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Spronk I, van Uden D, Lansdorp CA, van Dammen L, van Gemert R, Visser I, Versluis G, Wanders H, Geelen SJG, Verwilligen RAF, van der Vlegel M, Bijker GC, Heijblom MC, Fokke-Akkerman M, Stoop M, van Baar ME, Nieuwenhuis MK, Pijpe A, van Schie CMH, Gardien KLM, Lucas Y, Snoeks A, Scholten-Jaegers SMHJ, Meij-de Vries A, Haanstra TM, Weel-Koenders AEAM, Wood FM, Edgar DW, Bosma E, Middelkoop E, van der Vlies CH, van Zuijlen PPM. Development of a value-based healthcare burns core set for adult burn care. Burns 2024; 50:1925-1934. [PMID: 38902131 DOI: 10.1016/j.burns.2024.03.038] [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: 08/07/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Value-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients. METHODS A three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item 'important'. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set. RESULTS Twenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards. CONCLUSION A VBHC-burns core set was developed, consisting of outcomes and quality indicators that are important to burn patients and burn care professionals. The VBHC-burns core set is now systemically monitored and analysed in Dutch burn care to improve care and patient relevant outcomes. As improving burn care and patient relevant outcomes is important worldwide, the developed VBHC-burns core set could be inspiring for other countries.
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Affiliation(s)
- I Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres (ADBC), Maasstad Hospital, Rotterdam, the Netherlands; Dutch Burns Foundation, Beverwijk, the Netherlands.
| | - D van Uden
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - C A Lansdorp
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
| | - L van Dammen
- Association of Dutch Burn Centres (ADBC), Maasstad Hospital, Rotterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Burn Centre, Martini Hospital, Groningen, the Netherlands
| | | | - I Visser
- Dutch Association of Burn survivors
| | - G Versluis
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Dutch Association of Burn survivors
| | | | - S J G Geelen
- Burn Centre, Martini Hospital, Groningen, the Netherlands; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | | | - M van der Vlegel
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | - G C Bijker
- Burn Centre, Martini Hospital, Groningen, the Netherlands
| | - M C Heijblom
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - M Fokke-Akkerman
- Association of Dutch Burn Centres (ADBC), Martini Hospital, Groningen, the Netherlands
| | - M Stoop
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | - M E van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres (ADBC), Maasstad Hospital, Rotterdam, the Netherlands
| | - M K Nieuwenhuis
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands; Association of Dutch Burn Centres (ADBC), Martini Hospital, Groningen, the Netherlands; Department for Human Movement Sciences, University Medical Center Groningen, University of Groningen, the Netherlands
| | - A Pijpe
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centres (ADBC), Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - K L M Gardien
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | - Y Lucas
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - A Snoeks
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
| | | | - A Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam, the Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - T M Haanstra
- Dutch Burns Foundation, Beverwijk, the Netherlands; Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - A E A M Weel-Koenders
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands; Maasstad Hospital, Rotterdam, the Netherlands
| | - F M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia; Burn Injury Research Unit, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Western Australia, Australia
| | - D W Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia; Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Burn Injury Research Unit, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Western Australia, Australia; Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia
| | - E Bosma
- Burn Centre, Martini Hospital, Groningen, the Netherlands; Department of Surgery, Martini Hospital, Groningen, the Netherlands
| | - E Middelkoop
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centres (ADBC), Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - C H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Departments of Trauma and Burn Surgery, Maasstad Ziekenhuis, Rotterdam, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Trauma Research Unit, Department of Surgery, the Netherlands
| | - P P M van Zuijlen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands
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Ackermann A, Pappinen J, Nurmi J, Nordquist H, Saviluoto A, Mannila S, Mäkelä S, Torkki P. A scenario based approach to optimizing cost-effectiveness of physician-staffed Helicopter Emergency Medical Services compared to ground-based Emergency Medical Services in Finland. Scand J Trauma Resusc Emerg Med 2024; 32:60. [PMID: 38956713 PMCID: PMC11221128 DOI: 10.1186/s13049-024-01231-z] [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: 02/13/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES Since Helicopter Emergency Medical Services (HEMS) is an expensive resource in terms of unit price compared to ground-based Emergency Medical Service (EMS), it is important to further investigate which methods would allow for the optimization of these services. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared to ground-based EMS in developed scenarios with improvements in triage, aviation performance, and the inclusion of ischemic stroke patients. METHODS Incremental cost-effectiveness ratio (ICER) was assessed by comparing health outcomes and costs of HEMS versus ground-based EMS across six different scenarios. Estimated 30-day mortality and quality-adjusted life years (QALYs) were used to measure health benefits. Quality-of-Life (QoL) was assessed with EuroQoL instrument, and a one-way sensitivity analysis was carried out across different patient groups. Survival estimates were evaluated from the national FinnHEMS database, with cost analysis based on the most recent financial reports. RESULTS The best outcome was achieved in Scenario 3.1 which included a reduction in over-alerts, aviation performance enhancement, and assessment of ischemic stroke patients. This scenario yielded 1077.07-1436.09 additional QALYs with an ICER of 33,703-44,937 €/QALY. This represented a 27.72% increase in the additional QALYs and a 21.05% reduction in the ICER compared to the current practice. CONCLUSIONS The cost-effectiveness of HEMS can be highly improved by adding stroke patients into the dispatch criteria, as the overall costs are fixed, and the cost-effectiveness is determined based on the utilization rate of capacity.
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Affiliation(s)
- Axel Ackermann
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. BOX 00020, Helsingin Yliopisto, Helsinki, 00014, Finland.
| | - Jukka Pappinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. BOX 00020, Helsingin Yliopisto, Helsinki, 00014, Finland
| | - Jouni Nurmi
- Helsinki University Hospital and University of Helsinki, Acute, Medical Helicopter FinnHEMS 10, Vesikuja 9, Vantaa, 01530, Finland
- FinnHEMS Oy, c/o Avia Pilot, Lentäjäntie 3, Vantaa, 01530, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Department of Healthcare and Emergency care, Pääskysentie 1, Kotka, 48220, Finland
| | - Anssi Saviluoto
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Santtu Mannila
- Copterpoint Oy, Vähäniityntie 18B, Helsinki, 00570, Finland
| | - Simo Mäkelä
- Data Science, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. BOX 00020, Helsingin Yliopisto, Helsinki, 00014, Finland
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Zarzaur BL, Holler E, Ortiz D, Perkins A, Lasiter S, Gao S, French DD, Khan B, Boustani M. Collaborative Care for Injured Older Adults: The Trauma Medical Home Randomized Clinical Trial. JAMA Surg 2024; 159:756-764. [PMID: 38717762 PMCID: PMC11079789 DOI: 10.1001/jamasurg.2024.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/18/2024] [Indexed: 05/12/2024]
Abstract
Importance Older adults with recent injuries can have impaired long-term biopsychosocial function and may benefit from interventions adapted to their needs. Objective To determine if a collaborative care intervention, Trauma Medical Home (TMH), improved the biopsychosocial function of older patients in the year after injury. Design, Setting, and Participants This was a single-blinded, randomized clinical trial conducted at 4 level I trauma centers in Indianapolis, Indiana, and Madison, Wisconsin. Between October 2017 and October 2021, patients aged 50 years and older with an Injury Severity Score (ISS) of 9 or greater and without traumatic brain or spinal cord injury were enrolled. Exclusions were significant brain injury or a spinal cord injury with a persistent neurologic deficit at the time of enrollment, extensive burns, pregnancy, incarceration, neurodegenerative disease, visual or auditory impairment that would preclude study participation, a life expectancy of less than 1 year, significant alcohol or drug use history, and acute stroke during admission. Of 10 276 patients screened, 430 were randomized and 299 completed 12-month follow-up. Data were analyzed from March to July 2023. Intervention Intervention patients received 6 months of TMH delivered by a nurse care coordinator guided by an interdisciplinary team (trauma surgeon, pulmonary critical care and geriatrician physicians, nurses, and psychologist) in partnership with primary care. The care coordinator used standard protocols to monitor and treat biopsychosocial symptoms. Main Outcomes and Measures Primary outcomes were Medical Outcome Study Short Form-36 (SF-36) score and Short Physical Performance Battery (SPPB) score at 12 months. Secondary outcomes were Patient Health Questionnaire-9 (PHQ-9) score, the Generalized Anxiety Disorder scale-7 (GAD-7) score, and health care utilization. Results A total of 429 participants (228 [53.1%] female; mean [SD] age, 69.3 [10.8] years; mean [SD] ISS, 12.3 [4.6]) completed baseline assessments and were randomized. Follow-up was 76% (n = 324) at 6 months and 70% (n = 299) at 12 months. There were no differences between the TMH and usual care groups at 12 months in SF-36 Physical Component Summary score (mean [SD], 40.42 [12.82] vs 39.18 [12.43]), SF-36 Mental Component Summary score (mean [SD], 53.92 [10.02] vs 53.21 [10.82]), or SPPB score (mean [SD], 8.00 [3.60] vs 8.28 [3.88]). Secondary outcomes were also no different. Planned subgroup analysis revealed patients with baseline symptoms of anxiety or depression (high GAD-7 and PHQ-9 scores) experienced improvement in the Mental Component Summary score when randomized to the TMH intervention. Conclusions and Relevance The TMH intervention did not significantly influence quality of life, depressive and anxiety symptoms, or physical function of older adults with injury at 12 months. Subgroup analysis showed positive impact in patients with a high burden of anxiety and depression symptoms at enrollment. Collaborative care interventions may improve long-term outcomes of select patients, but further research is needed. Trial Registration ClinicalTrials.gov Identifier: NCT03108820.
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Affiliation(s)
- Ben L. Zarzaur
- Division of Acute Care and Regional General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington
| | - Damaris Ortiz
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Anthony Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | - Sue Lasiter
- School of Nursing and Health Studies, Health Sciences District, University of Missouri, Kansas City
| | - Sujuan Gao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | - Dustin D. French
- Department of Ophthalmology and Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Babar Khan
- Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Malaz Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis
- Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis
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Ackermann A, Pappinen J, Nurmi J, Nordquist H, Torkki P. The Estimated Cost-Effectiveness of Physician-Staffed Helicopter Emergency Medical Services Compared to Ground-Based Emergency Medical Services in Finland. Air Med J 2024; 43:229-235. [PMID: 38821704 DOI: 10.1016/j.amj.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Because the unit cost of helicopter emergency medical services (HEMS) is higher than traditional ground-based emergency medical services (EMS), it is important to further investigate the impact of HEMS. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared with ground-based EMS in Finland under current practices. METHODS The incremental cost-effectiveness ratio was evaluated using the differences in outcomes and costs between HEMS and ground-based EMS. The estimated mortality within 30 days and quality-adjusted life years (QALYs) were used to measure health benefits. Quality of life was estimated according to the EuroQoL scale, and a 1-way sensitivity analysis was conducted on the QALY indexes ranging from 0.6 to 0.8. Survival rates were calculated according to the national HEMS database, and the cost structure was estimated at 48 million euros based on financial statements. RESULTS HEMS prevented the 30-day mortality of 68.1 patients annually, with an incremental cost-effectiveness ratio of €43,688 to €56,918/QALY. Fixed costs accounted for 93% of HEMS expenses because of 24/7 operations, making the capacity utilization rate a major determinant of total costs. CONCLUSION HEMS intervention is cost-effective compared with ground-based EMS and is acceptable from a societal willingness-to-pay perspective. These findings contribute valuable insights for health care management decision making and highlight the need for future research for service optimization.
