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Jaekel C, Nienaber U, Neubert A, Kamp O, Wienhöfer L, Nohl A, Maegele M, Duesing H, Erichsen CJ, Frenzel S, Lefering R, Flohe S, Bieler D. Implementation of health-related quality of life in the German TraumaRegister DGU® - first results of a pilot study. Health Qual Life Outcomes 2024; 22:46. [PMID: 38840184 PMCID: PMC11151558 DOI: 10.1186/s12955-024-02261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/26/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Approximately 30,000 people are affected by severe injuries in Germany each year. Continuous progress in prehospital and hospital care has significantly reduced the mortality of polytrauma patients. With increasing survival rates, the functional outcome, health-related quality (hrQoL) of life and ability to work are now gaining importance. Aim of the study is, the presentation of the response behavior of seriously injured patients on the one hand and the examination of the factors influencing the quality of life and ability to work 12 months after major trauma on the other hand. Building on these initial results, a standard outcome tool shall be integrated in the established TraumaRegister DGU® in the future. METHODS In 2018, patients [Injury Severity Score (ISS) ≥ 16; age:18-75 years] underwent multicenter one-year posttraumatic follow-up in six study hospitals. In addition to assessing hrQoL by using the Short-Form Health Survey (SF-12), five additional questions (treatment satisfaction; ability to work; trauma-related medical treatment; relevant physical disability, hrQoL as compared with the prior to injury status) were applied. RESULTS Of the 1,162 patients contacted, 594 responded and were included in the analysis. The post-injury hrQoL does not show statistically significant differences between the sexes. Regarding age, however, the younger the patient at injury, the better the SF-12 physical sum score. Furthermore, the physically perceived quality of life decreases statistically significantly in relation to the severity of the trauma as measured by the ISS, whereas the mentally perceived quality of life shows no differences in terms of injury severity. A large proportion of severely injured patients were very satisfied (42.2%) or satisfied (39.9%) with the treatment outcome. It should be emphasized that patients with a high injury severity (ISS > 50) were on average more often very satisfied with the treatment outcome (46.7%). A total of 429 patients provided information on their ability to work 12 months post-injury. Here, 194 (45.2%) patients had a full employment, and 58 (13.5%) patients were had a restricted employment. CONCLUSION The present results show the importance of a structured assessment of the postinjury hrQoL and the ability to work after polytrauma. Further studies on the detection of influenceable risk factors on hrQoL and ability to work in the intersectoral course of treatment should follow to enable the best possible outcome of polytrauma survivors.
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Affiliation(s)
- Carina Jaekel
- Department of Orthopaedics and Traumatology, University Hospital and Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | | | - Anne Neubert
- Department of Orthopaedics and Traumatology, University Hospital and Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
| | - Oliver Kamp
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Lisa Wienhöfer
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Andre Nohl
- Department of Emergency Medicine, BG Klinikum Duisburg, Duisburg, 47249, Germany
| | - Marc Maegele
- Cologne-Merheim Medical Center (CMMC), Department of Trauma and Orthopedic Surgery, University Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany
| | - Helena Duesing
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Christoph J Erichsen
- Department of Trauma Surgery, BG Trauma Center Murnau, Murnau Am Staffelsee, Murnau, 82418, Germany
| | - Stephan Frenzel
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Universität Witten/Herdecke, Ostmerheimer Str.200, Haus 38, Cologne, 51109, Germany
| | - Sascha Flohe
- Department of Trauma, Orthopaedics and Hand Surgery, Städt. Klinikum Solingen, Solingen, Germany
| | - Dan Bieler
- Department of Orthopaedics and Traumatology, University Hospital and Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Department of Orthopedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany
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Lotfalla A, Halm JA, Schepers T, Giannakópoulos GF. Parameters influencing health-related quality of life after severe trauma: a systematic review (part II). Eur J Trauma Emerg Surg 2024; 50:93-106. [PMID: 37188975 PMCID: PMC10923745 DOI: 10.1007/s00068-023-02276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION It is increasingly recognized that health-related quality of life (HRQoL) is a relevant outcome to study in populations comprising severely injured patients. Although some studies have readily demonstrated a compromised HRQoL in those patients, evidence regarding factors that predict HRQoL is scarce. This hinders attempts to prepare patient-specific plans that may aid in revalidation and improved life satisfaction. In this review, we present identified predictors of HRQoL in patients that have suffered severe trauma. METHODS The search strategy included a database search until the 1st of January 2022 in the Cochrane Library, EMBASE, PubMed, and Web of Science, and reference checking. Studies were eligible for inclusion when (HR)QoL was studied in patients with major, multiple, or severe injury and/or polytrauma, as defined by authors by means of an Injury Severity Score (ISS) cut-off value. The results will be discussed in a narrative manner. RESULTS A total of 1583 articles were reviewed. Of those, 90 were included and used for analysis. In total, 23 possible predictors were identified. The following parameters predicted reduced HRQoL in severely injured patients and came forward in at least more than three studies: higher age, female gender, lower extremity injuries, higher rate of injury severity, lower achieved educational level, presence of (pre-existing) comorbidities and mental illness, longer duration of hospital stay, and high level of disability. CONCLUSION Age, gender, injured body region, and severity of injury were found to be good predictors of health-related quality of life in severely injured patients. A patient-centered approach, based on individual, demographic, and disease-specific predictors, is highly recommended.
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Affiliation(s)
- Annesimone Lotfalla
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Jens Anthony Halm
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Georgios Fredericus Giannakópoulos
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Simmel S, Kus S, Oberhauser C, Coenen M. [Quality of Life and Return to Work Following Rehabilitation - Results of the icfPROreha Study]. DIE REHABILITATION 2023; 62:268-277. [PMID: 37216965 DOI: 10.1055/a-2064-8434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Not only the severity of an injury, but also bio-psycho-social factors affect health-related quality of life and participation in social life after severe musculoskeletal injuries. METHODS Multicentre prospective longitudinal study with follow-up up to 78 weeks after discharge from inpatient trauma rehabilitation. Data were collected using a comprehensive assessment tool. Quality of life was assessed using the EQ-5D-5L, return to work by patients' self-reports and routine data of health insurances. Analyses of the association between quality of life and return to work, change over time in quality of life compared to the general German population and multivariate analyses to predict quality of life were conducted. RESULT Of 612 study participants (444 men (72.5%); M=48.5 years; SD 12.0), 502 (82.0%) returned to work 78 weeks after discharge from inpatient rehabilitation. Quality of life improved during rehabilitation treatment from 50.18 to 64.50 (mean of visual analogue scale of EQ-5D-5L) and slightly to 69.38 78 weeks after discharge from inpatient trauma rehabilitation. EQ-5D index was below the values of the general population. In total, 18 factors were selected to predict quality of life 78 weeks after discharge from inpatient trauma rehabilitation. Among others, pain at rest and suspected anxiety disorder at admission had a very strong effect on quality of life. Contextual factors such as therapies after acute care and self-efficacy also had an effect on quality of life 78 weeks after discharge from inpatient rehabilitation. CONCLUSION Bio-psycho-social factors affect long-term quality of life of patients with musculoskeletal injuries. Already at the time of discharge from acute treatment and even more at the beginning of inpatient rehabilitation, decisions can be made in order to achieve the best possible quality of life for those affected.
