The impacts of injury at the individual, community and societal levels: a systematic meta-review

Relationships between trauma death, disability, and geographic factors: a systematic review

OBJECTIVE

Trauma is a global health problem. The causes of trauma-related deaths are diverse and may depend in part on socioeconomic and geographical factors; however, there have been few studies addressing such relationships. The aim of this study was to investigate the relationships between trauma and geographical factors in order to support policy recommendations to reduce trauma-related deaths and disability.

METHODS

In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched international and Korean databases to retrieve relevant literature published between 2000 and 2020.

RESULTS

Thirty-two studies showed a positive relationship between the outcomes of major trauma and geographical factors. The study investigated regional factors including economic factors such as size of urban areas, gross domestic product, and poverty rate, as well as hospital parameters, such as presence of trauma centers and number of hospital beds. There was a tendency toward higher mortality rates in rural and low-income areas, and most of the studies reported that the presence of trauma centers reduced trauma-related mortality rates.

CONCLUSION

Our study showed that geographic factors influence trauma outcomes. The findings suggest geographical considerations be included in care plans to reduce death and disability caused by trauma.

Injury perceptions and their association with recovery outcomes in adults with traumatic orthopaedic injuries: a scoping review

PURPOSE

How people perceive their injury may be associated with recovery. This scoping review used the Common Sense Model of Illness Perceptions (CSM) as a framework to: (1) characterise injury perceptions; (2) describe biopsychosocial factors related to injury perceptions, and (3) determine how injury perceptions are associated with recovery outcomes.

MATERIALS AND METHODS

A broad search strategy was used across eight databases to identify studies exploring injury perceptions and related concepts in adults with traumatic orthopaedic injuries. Two reviewers independently screened and extracted data. Quality appraisal was performed using the Mixed Methods Appraisal Tool.

RESULTS

The search yielded 9736 records, of which 22 publications were included; 12 quantitative and 10 qualitative studies. Overall, the quality of the evidence was low to moderate. Consistent with the CSM, injury perceptions comprised beliefs relating to the injury diagnosis, consequences, causes, recovery duration, and treatments. Perceptions of injury were multidimensional and influenced by personal, inter-personal, and socio-cultural factors. Negative injury perceptions were associated with worse functional outcomes.

CONCLUSIONS

Although this review provided some insight into the characteristics of injury perceptions, relationships between injury perceptions and recovery, and characteristics of perceptions across different socio-cultural or clinical settings are still poorly understood.Implications for rehabilitationA person's perception of their injury is complex; it emerges from dynamic interactions between personal, interpersonal and socio-cultural elements.People who perceive that their injury represents a threat to them typically report higher pain, negative affect, and worse general health than people with more positive perceptions of injury.Rehabilitation providers should consider how they might positively influence perceptions of traumatic orthopaedic injury.Perceptions of injury might be influenced at the individual level (e.g., during healthcare encounters), or at a system level, such as through endorsement of codes of practice for rehabilitation clinicians or funding of psychologically informed treatments to help people better understand their injuries.

Concerns About Claiming, Postclaim Support, and Return to Work Planning: The Workplace's Impact on Return to Work

OBJECTIVE

The aim of this study was to determine how injured Australian workers perceived employer emotional (eg, empathy) and instrumental [eg, return-to-work (RTW) planning] support during the RTW process and examine associations between support and RTW.

METHODS

Using data from the 2014 National Return to Work Survey of injured workers with a workers' compensation claim, multinomial regression models examined relationships between support and RTW.

RESULTS

Receiving support and developing RTW plans were significantly associated with a greater likelihood of RTW. When controlled for one another in a single model, postclaim support had the strongest association with RTW, with RTW planning also significantly and positively associated with RTW.

CONCLUSION

Provision of both emotional and instrumental support are important employer-led work disability management interventions. Research is required to develop strategies for increasing employer support to lead to improved RTW outcomes for injured workers.