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Affiliation(s)
- Axel Ackermann
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland.
| | - Jukka Pappinen
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vantaa, Finland
| | - Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Paulus Torkki
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
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Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Home Versus Hospital Rehabilitation of Older Adults Following Hip Fracture Yields Similar Patient-Reported Outcome Measures. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241230293. [PMID: 38491840 PMCID: PMC10943717 DOI: 10.1177/00469580241230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/18/2024]
Abstract
The increase in hip fractures (HF) due to aging of the population and the rise in attractiveness of services provided at home following the COVID-19 pandemic, emphasize the need to compare outcomes of home versus hospital HF rehabilitation. To date, studies comparing the 2 services have focused primarily on clinical outcomes rather than patient-reported outcomes (PROs). This longitudinal observational study evaluated PROs of older adults with HF in the 2 settings. The SF36 questionnaire was used to measure PROs 3 times after surgery. The first PRO was retrospective and reflected pre-fracture health status. Descriptive statistics and mixed-effect logistic regression were used. Of 86 patients participating in the study, 41 had home rehabilitation and 45 had hospital rehabilitation. In both groups, the mental and physical scores plummeted 2 weeks after the HF, compared to pre-fracture status. The difference in improvement from pre-fracture status to recovery in both groups, were not significantly (P < .05) different, except for the pain domain. PROs of home versus hospital rehabilitation were similar, suggesting that rehabilitation at home can be as effective as hospital rehabilitation for suitable patients. This knowledge can improve quality of care in an aging global population.
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Affiliation(s)
- Hanna S. Schroeder
- Hebrew University of Jerusalem, Jerusalem, Israel
- Israeli Ministry of Health, Israel
| | - Avi Israeli
- Israeli Ministry of Health, Israel
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Omer Or
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Ora Paltiel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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Schieffelers DR, Dombrecht D, Lafaire C, De Cuyper L, Rose T, Vandewal M, Meirte J, Gebruers N, van Breda E, Van Daele U. Effects of exercise training on muscle wasting, muscle strength and quality of life in adults with acute burn injury. Burns 2023; 49:1602-1613. [PMID: 37188565 DOI: 10.1016/j.burns.2023.04.003] [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: 11/17/2022] [Revised: 02/23/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Exercise training during the acute phase of burns is difficult to implement but offers potential benefits. This multicenter trial explored the effects of an exercise program on muscular changes and quality of life during burn center stay. METHODS Fifty-seven adults with burns ranging between 10% and 70% TBSA were allocated to receive either standard of care (n = 29), or additionally exercise (n = 28), consisting of resistance and aerobic training, commenced as early as possible according to safety criteria. Muscle wasting (primary outcome), quantified by ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), muscle strength and quality of life (Burn Specific Health Scale-Brief (BSHS-B) and EQ-5D-5L) were assessed at baseline, four and eight weeks later, or hospital discharge. Mixed models were used to analyze between-group changes over time with covariates of interest added in stepwise forward modeling. RESULTS The addition of exercise training to standard of care induced significant improvements in QMLT, RF-CSA, muscle strength and the BSHS-B subscale hand function (ß-coefficient. 0.055 cm/week of QMLT, p = 0.005). No added benefit was observed for other quality-of-life measures. CONCLUSIONS Exercise training, administered during the acute phase of burns, reduced muscle wasting, and improved muscle strength throughout burn center stay.
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Affiliation(s)
- David R Schieffelers
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Dorien Dombrecht
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Cynthia Lafaire
- Burn Unit, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Lieve De Cuyper
- Burn Unit, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Thomas Rose
- Burn Unit, Military Hospital Queen Astrid, Rue Bruyn 1, 1120 Brussels, Belgium
| | - Martijn Vandewal
- Burn Unit, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium
| | - Jill Meirte
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Nick Gebruers
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Multidisciplinary Edema Clinic, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Eric van Breda
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Ulrike Van Daele
- Multidisciplinary Metabolic Research Unit (M2RUN), MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; OSCARE, Organization for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium.
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7
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Pei LX, Chan H, Erdelyi S, Jae L, Brubacher JR. Circumstances and outcome of active transportation injuries: protocol of a British Columbian inception cohort study. BMJ Open 2023; 13:e079219. [PMID: 37879691 PMCID: PMC10603471 DOI: 10.1136/bmjopen-2023-079219] [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: 08/25/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Active transport (AT) is promoted by urban planners and health officials for its environmental, economic and societal benefits and its uptake is increasing. Unfortunately, AT users can be injured or killed due to falls or collisions. Active transport injury (ATI) prevention efforts are hindered by limited research on the circumstances, associated infrastructure, injury pattern, severity and outcome of ATI events. This study seeks to address these knowledge gaps by identifying built environment features associated with injury and risk factors for a poor outcome following ATI. METHODS AND ANALYSIS This prospective observational study will recruit an inception cohort of 2000 ATI survivors, including pedestrians, cyclists and micromobility users aged 16 years and older who arrive at a participating emergency department within 48 hours of sustaining an ATI. Baseline interviews capture demographic and socioeconomic information, pre-injury health and functional status, as well as circumstances of the injury event and recovery expectations. Follow-up interviews at 2, 4, 6 and 12 months postinjury (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcomes, functional recovery and healthcare resource use and lost productivity costs. ETHICS AND DISSEMINATION The Active Transportation Injury Circumstances and Outcome Study is approved by our institutional research ethics board and the research ethics boards of all participating sites. This study aims to provide healthcare providers with knowledge of risk factors for poor outcome following ATI with the goal of improving patient management. Additionally, this study will provide insight into the circumstances of ATI events including built environment features and how those circumstances relate to recovery outcomes. This information can be used to inform city engineers and planners, policymakers and public health officials to plan roadway design and injury prevention policy.
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Affiliation(s)
- Lulu X Pei
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lina Jae
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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8
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Mohanty S, Holler E, Ortiz D, Meagher A, Perkins A, Bylund P, Khan B, Unverzagt F, Xu H, Ingraham A, Boustani M, Zarzaur B. Delirium and neuropsychological recovery among emergency general surgery survivors (DANE): study protocol for a randomized controlled trial and collaborative care intervention. Trials 2023; 24:634. [PMID: 37789461 PMCID: PMC10548755 DOI: 10.1186/s13063-023-07670-w] [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: 07/19/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Delirium is a complex neuropsychiatric syndrome which consists of acute and varying changes in cognition and consciousness. Patients who develop delirium are at increased risk for a constellation of physical, cognitive, and psychological disabilities long after the delirium has ended. Collaborative care models integrating primary and specialty care in order to address patients with complex biopsychosocial needs have been demonstrated to improve outcomes in patients with chronic diseases. The purpose of this study is to evaluate the ability of a collaborative care model on the neuropsychologic recovery of delirium survivors following emergency surgery. METHODS This protocol describes a multicenter (eight hospitals in three states) randomized controlled trial in which 528 patients who develop delirium following emergency surgery will be randomized to either a collaborative care model or usual care. The efficacy of the collaborative care model on cognitive, physical, and psychological recovery in these delirium survivors will then be evaluated over 18 months. DISCUSSION This will be among the first randomized clinical trials in postoperative delirium survivors evaluating an intervention designed to mitigate the downstream effects of delirium and improve the neuropsychologic recovery after surgery. We hope that the results of this study will add to and inform strategies to improve postoperative recovery in this patient group. TRIAL REGISTRATION ClinicalTrials.gov NCT05373017. Registered on May 12, 2022.
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Affiliation(s)
- Sanjay Mohanty
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emma Holler
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Damaris Ortiz
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ashley Meagher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anthony Perkins
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peggy Bylund
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Babar Khan
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | | | - Hupuing Xu
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Angela Ingraham
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, G5/335, USA
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Ben Zarzaur
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, G5/335, USA.
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9
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Collins J, Lizarondo L, Taylor S, Porritt K. Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review. Disabil Rehabil 2023; 45:3435-3455. [PMID: 36299236 DOI: 10.1080/09638288.2022.2133180] [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: 01/02/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event. METHODS The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools. RESULTS Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge. CONCLUSION This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process. IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.
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Affiliation(s)
- Jeanette Collins
- JBI, University of Adelaide, Adelaide, Australia
- Jeanette Collins, Rehabilitation in the Home (RITH), Perth, Australia
| | | | - Susan Taylor
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
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10
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Mohanty S, Holler E, Ortiz D, Meagher A, Perkins A, Bylund P, Khan B, Unverzagt F, Xu H, Ingraham A, Boustani M, Zarzaur B. Delirium and Neuropsychological Recovery among Emergency General Surgery Survivors (DANE): study protocol for a randomized controlled trial and collaborative care intervention. RESEARCH SQUARE 2023:rs.3.rs-3185716. [PMID: 37720054 PMCID: PMC10503839 DOI: 10.21203/rs.3.rs-3185716/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background: Delirium is a complex neuropsychiatric syndrome which consists of acute and varying changes in cognition and consciousness. Patients who develop delirium are at increased risk for a constellation of physical, cognitive, and psychological disability long after the delirium has ended. Collaborative care models integrating primary and specialty care in order to address patients with complex biopsychosocial needs has been demonstrated to improve outcomes in patients with chronic diseases. The purpose of this study is to evaluate the ability of a collaborative care model on the neuropsychologic recovery of delirium survivors following emergency surgery. Methods: This protocol describes a multicenter (eight hospitals in three states) randomized controlled trial in which 528 patients who develop delirium following emergency surgery will be randomized to either a collaborative care model or usual care. The efficacy of the collaborative care model on cognitive, physical, and psychological recovery in this delirium survivors will then be evaluated over eighteen months. Discussion: This will be among the first randomized clinical trials in postoperative delirium survivors evaluating an intervention designed to mitigate the downstream effects of delirium and improve the neuropsychologic recovery after surgery. We hope that the results of this study will add to and inform strategies to improve postoperative recovery in this patient group. Trial registration: NCT05373017 (clinicaltrials.gov).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Angela Ingraham
- University of Wisconsin-Madison School of Medicine and Public Health
| | | | - Ben Zarzaur
- University of Wisconsin-Madison School of Medicine and Public Health
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11
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Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER). Eur J Trauma Emerg Surg 2022; 49:929-938. [PMID: 36480054 PMCID: PMC10175317 DOI: 10.1007/s00068-022-02160-1] [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: 09/23/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. METHODS This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. RESULTS Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). CONCLUSION Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.
