Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash

Quality of life of survivors following road traffic orthopaedic injuries in Rwanda

Background

Road traffic injuries (RTI) pose a global public health threat, especially in low- and middle-income nations. These injuries typically cause orthopaedic problems that may negatively impair a person's physical and mental health and quality of life. Our study examined the quality of life of road traffic orthopaedic injuries (RTOI) survivors.

Methods

A cross-sectional study at five Rwandan referral hospitals, included 369 adult RTOI victims. Two years post-injury, participants completed the European Quality of life 5 Dimension 5 (EQ-5D-5L) and Visual Analogue Scale (VAS) Questionnaire between June 2 and August 31, 2022, with informed consent. Three EQ-5D-5L-VAS scores were used: low (0-40%), fair (41-60%), and excellent (61-100%). We used logistic regression analysis with a significance threshold of p < 0.05 to determine odds ratios (OR) and 95% CI.

Results

The RTOI victims had a mean age of 37.5 ± 11.26 years with sex ratio M:F:3:1. Usual activities (66.8%) and mobility (54.8%) were the most affected EQ-5D-5L dimensions. Residence, hospital stay, rehabilitation, and return to work affected mobility, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L/VAS score showed 34.95% poor QoL (0-40%) and 35.50% good QoL. Factors affecting QoL include level of education (OR = 1.66, p < <0.01), type of intervention (OR = 1.22, p = 0.003), rehabilitation (OR = 2.41, p < 0.01) and level of disability (OR = 196.41, p < 0.01). Mobility, self-care, usual activities, pain, comfort, anxiety, and depression vary moderately on Shannon's index.

Conclusion

The study highlights the significant impact of road traffic orthopaedic injuries (RTOI) on survivors' quality of life in Rwanda, revealing challenges in mobility and daily activities. Factors influencing quality of life include education level, medical intervention type, rehabilitation, and disability degree. The findings emphasize the need for tailored rehabilitation strategies and policy interventions to improve long-term outcomes for RTOI survivors.

Trajectories of health-related quality of life following road trauma: Latent growth mixture modeling across a 12-month cohort study

INTRODUCTION

Health-related quality of life (HRQoL) should be considered when evaluating the burden of road trauma (RT) injuries. This study aimed to identify distinct HRQoL trajectories following minor to severe RT injury and determine characteristics of trajectory membership.

METHODS

This prospective inception cohort study recruited 1480 RT survivors from three emergency departments in British Columbia, Canada (July 2018 - March 2020). HRQoL outcome was measured with the Short Form 12 survey (SF-12) and the 5-level version of the EuroQol instrument (EQ-5D-5L) at baseline (pre-injury) and at 2, 4, 6, and 12 months post-injury. Potential predictors of outcome trajectory included sociodemographic, psychological, medical, crash, and injury factors collected at baseline. We used a latent growth mixture model to identify distinct recovery trajectories and multinomial logistic regression to determine predictors of trajectory membership.

RESULTS

Three distinct HRQoL trajectories were identified for SF-12 subscales and EQ-5D-5L measures: Low/Moderate-Stable, High-Large decline, and High-Slight decline. Participants in the Low/Moderate-Stable trajectory had persistent low to moderate HRQoL before and after the injury. Those in the High-Large decline trajectory had good pre-injury HRQoL followed by persistently decreased HRQoL afterwards. The High-Slight decline trajectory was characterized by good pre-injury HRQoL and only a slight decline afterwards. Participants in the Low/Moderate-Stable and High-Large decline trajectories were considered at risk of permanently poor HRQoL following RT injury given their low HRQoL over a long period of time. Characteristics that placed participants in the Low/Moderate-Stable trajectory were older age, female gender, poor pre-injury health (medical comorbidity, prescribed medication use, complaints in the injured body area(s)), pre-injury somatic symptoms, pain catastrophizing or psychological distress, injury severity (ISS) and injury pain. Patients with head injury were less likely to be in the Low/Moderate-Stable trajectory. Risk factors for membership in the High-Large decline trajectory included older age (for physical HRQoL), younger age (for mental HRQoL), female gender, living alone, pre-injury psychological distress, ISS, injury pain, no expectations for a fast recovery, as well as head injuries, spine/back injuries or lower extremity injuries.

CONCLUSIONS

This study highlighted the heterogeneity of HRQoL trajectories following RT injury and the importance of considering differences between characteristics of survivors. In addition to injury type and severity, outcome is related to demographic factors, pre-injury health and pre-injury psychological factors.

Health-related quality of life in the year following road trauma: Longitudinal analysis using piecewise latent curve modeling

BACKGROUND

Road trauma (RT) survivors have reduced health-related quality of life (HRQoL). We identified phases and predictors of HRQoL change following RT injury.

METHODS

In a prospective cohort study of 1480 Canadian RT survivors aged 16 to 103 years (July 2018 - March 2020), physical component (PCS) and mental component (MCS) summary scores from the SF-12v2 were measured pre-injury and 2, 4, 6, and 12 months post-injury and their trajectories were analyzed with piecewise latent growth curve modeling. Potential predictors of HRQoL changes included sociodemographic, psychological, medical, and trauma-related factors.

RESULTS

PCS and MCS scores worsened from pre-injury to 2-months (phase 1) and then improved (phase 2), but never regained baseline values. Older age, somatic symptoms and pain catastrophizing were associated with lower preinjury PCS and MCS scores. Psychological distress was associated with lower preinjury MCS scores and higher preinjury PCS scores. Phase 1 PCS scores decreased most in females, participants with fewer pre-injury somatic symptoms and those without expectations for fast recovery. Phase 1 MCS decreases were associated with younger age, female sex, living alone, lower psychological distress, lack of expectation for fast recovery and higher injury pain. In phase 2, MCS improved most in participants not using recreational drugs; PCS improved most in participants with higher education and longer recovery expectations.

LIMITATIONS

There may be recall bias with reporting pre-injury HRQoL. Selection bias is possible.

CONCLUSIONS

Many factors influence HRQoL following RT. These findings may inform measures to minimize HRQoL reduction following RT and speed up subsequent recovery.

Twelve-month recovery following road trauma: Results from an inception cohort in Vancouver, Canada

BACKGROUND

Injury-related disability following road trauma is a major public health concern. Unfortunately, outcome following road trauma and risk factors for poor recovery are inadequately studied, especially for road trauma survivors with minor injuries that do not require hospitalization.

OBJECTIVES

This manuscript reports 12-month recovery outcomes for a large cohort of road trauma survivors.

METHODS

This was a prospective, observational inception cohort study of 1,480 road trauma survivors recruited between July 2018 and March 2020 from 3 trauma centres in British Columbia, Canada. Participants were aged ≥16 years and arrived in a participating emergency department within 24 h of a motor vehicle collision. Data on baseline health and injury severity were collected from structured interviews and medical records. Outcome measures, including the SF-12, were collected during follow-up interviews at 2, 4, 6 and 12 months. Predictors of recovery outcomes were identified using Cox proportional hazards models and summarized using hazard ratios.

RESULTS

Only 42 % of participants self-reported full recovery and only 66 % reported a return to usual daily activities. Females, older individuals, pedestrians, and those who required hospital admission had a poorer recovery than other groups. Similar patterns were observed for the SF-12 physical component. For the SF-12 mental component, no significant differences were observed between participants admitted to hospital and those discharged home from the ED. Return to work was reported by 77 % of participants who had a paying job at baseline, with no significant differences between sex and age groups.

CONCLUSIONS

In a large cohort of road trauma survivors, under half self-reported full recovery one year after the injury. Poor mental health recovery was observed in both participants admitted to hospital and those discharged home from the ED. This finding may indicate a need for early intervention and continued mental health monitoring for all injured individuals, including for those with less serious injuries.

Changes in health-related quality of life in patients admitted to emergency departments for attempted suicide: Findings from a large longitudinal study

BACKGROUND

Studies of quality of life among suicide attempters are limited while it is considered important for preventing reattempt of suicide. We investigated health related quality of life (HRQoL) in suicide attempters immediately after the suicide attempt and in the long term.

METHODS

This was longitudinal data from a randomized controlled multicenter trial. The Japanese version of the Short Form Health Survey-36 as HRQOL measured at 0, 6, and 12 months after randomization.

RESULTS

799 patients (356 men and 443 women) were analyzed. At baseline, the mean physical component summary (PCS) and the mental component summary (MCS) scores were 34.56 and 35.15, respectively, and they were significantly low compared with those of the general population. PCS scores significantly improved from baseline to 6 months (p = 0.003), from baseline to 12 months (p < 0.0001), and from baseline to 12 months (p = 0.002). MCS scores significantly improved from baseline to 6 months (p < 0.0001) and from baseline to 12 months (p < 0.0001). However, neither PCS nor MCS scores reached those of the general population norm at 12 months post-suicide attempt.

LIMITATIONS

Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded.

CONCLUSION

This study presents a trajectory of HRQoL scores in suicide attempters from immediately after the suicide attempt to 1 year later. Further studies on HRQoL in suicide attempters are needed to elucidate the effective care for the attempters.

Long-term functional outcomes in polytrauma: a fundamentally new approach is needed in prediction

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.

Clustering of trauma patients based on longitudinal data and the application of machine learning to predict recovery

Predicting recovery after trauma is important to provide patients a perspective on their estimated future health, to engage in shared decision making and target interventions to relevant patient groups. In the present study, several unsupervised techniques are employed to cluster patients based on longitudinal recovery profiles. Subsequently, these data-driven clusters were assessed on clinical validity by experts and used as targets in supervised machine learning models. We present a formalised analysis of the obtained clusters that incorporates evaluation of (i) statistical and machine learning metrics, (ii) clusters clinical validity with descriptive statistics and medical expertise. Clusters quality assessment revealed that clusters obtained through a Bayesian method (High Dimensional Supervised Classification and Clustering) and a Deep Gaussian Mixture model, in combination with oversampling and a Random Forest for supervised learning of the cluster assignments provided among the most clinically sensible partitioning of patients. Other methods that obtained higher classification accuracy suffered from cluster solutions with large majority classes or clinically less sensible classes. Models that used just physical or a mix of physical and psychological outcomes proved to be among the most sensible, suggesting that clustering on psychological outcomes alone yields recovery profiles that do not conform to known risk factors.

Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study

BACKGROUND

Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery.

METHODS

This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery.

RESULTS

The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039).

CONCLUSIONS

Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.

PERSIAN Traffic Safety and Health Cohort: a study protocol on postcrash mental and physical health consequences

BACKGROUND

Cohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health consequences of road traffic injuries (RTIs) postcrash through multiple follow-ups.

METHODS

This protocol study was designed to analyse human, vehicle and environmental factors as exposures relating to postcrash outcomes (injury, disability, death, property damage, quality of life, etc). Population sources include registered injured people and followed up healthy people in precrash cohort experienced RTIs. It includes four first-year follow-ups, 1 month (phone-based), 3 months (in-person, video/phone call), 6 and 12 months (phone-based) after crash. Then, 24-month and 36-month follow-ups will be conducted triennially. Various questionnaires such as Post-traumatic Stress Disorder Questionnaire, Patient Health Questionnaire, WHO Disability Assessment Schedules, Cost-related Information, etc are completed. Counselling with a psychiatrist and a medical visit by a practitioner are provided accompanied by extra tools (simulator-based driving assessment, and psychophysiological tests). Through preliminary recruitment plan, 5807, 2905, 2247 and 1051 subjects have been enrolled, respectively at the baseline, first, second and third follow-ups by now. At baseline, cars and motorcycles accounted for over 30% and 25% of RTIs. At first follow-up, 27% of participants were pedestrians engaged mostly in car crashes. Around a fourth of injuries were single injuries. Car occupants were injured in 40% of collisions.

DISCUSSION

The study provides an opportunity to investigate physical-psychosocial outcomes of RTIs, predictors and patterns at follow-up phases postinjury through longitudinal assessments, to provide advocates for evidence-based safety national policy-making.

Expert consensus and perspectives on recovery following road traffic crashes: a Delphi study

PURPOSE

To reach expert consensus on a definition for recovery following minor and moderate road traffic crash-related injuries and key factors that influence recovery, and to explore expert perspectives on risk identification methods.

MATERIALS AND METHODS

A three-round Delphi study was conducted in which 47 experts (insurance representatives, health care professionals and researchers) were consulted.

RESULTS

Strong expert agreement (86%) was reached for the definition: "Recovery is multifaceted and includes return to activities of daily living (ADLs), work and social/leisure activities at pre-injury level or at a level deemed acceptable by the individual, with minimal ongoing pain and symptoms, considering physical and mental health and wellbeing". Agreed key factors that influenced recovery included: resilience; coping skills; recovery expectations; pre-existing physical and mental health; workplace support; and, collaboration between the injured individual, treating providers and claim handlers. Expert perspectives on risk identification methods were mixed.

CONCLUSIONS

An accepted definition for recovery following minor and moderate road traffic crash-related injury was established, which could facilitate communication and engagement between different rehabilitation stakeholders. Strong consensus was achieved on nine key factors that influenced recovery. Further research is needed to evaluate whether injured persons agree with this definition and on the utility of risk identification methods.Implications for rehabilitationExpert consensus was established for a definition of recovery following minor and moderate road traffic crash-related injuries and nine key influencing factors.An established definition could facilitate communication and engagement between all rehabilitation stakeholders, which could improve the recovery process of the injured person.Rehabilitation professionals need to be familiar with the role of psychosocial factors, such as recovery expectations, resilience and coping skills, in the recovery process.The use of physical and psychological outcome measures at regular intervals could help to identify risk of poor recovery following minor and moderate road traffic crash-related injuries.

Quality of Life in Road Traffic Accident Survivors

Introduction

The loss of quality of life is the major consequence following a non-fatal road traffic accident (RTA). Previous research regarding quality of life did not include uninjured RTA survivors. The research aim was thus to evaluate the quality of life of the RTA survivors regardless of whether or not they sustained injures, and to identify factors associated with decreased quality of life after the RTA.

Methods

A cohort of 200 RTA survivors with and without injuries was followed after experiencing an RTA. The quality of life and mental health outcomes were assessed 1 month following RTA. A vast range of sociodemographic, pre-RTA health-related, RTA related, RTA injury-related, compensation-related factors and mental health outcomes were investigated.

Results

Decreased quality of life following an RTA showed an association with the low socioeconomic status of the RTA victims, poor pre-RTA health, injury-related factors, compensation-related factors and psychological disorders after the RTA.

Conclusions

Identifying predictors of decreased quality of life following an RTA will enable planning interventions targeting the most important factors that influence recovery of RTA victims. Assessing and recording of self-reported quality of life should be a part of the routine protocol in RTA survivors’ health-care.