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Affiliation(s)
| | - Sandra Kus
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München
- Pettenkofer School of Public Health, München
| | - Cornelia Oberhauser
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München
- Pettenkofer School of Public Health, München
| | - Michaela Coenen
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München
- Pettenkofer School of Public Health, München
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Bayen E, Ruet A, Jourdan C, Pradat-Diehl P, Charanton J, Nelson G, Azerad S, Meaude L, Vallat-Azouvi C, Azouvi P. Lack of effect of litigation on long-term outcome after severe traumatic brain injury. Ann Phys Rehabil Med 2023; 66:101725. [PMID: 36645967 DOI: 10.1016/j.rehab.2022.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Eléonore Bayen
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France, Laboratoire d'Imagerie Biomédicale (LIB) Sorbonne Université, Paris, France and Global Brain Health Institute, University of California San Francisco, United-States.
| | - Alexis Ruet
- Physical Medicine and Rehabilitation Department, CHU Caen, INSERM U1077, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Hospital, CHRU, Montpellier, France
| | - Pascale Pradat-Diehl
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France, Laboratoire d'Imagerie Biomédicale (LIB) Sorbonne Université, Paris, France and Global Brain Health Institute, University of California San Francisco, United-States
| | - James Charanton
- Centre Ressource Francilien du Traumatisme Crânien, Paris, France
| | - Gaelle Nelson
- Centre Ressource Francilien du Traumatisme Crânien, Paris, France
| | - Sylvie Azerad
- Unité de Recherche Clinique Paris-Ouest, Hôpital Ambroise Paré, Boulogne, France
| | - Layide Meaude
- Unité de Recherche Clinique Paris-Ouest, Hôpital Ambroise Paré, Boulogne, France
| | | | - Philippe Azouvi
- Physical Medicine and Rehabilitation Department, Raymond Poincaré hospital, AP-HP, GH Paris Saclay, Université Paris-Saclay, Inserm CESP, Villejuif, France
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Asfaw A, Quay B, Bushnell T, Pana-Cryan R. Injuries That Happen at Work Lead to More Opioid Prescriptions and Higher Opioid Costs. J Occup Environ Med 2022; 64:e823-e832. [PMID: 36136663 PMCID: PMC10066591 DOI: 10.1097/jom.0000000000002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to compare opioid prescription incidence, supply days, and cost associated with occupational injury and other injury-caused conditions. METHODS We used Medical Expenditure Panel Survey (MEPS) data for 2010-2019. The MEPS provides information on medical conditions and associated medical encounters, treatments, and treatment costs, as well as demographic, education, health, working status, income, and insurance coverage information. We used descriptive statistics and logistic and 2-part regressions. RESULTS Controlling for covariates and compared with other injury-caused conditions, occupational injury-caused conditions resulted in 33% higher odds of opioid prescribing, 32.8 more opioid prescription supply days, and $134 higher average cost. CONCLUSIONS Occupational injuries were associated with higher opioid incidence and costs, and more opioid supply days. These findings point to the need to focus on making work safer and the role employers may play in supporting worker recovery from injury and opioid use disorders.
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Affiliation(s)
- Abay Asfaw
- From the Centers for Disease Control and Prevention (CDC)-National Institute for Occupational Safety and Health (NIOSH)-Economic Research and Support Office, Washington, DC (Drs Asfaw and Pana-Cryan); Centers for Disease Control and Prevention (CDC)-National Institute for Occupational Safety and Health (NIOSH)-Economic Research and Support Office, Cincinnati, Ohio (Mr Quay, Dr Bushnell)
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Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2022; 49:747-761. [PMID: 36445397 PMCID: PMC10175342 DOI: 10.1007/s00068-022-02178-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
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King TL, Disney G, Sutherland G, Kavanagh A, Spittal MJ, Simons K. Associations between workers’ compensation and self-harm: A retrospective case-series study of hospital admissions data. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 30:100614. [DOI: 10.1016/j.lanwpc.2022.100614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ritschel M, Kuske S, Gnass I, Andrich S, Moschinski K, Borgmann SO, Herrmann-Frank A, Metzendorf MI, Wittgens C, Flohé S, Sturm J, Windolf J, Icks A. Assessment of patient-reported outcomes after polytrauma - instruments and methods: a systematic review. BMJ Open 2021; 11:e050168. [PMID: 34916311 PMCID: PMC8679059 DOI: 10.1136/bmjopen-2021-050168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We (1) collected instruments that assess health-related quality of life (HRQoL), activities of daily living (ADL) and social participation during follow-up after polytrauma, (2) described their use and (3) investigated other relevant patient-reported outcomes (PROs) assessed in the studies. DESIGN Systematic Review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, as well as the trials registers ClinicalTrials.gov and WHO ICTRP were searched from January 2005 to April 2018. ELIGIBILITY CRITERIA All original empirical research published in English or German including PROs of patients aged 18-75 years with an Injury Severity Score≥16 and/or an Abbreviated Injury Scale≥3. Studies with defined injuries or diseases (e.g. low-energy injuries) and some text types (e.g. grey literature and books) were excluded. Systematic reviews and meta-analyses were excluded, but references screened for appropriate studies. DATA EXTRACTION AND SYNTHESIS Data extraction, narrative content analysis and a critical appraisal (e.g. UK National Institute for Health and Care Excellence) were performed by two reviewers independently. RESULTS The search yielded 3496 hits; 54 publications were included. Predominantly, HRQoL was assessed, with Short Form-36 Health Survey applied most frequently. ADL and (social) participation were rarely assessed. The methods most used were postal surveys and single assessments of PROs, with a follow-up period of one to one and a half years. Other relevant PRO areas reported were function, mental disorders and pain. CONCLUSIONS There is a large variation in the assessment of PROs after polytrauma, impairing comparability of outcomes. First efforts to standardise the collection of PROs have been initiated, but require further harmonisation between central players. Additional knowledge on rarely reported PRO areas (e.g. (social) participation, social networks) may lead to their consideration in health services provision. PROSPERO REGISTRATION NUMBER CRD42017060825.
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Affiliation(s)
- Michaela Ritschel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Silke Kuske
- Fliedner Fachhochschule Düsseldorf, University of Applied Sciences, Düsseldorf, Germany
| | - Irmela Gnass
- Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Kai Moschinski
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sandra Olivia Borgmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Annegret Herrmann-Frank
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Charlotte Wittgens
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sascha Flohé
- Department of Trauma, Orthopaedics and Hand Surgery, Städt. Klinikum Solingen, Solingen, Germany
- Department of Orthopaedics and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Joachim Windolf
- Department of Orthopaedics and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Orchard C, Carnide N, Smith P, Mustard C. The Association Between Case Manager Interactions and Serious Mental Illness Following a Physical Workplace Injury or Illness: A Cross-Sectional Analysis of Workers' Compensation Claimants in Ontario. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:895-902. [PMID: 33818670 DOI: 10.1007/s10926-021-09974-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
Poor mental health is a common occurrence among workers recovering from a work-related injury or illness. The objective of this cross-sectional study was to estimate the association between adverse interactions with workers' compensation case managers and experiencing a serious mental illness 18-months following a workplace injury or illness. A cohort of 996 workers' compensation claimants in Ontario Canada were interviewed 18 months following a disabling work-related injury or illness. Perceptions of informational and interpersonal justice in case manager interactions were defined as the primary independent variables, and Kessler Psychological Distress (K6) scores greater than 12, indicative of a serious mental illness, was defined as the outcome. Multivariate modified Poisson models estimated the association between perceptions of adverse case manager interactions and a serious mental illness, following adjustment for sociodemographic and work characteristics and pre-injury mental health. The prevalence of serious mental illness at 18 months was 16.6%. Low perceptions of informational justice, reported by 14.4% of respondents, were associated with a 2.58 times higher risk of serious mental illness (95% CI 1.30-5.10). Moderate and low perceptions of interpersonal justice, reported by 44.1% and 9.2% of respondents respectively, were associated with a 2.01 and 3.57 times higher risk of serious mental illness (95% CI moderate: 1.18-3.44, 95% CI poor: 1.81-7.06). This study provides further support for the impact of poor interactions with claims case managers on mental health, highlighting the importance of open and fair communication with workers' compensation claimants in ensuring timely recovery and return-to-work.