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12
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Loggers SAI, Willems HC, Van Balen R, Gosens T, Polinder S, Ponsen KJ, Van de Ree CLP, Steens J, Verhofstad MHJ, Zuurmond RG, Van Lieshout EMM, Joosse P. Evaluation of Quality of Life After Nonoperative or Operative Management of Proximal Femoral Fractures in Frail Institutionalized Patients: The FRAIL-HIP Study. JAMA Surg 2022; 157:424-434. [PMID: 35234817 PMCID: PMC8892372 DOI: 10.1001/jamasurg.2022.0089] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Decision-making on management of proximal femoral fractures in frail patients with limited life expectancy is challenging, but surgical overtreatment needs to be prevented. Current literature provides limited insight into the true outcomes of nonoperative management and operative management in this patient population. Objective To investigate the outcomes of nonoperative management vs operative management of proximal femoral fractures in institutionalized frail older patients with limited life expectancy. Design, Setting, and Participants This multicenter cohort study was conducted between September 1, 2018, and April 25, 2020, with a 6-month follow-up period at 25 hospitals across the Netherlands. Eligible patients were aged 70 years or older, frail, and institutionalized and sustained a femoral neck or pertrochanteric fracture. The term frail implied at least 1 of the following characteristics was present: malnutrition (body mass index [calculated as weight in kilograms divided by height in meters squared] <18.5) or cachexia, severe comorbidities (American Society of Anesthesiologists physical status class of IV or V), or severe mobility issues (Functional Ambulation Category ≤2). Exposures Shared decision-making (SDM) followed by nonoperative or operative fracture management. Main Outcomes and Measures The primary outcome was the EuroQol 5 Dimension 5 Level (EQ-5D) utility score by proxies and caregivers. Secondary outcome measures were QUALIDEM (a dementia-specific quality-of-life instrument for persons with dementia in residential settings) scores, pain level (assessed by the Pain Assessment Checklist for Seniors With Limited Ability to Communicate), adverse events (Clavien-Dindo classification), mortality, treatment satisfaction (numeric rating scale), and quality of dying (Quality of Dying and Death Questionnaire). Results Of the 172 enrolled patients with proximal femoral fractures (median [25th and 75th percentile] age, 88 [85-92] years; 135 women [78%]), 88 opted for nonoperative management and 84 opted for operative management. The EQ-5D utility scores by proxies and caregivers in the nonoperative management group remained within the set 0.15 noninferiority limit of the operative management group (week 1: 0.17 [95% CI, 0.13-0.29] vs 0.26 [95% CI, 0.11-0.23]; week 2: 0.19 [95% CI, 0.10-0.27] vs 0.28 [95% CI, 0.22-0.35]; and week 4: 0.24 [95% CI, 0.15-0.33] vs 0.34 [95% CI, 0.28-0.41]). Adverse events were less frequent in the nonoperative management group vs the operative management group (67 vs 167). The 30-day mortality rate was 83% (n = 73) in the nonoperative management group and 25% (n = 21) in the operative management group, with 26 proxies and caregivers (51%) in the nonoperative management group rating the quality of dying as good-almost perfect. Treatment satisfaction was high in both groups, with a median numeric rating scale score of 8. Conclusions and Relevance Results of this study indicated that nonoperative management of proximal femoral fractures (selected through an SDM process) was a viable option for frail institutionalized patients with limited life expectancy, suggesting that surgery should not be a foregone conclusion for this patient population.
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Affiliation(s)
- Sverre A. I. Loggers
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hanna C. Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam University Medical Center location AMC, Amsterdam, the Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kornelis J. Ponsen
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands,Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | | | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Esther M. M. Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter Joosse
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands,Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
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13
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Sadeghi-Bazargani H, Shahedifar N, Somi MH, Poustchi H, Bazargan-Hejazi S, Asghari Jafarabadi M, Sadeghi V, Golestani M, Pourasghar F, Mohebbi I, Ahmadi S, Shafiee-Kandjani AR, Ala A, Abdi S, Rezaei M, Farahbakhsh M. PERSIAN Traffic Safety and Health Cohort: a study protocol on postcrash mental and physical health consequences. Inj Prev 2022; 28:269-279. [PMID: 35292482 DOI: 10.1136/injuryprev-2021-044499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/10/2022] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Nasrin Shahedifar
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of) .,Injury Epidemiology and Prevention Research Group, Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Mohammad Hossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles Drew University of Medicine and Science, Los Angeles, California, USA
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of).,Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran (the Islamic Republic of)
| | - Vahideh Sadeghi
- Health Services Management Department, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mina Golestani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Faramarz Pourasghar
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Iraj Mohebbi
- Department of Occupational Medicine, Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran (the Islamic Republic of)
| | - Sajjad Ahmadi
- Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Reza Shafiee-Kandjani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Alireza Ala
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Salman Abdi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mahdi Rezaei
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mostafa Farahbakhsh
- Research Center of Psychiatry and Behavioural Sciences, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
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Alghnam S, Alghamdi M, Alzahrani S, Alzomai S, Alghannam A, Albabtain I, Alsheikh K, Bajowaiber M, Alghamdi A, Alibrahim F, Aldibasi O. The prevalence of long-term rehabilitation following motor-vehicle crashes in Saudi Arabia: a multicenter study. BMC Musculoskelet Disord 2022; 23:202. [PMID: 35241048 PMCID: PMC8895876 DOI: 10.1186/s12891-022-05153-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction In Saudi Arabia, motor-vehicle crashes (MVC) are the leading cause of disability-adjusted life years (DALYs). There is limited information locally on the magnitude and need for rehabilitation following MVC. This study examined the prevalence of MVC patients requiring long-term rehabilitation and the epidemiology of associated injuries. Methods A retrospective study was conducted at four hospitals of the National Guard Hospitals Affairs from January 2016 to March 2019. The study used data from an institutional trauma registry of all MVC admissions. Chi-square tests, bivariate and multivariate analyses were conducted to compare patients requiring long-term and short-term rehabilitation. Results The study included 506 patients. The study population was relatively young, with an average age was 32.8 ± 15.5 years, and the majority were males. Over two-thirds (71.3%) of patients required long-term rehabilitation. Half the patients sustained multiple fractures, and 17.0% sustained traumatic brain injuries. Overall, 53.1 and 61.8% of patients required occupational and physiotherapy, respectively. Those admitted to the intensive care unit were four times more likely to need long-term rehabilitation. Conclusions We found a significant burden of long-term rehabilitation following MVC. Patients were relatively young, thus posing a significant burden on future healthcare utilization. Policymakers should use these findings to guide primary, secondary, and tertiary prevention to improve health outcomes.
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Affiliation(s)
- Suliman Alghnam
- Population Health Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Mashael Alghamdi
- Population Health Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sarah Alzahrani
- Population Health Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sufyan Alzomai
- Population Health Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulah Alghannam
- Lifestyle and Health Research Center, Health Sciences Research Center , Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ibrahim Albabtain
- Department of Surgery, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid Alsheikh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Orthopedics, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
| | - Miasem Bajowaiber
- National Center for Road Safety, Ministry of Transportation, Riyadh, Saudi Arabia
| | - Ali Alghamdi
- National Center for Road Safety, Ministry of Transportation, Riyadh, Saudi Arabia
| | | | - Omar Aldibasi
- Biostatistics Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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James A, Tran VT, Gauss T, Hamada S, Roquet F, Bitot V, Boutonnet M, Raux M, Ravaud P. Important Issues to Severe Trauma Survivors: A Qualitative Study. Ann Surg 2022; 275:189-195. [PMID: 32209913 DOI: 10.1097/sla.0000000000003879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identify issues that are important to severe trauma survivors up to 3 years after the trauma. BACKGROUND Severe trauma is the first cause of disability-adjusted life years worldwide, yet most attention has focused on acute care and the impact on long-term health is poorly evaluated. METHOD We conducted a large-scale qualitative study based on semi-structured phone interviews. Qualitative research methods involve the systematic collection, organization, and interpretation of conversations or textual data with patients to explore the meaning of a phenomenon experienced by individuals themselves. We randomly selected severe trauma survivors (abbreviated injury score ≥3 in at least 1 body region) who were receiving care in 6 urban academic level-I trauma centers in France between March 2015 and March 2018. We conducted double independent thematic analysis. Issues reported by patients were grouped into overarching domains by a panel of 5 experts in trauma care. Point of data saturation was estimated with a mathematical model. RESULTS We included 340 participants from 3 months to 3 years after the trauma [median age: 41 years (Q1-Q3 24-54), median injury severity score: 17 (Q1-Q3 11-22)]. We identified 97 common issues that we grouped into 5 overarching domains: body and neurological issues (29 issues elicited by 277 participants), biographical disruption (23 issues, 210 participants), psychological and personality issues (21 issues, 147 participants), burden of treatment (14 issues, 145 participants), and altered relationships (10 issues, 87 participants). Time elapsed because the trauma, injury location, or in-hospital trauma severity did not affect the distribution of these domains across participants' answers. CONCLUSIONS This qualitative study explored trauma survivors' experiences of the long-term effect of their injury and allowed for identifying a set of issues that they consider important, including dimensions that seem overlooked in trauma research. Our findings confirm that trauma is a chronic medical condition that demands new approaches to post-discharge and long-term care.
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Affiliation(s)
- Arthur James
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Center d'épidémiologie clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France AP-HP
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Sorbonne Université, Paris, France
| | - Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- Center d'épidémiologie clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France AP-HP
| | - Tobias Gauss
- Department of Anaesthesia and Critical Care, Hôpital Beaujon, HUPNVS, AP-HP, Clichy, France
| | - Sophie Hamada
- Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
- CESP, INSERM, Université paris Sud, UVSQ, Université Paris-Saclay, Paris
| | - Florian Roquet
- Service d'Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Service de Biostatistique et Informatique Médicale, Unité INSERM UMR 1153, Université Paris Diderot, Paris, France
| | - Valérie Bitot
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service d'anesthésie et des réanimations chirurgicales, Créteil Cedex, France
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart Cedex, France
| | - Mathieu Raux
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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16
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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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Houwen T, Vugts MAP, Lansink KWW, Theeuwes HP, Neequaye N, Beerekamp MSH, Joosen MCW, de Jongh MAC. Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Qualitative and Quantitative Formative Evaluations (Preprint). JMIR Hum Factors 2021; 9:e35342. [PMID: 35723928 PMCID: PMC9254041 DOI: 10.2196/35342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients’ health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations. Objective This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals. Methods Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models. Results Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3, 95% CI 2.55-4.34; P<.001) or a web viewer (OR 2.3, 95% CI 1.64-3.31; P<.001) was considered the most important for an mHealth solution by surgeons, followed by the inclusion of periodic self-measurements (OR 2, 95% CI 1.64-2.46; P<.001), the local adjustment of patient information (OR 1.8, 95% CI 1.42-2.33; P<.001), local hospital identification (OR 1.7, 95% CI 1.31-2.10; P<.001), complication detection (OR 1.5, 95% CI 1.21-1.84; P<.001), and the personalization of rehabilitation through artificial intelligence (OR 1.4, 95% CI 1.13-1.62; P=.001). Conclusions In the context of trauma care, end users have many requirements for an mHealth solution that addresses psychosocial functioning; dependable information; and, possibly, a prediction of how a patient’s recovery trajectory is evolving. A structured development approach provided insights into value drivers and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most—but plausibly not yet all—end users in trauma care will value. This study could inspire the trauma care community.
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Affiliation(s)
- Thymen Houwen
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Miel A P Vugts
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Koen W W Lansink
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Hilco P Theeuwes
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Nicky Neequaye
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | | | - Margot C W Joosen
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Mariska A C de Jongh
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
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18
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van Ditshuizen JC, van Lieshout EMM, van Beeck EF, Verhofstad MHJ, den Hartog D. Health-related quality of life and return to work 1 year after major trauma from a network perspective. Eur J Trauma Emerg Surg 2021; 48:2421-2431. [PMID: 34514511 PMCID: PMC9192406 DOI: 10.1007/s00068-021-01781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/01/2021] [Indexed: 12/04/2022]
Abstract
Introduction Major trauma often results in long-term disabilities. The aim of this study was to assess health-related quality of life, cognition, and return to work 1 year after major trauma from a trauma network perspective. Methods All major trauma patients in 2016 (Injury Severity Score > 15, n = 536) were selected from trauma region Southwest Netherlands. Eligible patients (n = 365) were sent questionnaires with the EQ-5D-5L and questions on cognition, level of education, comorbidities, and resumption of paid work 1 year after trauma. Results A 50% (n = 182) response rate was obtained. EQ-US and EQ-VAS scored a median (IQR) of 0.81 (0.62–0.89) and 70 (60–80), respectively. Limitations were prevalent in all health dimensions of the EQ-5D-5L; 90 (50%) responders reported problems with mobility, 36 (20%) responders reported problems with self-care, 108 (61%) responders reported problems during daily activities, 129 (73%) responders reported pain or discomfort, 70 (39%) responders reported problems with anxiety or depression, and 102 (61%) of the patients reported problems with cognition. Return to work rate was 68% (37% full, 31% partial). A median (IQR) EQ-US of 0.89 (0.82–1.00) and EQ-VAS of 80 (70–90) were scored for fully working responders; 0.77 (0.66–0.85, p < 0.001) and 70 (62–80, p = 0.001) for partial working respondents; and 0.49 (0.23–0.69, p < 0.001) and 55 (40–72, p < 0.001) for unemployed respondents. Conclusion The majority experience problems in all health domains of the EQ-5D-5L and cognition. Return to work status was associated with all health domains of the EQ-5D-5L and cognition.
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Affiliation(s)
- Jan C. van Ditshuizen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M. M. van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ed F. van Beeck
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michiel H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Abstract
Many Intensive Care (ICU) survivors experience long lasting impairments in physical and psychological health as well as social functioning. The objective of our study was to evaluate these effects up to 10 years after ICU discharge. We performed a long-term prospective cohort study in patients admitted for longer than 48 h in a medical-surgical ICU. We evaluated health-related quality of life (HRQOL) before ICU admission using the Short-form-36 (SF-36), at ICU discharge, at hospital discharge and at 1, 2, 5 and 10 years follow up (all by patients). Changes in HRQOL were assessed based on linear mixed modeling. We included a total of 749 patients (from 2000 to 2008). During 10 years 475 (63.4%) patients had died, 125 (16.7%) patients were lost to follow up and 149 (19.9%) patients could be evaluated. The mean scores of four HRQOL dimensions (i.e., physical functioning (p < 0.001; mean 54, SD 32, effect size 0.77, 95% CI [0.54-1.0]), role-physical (p < 0.001; mean 44, SD 47, effect size 0.65, 95% CI [0.41-0.68] general health (p < 0.001; mean 52, SD 27, effect size 0.48; 95% CI 0.25-0.71) and social functioning (p < 0.001; mean 72, SD 32, effect size 0.41, 95% CI [0.19-0.64]) were still lower 10 years after ICU discharge compared with pre-admission levels (n = 149) and with an age reference population. Almost all SF-36 dimensions changed significantly over time from ICU discharge up to 10 years after ICU discharge. Over the 10 year follow up physical functioning of medical-surgical ICU survivors remains impaired compared with their pre-admission values and an age reference population. However, effect sizes showed no significant differences suggesting that surviving patients largely regained their age-specific HRQOL at 10 years.
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20
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Hung KKC, Rainer TH, Yeung JHH, Cheung C, Leung Y, Leung LY, Chong M, Ho HF, Tsui KL, Cheung NK, Graham C. Seven-year excess mortality, functional outcome and health status after trauma in Hong Kong. Eur J Trauma Emerg Surg 2021; 48:1417-1426. [PMID: 34086062 DOI: 10.1007/s00068-021-01714-z] [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: 01/21/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose was to investigate long-term health impacts of trauma and the aim was to describe the functional outcome and health status up to 7 years after trauma. METHODS We conducted a prospective, multi-centre cohort study of adult trauma patients admitted to three regional trauma centres with moderate or major trauma (ISS ≥ 9) in Hong Kong (HK). Patients were followed up at regular time points (1, 6 months and 1, 2, 3, 4, 5, 6, and 7 years) by telephone using extended Glasgow Outcome Scale (GOSE) and the Short-Form 36 (SF36). Observed annual mortality rate was compared with the expected mortality rate estimated using the HK population cohort. Linear mixed model (LMM) analyses examined the changes in SF36 with subgroups of age ≥ 65 years, ISS > 15, and GOSE ≥ 5 over time. RESULTS At 7 years, 115 patients had died and 48% (138/285) of the survivors responded. The annual mortality rate (AMR) of the trauma cohort was consistently higher than the expected mortality rate from the general population. Forty-one percent of respondents had upper good recovery (GOSE = 8) at 7 years. Seven-year mean PCS and MCS were 45.06 and 52.06, respectively. LMM showed PCS improved over time in patients aged < 65 years and with baseline GOSE ≥ 5, and the MCS improved over time with baseline GOSE ≥ 5. Higher mortality rate, limited functional recovery and worse physical health status persisted up to 7 years post-injury. CONCLUSION Long-term mortality and morbidity should be monitored for Asian trauma centre patients to understand the impact of trauma beyond hospital discharge.
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Affiliation(s)
- Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Timothy H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Emergency Medicine Unit, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Janice Hiu Hung Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Catherine Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yuki Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Marc Chong
- School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hiu Fai Ho
- Accident and Emergency Department, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Kwok Leung Tsui
- Trauma Committee, New Territory West Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Nai Kwong Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Colin Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. .,Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong.
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21
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Predictors of poor health and functional recovery following road trauma: protocol of a British Columbian inception cohort study. BMJ Open 2021. [PMCID: PMC8039231 DOI: 10.1136/bmjopen-2021-049623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Road trauma (RT) is a major public health problem affecting physical and mental health, and may result in prolonged absenteeism from work or study. It is important for healthcare providers to know which RT survivors are at risk of a poor outcome, and policy-makers should know the associated costs. Unfortunately, outcome after RT is poorly understood, especially for RT survivors who are treated and released from an emergency department (ED) without the need for hospital admission. Currently, there is almost no research on risk factors for a poor outcome among RT survivors. This study will use current Canadian data to address these knowledge gaps. Methods and analysis We will follow an inception cohort of 1500 RT survivors (16 years and older) who visited a participating ED within 24 hours of the accident. Baseline interviews determine pre-existing health and functional status, and other potential risk factors for a poor outcome. Follow-up interviews at 2, 4, 6, and 12 months (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcome, functional recovery, and healthcare resource use and lost productivity costs. Ethics and dissemination The Road Trauma Outcome Study is approved by our institutional Research Ethics Board. This study aims to provide healthcare providers with knowledge on how quickly RT survivors recover from their injuries and who may be more likely to have a poor outcome. We anticipate that this information will be used to improve management of all road users following RT. Healthcare resource use and lost productivity costs will be collected to provide a better cost estimate of the effects of RT. This information can be used by policy-makers to make informed decisions on RT prevention programmes.
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Vardon-Bounes F, Gracia R, Abaziou T, Crognier L, Seguin T, Labaste F, Geeraerts T, Georges B, Conil JM, Minville V. A study of patients' quality of life more than 5 years after trauma: a prospective follow-up. Health Qual Life Outcomes 2021; 19:18. [PMID: 33419450 PMCID: PMC7796607 DOI: 10.1186/s12955-020-01652-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term fate of severely injured patients in terms of their quality of life is not well known. Our aim was to assess the quality of life of patients who have suffered moderate to severe trauma and to identify primary factors of long-term quality of life impairment. METHODS A prospective monocentric study conducted on a number of patients who were victims of moderate to severe injuries during the year 2012. Patients were selected based on an Injury Severity Score (ISS) more than or equal to 9. Quality of life was assessed by the MOS SF-36 and NHP scores as a primary evaluation criterion. The secondary evaluation criteria were the determination of the socio-economic impact on quality of life and the identification of factors associated with disability. RESULTS Two hundred and eight patients were contacted by e-mail or telephone. Fifty-five patients participated in this study (with a participation level of 26.4%), including 78.2% men, with a median age of 46. Significant alterations in quality of life were observed with the NHP and MOS SF-36 scale, including physical and psychological components. This resulted in a major socio-economic impact as 26% of the patients could not resume their professional activities (n = 10), 20% required retraining in other lines of work, and 36.4% had a disability status. The study showed that scores ≤ 85 on the physical functioning variable of the MOS SF 36 scale was associated with disability. CONCLUSION More than five years after a moderate to severe injury, patients' quality of life was significantly impacted, resulting in significant socio-economic consequences. Disability secondary to major trauma seems to be associated with a score ≤ 85 on the physical functioning dimension of the MOS SF-36 scale. This study raises the question of whether or not early rehabilitation programs should be implemented in order to limit the long-term impact of major trauma.
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Affiliation(s)
- Fanny Vardon-Bounes
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France. .,Inserm U1048, I2MC, Université Paul Sabatier, 31024, Toulouse Cedex 03, France.
| | - Romain Gracia
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Timothée Abaziou
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Laure Crognier
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Thierry Seguin
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - François Labaste
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Thomas Geeraerts
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Bernard Georges
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Jean-Marie Conil
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France.,Inserm U1048, I2MC, Université Paul Sabatier, 31024, Toulouse Cedex 03, France
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23
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Boersma-van Dam E, van de Schoot R, Hofland HWC, Engelhard IM, Van Loey NEE. Individual recovery of health-related quality of life during 18 months post-burn using a retrospective pre-burn measurement: an exploratory study. Qual Life Res 2020; 30:737-749. [PMID: 33090372 PMCID: PMC7952339 DOI: 10.1007/s11136-020-02678-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 01/17/2023]
Abstract
Purpose This study explored the individual trajectories of health-related quality of life (HRQL) compared to recalled pre-burn level of HRQL and investigated whether burn severity and post-traumatic stress disorder (PTSD) symptoms increase the risk of not returning to pre-burn level of HRQL. Methods Data were obtained from 309 adult patients with burns in a multicenter study. Patients completed the EQ-5D-3L questionnaire with a Cognition bolt-on shortly after hospital admission, which included a recalled pre-injury measure, and, again, at 3, 6, 12 and 18 months post-burn. Burn severity was indicated by the number of surgeries, and PTSD symptoms were assessed with the IES-R at three months post-burn. Pre- and post-injury HRQL were compared to norm populations. Results Recalled pre-injury HRQL was higher than population norms and HRQL at 18 months post-burn was comparable to population norms. Compared to the pre-injury level of functioning, four HRQL patterns of change over time were established: Stable, Recovery, Deterioration, and Growth. In each HRQL domain, a subset of patients did not return to their recalled pre-injury levels, especially with regard to Pain, Anxiety/Depression, and Cognition. Patients with more severe burns or PTSD symptoms were less likely to return to pre-injury level of functioning within 18 months post-burn. Conclusion This study identified four patterns of individual change. Patients with more severe injuries and PTSD symptoms were more at risk of not returning to their recalled pre-injury HRQL. This study supports the face validity of using a recalled pre-burn HRQL score as a reference point to monitor HRQL after burns. Electronic supplementary material The online version of this article (10.1007/s11136-020-02678-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elise Boersma-van Dam
- Association of Dutch Burn Centres, P.O. Box 1015, 1940 EA, Beverwijk, The Netherlands. .,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Rens van de Schoot
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands.,Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | | | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, P.O. Box 1015, 1940 EA, Beverwijk, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
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Razaeian S, Zhang D, Harb A, Meller R, Krettek C, Hawi N. Distal Biceps Tendon Repair Using a Modified Double-Incision Technique: Patient-Reported Outcomes With 10-Year Follow-up. Orthop J Sports Med 2020; 8:2325967120944812. [PMID: 32913874 PMCID: PMC7444136 DOI: 10.1177/2325967120944812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background: In the setting of complete distal biceps tendon rupture, surgical repair has become the standard of care to restore optimal elbow function, but the optimal approach and method of tendon fixation are still subjects of debate and have remained controversial for more than half a century. Purpose: To evaluate patient-reported long-term outcomes after distal biceps tendon repair using a modified double-incision technique. Study Design: Case series; Level of evidence, 4. Methods: We reviewed primary distal biceps tendon repairs after isolated tendon rupture using the modified muscle-splitting double-incision approach and transosseous suture fixation technique described by Morrey et al (1985), which had been performed at our level 1 trauma center between January 2000 and December 2013. Outcome measures included the subjective elbow value (SEV), the Oxford Elbow Score (OES) with its 3 domains (function, pain, and social-psychological), a self-performed hook test, and the 3-level version of the EuroQoL 5-dimensional instrument (EQ-5D-3L) as a measure of health status. Levels of overall satisfaction were determined by asking whether the patient would consent to the operation again. In addition, patients were asked to report any complications. Results: A total of 30 patients met the inclusion criteria, and 25 patients were available for the survey. Mean age at the time of rupture was 47 years. All patients were male. Mean follow-up was 120 months (range, 57-207 months). The follow-up rate was 83.34%. The following outcome results were obtained: SEV, 88.16% ± 25.18%; OES, 43.80 ± 10.56 out of 48 points; OES Pain, 92.50% ± 23.03%; OES Function, 92.25% ± 22.19%; OES Social-Psychological, 89% ± 23.68%; EQ-5D-3L, 0.93 ± 0.21. All patients described a negative hook test. Patient-reported complications included painless limitation in forearm rotation in 8% of patients (n = 2); reduced flexion and forearm rotation strength with and without pain in 8% (n = 2) and 4% (n = 1), respectively; synostosis after 1 year requiring revision surgery in 4% (n = 1); and transient wrist drop in 4% (n = 1). The overall complication rate was 28% (7/25), and 96% (n = 24) would consent to the operation again. Conclusion: Despite the cited approach-related morbidity, we report an excellent patient-reported long-term outcome for the double-incision distal biceps repair technique.
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Affiliation(s)
- Sam Razaeian
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Afif Harb
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Rupert Meller
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Nael Hawi
- Trauma Department, Hannover Medical School, Hannover, Germany
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Geraerds AJLM, Richardson A, Haagsma J, Derrett S, Polinder S. A systematic review of studies measuring health-related quality of life of general injury populations: update 2010-2018. Health Qual Life Outcomes 2020; 18:160. [PMID: 32471430 PMCID: PMC7260776 DOI: 10.1186/s12955-020-01412-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Background Studies examining the impact of injury on health-related quality of life (HRQL) over time are necessary to understand the short- and long-term consequences of injury for population health. The aim of this systematic review was to provide an evidence update on studies that have measured HRQL over time in general injury populations using a generic (general) health state measure. Methods Studies conducted between 2010 and 2018 that assessed HRQL at more than one time point among general injury populations were eligible for inclusion. Two reviewers independently extracted information from each study on design, HRQL measure used, method of HRQL measure administration, timing of assessment(s), predictive variables, ability to detect change, and findings. Quality appraisals of each study were also completed by two reviewers using items from the RTI Item Bank on Risk of Bias and Precision of Observational Studies and the Guidelines for the Conduction of Follow-up Studies Measuring Injury-Related Disability. Results Twenty-nine studies (44 articles) that met the inclusion criteria were identified. HRQL was measured using 14 different generic measures; the SF-36, SF-12, and EQ-5D were used most frequently. A varying number of follow-up assessments were undertaken, ranging from one to five. Follow-up often occurred 12 months post-injury. Fewer studies (n = 11) examined outcomes two or more years post-injury, and only one to 10 years post-injury. While most studies documented improvements in HRQL over time since the injury event, study populations had not returned to pre-injury status or reached general population norm HRQL values at post-injury follow-ups. Conclusions Since 2010 there has been a substantial increase in the number of studies evaluating the HRQL of general injury populations. However, significant variability in study design continues to impede quantification of the impact of injury on population health over time. Variation between studies is particularly evident with respect to timing and number of follow-up assessments, and selection of instruments to evaluate HRQL.
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Affiliation(s)
- A J L M Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
| | - Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
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Van Lieshout EMM, Wijffels MME. Patient-reported outcomes: Which ones are most relevant? Injury 2020; 51 Suppl 2:S37-S42. [PMID: 31708093 DOI: 10.1016/j.injury.2019.10.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/30/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
The use of patient-reported outcome measures (PROs) in research and clinical use in orthopedic trauma surgery has increased dramatically over the past decades, and this trend will continue in the future. This review aimed to provide insight into the way PROs can best be identified, reviewed, selected, and used in orthopedic trauma studies and patient care. Selection of instruments for a specific (research) question starts with a systematic literature review for identifying the mostly used instruments. From this list, the instruments that are most suitable for the intended use are selected. Readability, usability, and costs should be considered at this stage. For the selected instruments, the next step is to search the literature systematically in order to determine if the measurement properties of these instruments meet the quality standard as outlined by the COSMIN group. Instruments need to be valid for the targeted condition, intervention as well as population. If not available in the primary language of the targeted population, the instrument requires translation according to a state of the art procedure and validation in the new language. Reporting guidelines like the SPIRIT-PRO and CONSORT-PRO are available in order to guide the reporting of PROs in study protocol and outcome reports, respectively. Using Core Outcome Sets improves the validity of results of clinical research and increases the feasibility of conducting meta-analyses. If the standards and procedures as outlined above are used, the use of PROs will contribute to improved patient care and clinical research.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, P.O. Box 2040, The Netherlands.
| | - Mathieu M E Wijffels
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, P.O. Box 2040, The Netherlands
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Kruithof N, Polinder S, de Munter L, van de Ree CLP, Lansink KWW, de Jongh MAC. Health status and psychological outcomes after trauma: A prospective multicenter cohort study. PLoS One 2020; 15:e0231649. [PMID: 32315373 PMCID: PMC7173764 DOI: 10.1371/journal.pone.0231649] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/29/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up. Methods Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D-3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses. Results A total of 4,883 patients participated (median age 68 (Interquartile range 53–80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively. Discussion HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress. Trial registration ClinicalTrials.gov identifier: NCT02508675.
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Affiliation(s)
- Nena Kruithof
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands
- * E-mail:
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Leonie de Munter
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands
| | | | - Koen W. W. Lansink
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands
- Department of Surgery, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
| | - Mariska A. C. de Jongh
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
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Havermans RJM, de Jongh MAC, de Munter L, Lansink KWW. Longitudinal analysis of health status the first year after trauma in severely injured patients. Scand J Trauma Resusc Emerg Med 2020; 28:29. [PMID: 32312282 PMCID: PMC7169038 DOI: 10.1186/s13049-020-00719-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE While survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma. METHODS A multicentre prospective observational cohort study was conducted. Adult trauma patients with severe injuries (ISS ≥ 16) were included from August 2015 until November 2016 if admitted to one of the hospitals in Noord-Brabant (the Netherlands). Outcome measure was health status, measured by the EuroQol-5D (EQ-5D utility and EQ-Visual analogue scale) and the Health Utilities Index (HUI2 and HUI3) one week and one, three, six, and twelve months after injury. Patient and trauma characteristics were analysed as prognostic factors with linear mixed models. The effect of each prognostic factor over time was analysed by adding the interaction term between the prognostic factor and time point in a multivariable linear mixed model, adjusted for confounders. Additionally, the risk factors for problems in the EQ-5 dimensions of HS and cognition were analysed. RESULTS In total 239 severely injured patients participated. Pre-injury health status, hospital length of stay, ISS and comorbidities were significant prognostic factors for a lower health status. A younger age and extremity injury were prognostic factors for a lower health status until one month after trauma and unemployment before trauma and comorbidities six until twelve months after trauma. In the EQ-5 dimensions 44.1% remained problems in mobility, 15.3% in self-care, 46.4% in activity, 53.3% in pain, 32.5% in anxiety and 35.7% in cognition. CONCLUSIONS Lower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.
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Affiliation(s)
- Roos Johanna Maria Havermans
- Brabant Trauma Registry, Network Emergency Care Brabant, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | | | - Leonie de Munter
- Department Trauma TopCare, ETZ hospital, Tilburg, The Netherlands
| | - Koen Willem Wouter Lansink
- Brabant Trauma Registry, Network Emergency Care Brabant, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.,Department of Surgery, ETZ hospital, Tilburg, The Netherlands
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Early mobilization versus plaster immobilization of simple elbow dislocations: a cost analysis of the FuncSiE multicenter randomized clinical trial. Arch Orthop Trauma Surg 2020; 140:877-886. [PMID: 31760487 PMCID: PMC7295826 DOI: 10.1007/s00402-019-03309-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The primary aim was to assess and compare the total costs (direct health care costs and indirect costs due to loss of production) after early mobilization versus plaster immobilization in patients with a simple elbow dislocation. It was hypothesized that early mobilization would not lead to higher direct and indirect costs. MATERIALS AND METHODS This study used data of a multicenter randomized clinical trial (FuncSiE trial). From August 25, 2009 until September 18, 2012, 100 adult patients with a simple elbow dislocation were recruited and randomized to early mobilization (immediate motion exercises; n = 48) or 3 weeks plaster immobilization (n = 52). Patients completed questionnaires on health-related quality of life [EuroQoL-5D (EQ-5D) and Short Form-36 (SF-36 PCS and SF-36 MCS)], health care use, and work absence. Follow-up was 1 year. Primary outcome were the total costs at 1 year. Analysis was by intention to treat. RESULTS There were no significant differences in EQ-5D, SF-36 PCS, and SF-36 MCS between the two groups. Mean total costs per patient were €3624 in the early mobilization group versus €7072 in the plaster group (p = 0.094). Shorter work absenteeism in the early mobilization group (10 versus 18 days; p = 0.027) did not lead to significantly lower costs for loss of productivity (€1719 in the early mobilization group versus €4589; p = 0.120). CONCLUSION From a clinical and a socio-economic point of view, early mobilization should be the treatment of choice for a simple elbow dislocation. Plaster immobilization has inferior results at almost double the cost.
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Gauffin E, Öster C. Patient perception of long-term burn-specific health and congruence with the Burn Specific Health Scale-Brief. Burns 2019; 45:1833-1840. [DOI: 10.1016/j.burns.2018.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/19/2018] [Accepted: 12/22/2018] [Indexed: 12/24/2022]
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Joosse P, Loggers SAI, Van de Ree CLPM, Van Balen R, Steens J, Zuurmond RG, Gosens T, Van Helden SH, Polinder S, Willems HC, Van Lieshout EMM. The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study. BMC Geriatr 2019; 19:301. [PMID: 31703579 PMCID: PMC6839183 DOI: 10.1186/s12877-019-1324-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. Methods This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. Discussion The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. Trial registration The study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018).
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Affiliation(s)
- Pieter Joosse
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands
| | - Sverre A I Loggers
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - C L P Marc Van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis (location Westfriesgasthuis), P.O. Box 600, 1620 AR, Hoorn, The Netherlands.,Department of Orthopaedic Surgery, Dijklanders Ziekenhuis (location Waterland Ziekenhuis), P.O. Box 250, 1440 AG, Purmerend, The Netherlands
| | - Rutger G Zuurmond
- Department of Orthopaedic Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Sven H Van Helden
- Department of Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hanna C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC location AMC, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Prinja S, Jagnoor J, Sharma D, Aggarwal S, Katoch S, Lakshmi PVM, Ivers R. Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India. PLoS One 2019; 14:e0224721. [PMID: 31697781 PMCID: PMC6837486 DOI: 10.1371/journal.pone.0224721] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Injuries are a major public health problem, resulting in high health care demand and economic burden. They result in loss of disability adjusted life years (DALYs) and high out-of-pocket expenditure. However, there is little evidence on the economic burden of injuries in India. We undertook this study to report out-of-pocket expenditure and the prevalence of catastrophic health expenditure for injuries related hospitalizations in public sector hospitals in North India. Further, we also evaluate the determinants of catastrophic health expenditure. Methods and analysis A prospective observational study was conducted. Participants were recruited from three hospitals for all injury cases. Data were collected via face-to-face baseline interviews and follow-up interviews over the phone at 1, 2, 4 and 12 months post-injury. Prevalence of catastrophic health expenditure (more than 30% of consumption expenditure) and impoverishment (International dollar 1.90) were estimated. Results Road traffic injuries (57%) were the leading cause of injury. Direct out-of-pocket expenditure for hospitalizations was INR 16,768 (USD 263) while indirect productivity loss was INR 8,164 (USD 128). The prevalence of catastrophic expenditure was 22.2% with 12.2% slipping below poverty line. Prevalence of catastrophic health expenditure and impoverishment was higher and significantly associated with poorest quintile, tertiary care hospital and increased duration of hospitalization (p< 0.001). Conclusion The economic impact of injuries is notably high both in terms of out-of-pocket expenditure and productivity loss. A high proportion of households experienced catastrophic expenditure and impoverishment following an injury, highlighting need for programs to prevent injuries.
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Affiliation(s)
- Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Jagnoor Jagnoor
- The George Institute for Global Health, New Delhi, India
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Deepshikha Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Katoch
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P. V. M. Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rebecca Ivers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
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Wijffels MME, Prins JTH, Polinder S, Blokhuis TJ, De Loos ER, Den Boer RH, Flikweert ER, Pull Ter Gunne AF, Ringburg AN, Spanjersberg WR, Van Huijstee PJ, Van Montfort G, Vermeulen J, Vos DI, Verhofstad MHJ, Van Lieshout EMM. Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial. World J Emerg Surg 2019; 14:38. [PMID: 31384292 PMCID: PMC6668138 DOI: 10.1186/s13017-019-0258-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background Multiple rib fractures are common injuries in both the young and elderly. Rib fractures account for 10% of all trauma admissions and are seen in up to 39% of patients after thoracic trauma. With morbidity and mortality rates increasing with the number of rib fractures as well as poor quality of life at long-term follow-up, multiple rib fractures pose a serious health hazard. Operative fixation of flail chest is beneficial over nonoperative treatment regarding, among others, pneumonia and both intensive care unit (ICU) and hospital length of stay. With no high-quality evidence on the effects of multiple simple rib fracture treatment, the optimal treatment modality remains unknown. This study sets out to investigate outcome of operative fixation versus nonoperative treatment of multiple simple rib fractures. Methods The proposed study is a multicenter randomized controlled trial. Patients will be eligible if they have three or more multiple simple rib fractures of which at least one is dislocated over one shaft width or with unbearable pain (visual analog scale (VAS) or numeric rating scale (NRS) > 6). Patients in the intervention group will be treated with open reduction and internal fixation. Pre- and postoperative care equals treatment in the control group. The control group will receive nonoperative treatment, consisting of pain management, bronchodilator inhalers, oxygen support or mechanical ventilation if needed, and pulmonary physical therapy. The primary outcome measure will be occurrence of pneumonia within 30 days after trauma. Secondary outcome measures are the need and duration of mechanical ventilation, thoracic pain and analgesics use, (recovery of) pulmonary function, hospital and ICU length of stay, thoracic injury-related and surgery-related complications and mortality, secondary interventions, quality of life, and cost-effectiveness comprising health care consumption and productivity loss. Follow-up visits will be standardized and daily during hospital admission, at 14 days and 1, 3, 6, and 12 months. Discussion With favorable results in flail chest patients, operative treatment may also be beneficial in patients with multiple simple rib fractures. The FixCon trial will be the first study to compare clinical, functional, and economic outcome between operative fixation and nonoperative treatment for multiple simple rib fractures. Trial registration www.trialregister.nl, NTR7248. Registered May 31, 2018.
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Affiliation(s)
- Mathieu M E Wijffels
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jonne T H Prins
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- 2Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Taco J Blokhuis
- 3Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Erik R De Loos
- 4Department of Surgery, Zuyderland Medisch Centrum, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands
| | - Roeland H Den Boer
- 5Department of Surgery, Spaarne Gasthuis, P.O. Box 417, 2000 AK Haarlem, The Netherlands
| | - Elvira R Flikweert
- 6Department of Surgery, Deventer Ziekenhuis, P.O. Box 5001, 7400 GC Deventer, The Netherlands
| | | | - Akkie N Ringburg
- 8Department of Surgery, Ikazia Ziekenhuis, P.O. Box 5009, 3008 AA Rotterdam, The Netherlands
| | | | - Pieter J Van Huijstee
- Department of Surgery, Haga Ziekenhuis, P.O. Box 40551, 2504 LN The Hague, The Netherlands
| | - Gust Van Montfort
- 11Department of Surgery, Catharina Ziekenhuis, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Jefrey Vermeulen
- 12Department of Surgery, Maasstad Ziekenhuis, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
| | - Dagmar I Vos
- 13Department of Surgery, Amphia Ziekenhuis, P.O. Box 90158, 4800 RK Breda, The Netherlands
| | - Michael H J Verhofstad
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Jagnoor J, Prinja S, Nguyen H, Gabbe BJ, Peden M, Ivers RQ. Mortality and health-related quality of life following injuries and associated factors: a cohort study in Chandigarh, North India. Inj Prev 2019; 26:315-323. [PMID: 31273029 DOI: 10.1136/injuryprev-2019-043143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Injuries are among the 10 leading causes of deaths worldwide. In recent years, the quality and reporting of injury mortality has improved but little or no data are available on the morbidity burden and impact of non-fatal injuries in India. This study evaluates health recovery status postinjury, identifying predictors of recovery in North India. METHODS Prospective cohort study recruiting patients from one tertiary-level and two secondary-level hospitals in North India between April and June 2014 hospitalised due to any injury. Health-related quality of life was assessed at baseline and at 1-month, 2-month, 4-month and 12-month postinjury using the EuroQol five-dimensional (EQ-5D-5L) questionnaire. Multivariable linear regressions with generalised estimating equations were used to examine the relationship between sociodemographic and injury-related factors with the EQ-5D-5L single utility score and the visual analogue scale (VAS) score. RESULTS A total of 2416 eligible patients aged ≥18 years were enrolled in the study. Of these, 2150 (74%) completed baseline and all four follow-up EQ-5D-5L questionnaires. Almost 7% (n=172) patients died by the first follow-up and the overall mortality at 12 months was 9% (n=176). Both EQ-5D-5L utility and VAS scores dropped significantly at 1-month postinjury but gradually improved at 2, 4 and 12 months. Severe injuries, defined as those requiring a hospital stay of ≥7 days, were associated with lower utility scores at 1-month, 2-month and 4-month follow-ups (p<0.001). CONCLUSION This is the first study to examine health outcomes following injuries in India. The findings highlight the need to understand the social, psychological and biological factors influencing recovery outcomes. High mortality following discharge emphasises the need to invest in secondary and tertiary injury prevention in India.
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Affiliation(s)
- Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, New Delhi, India .,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, Punjab, India
| | - Ha Nguyen
- Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia.,John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Belinda J Gabbe
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Margaret Peden
- The George Institute for Global Health UK, Oxford, Oxfordshire, UK
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia
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Wihlke G, Strömmer L, Troëng T, Brattström O. Long-term follow-up of patients treated for traumatic injury regarding physical and psychological function and health-related quality of life. Eur J Trauma Emerg Surg 2019; 47:129-135. [PMID: 31236642 DOI: 10.1007/s00068-019-01170-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Trauma patients often suffer for long time after their injury with physical and psychological problems. Patient-reported outcome measurements (PROM) help us to understand outcomes beyond mortality. The aim of the study was to describe a sample of Swedish trauma patients, regarding their physical function, psychological morbidity, and quality of life after trauma. METHODS The study population was sourced from the Swedish Trauma Register: taking 1 month of data from five hospitals, over three consecutive years. 218 patients met the inclusion criteria, 147 data sets were used. Inclusion criteria included: age ≥ 18; New Injury Severity Scale (NISS) ≥ 9; and discharged alive. Data were collected at 3, 6, and 12 months after the trauma. EuroQol-5D (EQ-5D), Posttraumatic Symptom Scale-10 (PTSS-10) questionnaires and Glasgow Outcome Score (GOS) instrument were used with additional questions about pain and return to work. RESULTS 12 months after the trauma: full functional recovery (GOS 5) was seen in 68% of the patients; 59% reported difficult or moderate pain or discomfort; and 44.5% of the patients had returned to work. In EQ-5D mobility dimension, no recovery was evident between 6 and 12 months. Twenty percent of the patients had significant symptoms for PTSD after 6 months and 16% after 3 months and 12 months. CONCLUSION Trauma patients had decreased physical function and psychological morbidity up to 1 year after the initial injury. Incorporating PROM in the follow-up after trauma is important to understand the patient's perspective of care and treatment.
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Affiliation(s)
- Gunilla Wihlke
- Trauma and Reparative Medicine, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden. .,Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176, Stockholm, Sweden.
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, 141 86, Stockholm, Sweden
| | - Thomas Troëng
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Olof Brattström
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176, Stockholm, Sweden.,Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, 141 86, Stockholm, Sweden
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de Graaf MW, Reininga IHF, Wendt KW, Heineman E, El Moumni M. The Short Musculoskeletal Function Assessment: a study of the reliability, construct validity and responsiveness in patients sustaining trauma. Clin Rehabil 2019; 33:923-935. [PMID: 30722686 PMCID: PMC6482597 DOI: 10.1177/0269215519828152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 01/11/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess test-retest reliability, construct validity and responsiveness of the Dutch Short Musculoskeletal Function Assessment (SMFA-NL) in patients who sustained acute physical trauma. DESIGN A longitudinal cohort study. SETTING A level 1 trauma center in The Netherlands. SUBJECTS Patients who required hospital admission after sustaining an acute physical trauma. INTERVENTION Patients completed the SMFA-NL at six weeks, eight weeks and six months post-injury. MAIN MEASURE The measures used were The Dutch Short Musculoskeletal Function Assessment. Test-retest reliability (between six and eight weeks post-injury) using intraclass correlation coefficients, the smallest detectable change and Bland and Altman plots. Construct validity (six weeks post-injury) and responsiveness (between six weeks and six months post-injury) were evaluated using the hypothesis testing method. RESULTS A total of 248 patients (mean age: 46.5, SD: 13.4) participated, 145 patients completed the retest questionnaires (eight weeks) and 160 patients completed the responsiveness questionnaires (six months). The intraclass correlation coefficients indicated good to excellent reliability on all subscales (0.80 to 0.98). The smallest detectable change was 17.4 for the Upper Extremity Dysfunction subscale, 11.0 for the Lower Extremity Dysfunction subscales, 13.9 for the Problems with Daily Activities subscale and 16.5 for the Mental and Emotional Problems subscale. At group level, the smallest detectable change ranged from 1.48 to 1.96. A total of 86% of the construct validity hypotheses and 79% of the responsiveness hypotheses were confirmed. CONCLUSION This study showed that the SMFA-NL has good to excellent reliability, sufficient construct validity and is able to detect change in physical function over time.
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Affiliation(s)
- Max W de Graaf
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge HF Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rainer TH, Hung KKC, Yeung JHH, Cheung SKC, Leung YK, Leung LY, Goggins WB, Ho HF, Kam CW, Cheung NK, Graham CA. Trajectory of functional outcome and health status after moderate-to-major trauma in Hong Kong: A prospective 5 year cohort study. Injury 2019; 50:1111-1117. [PMID: 30827704 DOI: 10.1016/j.injury.2019.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma care systems in Asia have been developing in recent years, but there has been little long-term outcome data from injured survivors. This study aims to evaluate the trajectory of functional outcome and health status up to five years after moderate to major trauma in Hong Kong. METHODS We report the five year follow up results of a multicentre, prospective cohort from the trauma registries of three regional trauma centres in Hong Kong. The original cohort recruited 400 adult trauma patients with ISS ≥ 9. Telephone follow up was conducted longitudinally at seven time points, and the extended Glasgow Outcome Scale (GOSE) and Short-Form 36 (SF36) were tracked. RESULTS 119 out of 309 surviving patients (39%) completed follow up after 5 years. The trajectory of GOSE, PCS and MCS showed gradual improvements over the seven time points. 56/119 (47.1%) patients reported a GOSE = 8 (upper good recovery), and the mean PCS and MCS was 47.8 (95% CI 45.8, 49.9) and 55.8 (95% CI 54.1, 57.5) respectively at five years. Univariate logistic regression showed change in PCS - baseline to 1 year and 1 year to 2 years, and change in MCS - baseline to 1 year were associated with GOSE = 8 at 5 years. Linear mixed effects model showed differences in PCS and MCS were greatest between 1-month and 6-month follow up. CONCLUSIONS After injury, the most rapid improvement in PCS and MCS occurred in the first six to 12 months, but further recovery was still evident for MCS in patients aged under 65 years for up to five years.
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Affiliation(s)
- T H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; School of Medicine, Cardiff University, United Kingdom
| | - K K C Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong
| | - J H H Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong
| | - S K C Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
| | - Y K Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
| | - L Y Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
| | - W B Goggins
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
| | - H F Ho
- Accident and Emergency Department, Queen Elizabeth Hospital, Hong Kong
| | - C W Kam
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Accident and Emergency Department, Tuen Mun Hospital, Hong Kong
| | - N K Cheung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong
| | - C A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong; Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong.
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Palmer CS, Cameron PA, Gabbe BJ. Comparison of revised Functional Capacity Index scores with Abbreviated Injury Scale 2008 scores in predicting 12-month severe trauma outcomes. Inj Prev 2019; 26:138-146. [PMID: 30928915 DOI: 10.1136/injuryprev-2018-043085] [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: 11/19/2018] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Anatomical injury as measured by the AIS often accounts for only a small proportion of variability in outcomes after injury. The predictive Functional Capacity Index (FCI) appended to the 2008 AIS claims to provide a widely available method of predicting 12-month function following injury. OBJECTIVES To determine the extent to which AIS-based and FCI-based scoring is able to add to a simple predictive model of 12-month function following severe injury. METHODS Adult trauma patients were drawn from the population-based Victorian State Trauma Registry. Major trauma and severely injured orthopaedic trauma patients were followed up via telephone interview including Glasgow Outcome Scale-Extended, the EQ-5D-3L and return to work status. A battery of AIS-based and FCI-based scores, and a simple count of AIS-coded injuries were added in turn to a base model using age and gender. RESULTS A total of 20 813 patients survived to 12 months and had at least one functional outcome recorded, representing 85% follow-up. Predictions using the base model varied substantially across outcome measures. Irrespective of the method used to classify the severity of injury, adding injury severity to the model significantly, but only slightly improved model fit. Across the outcomes evaluated, no method of injury severity assessment consistently outperformed any other. CONCLUSIONS Anatomical injury is a predictor of trauma outcome. However, injury severity as described by the FCI does not consistently improve discrimination, or even provide the best discrimination compared with AIS-based severity scores or a simple injury count.
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Affiliation(s)
- Cameron S Palmer
- Trauma Service, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University Medical School, Swansea, UK
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Ryder C, Mackean T, Hunter K, Williams H, Clapham K, Holland AJA, Ivers R. Equity in functional and health related quality of life outcomes following injury in children - a systematic review. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1581918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Courtney Ryder
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Tamara Mackean
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Kate Hunter
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Hayley Williams
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Andrew J. A. Holland
- Discipline of Child & Adolescent Health, The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, UNSW, Sydney, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
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Morris R, Pallister I, Trickett RW. Measuring outcomes following tibial fracture. Injury 2019; 50:521-533. [PMID: 30482409 DOI: 10.1016/j.injury.2018.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported outcomes. METHODS A systematic review of publications since 2009 was performed, looking specifically at acute, adult tibial shaft fractures. Ovid Medline, Embase, PubMed and PsycINFO databases were searched for relevant titles which were then screened by two authors with adjudication where necessary by a third. Relevant articles were reviewed in full and data was extracted concerning the study participants, study design and any measures that were used to quantify the results following fracture. The results were collated and patient reported outcome measures were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards. RESULTS A total of 943 titles and articles were reviewed, with 117 included for full analysis. A wide range of clinical and radiological "outcomes" were described, along with named clinician- and patient-reported outcome measures. There was considerable heterogeneity and lack of detail in the description of the simplest outcomes, such as union, infection or reoperation. Reported clinician and patient reported outcome measures are variably used. None of the identified patient reported outcome measures have been validated for use following tibial fracture. CONCLUSION We recommend definition of a core outcome set for use following tibial fracture. This will standardise outcome reporting following these injuries. Furthermore, there is need for a validated patient reported outcome measure to better assess patient important outcomes in this patient group.
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Affiliation(s)
- R Morris
- Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK
| | - I Pallister
- Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK
| | - R W Trickett
- Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK.
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Health-related quality of life in children after burn injuries: A systematic review. J Trauma Acute Care Surg 2018; 85:1110-1118. [DOI: 10.1097/ta.0000000000002072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Lieshout EM, Van Yperen DT, Van Baar ME, Polinder S, Boersma D, Cardon AY, De Rijcke PA, Guijt M, Klem TM, Lansink KW, Ringburg AN, Staarink M, Van de Schoot L, Van der Veen AH, Van Eijck FC, Van Eerten PV, Vegt PA, Vos DI, Waleboer M, Verhofstad MH, Van der Vlies CH. Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study. BMJ Open 2018; 8:e023709. [PMID: 30446574 PMCID: PMC6252702 DOI: 10.1136/bmjopen-2018-023709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with<10% total bodysurface area (TBSA) burned who are admitted (or secondarily referred) to a burn centre. If admissions were in agreement with the EMSB, referral criteria will also be determined. METHODS AND ANALYSIS In this multicentre, prospective, observational study (cohort study), the following two groups of patients will be followed: 1) all patients (no age limit) admitted with burn-related injuries to a hospital without a dedicated burn centre in the Southwest Netherlands or Brabant Trauma Region and 2) all patients (no age limit) with<10% TBSA burned who are primarily admitted (or secondarily referred) to the burn centre of Maasstad Hospital. Data on the burn injury characteristics (primary outcome), EMSB compliance, treatment, treatment costs and outcome will be collected from the patients' medical files. At 3 weeks and at 3, 6 and 12 months after trauma, patients will be asked to complete the quality of life questionnaire (EuroQoL-5D), and the patient-reported part of the Patient and Observer Scar Assessment Scale (POSAS). At those time visits, the coordinating investigator or research assistant will complete the observer-reported part of the POSAS. ETHICS AND DISSEMINATION This study has been exempted by the medical research ethics committee Erasmus MC (Rotterdam, The Netherlands). Each participant will provide written consent to participate and remain encoded during the study. The results of the study are planned to be published in an international, peer-reviewed journal. TRIAL REGISTRATION NUMBER NTR6565.
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Affiliation(s)
- Esther Mm Van Lieshout
- Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan T Van Yperen
- Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Burn Center, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Margriet E Van Baar
- Association of Dutch Burn Centers, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Doeke Boersma
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, Noord-Brabant, The Netherlands
| | - Anne Ymvp Cardon
- Department of Surgery, ZorgSaam Zeeuws-Vlaanderen, Terneuzen, Zeeland, The Netherlands
| | - Piet Ar De Rijcke
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, Zuid-Holland, The Netherlands
| | - Marc Guijt
- Department of Surgery, Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - Taco Mal Klem
- Department of Surgery, Franciscus Gasthuis&Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Koen Ww Lansink
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Akkie N Ringburg
- Department of Surgery, Ikazia Ziekenhuis, Rotterdam, Zuid-Holland, The Netherlands
| | - Maarten Staarink
- Department of Surgery, Van Weel-Bethesda Ziekenhuis, Middelharnis, Zuid-Holland, The Netherlands
| | - Leon Van de Schoot
- Department of Surgery, Beatrix Ziekenhuis/Rivas, Gorinchem, Zuid-Holland, The Netherlands
| | | | - Floortje C Van Eijck
- Department of Surgery, Bravis Ziekenhuis, Bergen op Zoom, Noord-Brabant, The Netherlands
| | - Percy V Van Eerten
- Department of Surgery, Máxima Medisch Centrum, Veldhoven, Noord-Brabant, The Netherlands
| | - Paul A Vegt
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, The Netherlands
| | - Dagmar I Vos
- Department of Surgery, Amphia Ziekenhuis, Breda, The Netherlands
| | - Marco Waleboer
- Department of Surgery, Admiraal De Ruyter Ziekenhuis, Goes, Zeeland, The Netherlands
| | - Michael Hj Verhofstad
- Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cornelis H Van der Vlies
- Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Burn Center, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
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Pre-injury health status of injured patients: a prospective comparison with the Dutch population. Qual Life Res 2018; 28:649-662. [PMID: 30377947 PMCID: PMC6394497 DOI: 10.1007/s11136-018-2035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 12/05/2022]
Abstract
Purpose The aim of this study was to assess whether injured patients have a different pre-injury health status compared to the Dutch population. Methods A broad range of injured patients (age ≥ 18 and ≤ 75 years) completed the condition-specific Short Musculoskeletal Function Assessment (SMFA-NL) and generic health-related quality of life questionnaire EuroQol-5D (EQ-5D), within 2 weeks after patients sustained an injury. Patients reported their health status of the week before their injury. Scores were compared to the Dutch normative data of the questionnaires. Gender, age, educational level, relationship status, and comorbidity adjusted differences were calculated for the SMFA-NL. Results A total of 596 injured patients completed the questionnaires (response rate: 43%). Unadjusted pre-injury SMFA-NL scores of injured patients were significantly better compared to the Dutch normative data (ranging from + 2.4 to + 8.6 points, p < 0.001 for all subscales and indices). The unadjusted EQ-5D difference score was 0.05 points (p < 0.001) higher in the group of injured patients. Adjusted pre-injury scores were higher than the SMFA-NL normative data. Function index: + 3.6, p < 0.001, bother index: + 3.0, p < 0.001 upper extremity dysfunction: + 0.8, p = 0.2, lower extremity dysfunction: + 3.7, p < 0.001. Problems with daily activities: + 2.8, p = 0.001. Mental and emotional problems: + 6.8, p < 0.001. Conclusions Injured patients reported a better pre-injury health status compared to the Dutch population. Patient characteristics explained an important part of the difference in health status between injured patients and the Dutch population.
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Bielska IA, Brison R, Brouwer B, Janssen I, Johnson AP, Day AG, Pickett W. Is recovery from ankle sprains negatively affected by obesity? Ann Phys Rehabil Med 2018; 62:8-13. [PMID: 30290281 DOI: 10.1016/j.rehab.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Ankle sprains are common injuries that may lead to long-term morbidity. Individuals with obesity are at increased risk for ankle sprains; however, prognostic associations between body mass index (BMI) and recovery are less well understood. This study investigated whether BMI status affects recovery from ankle sprains. METHODS We included individuals≥16 years old with grade 1 or 2 ankle sprains who sought emergency department treatment in Kingston, Ontario, Canada. Height in centimeters and weight in kilograms were measured at baseline by using a height rod and a standard medical column scale, respectively. BMI was calculated and categorized as non-overweight,<25.0kg/m2; overweight, 25.0-29.9kg/m2; and obese,≥30kg/m2. Recovery was assessed at 1, 3 and 6 months post-injury by the Foot and Ankle Outcome Score (FAOS). Continuous FAOS and binary recovery status were compared by BMI group at each assessment using a repeated measures linear mixed effects model and logistic regression, respectively. RESULTS In total, 504 individuals were recruited and 6-month follow-up data were collected for 80%. We observed no significant differences in recovery at 1 and 3 months post-injury. At 6 months, between 53% and 66% of the participants were considered to have recovered according to the FAOS. The mean difference in unadjusted FAOS between participants classified as obese and non-overweight was -23.02 (95% confidence interval, -38.99 to -7.05) but decreased after adjusting for confounders. The odds ratio for recovery was 0.60 (0.37-0.97) before adjustment and 0.74 (0.43-1.29) after adjustment. Six-month recovery was significantly lower for participants with obesity than non-overweight participants on the FAOS Pain and Function in Daily Living subscales but were not clinically meaningful. CONCLUSIONS All BMI groups showed improvements from ankle sprain over time. However, at 6 months, a sizeable proportion of the participants had not fully recovered particularly among individuals classified as obese. The findings suggest that individuals with obesity may benefit from specialized interventions focused on symptom management and functional activity.
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Affiliation(s)
- I A Bielska
- Department of Public Health Sciences, Queen's University, K7L 3N6 Kingston, ON, Canada.
| | - R Brison
- Department of Public Health Sciences, Queen's University, K7L 3N6 Kingston, ON, Canada; Department of Emergency Medicine, Queen's University, K7L 3N6 Kingston, ON, Canada
| | - B Brouwer
- School of Rehabilitation Therapy, Queen's University, K7L 3N6 Kingston, ON, Canada; Department of Kinesiology and Health Studies, Queen's University, K7L 3N6 Kingston, ON, Canada
| | - I Janssen
- Department of Public Health Sciences, Queen's University, K7L 3N6 Kingston, ON, Canada; Department of Kinesiology and Health Studies, Queen's University, K7L 3N6 Kingston, ON, Canada
| | - A P Johnson
- Department of Public Health Sciences, Queen's University, K7L 3N6 Kingston, ON, Canada
| | - A G Day
- Kingston General Hospital Research Institute, K7L 2V7 Kingston, ON, Canada
| | - W Pickett
- Department of Public Health Sciences, Queen's University, K7L 3N6 Kingston, ON, Canada; Department of Emergency Medicine, Queen's University, K7L 3N6 Kingston, ON, Canada
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Spronk I, Legemate C, Oen I, van Loey N, Polinder S, van Baar M. Health related quality of life in adults after burn injuries: A systematic review. PLoS One 2018; 13:e0197507. [PMID: 29795616 PMCID: PMC5967732 DOI: 10.1371/journal.pone.0197507] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/03/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns. METHODS A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool. RESULTS Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition. CONCLUSION Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Catherine Legemate
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
| | - Irma Oen
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - Nancy van Loey
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
- Utrecht University, Department of Clinical Psychology, Utrecht, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Margriet van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
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Health-related quality of life and recovery patterns among hospitalised injury patients in Vietnam. Qual Life Res 2017; 27:619-629. [PMID: 29079888 DOI: 10.1007/s11136-017-1724-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To measure post-injury health-related quality of life (HRQoL) among hospitalised injury patients following discharge and to identify factor associated with lower HRQoL over time. METHOD A prospective cohort study was conducted from January 2010 to October 2011 in Thai Binh province, Vietnam. Participants were 18 years or older, hospitalised for at least 1 day and normally residing in Thai Binh province. Data on demographic and injury characteristics were collected during their hospital stay. Data on HRQoL, measured by the Health Utilities Index mark 3 (HUI3), were collected in the participants' home at 1, 2, 4 and 12 months after their hospital discharge. Generalised estimating equation model was selected to examine the association of demographic and injury characteristics with HRQoL which were repeatedly measured over time. RESULTS HUI3 multi-attribute score was lowest at the first follow-up (0.52 for males, 0.28 for females). The scores significantly improved over time (increment of 0.08 or greater, p values < 0.001). Ambulation and Pain were single-attributes with scores significantly increased over time (increment of 0.05 or greater, p values < 0.001). Factors identified to be associated with lower HUI3 scores were older age (p values < 0.02 or less), more severe injury (p values = 0.05 or less) and having other illnesses (p values < 0.01). CONCLUSION The study provides important, and previously unreported, estimates of post-injury HRQoL in Vietnam. Even for those having the lowest levels of severity, the loss in HRQoL is significant, highlighting the importance of efforts on injury prevention and rehabilitation services.
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Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Druery M, Newcombe PA, Cameron CM, Lipman J. Factors influencing psychological, social and health outcomes after major burn injuries in adults: cohort study protocol. BMJ Open 2017; 7:e017545. [PMID: 28624761 PMCID: PMC5726110 DOI: 10.1136/bmjopen-2017-017545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The goal of burn care is that 'the quality of the outcome must be worth the pain of survival'. More research is needed to understand how best to deliver care for patients with burns to achieve this aim. Loss of independence, function as well as loss of income for patients with burns and carers cause a significant burden at both individual and societal levels. Much is being done to advance knowledge in the clinical care field; however, there has been a paucity of research exploring psychosocial outcomes. This paper describes the study background and methods, as implemented in an Australian cohort study of psychosocial outcomes after major burn injuries. METHODS AND ANALYSIS In this inception cohort study, a target sample of 230 participants, aged 18 years or over, admitted to a single statewide burns centre with a burn injury are identified by hospital staff for inclusion. Baseline survey data are collected either in person or by telephone within 28 days of the injury and participants then followed up with telephone interviews at 3, 6 and 12 months postburn. Injury and burns treatment information is collected from medical records. Social support is measured as a predictor variable using the Multidimensional Scale of Perceived Social Support. Outcome data are collected via standardised measures in the domains of Quality of Life (SF-12, EQ-5D, BSHS-B), depression (PHQ-9), post-traumatic stress disorder (PCL-C, PAS), community integration (CIQ-R) and Quality-Adjusted Life Years (EQ-5D). Additional survey questions measure life satisfaction, return to work and public services utilisation at 12 months postinjury. Data analysis methods will include analysis of variance, Pearson correlation and hierarchical multiple regression analyses. ETHICS AND DISSEMINATION Hospital-based and University of Queensland Human Research Ethics Committees have approved the protocol. Results from the study will be disseminated at national and international conferences, in peer-reviewed journals and in a doctoral thesis. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry (ACTRN12616000828426). Retrospectively registered on 23 June 2016; pre-results.
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Affiliation(s)
- Martha Druery
- Burns Trauma and Critical Care Research Centre, University of Queensland, Herston, Australia
| | - Peter A Newcombe
- School of Psychology, University of Queensland, St Lucia, Australia
| | - Cate M Cameron
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Australia
| | - Jeffrey Lipman
- Burns Trauma and Critical Care Research Centre, University of Queensland, Herston, Australia
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Gopinath B, Jagnoor J, Harris IA, Nicholas M, Casey P, Blyth F, Maher CG, Cameron ID. Health-related quality of life 24 months after sustaining a minor musculoskeletal injury in a road traffic crash: A prospective cohort study. TRAFFIC INJURY PREVENTION 2017; 18:251-256. [PMID: 27736156 DOI: 10.1080/15389588.2016.1244335] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES A better understanding of the long-term factors that independently predict poorer quality of life following mild to moderate musculoskeletal injuries is needed. We aimed to establish the predictors of quality of life (including sociodemographic, health, psychosocial, and pre-injury factors) 24 months after a noncatastrophic road traffic injury. METHODS In a prospective cohort study of 252 participants with mild/moderate injury sustained in a road traffic crash, quality of life was measured 24 months following the baseline survey. A telephone-administered questionnaire obtained information on various potential explanatory variables. Health-related quality of life was measured using the European Quality of Life-5 Dimensions (EQ-5D) and Medical Outcomes Survey Short Form-12 (SF-12). Multivariable linear regression analyses determined the associations between explanatory variables and quality of life measures. RESULTS Mean SF-12 physical component summary (PCS) and mental component summary (MCS) scores increased by 7.3 and 2.5 units, respectively, from baseline to 24-month follow-up. Each 10-year increase in baseline age was independently associated with 3.1-unit (P < .001) and 1.5-unit (P = .001) decrease in EQ Visual Analogue Scale (VAS) and SF-12 PCS scores at follow-up, respectively. Poor/fair compared to excellent pre-injury health was associated with a 0.16-, 21.3-, and 11.5-unit decrease in EQ-5D summary (P = .03), VAS scores (P = .001), and SF-12 PCS scores (P < .001), respectively. Baseline pain severity ratings and pain catastrophizing scores were inversely associated with 24-month EQ VAS scores (both P < .001). Each unit increase in baseline pain score (P = .001) and pain catastrophizing score (P = .02) was associated with a 1.0- and 4.6-unit decrease in SF-12 MCS scores at 24 months, respectively. Other observed predictors of quality of life measures (EQ-5D summary and/or VAS scores and/ or SF-12 MCS) included marital status, smoking, hospital admission, pre-injury health (anxiety/depression and chronic illness), and whiplash injury. CONCLUSION Sociodemographic indicators, pre-injury health, and biopsychosocial correlates were independently associated with health-related quality of life 24 months following a noncatastrophic road traffic crash injury.
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Affiliation(s)
- Bamini Gopinath
- a John Walsh Centre for Rehabilitation Studies , Kolling Institute of Medical Research, University of Sydney , Australia
| | - Jagnoor Jagnoor
- a John Walsh Centre for Rehabilitation Studies , Kolling Institute of Medical Research, University of Sydney , Australia
| | - Ian A Harris
- b Ingham Institute for Applied Medical Research, University of New South Wales , Australia
| | - Michael Nicholas
- c Pain Management Research Institute, Sydney Medical School, University of Sydney , Australia
| | - Petrina Casey
- a John Walsh Centre for Rehabilitation Studies , Kolling Institute of Medical Research, University of Sydney , