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Meakes S, Enninghorst N, Weaver N, Hardy BM, Balogh ZJ. Long-term functional outcomes in polytrauma: a fundamentally new approach is needed in prediction. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02430-6. [PMID: 38358513 DOI: 10.1007/s00068-023-02430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE Modern trauma care has reduced mortality but poor long-term outcomes with low follow-up rates are common with limited recommendations for improvements. The aim of this study was to describe the impact of severe injury on the health-related quality of life, specifically characterise the non-responder population and to identify modifiable predictors of poorer outcomes. METHODS Five-year (2012-2016) prospective cohort study was performed at a level 1 trauma centre. Baseline Short-Form Health Survey (SF36) was collected at admission, and at 6 and 12 months postinjury together with demographics, injury mechanism and severity, psychosocial wellbeing, and return to work capacity. RESULTS Of the 306 consecutive patients [age 52 ± 17 years, male 72%, ISS 21 (17, 29), mortality 5%], 195 (64%) completed questionnaires at baseline, and at 12 months. Preinjury physical health scores were above the general population (53.1 vs. 50.3, p < 0.001) and mental health component was consistent with the population norms (51.7 vs. 52.9, p = 0.065). One year following injury, both physical health (13.2, 95% CI 14.8, 11.6) and mental health scores (6.0, 95% CI 8.1, 3.8) were significantly below age- and sex-adjusted preinjury baselines. Non-responders had similar ISS but with a lower admission GCS, and were more likely to be younger, and without comorbidities, employment, or university education. CONCLUSION Contrary to their better than population norm preinjury health status, polytrauma patients remain functionally impaired at least 1 year after injury. The identified high risk for non-responding group needs more focused efforts for follow-up. A fundamentally different approach is required in polytrauma research which identify modifiable predictors of poor long-term outcomes.
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Affiliation(s)
- Simone Meakes
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Natalie Enninghorst
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Natasha Weaver
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Benjamin M Hardy
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
- Injury and Trauma Research Program, Hunter Medical Research Institute, Newcastle, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
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Pozzato I, Tran Y, Gopinath B, Cameron ID, Craig A. The importance of self-regulation and mental health for effective recovery after traffic injuries: A comprehensive network analysis approach. J Psychosom Res 2024; 177:111560. [PMID: 38118203 DOI: 10.1016/j.jpsychores.2023.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Traffic injuries significantly impact people's psychological, physical and social wellbeing, and involve complex self-regulation responses. Psychological impacts are seldom recognized and addressed holistically. This study employs network analysis to investigate the interconnectedness between different dimensions that influence mental health vulnerability and recovery after traffic injuries. METHODS 120 adults with mild-to-moderate traffic injuries and 112 non-injured controls were recruited. The network investigation employed two main approaches. Four cross-sectional networks examined the interrelationships between self-regulation responses (cognitive and autonomic) and various health dimensions (psychological, physical, social) over time (1, 3, 6, 12 months). Three predictive networks explored influences of acute self-regulation responses (1 month) on long-term outcomes. Network analyses focused on between-group differences in overall connectivity and centrality measures (nodal strength). RESULTS An overall measure of psychological wellbeing consistently emerged as the most central (strongest) node in both groups' networks. Injured individuals showed higher overall connectivity and differences in the centrality of self-regulation nodes compared to controls, at 1-month and 12-months post-injury. These patterns were similarly observed in the predictive networks, including differences in cognitive and autonomic self-regulation influences. CONCLUSIONS Network analyses highlighted the crucial role of psychological health and self-regulation, in promoting optimal wellbeing and effective recovery. Post-traffic injury, increased connectivity indicated prolonged vulnerability for at least a year, underscoring the need of ongoing support beyond the initial improvements. A comprehensive approach that prioritizes psychological health and self-regulation through psychologically informed services, early psychological screening, and interventions promoting cognitive and autonomic self-regulation is crucial for mitigating morbidity and facilitating recovery. TRIAL REGISTRATION IMPRINT study, ACTRN 12616001445460.