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Affiliation(s)
- Christa Orchard
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T3M7, Canada.
- Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON, M5G2E9, Canada.
| | - Nancy Carnide
- Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON, M5G2E9, Canada
| | - Peter Smith
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T3M7, Canada
- Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON, M5G2E9, Canada
- School of Population Health and Preventive Medicine, Monash University, 553 Kilda Road, Melbourne, VIC, 3004, Australia
| | - Cameron Mustard
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T3M7, Canada
- Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON, M5G2E9, Canada
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Savitsky B, Radomislensky I, Goldman S, Gitelson N, Frid Z, Peleg K. Returning to Work Following an Injury: Practical Usage of a Predictive Model Based on a Nationwide Study. J Community Health 2020; 45:183-193. [PMID: 31485793 DOI: 10.1007/s10900-019-00730-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Work absenteeism following an injury creates an economic burden on society and the individual. Programs encouraging return to work (RTW) should be implemented for high risk populations. The aim of this study was to identify the predictors for duration until RTW following an injury. The Israeli National Trauma Registry and the National Insurance Institute database (2008-2013) were linked. Logistic-regression models tested the probability not RTW within 1 month, 1 year and 2 years among 67% of the population and the quality of the model was examined among 33% of the population. The study population comprised 45,291 casualties (aged 21-67 and employed prior to injury as salaried workers). The majority of the study population (61%) RTW within 1 month from the injury event. Injury severity, multiple injuries, brain injury, traffic related injuries and fall injuries were significantly associated with work absenteeism. A dose-response relationship was found between income and not RTW: the lower the income the greater was the chance of not RTW. Among casualties with occupational injuries the odds for not RTW within a month, a year and 2 years were respectively, 3.7, 2.4 and 2 times significantly greater in comparison with casualties not injured at work. Underprivileged ethnic groups (Arabs and immigrants from Ethiopia) had a greater chance for long out of work stay following an injury. The outcomes of this study identified casualties at high risk for not RTW and enables health professionals to develop intervention programs focusing on returning to a productive lifestyle.
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Affiliation(s)
- Bella Savitsky
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, 52621, Ramat Gan, Israel.
| | - Irina Radomislensky
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, 52621, Ramat Gan, Israel
| | - Sharon Goldman
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, 52621, Ramat Gan, Israel
| | - Natalia Gitelson
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Zhanna Frid
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Kobi Peleg
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, 52621, Ramat Gan, Israel.,Department of Disaster Management, School of Public Health, Tel Aviv University, Tel Aviv, Israel
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Savitsky B, Radomislensky I, Goldman S, Gitelson N, Frid Z, Peleg K. Socio-economic disparities and returning to work following an injury. Isr J Health Policy Res 2020; 9:35. [PMID: 32616064 PMCID: PMC7330957 DOI: 10.1186/s13584-020-00392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/23/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Traumatic injury is one of the main reasons for temporary and permanent occupational disability. The objective of this study was to define the role of socio-economic position on post-injury occupational absenteeism. METHODS This was a nationwide retrospective cohort study, based on linking The Israeli National Trauma Registry (INTR) and the National Insurance Institute (NII) databases. The study population included 44,740 injured workers (residents of Israel, aged 21-67, hospitalized between 2008 and 2013 and employed prior to injury as salaried workers). Logistic-regression models tested the probability of not returning to work (RTW). RESULTS The majority of the study population (61%) RTW within 1 month following the injury event. Income prior to injury was significantly associated with longer out of work stay, explaining 9% variance. A significant interaction (p value < 0.0001) was found between age and income on out of work stay more than 1 month, 1 year and 2 years. Logistic regression models of out of work stay were conducted separately for all age groups. Lower income was associated with greater chance for out of work stay for more than 1 month; and the gap between the lowest and highest income quartiles was greater among older workers (age 55+), where there was an elevenfold increase in probability of not RTW among casualties from the lowest vs. highest income quartile. In comparison to other population groups, Arabs were at greater odds of longer out of work stay following an injury. Among injured persons recognized by the NII as having occupational injuries, the odds for not RTW within a month, a year and 2 years were respectively 3.9, 2.5 and 2.2 times significantly greater in comparison to employees injured outside the workplace. CONCLUSIONS This study identified population groups with a high probability of not RTW following an injury requiring hospitalization. Intervention programs for injured employees should promote early rehabilitation and aim to shorten out of work stay. These programs should be ethnically adapted and focus on underprivileged and disadvantaged populations.
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Affiliation(s)
- Bella Savitsky
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Public Health Policy Research, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel
| | - Irina Radomislensky
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Public Health Policy Research, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel
| | - Sharon Goldman
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Public Health Policy Research, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel
| | - Natalia Gitelson
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Zhanna Frid
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Kobi Peleg
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Public Health Policy Research, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel
- Department of Disaster Management, School of Public Health, Tel Aviv University, Tel-Aviv, Israel
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Travel barriers, unemployment, and external fixation predict loss to follow-up after surgical management of lower extremity fractures in Dar es Salaam, Tanzania. OTA Int 2020; 3:e061. [PMID: 33937685 PMCID: PMC8081490 DOI: 10.1097/oi9.0000000000000061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 12/08/2019] [Indexed: 12/26/2022]
Abstract
Objective: Predict loss to follow-up in prospective clinical investigations of lower extremity fracture surgery. Design: Secondary analysis of 2 prospective clinical trials. Setting: National public orthopaedic and neurologic trauma tertiary referral hospital in Dar es Salaam, Tanzania, a low-income country in sub-Saharan Africa. Patients/Participants: Three hundred twenty-nine femoral shaft and 240 open tibial shaft fracture patients prospectively enrolled in prospective controlled trials of surgical fracture management by external fixation, plating, or intramedullary nailing between June 2015 and March 2017. Intervention: Telephone contact for failure to attend scheduled 1-year clinic visit. Main Outcome Measurements: Ascertainment of primary trial outcome at 1-year from surgery; post-hoc telephone questionnaire for reasons patient did not attend the 1-year clinic visit. Results: One hundred twenty-seven femur fracture (39%) and 68 open tibia fracture (28%) patients did not attend the 1-year clinic visit. Telephone contact significantly improved ascertainment of the primary study outcome by 20% between 6-month and 1-year clinic visits to 82% and 92% respectively at study completion. Multivariable analysis associated unemployment (OR = 2.5 [1.7–3.9], P < .001), treatment with an external fixator (OR = 1.7 [1.0–2.8], P = .033), and each additional 20 km between residence and clinic (OR = 1.03 [1.00–1.06], P = .047] with clinic nonattendance. One hundred eight (55%) nonattending patients completed the telephone questionnaire, reporting travel distance to the hospital (49%), and travel costs to the hospital (46%) as the most prevalent reasons for nonattendance. Sixty-five percent of patients with open tibia fractures cited relocation after surgery as a contributing factor. Conclusions: Relocation during recovery, travel distance, travel cost, unemployment, and use of an external fixator are associated with loss to clinical follow-up in prospective investigations of femur and open tibia fracture surgery in this population. Telephone contact is an effective means to assess outcome.
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Dobbe A, Beaupre LA, Almansoori KA, Fung TS, Scharfenberger AV. Functional Outcomes of Isolated Infrasyndesmotic Fibula Fractures. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419892227. [PMID: 35097357 PMCID: PMC8564941 DOI: 10.1177/2473011419892227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Ankle fractures are among the most common injuries encountered by orthopedic surgeons, with an incidence ranging from 71 to 187 per 100 000 people. Few studies have reliably investigated injuries involving isolated fractures of the distal fibula below the level of the ankle syndesmosis. Therefore, this study details on the patient-reported outcomes of nonoperatively managed isolated infrasyndesmotic fibula (ISF) fractures with a minimum 3-year follow-up. Methods: A retrospective population-based cohort study was undertaken across all emergency departments serving a major urban population. Among 159 consecutive patients meeting inclusion criteria, 108 agreed to participate. Clinical information, functional outcomes, and radiographic measurements were collected from electronic medical records and 3 validated outcome measures: the American Academy of Orthopaedic Surgeons (AAOS) Foot & Ankle Scale (FAS), the AAOS Shoe-Comfort Scale (SCS), and a general questionnaire. Results: An incidence of 22 ISF fractures per 100 000 people/year was found with FAS (91.2 ± 12.9) and SCS scores (76.8 ± 27.7), similar to reported population norms. Approximately 40% of patients (n = 43) reported continuing symptoms including pain (81.8%), stiffness (68.1%), and/or instability (39.0%). Less than 13% (n = 14) reported “severe” disabilities, and no patients required operative intervention within the follow-up period. Less-favorable outcomes were reported among work-related injuries, female patients, and “avulsion-type” fractures less than 10 mm in height (P < .01). No relationships were identified between age, degree of articular-incongruity, fracture-displacement, and self-reported outcomes. Conclusions: The majority of patients with nonoperatively managed ISF fractures reported good-to-excellent early functional outcomes. Less-favorable outcomes were reported among work-related injuries, female patients, and “avulsion-type” fractures. Level of Evidence: Level III, comparative series.
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Affiliation(s)
- Ashlee Dobbe
- Department of Orthopedic Surgery, University of British Columbia, Kelowna, British Columbia, Canada
| | - Lauren A. Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | | | - Tak-Shing Fung
- Department of Information Technology, University of Calgary, Calgary, Canada
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Allemann F, Heining S, Zelle B, Probst C, Pape HC. Risk factors for complications and adverse outcomes in polytrauma patients with associated upper extremity injuries. Patient Saf Surg 2019; 13:7. [PMID: 30740144 PMCID: PMC6360674 DOI: 10.1186/s13037-019-0187-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In terms of upper extremity fractures by patients with multiple injuires, a lot of studies have assessed the functional outcome following trauma to have less favorable outcomes in regards to functional recovery. We tested the hypothesis that differences in clinical outcome occur between shaft and articular injuries of the upper extremity, when patients that sustained neurologic deficits (e.g. brachial plexus lesions) are excluded. METHODS We involved Patients with isolated or combined upper extremity fracture, ISS > 16 in a level one trauma center. The follow up was at least 10 years after the initial injury. Both clinical examination (range of motion, instability, contractures, peripheral nerve damage) and radiographic analysis were carried out. We evaluated also the development of heterotopic ossifications. To analyse patients were subdivided into 3 different subgroups (articular [IA], shaft [IS], and combined [C]). RESULTS A statistically significant difference was found when ROM was compared between Group IS and C (p = 0.012), for contractures between Groups IA and C (p = 0.009) and full muscle elbow forces between Groups IS and C (p = 0.005) and Group IA and IS (p = 0.021). There was a significantly increased incidence in heterotopic ossifications when articular involvement was present. This applied for the isolated (p < 0.02) and the combined group (Group C vs Group IS, p = 0.003).When Brooker type I/II in group IA and Brooker types III/IV were combined, there was a significant difference (p < 0.001). In group IA (n = 1) and in group C (n = 6), HO developed or worsened after revision surgery, all of which were performed for malunion or nonunion. CONCLUSIONS In this study, patients with isolated shaft fractures of the upper extremity tend to have a more favorable outcome in comparison with combined to isolated articular fractures in terms of range of motion, pain and the ability to use the arm for everyday activities.In the clinical practice of the treatment of polytraumatized patients with upper extremity injuries, we feel that the relevance of these injuries should not be underestimated. They are especially prone to development of heterotopic ossifications, thus requiring prophylactic measures, if necessary. As their incidence increases with the rate of reoperations, we feel that even during initial care, meticulous surgery is required to avoiding the necessity of revision surgeries. Similar to injuries below the knee, upper extremity injuries, should be treated to avoid any functional disability.
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Affiliation(s)
- Florin Allemann
- Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
| | - Sandro Heining
- Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
| | - Boris Zelle
- University of Texas Science Center at San Antonio, Floyd Curl Dr., 7703, San Antonio, TX 78229 USA
| | - Christian Probst
- Department of Trauma, Cologne-Merheim Med. Center, Ostmerheimerstr. 200, 51109 Koln, Germany
| | - Hans-Christoph Pape
- Department of Trauma, Universitaetsspital, University of Zurich, Raemistr.100, 8091 Zurich, Switzerland
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Plomb-Holmes C, Lüthi F, Vuistiner P, Leger B, Hilfiker R. A Return-to-Work Prognostic Model for Orthopaedic Trauma Patients (WORRK) Updated for Use at 3, 12 and 24 Months. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:568-575. [PMID: 28012065 PMCID: PMC5709449 DOI: 10.1007/s10926-016-9688-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Purpose Updating the Wallis Occupational Rehabilitation Risk (WORRK) model formula, predicting non-return to work (nRTW) at different time points (3 and 12 months) than in the validation study (2 years). Methods Secondary analysis of two samples was carried out (following orthopaedic trauma), including work status, the first at 3 months (428 patients) and the second at 12 months (431 patients) after discharge from rehabilitation. We used calibration (agreement between predicted probabilities and observed frequencies) and discrimination (area under the receiver operating characteristics curve) to assess performance of the model after fitting it in the new sample, then calculated the probabilities of nRTW based on the coefficients from the 2-year prediction. Finally, the intercepts were updated for both 3- and 12-month prediction models (re-calibration was necessary for the adjustment of these probabilities) and performance re-evaluated. Results Patient characteristics were similar in all samples (mean age 43 in both groups; 86% male at 3 months, 84% male at 12 months). The proportion of nRTW at 3 months was 63.8% and 53.4% at 12 months (50.36% at 2 years). Performance of the original WORRK for both 3- and 12-month prediction showed an AUC of 0.73, while statistically significant miscalibration was found for both time points (p < 0.001). After the updating of the intercept, calibration was improved and did not show significant miscalibration (p = 0.458 and 0.341). The AUC stayed at 0.73. Conclusion The WORRK model was successfully adapted by changing the intercept for 3- and 12-month prediction of nRTW, now available for use in clinical practice.
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Affiliation(s)
- Chantal Plomb-Holmes
- Department for Musculoskeletal Rehabilitation, Clinique romande de réadaptation suvacare, Sion, Switzerland.