What can trauma patients' experiences and perspectives tell us about the perceived quality of trauma care? a qualitative study set within the UK National Health Service

The global drive for improvements in the efficiency and quality of healthcare has led to the development of frameworks to assist in defining and measuring 'good quality care'. However, such frameworks lack a systematic or meaningful definition of what 'good quality care' means from the patients' perspective. The present research provides an in-depth analysis of patients' experiences in a hospital setting from a quality of care perspective. Forty-five adults (aged 16-70) hospitalised in one of four UK NHS trusts following an unintentional injury were interviewed about their experiences of care. The findings show variability in perceived quality of care within the same hospital episode which cannot be meaningfully captured by existing frameworks. The context of trauma care (e.g. distressing nature of injury, patient vulnerability, expectations of hospitalisation and participants' interaction with different service providers) defined the care experience and the value of being 'cared for'. Participants identified some aspects of good and care which related to holistic, person-centred and personalised care beyond the medical needs. Participants discussed the value of being understood, staff thinking of their needs beyond hospitalisation, staff trying 'their best' despite constrains of current care, having their emotional needs recognised and addressed and staff competence. Patients reported also poor quality of care and 'not being cared for' by specific staff groups which they expected to fulfil this role, rushed and unsympathetic care, lack of recognition for emotional impact of injury mapped onto existing quality frameworks e.g. safety, equity, accessibility and patient-centeredness as well as quality of interaction with providers, empathetic care which extended beyond medical needs, coordination of care, and the positivity of care delivery as important dimensions of quality care with implications for their recovery. The findings have implications for quality frameworks and theoretical definitions of quality of care; they demonstrate the importance of patient experience in addition to clinical effectiveness and safety as an essential dimension of quality care. In terms of practice, the findings support the need to incorporate knowledge and training of injured adults' psychological needs, and the value of interaction with professionals as a patient defined dimension of the quality of care.

A Follow-Up Study on Return to Work in the Year After Reporting an Occupational Injury Stratified by Outcome of the Workers' Compensation System

Objective:

The aim of this study was to compare return rates to work between different groups according to the decision from the workers’ compensation.

Method:

Register data on disability benefits were used to describe return rates to work in Kaplan–Meier curves and association with decision on compensation claims. Disability benefits were granted by the municipalities independently of any compensation claim if sick-listed.

Results:

Claimants with ongoing claims were the group with the largest proportion remaining on disability benefits. Claimants with rejected claims returned to work at the same rate (occupational disease) or slower (industrial accident) than claimants with recognized claim without compensation the subsequent year and at a faster rate after decision.

Conclusion:

Compensation claims and proceedings of the workers’ compensation system probably increase time to return to work; other factors such as health and social difficulties, however, may explain some of these differences.

Work Disability in Australia: An Overview of Prevalence, Expenditure, Support Systems and Services

Purpose This study sought to describe Australian systems of income support for people with work disability. Specific aims were to summarise and compare the features of the income support systems, including the rehabilitation and employment services funded or provided by those systems, and factors affecting transition between systems. Further objectives were to estimate the prevalence of work disability in Australia and the national expenditure on work disability income support. Methods A mixed methods project involving collation and analysis of existing publicly available documentation and data, and interviews with 25 experts across ten major systems of income support. The prevalence of work disability and expenditure in each system, and in total, was estimated using publicly accessible data sources. System features and service models were synthesised from data sources, tabulated and compared qualitatively. Results In Australia during the 2015/2016 financial year an estimated 786,000 people with work disability received income support from a Commonwealth, state, territory or private source. An additional 6.5 million people accessed employer provided leave entitlements for short periods of work incapacity. A total of $37.2 billion Australian dollars was spent on income support for these people during the year. This support was provided through a complex array of government authorities, private sector insurers and employers. Service models vary substantially between systems, with case management the only service provided across all systems. Healthcare and return to work services were provided in some systems, although models differed markedly between systems. Income support ranged from 19 to 100% of earnings for a person earning the average weekly Australian wage pre-disability. There is a paucity of information relating to movement between systems of support, however it is likely that many thousands of people with long periods of work disability transition between systems annually. Conclusions This study demonstrates the substantial financial and human impact of work disability on Australian society. Findings indicate multiple opportunities for reducing the burden of work disability, including aligning case management and healthcare service models, and engaging employers in prevention and rehabilitation. The findings suggest a need for greater interrogation and evaluation of Australian work disability support systems.