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Affiliation(s)
- Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Yvonne Tran
- Macquarie University, Hearing Research Centre, Faculty of Medicine, Health and Human Sciences, Australia
| | - Bamini Gopinath
- Macquarie University, Hearing Research Centre, Faculty of Medicine, Health and Human Sciences, Australia
| | - Ian D Cameron
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ashley Craig
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Chan H, Erdelyi S, Jiang A, McLeod C, Koehoorn M, Brubacher JR. Did implementation of no-fault auto-insurance in British Columbia, Canada, impact return to work following road trauma? Protocol for a before-after survival analysis. BMJ Open 2023; 13:e075858. [PMID: 37739458 PMCID: PMC10533740 DOI: 10.1136/bmjopen-2023-075858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Road trauma (RT) is a major public health problem that often results in prolonged absenteeism from work. Limited evidence suggests that recovery after RT is associated with automobile insurance compensation schemes. In May 2021, British Columbia, Canada switched from fault-based to no-fault auto-insurance coverage. This manuscript presents the protocol for a planned evaluation of that natural experiment: We will evaluate the impact of changing automobile insurance schemes on return to work following RT. METHODS AND ANALYSIS The evaluation will use a before-after design to analyse auto-insurance claims (1 April 2019 to 30 April 2024) in order to compare recovery of claimants with non-catastrophic injuries who filed claims under the no-fault insurance scheme to that of those who filed claims under the previous system. Claimants will be followed from date of injury until they return to work or have been followed for 6 months (right-censored). We will perform sensitivity analyses to examine the robustness of our findings. First, we will exclude injuries that occurred during the COVID-19 provincial State of Emergency. Second, we will use propensity score methods rather than conventional covariate adjustment to address potential imbalance between characteristics of claimants pre-change and post-change. Finally, as the implementation effect may have a heterogeneous association with time off work, we will use quantile regression with right-censoring at 6 months to model differences in return to work at the 25th, 50th, 75th and 90th percentiles. ETHICS AND DISSEMINATION The study uses de-identified data and is approved by the University of British Columbia Clinical Research Ethics Board (H20-03644). This research is funded by the Insurance Corporation of British Columbia (ICBC). Findings will be published in the peer-reviewed literature and summarised in a report prepared for ICBC. We anticipate that our findings will inform policy decisions in other jurisdictions considering switching to no-fault auto-insurance schemes.
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Affiliation(s)
- Herbert Chan
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Jiang
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher McLeod
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Vallmuur K, McCreanor V, Watson A, Cameron C, Cramb S, Dias S, Banu S, Warren J. Understanding compensable and non-compensable patient profiles, pathways and physical outcomes for transport and work-related injuries in Queensland, Australia through data linkage. BMJ Open 2023; 13:e065608. [PMID: 36697052 PMCID: PMC9884851 DOI: 10.1136/bmjopen-2022-065608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION In many jurisdictions, people experiencing an injury often pursue compensation to support their treatment and recovery expenses. Healthcare costs form a significant portion of payments made by compensation schemes. Compensation scheme regulators need accurate and comprehensive data on injury severity, treatment pathways and outcomes to enable scheme modelling, monitoring and forecasting. Regulators routinely rely on data provided by insurers which have limited healthcare information. Health data provide richer information and linking health data with compensation data enables the comparison of profiles, patterns, trends and outcomes of injured patients who claim and injured parties who are eligible but do not claim. METHODS AND ANALYSIS This is a retrospective population-level epidemiological data linkage study of people who have sought ambulatory, emergency or hospital treatment and/or made a compensation claim in Queensland after suffering a transport or work-related injury, over the period 1 January 2011 to 31 December 2021. It will use person-linked data from nine statewide data sources: (1) Queensland Ambulance Service, (2) Emergency Department, (3) Queensland Hospital Admitted Patients, (4) Retrieval Services, (5) Hospital Costs, (6) Workers' Compensation, (7) Compulsory Third Party Compensation, (8) National Injury Insurance Scheme and (9) Queensland Deaths Registry. Descriptive, parametric and non-parametric statistical methods and geospatial analysis techniques will be used to answer the core research questions regarding the patient's health service use profile, costs, treatment pathways and outcomes within 2 years postincident as well as to examine the concordance and accuracy of information across health and compensation databases. ETHICS AND DISSEMINATION Ethics approval was obtained from the Royal Brisbane and Women's Hospital Human Research Ethics Committee, and governance approval was obtained via the Public Health Act 2005, Queensland. The findings of this study will be used to inform key stakeholders across the clinical, research and compensation regulation area, and results will be disseminated through peer-reviewed journals, conference presentations and reports/seminars with key stakeholders.
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Affiliation(s)
- Kirsten Vallmuur
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Victoria McCreanor
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Angela Watson
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Cate Cameron
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Shannon Dias
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Shahera Banu
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Jacelle Warren
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
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Papic C, Kifley A, Craig A, Grant G, Collie A, Pozzato I, Gabbe B, Derrett S, Rebbeck T, Jagnoor J, Cameron ID. Factors associated with long term work incapacity following a non-catastrophic road traffic injury: analysis of a two-year prospective cohort study. BMC Public Health 2022; 22:1498. [PMID: 35931966 PMCID: PMC9356415 DOI: 10.1186/s12889-022-13884-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain). Methods Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to ‘any’ or ‘full duties’ paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates. Results Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury. Conclusions Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW. Trial registration This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752).
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Affiliation(s)
- Christopher Papic
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia.
| | - Annette Kifley
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Ashley Craig
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Genevieve Grant
- Australian Centre for Justice Innovation, Faculty of Law, Monash University, Clayton, Victoria, 3800, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Victoria, 3004, Australia
| | - Ilaria Pozzato
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Victoria, 3004, Australia
| | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Trudy Rebbeck
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, and Faculty of Medicine, University of New South Wales, Level 5/1 King St, Newtown, NSW, 2042, Australia
| | - Ian D Cameron
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
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Cunha-Diniz F, Taveira-Gomes T, Teixeira JM, Magalhães T. Trauma outcomes in nonfatal road traffic accidents: a Portuguese medico-legal approach. Forensic Sci Res 2022; 7:528-539. [PMID: 36353310 PMCID: PMC9639525 DOI: 10.1080/20961790.2022.2031548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’ age group and sex. We used the Portuguese medico-legal rules for personal injury assessment, in the scope of the Civil Law in that country, which includes a three-dimensional methodology. This was a retrospective study including 667 victims of road traffic accidents aged 3–94 years old. Their final medico-legal reports all used the Portuguese methodology for personal injury assessment. Outcomes were analysed by the victims’ age group (children, working-age adults, and older people) and sex. Road traffic accidents were generally serious (ISS mean 9.5), with higher severity in children and older people. The most frequent body sequelae were musculoskeletal (64.8%), which were associated with functional and situational outcomes. Temporary damage resulted in an average length of impairment of daily life of 199.6 days, 171.7 days to return to work, and an average degree of quantum doloris (noneconomic damage related to physical and psychological harm) of 3.7/7. The average permanent damage was 7.3/100 points for Permanent Functional Deficit, 0.43/3 for Permanent Professional Repercussion, 2/7 for Permanent Aesthetic Damage, 3.9/7 for Permanent Repercussion on Sexual Activity and 3.2/7 for Permanent Repercussion on Sport and Leisure Activities. Overall, 19% of people became permanently dependent (10.6% needed third-party assistance). The medico-legal methodology used, considering victims’ real-life situation, allows a comprehensive assessment. There were several significant differences among the three age groups but none between sexes. These differences and the impact of the more severe cases justify further detailed medico-legal studies in these specific situations on children, older people, and severely injured victims.Key points: This was a retrospective study of accident mechanisms and injury outcomes in Portugal, and considered the outcomes in the victims’ real-life situation. Lesions from road traffic accidents were generally serious, with higher severity among children and older people. The most frequent sequels were musculoskeletal, and associated with functional and situational outcomes. Both temporary and permanent outcomes had repercussions for the victims. There were significant differences between children, working-age adults and older people, but none between sexes.
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Affiliation(s)
| | - Tiago Taveira-Gomes
- CINTESIS—Faculty of Medicine, University of Porto, Porto, Portugal
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
- Fernando Pessoa University, Porto, Portugal
| | | | - Teresa Magalhães
- CINTESIS—Faculty of Medicine, University of Porto, Porto, Portugal
- IINFACTS—Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
- Porto Healthcare Unity—Accidents, Fidelidade—Insurance Company, Porto, Portugal
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Denu ZA, Yassin MO, Yesuf M, Azale T, Biks GA, Gelaye KA. Disability scores rate changes and predictors among road traffic injury victims admitted at Gondar specialized comprehensive hospital northwest Ethiopia: A prospective follow-up study. TRAFFIC INJURY PREVENTION 2021; 23:40-45. [PMID: 34739307 DOI: 10.1080/15389588.2021.1990895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Measuring the level of disability following trauma is a key step for secondary and tertiary level trauma prevention. It can give important evidence for decision-makers and program implementers on the need for establishing rehabilitation centers. METHODS This is a longitudinal follow-up study on 235 road traffic injury survivors. Patients were followed for 12 months, and the outcome was ascertained using the brief WHODAS-II 12-item instrument at 1, 3, 6, and 12-months post-injury. The level of disability was divided into five groups from no disability to very severe based on their disability scores. Work status was assessed at each survey using a single question "are you back to work?" We employed a linear mixed model to identify disability scores changes over time and risk factors associated with disability. Statistically, a significant association was declared at p < 0.05. RESULTS The overall mean disability score was 24.9 ± 11.3 at one month and 8.3 ± 6.4 after 12 months of injury. Disability score has decreased by 1.3 units over time during 12 months post-injury. Functional limitation persisted on 25-88% of participants at specific dimensions of disability at the end of the study. After a year of injury, 44% of participants didn't return to work. Injury severity score (β = 0.47, p < 0.001, length of hospital stays (β = 0.88, p < 0.005) and discharge against medical advice (β = 2.18, p < 0.001) were found to be predictors of disability following road traffic injuries. CONCLUSION The current study demonstrated that, though there was a decrease in disability score over time, a significant number of participants were with some degree of limitation after one year of injury, and nearly half of them didn't return to work. Shortening of long waiting times and counseling services need to be considered by the hospital. Community-based Rehabilitation centers (CBR) should be expanded. Further study should be conducted to uncover the reasons for preferring traditional bone fixers over medical management.
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Affiliation(s)
- Zewditu Abdissa Denu
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mensur Osman Yassin
- Department of Surgery, School of Medicine College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhammed Yesuf
- Department of Orthopedics and trauma, School of Medicine College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Department of Health Communication and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health Policy and Management, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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