequences—Part II: Predictors of Impairment and Disability. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9334-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Uleberg O, Pape K, Kristiansen T, Romundstad PR, Klepstad P. Population-based analysis of the impact of trauma on longer-term functional outcomes. Br J Surg 2018; 106:65-73. [PMID: 30221344 DOI: 10.1002/bjs.10965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/14/2018] [Accepted: 06/30/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Functional outcome measures are important as most patients survive trauma. The aim of this study was to describe the long-term impact of trauma within a healthcare region from a social perspective. METHODS People active in work or education and admitted to hospitals in Central Norway in the interval 1 June 2007 to 31 May 2010 after sustaining trauma were included in the study. Clinical data were linked to Norwegian national registers of cause of death, sickness and disability benefits, employment and education. Primary outcome measures were receipt of medical benefits and time to return to preinjury work level. Secondary outcome measures were mortality within 30 days or during follow-up. RESULTS Some 1191 patients were included in the study, of whom 193 (16·2 per cent) were severely injured (Injury Severity Score greater than 15). Five years after injury, the prevalence of medical benefits was 15·6 per cent among workers with minor injuries, 22·3 per cent in those with moderate injuries and 40·5 per cent among workers with severe injuries. The median time after injury until return to work was 1, 4 and 11 months for patients with minor, moderate and severe injuries respectively. Twelve patients died within 30 days and an additional 17 (1·4 per cent) during follow-up. CONCLUSION Patients experiencing minor or major trauma received high levels of medical benefits; however, most recovered within the first year and resumed preinjury work activity. Patients with severe trauma were more likely to receive medical benefits and have a delayed return to work. Registration number: NCT02602405 (http://www.clinicaltrials.gov).
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Affiliation(s)
- O Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - K Pape
- Department of Public Health, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - T Kristiansen
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - P R Romundstad
- Department of Public Health, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - P Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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17
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Motor Vehicle Collisions and Their Consequences—Part 1: Common Physical, Psychosocial, and Cognitive Outcomes. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9331-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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Hahn Y, Tiernan G, Berecki-Gisolf J. The impact of opioid analgesic prescription uptake on the costs of recovery from injury: Evidence from compensable orthopaedic road trauma patients. ACCIDENT; ANALYSIS AND PREVENTION 2018; 117:32-39. [PMID: 29631183 DOI: 10.1016/j.aap.2018.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/26/2018] [Accepted: 03/31/2018] [Indexed: 06/08/2023]
Abstract
Long-term opioid prescribing after compensable orthopaedic injury may contribute to the 'long right tail' in the cost of recovery. The aim of this study was to estimate the effect of prescription opioid uptake on injury compensation cost, using orthopaedic road traffic injury claims data from Victoria, Australia. We used a maximum likelihood estimation that accounts for potential endogeneity associated with opioid uptake, utilizing information on the doctor's differential propensity to prescribe opioids when treating other compensable injury patients. Our results suggest that opioid recipients incurred significantly greater hospital costs, income compensation payments, and medical and paramedical expenses. Overall, income compensation was the primary driver of the claim cost difference between opioid recipients and non-recipients. The findings imply that there is scope to impose restrictions on long-term opioid usage, and to encourage the use of alternative pain relief medicines.
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Affiliation(s)
- Youjin Hahn
- School of Economics, Yonsei University. Postal address: 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Gemma Tiernan
- The Cube Group, Postal address: 7/136 Exhibition Street, Melbourne, VIC, 3000, Australia.
| | - Janneke Berecki-Gisolf
- Accident Research Centre, Monash University, Postal address: MUARC, Building 70, 21 Alliance Lane, Monash University, Clayton, VIC, 3800, Australia.
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Ranganathan V, Panneerselvam E, Chellappazham S, Balasubramaniam S, Raja V. B. K. Evaluation of Depression Associated With Post-Traumatic Stress Disorder After Maxillofacial Injuries—A Prospective Study. J Oral Maxillofac Surg 2018; 76:1282.e1-1282.e9. [DOI: 10.1016/j.joms.2018.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
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