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland.
| | - François Lüthi
- Department for Musculoskeletal Rehabilitation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- Département de l'Appareil Locomoteur, Hôpital Orthopédique, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Vuistiner
- Department for Musculoskeletal Rehabilitation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bertrand Leger
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland
| | - Roger Hilfiker
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), Sion, Switzerland
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Gabbe BJ, Simpson PM, Cameron PA, Ponsford J, Lyons RA, Collie A, Fitzgerald M, Judson R, Teague WJ, Braaf S, Nunn A, Ameratunga S, Harrison JE. Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study. PLoS Med 2017; 14:e1002322. [PMID: 28678814 PMCID: PMC5497942 DOI: 10.1371/journal.pmed.1002322] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improved understanding of the quality of survival of patients is crucial in evaluating trauma care, understanding recovery patterns and timeframes, and informing healthcare, social, and disability service provision. We aimed to describe the longer-term health status of seriously injured patients, identify predictors of outcome, and establish recovery trajectories by population characteristics. METHODS AND FINDINGS A population-based, prospective cohort study using the Victorian State Trauma Registry (VSTR) was undertaken. We followed up 2,757 adult patients, injured between July 2011 and June 2012, through deaths registry linkage and telephone interview at 6-, 12-, 24-, and 36-months postinjury. The 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3L) was collected, and mixed-effects regression modelling was used to identify predictors of outcome, and recovery trajectories, for the EQ-5D-3L items and summary score. Mean (SD) age of participants was 50.8 (21.6) years, and 72% were male. Twelve percent (n = 333) died during their hospital stay, 8.1% (n = 222) of patients died postdischarge, and 155 (7.0%) were known to have survived to 36-months postinjury but were lost to follow-up at all time points. The prevalence of reporting problems at 36-months postinjury was 37% for mobility, 21% for self-care, 47% for usual activities, 50% for pain/discomfort, and 41% for anxiety/depression. Continued improvement to 36-months postinjury was only present for the usual activities item; the adjusted relative risk (ARR) of reporting problems decreased from 6 to 12 (ARR 0.87, 95% CI: 0.83-0.90), 12 to 24 (ARR 0.94, 95% CI: 0.90-0.98), and 24 to 36 months (ARR 0.95, 95% CI: 0.95-0.99). The risk of reporting problems with pain or discomfort increased from 24- to 36-months postinjury (ARR 1.06, 95% CI: 1.01, 1.12). While loss to follow-up was low, there was responder bias with patients injured in intentional events, younger, and less seriously injured patients less likely to participate; therefore, these patient subgroups were underrepresented in the study findings. CONCLUSIONS The prevalence of ongoing problems at 3-years postinjury is high, confirming that serious injury is frequently a chronic disorder. These findings have implications for trauma system design. Investment in interventions to reduce the longer-term impact of injuries is needed, and greater investment in primary prevention is needed.
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Affiliation(s)
- Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Farr Institute, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Pam M. Simpson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ronan A. Lyons
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Farr Institute, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Trauma Service, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Rodney Judson
- Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Warwick J. Teague
- Trauma Service, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Surgical Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Sandra Braaf
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - James E. Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, South Australia, Australia
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Padovani C, Da Silva JM, Rotta BP, Neto RDCP, Fu C, Tanaka C. Recovery of functional capacity in severe trauma victims at one year after injury: association with trauma-related and hospital stay aspects. J Phys Ther Sci 2016; 28:1432-7. [PMID: 27313345 PMCID: PMC4905884 DOI: 10.1589/jpts.28.1432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/19/2016] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the functional capacity of trauma
survivors one year after hospital discharge and to identify associations with trauma- and
hospital stay-related aspects in a developing country. [Subjects and Methods] This study
included severe trauma patients (Injury Severity Score ≥16; ≥18 years
old) who were admitted to an intensive care unit in Sao Paulo, Brazil. Hospital stay data
were collected from the patients’ records. Functional capacity was assessed using the
Glasgow Outcome Scale and Lawton Instrumental Activities of
Daily Living Scale one year after hospital discharge. Patients were asked if
they had returned to work/school. [Results] Forty-nine patients completed follow-up.
According to the Glasgow Outcome Scale data, most patients had moderate
or mild/no dysfunction. The Lawton Instrumental Activities of Daily Living
Scale showed that 60–70% of the subjects performed most activities
independently. Multiple linear regression of the Glasgow score, Acute Physiology
and Chronic Health Disease Classification System II score, length of mechanical
ventilation, and hospital length of stay revealed an association between the
Lawton Instrumental Activities of Daily Living Scale and hospital
length of stay. Overall, 32.6% of the subjects had returned to work/school. [Conclusion]
Most severe trauma patients experienced functional recovery, although only one-third had
returned to work/school one year after hospital discharge. Hospital length of stay was
identified as a significant predictor of functional recovery.
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Affiliation(s)
- Cauê Padovani
- Hospital das Clínicas da Faculdade de Medicina, University of São Paulo, Brazil; Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Brazil
| | | | - Bruna Peruzzo Rotta
- Hospital do Servidor Público Estadual, Brazil; Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Brazil
| | | | - Carolina Fu
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Brazil
| | - Clarice Tanaka
- Hospital das Clínicas da Faculdade de Medicina, University of São Paulo, Brazil; Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, Brazil
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Kilgour E, Kosny A, Akkermans A, Collie A. Procedural Justice and the Use of Independent Medical Evaluations in Workers’ Compensation. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9222-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Impact of the severity of trauma on early retirement. Injury 2014; 45:618-23. [PMID: 24176678 DOI: 10.1016/j.injury.2013.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/18/2013] [Accepted: 09/09/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the association between Injury Severity Score (ISS) and subsequent risk of early retirement. DESIGN Observational cohort study with follow-up based on prospectively collected data. Hospital-based data were linked to national register data on pension reception and vital status. SETTING Level-one urban trauma centre. PARTICIPANTS Patients aged 18-64 years entering the trauma centre in Copenhagen during 1999-2007 who were alive after three days were followed until early retirement, death or emigration. MAIN OUTCOME MEASURES Primary outcome was early retirement, defined as receiving disability pension (unintentional) or voluntary early retirement pension (intentional) before the regular age of retirement (65 years). Relative risk of early retirement according to ISS (low, ISS 1-15 vs. high, ISS 16-75) was assessed using Cox proportional hazards regression, adjusted for age and gender. RESULTS Of all 6687 patients admitted to the trauma centre, a total of 1722 trauma patients were included and followed for a median of 6.2 years (interquartile range (IQR) 3.7-9.1). Of these, 1305 (75.8%) were males, median age was 35.0 years (IQR 25.4-46.5), and median ISS was 16 (IQR 9-25). Three hundred and twenty-two patients retired during follow-up. Patients with high ISS, compared to patients with low ISS, had an increased risk of early retirement, adjusted hazard ratio 2.60 (95% confidence interval (CI) 2.05-3.30; p<0.001). Relative increase in retirement risk was 1.04 (95% CI 1.03-1.05) per ISS point and 1.03 (95% CI 1.03-1.04) per year older. Gender was not found to be a significant risk factor (p=0.69). Five-year absolute risks of early retirement were 9.9% (95% CI 7.8-12.0%) for the low ISS group and 24.6% (95% CI 21.6-27.5%) for the high ISS group. CONCLUSIONS The risk of early retirement is 2.6 times higher in severely injured patients (ISS 16-75) than the risk in low to moderately injured patients (ISS 1-15) and they have a high absolute 5-year risk as well. Early, targeted interventions to assist with return to work might be able to reduce this risk.
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Hepp U, Schnyder U, Hepp-Beg S, Friedrich-Perez J, Stulz N, Moergeli H. Return to work following unintentional injury: a prospective follow-up study. BMJ Open 2013; 3:e003635. [PMID: 24327361 PMCID: PMC3863117 DOI: 10.1136/bmjopen-2013-003635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to predict time off work following unintentional injuries due to accidents leading to hospital admission. DESIGN Prospective 6-month follow-up study. SETTING Department of Trauma Surgery of a University Hospital. PARTICIPANTS Consecutively recruited victims of unintentional injuries (n=221) hospitalised for a minimum of 32 h including two consecutive nights. All the participants were aged 18-65 years and were able to participate in an assessment within 30 days of the accident. MAIN OUTCOME MEASURES Interview-assessed number of days off work during the 6 months immediately following the accident. RESULTS The patients' subjective appraisals of (1) accident severity and (2) their ability to cope with the resulting injury and its job-related consequences predicted time off work following the accident beyond the impact of the objective severity of their injury and the type of accident involved. CONCLUSIONS The patients' subjective appraisals of the accident severity and of their ability to cope with its consequences are highly relevant for return to work after accidents. Extending the findings from previous studies on severely injured and otherwise preselected accident victims, this seems to apply to the whole spectrum of patients hospitalised with unintentional injuries.
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Affiliation(s)
- Urs Hepp
- Outpatient Department, Psychiatric Services Aargau (Teaching Hospital of the University of Zurich), Brugg, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Niklaus Stulz
- Outpatient Department, Psychiatric Services Aargau (Teaching Hospital of the University of Zurich), Brugg, Switzerland
| | - Hanspeter Moergeli
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
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Lilley R, Davie G, Langley J, Ameratunga S, Derrett S. Do outcomes differ between work and non-work-related injury in a universal injury compensation system? Findings from the New Zealand Prospective Outcomes of Injury Study. BMC Public Health 2013; 13:995. [PMID: 24148609 PMCID: PMC4015720 DOI: 10.1186/1471-2458-13-995] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/16/2013] [Indexed: 12/02/2022] Open
Abstract
Background Poorer recovery outcomes for workers injured in a work setting, as opposed to a non-work setting, are commonly attributed to differences in financial gain via entitlement to compensation by injury setting (ie. workers compensation schemes). To date, this attribution hasn’t been tested in a situation where both work and non-work-related injuries have an equivalent entitlement to compensation. This study tests the hypothesis that there will be no differences in recovery outcomes for workers by injury setting (work and non-work) within a single universal entitlement injury compensation scheme. Methods Workforce active participants from the Prospective Outcomes of Injury Study (POIS) cohort were followed up at 3- and 12-months following injury. Participants who were injured in the period June 2007- May 2009 were recruited from New Zealand’s universal entitlement injury compensation scheme managed by the Accident Compensation Corporation (ACC). An analysis of ten vocational, disability, functional and psychological recovery outcomes was undertaken by injury setting. Modified Poisson regression analyses were undertaken to examine the relationship between injury setting and recovery outcomes. Results Of 2092 eligible participants, 741 (35%) had sustained an injury in a work setting. At 3 months, workers with work-related injuries had an elevated risk of work absence however, this difference disappeared after controlling for confounding variables (adjusted RR 1.10, 95% CI 0.94-1.29). By 12 months, workers with work-related injuries had poorer recovery outcomes with a higher risk of absence from work (aRR 1.37, 95% CI 1.10-1.70), mobility-related functional problems (aRR 1.35, 95% CI 1.14-1.60), disability (aRR 1.32, 95% CI 1.04-1.68) and impaired functioning related to anxiety/depression (aRR 1.21, 95% CI 1.00-1.46). Conclusion Our study, comparing recovery outcomes for workers by injury setting within a single universal entitlement injury compensation scheme, found mixed support for the hypothesis tested. After adjustment for possible covariates recovery outcomes did not differ by injury setting at 3 months following injury, however, by 12 months vocational, disability and some functional outcomes, were poorer for workers with work-related injuries. Given our findings, and other potential mechanisms for poorer outcomes for workers with work-related injuries, further research beyond differences in entitlement to compensation should be undertaken to inform future interventions.
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Affiliation(s)
- Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Dienstknecht T, Pfeifer R, Horst K, Sellei RM, Berner A, Zelle BA, Probst C, Pape HC. The long-term clinical outcome after pelvic ring injuries. Bone Joint J 2013; 95-B:548-53. [DOI: 10.1302/0301-620x.95b4.30804] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the functional and socioeconomic long-term outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre between 1973 and 1990 with multiple blunt orthopaedic injuries including an injury to the pelvic ring, with an Injury Severity Score (ISS) of ≥ 16. These patients were invited for clinical review at a minimum of ten years after the initial injury, at which point functional results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior (group P) and 43 combined anterior/posterior pelvic ring injuries (group A/P) were included. The mean age of the patients at injury was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42), being significantly worse compared with the other two groups (p = 0.004 and p = 0.024, respectively). A total of 42 patients (39%) had a limp and 12 (11%) required crutches. Car or public transport usage was restricted in 16 patients (15%). Overall patients in groups P and A/P had a worse outcome. The long-term outcome of patients with posterior or combined anterior/posterior pelvic ring injuries is poorer than of those with an isolated anterior injury. Cite this article: Bone Joint J 2013;95-B:548–53.
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Affiliation(s)
- T. Dienstknecht
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - R. Pfeifer
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - K. Horst
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - R. M. Sellei
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - A. Berner
- University Hospital Regensburg, Department
of Trauma Surgery, Franz-Josef-Strauss-Allee
11, 93053 Regensburg, Germany
| | - B. A. Zelle
- UT Health Science Center at San Antonio, Department
of Orthopaedic Surgery, Division of Orthopaedic
Traumatology 7703 Floyd Curl Dr, MC-7774, San
Antonio, TX 78229, USA
| | - C. Probst
- Cologne Merheim Medical Center, Department
of Trauma and Orthopaedic Surgery, Ostmerheimer
Str. 200, 51109 Cologne, Germany
| | - H-C. Pape
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
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Abstract
BACKGROUND Loss of follow-up represents a potential source of bias. Suggested guidelines propose 20% loss of follow-up as acceptable. However, these guidelines have not been established through scientific investigations. The goal of this study was to evaluate how loss of follow-up influences the statistical significance in a trauma database. METHODS A database of 637 polytrauma patients with an average follow-up of 17.5 years postinjury was used. The functional outcome of workers' compensation patients versus nonworkers' compensation patients was compared using a validated scoring system. A significant difference between the 2 groups was found (P < 0.05). We simulated a gradually increasing loss of follow-up by randomly deleting an increasing number of patients from 2%, 5%, and 10%, and then increasing in increments of 5% until the significance changed. This process was repeated 50 times, each time with a different electronic random generator. For each simulation series, we documented at which simulated loss of follow-up that the results turned from significant (P < 0.05) to nonsignificant (P > 0.05). RESULTS Among 50 simulation series, the turning point from significant to nonsignificant varied between 15% and 75% loss of follow-up. A simulated loss of follow-up of 10% did not change the statistical significance in any of the simulation series; a simulated loss of follow-up of 20% changed the statistical significance in 28% of our simulation series. CONCLUSIONS A loss of follow-up of 20% or less may frequently change the study results. Researchers should establish protocols to minimize loss of follow-up and clearly state the loss of follow-up in manuscript publications.
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Impact of isolated acetabular and lower extremity fractures on long-term outcome. J Trauma Acute Care Surg 2012; 72:467-72. [PMID: 22439211 DOI: 10.1097/ta.0b013e318219fbfa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The long-term clinical status of surviving patients with multiple injuries has not been well described. The aim of this study was to evaluate the long-term outcome of acetabular and lower limb injuries. METHODS Patients treated at a Level I trauma center at least 10 years before participation in this study were invited for a follow-up physical examination. Six hundred thirty-seven patients were examined. Inclusion criteria are as follows: Injury Severity Score ≥16 Points;treatment in a Level I trauma center; and injuries of the lower limb: fractures of the acetabulum, proximal femur, femoral shaft,knee joint, and tibial shaft. Exclusion criteria are as follows: incomplete follow-up examination, amputations, ankle and foot fractures, and patients older than 60 years and younger than 3 years. The follow-up examination included the following parameters:range of motion, pain, limping, successful rehabilitation, and outcome scores. RESULTS Of 525 patients with fractures of the acetabulum and lower limb, 229 patients fulfilled the inclusion criteria. Mean age: 24.9 (range,3–60) years; Injury Severity Score: 19.66 (range, 16–43). The most frequent rates of ongoing local pain were stated by patients with fractures of the acetabulum (50%) and the proximal femur (45%). Moreover, the incidence of abnormal gait was significantly lower in patients with femoral shaft fractures when compared with the patients with fractures of the acetabulum (3.7% vs. 35%;p 0.0001), proximal femur (3.7% vs. 20%; p≤ 0.006), and tibial shaft (3.7% vs. 14.7%; p = 0.023). CONCLUSIONS Our results demonstrate a better long-term outcome in patients with femur shaft fractures, whereas patients with articular fractures and proximal femur fractures were associated with poorer outcomes. Fracture location is determining factor for long-term outcome
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Factors that affect the occurrence and chronicity of occupation-related musculoskeletal disorders. Best Pract Res Clin Rheumatol 2011; 25:103-15. [PMID: 21663853 DOI: 10.1016/j.berh.2011.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 12/16/2010] [Indexed: 11/23/2022]
Abstract
The components that affect the occurrence and chronicity of musculoskeletal disease are multifactorial. The return to work process and prevention of future chronic disability commences at the time of the initial assessment. The clinician can identify, at an early stage, patients with negative expectations of return to work and adopt a care plan oriented to functional adaptation. Medical and psychosocial treatment plans taking account of coping preferences, beliefs and practices are more likely to help prevent chronic disability. Other factors that can influence the long-term disability rate include medically discretionary or unnecessary time off work and litigation itself. Workplace factors can result in unnecessary absenteeism and poorly managed presenteeism.
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Socio-economic outcome after blunt orthopaedic trauma: Implications on injury prevention. Patient Saf Surg 2011; 5:9. [PMID: 21569475 PMCID: PMC3105957 DOI: 10.1186/1754-9493-5-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/13/2011] [Indexed: 12/02/2022] Open
Abstract
Background Several large studies have identified factors associated with long-term outcome after orthopaedic injuries. However, long-term social and economic implications have not been published so far. The aim of this investigation is to study the long-term socio-economic consequences of patients sustaining severe trauma. Methods Patients treated at a level one trauma center were invited for a follow-up (at least 10 years) examination. There were 637 patients who responded and were examined. Inclusion criteria included injury severity score (ISS) ≥ 16 points, presence of lower and upper extremity fractures, and age between 3 and 60 years. Exclusion criteria included the presence of amputations and paraplegia. The socio-economic outcome was evaluated in three age groups: group I (< 18 years), group II (19 - 50 years), and group III (> 50 years). The following parameters were analyzed using a standardized questionnaire: financial losses, net income losses, pension precaution losses, need for a bank loan, and the decrease in number of friends. Results 510 patients matched all study criteria, and breakdown of groups were as follows: 140 patients in group I, 341 patients in group II, and 29 patients in group III. Financial losses were reported in all age groups (20%-44%). Younger patients (group I) were associated with less income losses when compared with other groups (p < 0.05). Financial deterioration was more frequently reported in age group II (p < 0.05). Social consequences (number of friends decreased) were predominantly stated in patients younger than 18 years old (p < 0.05). Conclusions Economic consequences are reported by polytraumatized patients even ten or more years after injury. Financial losses appear to be common in patients between 19 and 50 years. In contrast, social deprivation appears to be most pronounced in the younger age groups. Early socio-economic support and measures of injury prevention should focus on these specific age groups.
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Hepp U, Moergeli H, Buchi S, Bruchhaus-Steinert H, Sensky T, Schnyder U. The long-term prediction of return to work following serious accidental injuries: a follow up study. BMC Psychiatry 2011; 11:53. [PMID: 21470424 PMCID: PMC3082290 DOI: 10.1186/1471-244x-11-53] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 04/06/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Considerable indirect costs are incurred by time taken off work following accidental injuries. The aim of this study was to predict return to work following serious accidental injuries. METHOD 121 severely injured patients were included in the study. Complete follow-up data were available for 85 patients. Two weeks post trauma (T1), patients rated their appraisal of the injury severity and their ability to cope with the injury and its job-related consequences. Time off work was assessed at one (T2) and three years (T3) post accident. The main outcome was the number of days of sick leave taken due to the accidental injury. RESULTS The patients' appraisals a) of the injury severity and b) of their coping abilities regarding the accidental injury and its job-related consequences were significant predictors of the number of sick-leave days taken. Injury severity (ISS), type of accident, age and gender did not contribute significantly to the prediction. CONCLUSIONS Return to work in the long term is best predicted by the patients' own appraisal of both their injury severity and the ability to cope with the accidental injury.
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Affiliation(s)
- Urs Hepp
- Psychiatrische Dienste Aargau AG, Baden, Switzerland.
| | - Hanspeter Moergeli
- Department of Psychiatry, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Tom Sensky
- Division of Neurosciences and Psychological Medicine, Imperial College School of Medicine, West Middlesex Hospital, Isleworth, Middlesex, UK
| | - Ulrich Schnyder
- Department of Psychiatry, University Hospital Zurich, Zurich, Switzerland
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Predictors of Late Clinical Outcome Following Orthopedic Injuries After Multiple Trauma. ACTA ACUST UNITED AC 2010; 69:1243-51. [DOI: 10.1097/ta.0b013e3181ce1fa1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O'Donnell ML, Creamer MC, McFarlane AC, Silove D, Bryant RA. Does access to compensation have an impact on recovery outcomes after injury? Med J Aust 2010; 192:328-33. [PMID: 20230350 DOI: 10.5694/j.1326-5377.2010.tb03532.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 10/27/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident (MVA) compensation on recovery outcomes at 24 months after injury. DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria, Australia. Participants were 391 randomly selected injury patients with moderate-to-severe injuries. Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes. MAIN OUTCOME MEASURES Health outcomes at 24 months, including anxiety and depression severity, quality of life and disability. RESULTS Medical records identified two groups of compensation patients: MVA-compensable and non-compensable patients. After controlling for baseline variables, the MVA-compensable patients, at 24 months, had higher levels of post-traumatic stress disorder, anxiety and depression, and were less likely to have returned to their pre-injury number of work hours. However, some patients in the non-compensable group had accessed other forms of compensation (eg, private health care or compensation for victims of crime). When these were removed from the non-compensable group, the differences between MVA-compensable and non-compensable groups all but disappeared. CONCLUSION Our findings do not support previous research showing that access to compensation is associated with poor recovery outcomes. The relationship between access to compensation and health outcomes is complex, and more high-level research is required.
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Simmel S, Bühren V. [Surviving multiple trauma--what comes next? The rehabilitation of seriously injured patients]. Unfallchirurg 2010; 112:965-74. [PMID: 19816668 DOI: 10.1007/s00113-009-1686-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The survival chances of multiple trauma patients have improved continuously over the last decades. Therefore, not only the question of whether the patient survives a serious accident arises, but rather how the patient survives it. The after effects of trauma are seen not only physically, but also psychologically and socially. These affect quality of life and are evident years after the accident. The International Classification of Functioning, Disability and Health (ICF) provides a system to classify the after effects of trauma, which can be measured with the help of assessment instruments. Knowing which parameters can influence trauma after effects is essential for the planning, organization, and implementation of a rehabilitation programme following severe injury. The requirements of an optimal rehabilitation process place high demands on the rehabilitation facility and on the rehabilitation team, which ultimately can only be fulfilled by specialized facilities.
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Affiliation(s)
- S Simmel
- Abteilung für BG-Rehabilitation, BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418 Murnau.
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Regional Differences in Rehabilitation Needs, Rehabilitation Access, and Physical Outcomes Among Multiple Trauma Survivors. Am J Phys Med Rehabil 2009; 88:387-98. [DOI: 10.1097/phm.0b013e31819c592f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
OBJECTIVE To determine predictors of moderate or severe pain 6 months after orthopaedic injury. DESIGN Prospective cohort study. SETTING Two adult level 1 trauma centers in Victoria, Australia. PARTICIPANTS A total of 1290 adults admitted with orthopaedic injuries and registered by the Victorian Orthopaedic Trauma Outcomes Registry. MAIN OUTCOME MEASURES Participant self-reported pain and health status using an 11-point numerical rating scale and the 12-item Short-Form health survey, respectively. RESULTS The prevalence of moderate or severe pain was 48% [95% confidence interval (CI), 45-51] at discharge and 30% (95% CI, 28-33) at 6 months postinjury. Failure to complete high school [adjusted odds ratio (AOR) 1.5 (95% CI, 1.1-1.9)], self-reported preinjury pain-related disability [AOR 1.8 (95% CI, 1.3-2.5)], eligibility for compensation [AOR 2.1 (95% CI, 1.6-2.8)], and moderate or severe pain at discharge from the acute hospital [AOR 2.4 (95% CI, 1.8-3.1)] were found to be independent predictors of moderate or severe pain at 6 months postinjury. CONCLUSIONS Moderate or severe pain is commonly reported 6 months after orthopaedic trauma. Pain intensity at discharge and the effects of a "no-fault" compensation system are potentially modifiable factors that might be addressed through intervention studies to reduce the burden of persistent pain after orthopaedic trauma.
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Harris I, Dao ATT, Young J, Solomon M, Jalaludin BB, Rae H. Factors predicting patient satisfaction following major trauma. Injury 2007; 38:1102-8. [PMID: 17697676 DOI: 10.1016/j.injury.2007.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 04/28/2007] [Accepted: 05/03/2007] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patient satisfaction is an intuitively important outcome measure and has been previously linked to general health status. Previous research on patient satisfaction after injury has concentrated on satisfaction with medical care. This study aims to explore possible predictors of patient satisfaction with outcome following major trauma. METHODS A cross-sectional survey involving consecutive adult patients involved in major accidental trauma from a major metropolitan trauma centre, over a 5-year period, was performed between 1 and 6 years post-injury. The outcome used was patient satisfaction with progress since the injury. Multiple logistic regression was used to develop a model of significant predictors of patient satisfaction. RESULTS The survey was mailed to 728 eligible patients, 56 were excluded due to death or inability to complete the survey, 93 refused to participate and 90 were not contactable. One hundred and thirty-four patients did not respond and 355 completed surveys were returned. Patient dissatisfaction was found to be significantly associated with unemployment at the time of follow up (OR, 2.38; 95% CI, 1.38-4.08; p=0.004), having one or more chronic illnesses at the time of injury (OR, 2.57; 95% CI, 1.45-4.55; p=0.001), being involved in a motor vehicle accident (OR, 1.83; 95% CI, 1.02-3.30; p=0.04) and having an unsettled compensation claim (OR, 5.19; 95% CI, 2.80-9.65; p<0.0001). Patient satisfaction was not significantly associated with any measure of injury severity. CONCLUSIONS Having an unsettled compensation claim after major trauma is the strongest predictor of patient dissatisfaction following major trauma, allowing for other factors.
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Affiliation(s)
- Ian Harris
- Orthopaedic Department, Liverpool Hospital, Elizabeth Street, Liverpool, NSW 2170, Australia.
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Gabbe BJ, Cameron PA, Williamson OD, Edwards ER, Graves SE, Richardson MD. The relationship between compensable status and long‐term patient outcomes following orthopaedic trauma. Med J Aust 2007; 187:14-7. [PMID: 17605697 DOI: 10.5694/j.1326-5377.2007.tb01108.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 02/15/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the relationship between compensable status in a "no-fault" compensation scheme and long-term outcomes after orthopaedic trauma. DESIGN AND SETTING Prospective cohort study within two adult Level 1 trauma centres in Victoria, Australia. PARTICIPANTS Blunt trauma patients aged 18-64 years, admitted between September 2003 and August 2004 with orthopaedic injuries and funded by the no-fault compensation scheme for transport-related injury, or deemed non-compensable. MAIN OUTCOME MEASURES 12-item Short Form Health Survey (SF-12) and return to work or study at 12 months after injury. RESULTS Of 1033 eligible patients, 707 (68.8%) provided follow-up data; 450 compensable and 247 non-compensable patients completed the study. After adjusting for differences across the groups (age, injury severity, head injury status, injury group, and discharge destination) using multivariate analyses, compensable patients were more likely than non-compensable patients to report moderate to severe disability at follow-up for the physical (adjusted odds ratio [AOR], 2.0; 95% CI, 1.3-2.9), and mental (AOR, 1.6; 95% CI, 1.1-2.5) summary scores of the SF-12. Compensable patients were less likely than non-compensable patients to have returned to work or study, even after adjusting for injury severity, age, head injury status and discharge destination (AOR, 0.6; 95% CI, 0.3-0.9). CONCLUSIONS Patients covered by the no-fault compensation system for transport-related injuries in Victoria had worse outcomes than non-compensable patients.
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Affiliation(s)
- Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Pape HC, Zelle B, Lohse R, Stalp M, Hildebrand F, Krettek C, Panzica M, Duhme V, Sittaro NA. Evaluation and outcome of patients after polytrauma--can patients be recruited for long-term follow-up? Injury 2006; 37:1197-203. [PMID: 17087960 DOI: 10.1016/j.injury.2006.07.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Accepted: 07/12/2006] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is limited information available about the long-term follow-up of polytrauma patients. In this study, the social and medical sequelae of trauma were reinvestigated at 10 years after the injury. METHODS Patients were selected out of a population of polytraumatised patients treated at Hannover Medical School between 1973 and 1990. INCLUSION CRITERIA multiple injuries treated at one institution, age between 3 and 60 years of age at the time of injury. Patients were recruited by gathering their residences from the charts. If patients had moved, up to three different registration offices were contacted by mail. The patient was contacted by mail (maximum three times) and by telephone. A patient was documented as lost to follow-up if none of these attempts was successful, or if he did not fulfil three subsequent appointments. All patients were examined by a physician, using a patient questionnaire and a standardized physical exam. RESULTS Six hundred thirty-seven patients (67.8% of the potential enrollees) were evaluated on an outpatient basis by a trauma surgeon using a self-administered patient questionnaire and a standardized physical exam. In these, the average follow-up was 17.5 (range 10-28) years; the average Injury Severity Score (ISS) was 20.7 (range 4-54). Head injuries were the third most frequent injuries, but represented the most frequent cause of permanent disability (40%). The overall rehabilitation status graded by the patients was very good in 14.1%, good in 33.0%, satisfactory in 29.3%, sufficient in 16.0% and poor or insufficient in 7.5%. CONCLUSIONS This study suggests that a high percentage of patients can be recruited for follow-up even after 10 years post trauma with the use of a meticulous reinvitation strategy. Head injuries accounted for the most frequent cause of disability, suggesting that more research should be provided to minimise the degree of injury and improve the outcome for head injured patients. Subjective grading of the outcome was better than expected in patients who had regained complete social rehabilitation.
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Affiliation(s)
- H-C Pape
- Department of Orthopaedics, University of Pittsburgh Medical Center, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA 15213, USA.
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