Recovery Within Injury Compensation Schemes: A System Mapping Study

Purpose Many industrialised nations have systems of injury compensation and rehabilitation that are designed to support injury recovery and return to work. Despite their intention, there is now substantial evidence that injured people, employers and healthcare providers can experience those systems as difficult to navigate, and that this can affect injury recovery. This study sought to characterise the relationships and interactions occurring between actors in three Australian injury compensation systems, to identify the range of factors that impact on injury recovery, and the interactions and inter-relationships between these factors. Methods This study uses data collected directly from injured workers and their family members via qualitative interviews, analysed for major themes and interactions between themes, and then mapped to a system level model. Results Multiple factors across multiple system levels were reported by participants as influencing injury recovery. Factors at the level of the injured person's immediate environment, the organisations and personnel involved in rehabilitation and compensation processes were more commonly cited than governmental or societal factors as influencing physical function, psychological function and work participation. Conclusions The study demonstrates that injury recovery is a complex process influenced by the decisions and actions of organisations and individuals operating across multiple levels of the compensation system. Changes occurring 'upstream', for instance at the level of governmental or organisational policy, can impact injury recovery through both direct and diffuse pathways.

Impact of further injury on participation in work and activities among those previously injured: results from a New Zealand prospective cohort study

PURPOSE

To examine participation in paid work, unpaid work and activities 12 months after a sentinel (initial) injury, and to determine the impact of sustaining a subsequent injury (SI) on these participation outcomes.

METHODS

Participants were recruited to the Prospective Outcomes of Injury Study following an Accident Compensation Corporation (ACC; New Zealand's no-fault injury insurer) entitlement claim injury. Outcomes were whether participants reported reduced paid work hours, reduced unpaid work (e.g. housework, gardening) or reduced activities (e.g. socialising, leisure pursuits) at 12 months compared to before the sentinel injury event. SIs were ACC claims of any type. Using multivariable models, characteristics of SIs were examined as potential predictors of reduced participation.

RESULTS

At 12 months, 30% had reduced paid work hours, 12% had reduced unpaid work and 25% had reduced activities. Sustaining a SI predicted reduced paid work (RR 1.5; 95% CI 1.2, 1.8), but not unpaid work or activities. Participants who had sustained intracranial SIs were at highest risk of reduced paid work (RR 3.2, 95% CI 1.9, 5.2). Those sustaining SIs at work were less likely to have reduced paid work (RR 0.7; 95% CI 0.6, 1.0) than those with only non-work SIs. Participants sustaining assaultive SIs had higher risk of reduced unpaid work (RR 2.6, 95% CI 1.0, 6.8).

CONCLUSIONS

Reduced participation is prevalent after a substantive sentinel injury, and sustaining a SI impacts on return to paid work. Identification of SI characteristics that put people at high risk of participation restriction may be useful for focusing on rehabilitative attention.

"That's what you do for people you love": A qualitative study of social support and recovery from a musculoskeletal injury

Background

Social support has been identified as a significant factor in facilitating better health outcomes following injury. However, research has primarily focused on the role of social support from the perspective of the person experiencing an injury. Limited research has examined the experiences of the family members and friends of a person with injury. This study aims to explore the perceptions and experiences of social support and recovery following a transport-related musculoskeletal injury (MSI) in a population of injured persons and their family members and friends.

Methods

This study was conducted using a phenomenological qualitative research design. In-depth semi-structured interviews were conducted with ten persons with MSI, recruited via the Transport Accident Commission (TAC) in Victoria, Australia. Seven family members and friends were also interviewed. The data was analysed using constant comparative method and thematic analysis.

Results

Several themes were identified including: (1) key sources and types of support received, (2) relationship development and (3) challenges of providing and receiving support. Participants with MSI reported stories about how the social network provided emotional and tangible support. Family members and friends confirmed the supportive acts provided to the participants with MSI. Positive iterative changes in relationships were reported by the participants with MSI. Participants with MSI, their family members and friends described several difficulties including loss of independence, feeling like a burden, and the impact of caring on health and well-being.

Conclusions

The role of social support is complex given the multitude of people involved in the recovery process. The findings of this study suggest that persons with MSI may benefit from support groups and maintenance of existing support networks. Furthermore, family members and friends engaged in the recovery process may benefit from support in this role.

Preventing recurrent ankle sprains: Is the use of an App more cost-effective than a printed Booklet? Results of a RCT

Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program via a printed Booklet or a mobile application. Regarding the high incidence of ankle sprains, cost-effectiveness regarding implementation can have a large effect on total societal costs. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates leading to costs and hence to differences in cost-effectiveness. In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available "Strengthen your ankle" App and the other half received a printed Booklet. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and incremental cost-effectiveness ratio (ICER). During follow-up, 31 athletes suffered from a recurrent ankle sprain that led to costs resulting in a hazard ratio of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. This study showed that the method of implementing the NMT program using an App or a Booklet led to similar cost-effectiveness ratios and the same occurrence of recurrent injuries leading to costs. Both the App and the Booklet can be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness at 12-month follow-up.

Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review

INTRODUCTION

Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for.

OBJECTIVE

The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention.

METHODS

An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included.

RESULTS

Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented.

CONCLUSIONS

Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.

Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review

BACKGROUND

Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity.

OBJECTIVE

This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature.

MATERIALS AND METHODS

A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries.

CONCLUSIONS

Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden.

The injury trajectory for young people 16-24 years in the six months following injury: A mixed methods study

BACKGROUND

Adolescents and young people are the population at greatest risk of injury and therefore injury-related mortality and morbidity. Inquiry into the injury trajectory of young people is needed to identify this group's specific needs for healthcare. This paper reports the integration of quantitative and qualitative findings from a sequential explanatory mixed methods study examining young people aged 16-24 years' experience and trajectory of traumatic physical injury in the initial six months. The aim of integration was to address the question: In what ways are injured young peoples' experiences and self-management during the initial six months of the injury trajectory impacted by their injury, family support, and provision of healthcare?

METHODS

Key findings from epidemiological datasets on young person injuries from hospital and coronial databases (Phase 1) were combined with key findings from qualitative interviews with 12 injured young people and 10 family members (Phase 2).

RESULTS

The integration of findings from Phase 1 and Phase 2 resulted in three new findings; [1] (Alfred Health, 2014). A young person's perception of the severity of their injury, as well as the amount of time spent in hospital, impacts substantially on the way in which they experience injury, and this is managed differently between genders; [2] (Newnam et al., 2014). Admission to an Intensive care unit, including the intensity and duration of care, is the primary influence on how a family will provide support to the young person in the inpatient period; and [3] (Lyons et al., 2010). Young people's perception and understanding of their recovery from injury is in contrast with how healthcare systems are structured to provide rehabilitation and recovery care.

CONCLUSION

The injury trajectory and recovery process of young people in the six months following injury have been have conceptualised. These trajectories of recovery can inform the development of anticipatory guidance frameworks for clinicians and guide the provision of and planning for clinical services for injured young people.

Does time off work after injury vary by jurisdiction? A comparative study of eight Australian workers' compensation systems

OBJECTIVES

To determine whether the jurisdiction in which a work-related injury compensation claim is made is an independent predictor of duration of time off work following work injury, and if so, the magnitude of the effect.

SETTING

Eight Australian state and territory workers' compensation systems, providing coverage for more than 90% of the Australian labour force. Administrative claims data from these systems were provided by government regulatory authorities for the study.

PARTICIPANTS

95 976 Australian workers with workers' compensation claims accepted in 2010 and with at least 2 weeks of compensated time off work.

PRIMARY OUTCOME MEASURE

Duration of time lost from work in weeks, censored at 104 weeks.

RESULTS

After controlling for demographic, worker, injury and employer factors in a Cox regression model, significant differences in duration of time loss between state and territory of claim were observed. Compared with New South Wales, workers in Victoria, South Australia and Comcare had significantly longer durations of time off work and were more likely to be receiving income benefits at 104 weeks postinjury, while workers in Tasmania and Queensland had significantly shorter durations of time off work.

CONCLUSIONS

The jurisdiction in which an injured worker makes a compensation claim has a significant and independent impact on duration of time loss. Further research is necessary to identify specific compensation system policies and practices that promote timely and appropriate return to work and reduce duration of time off work.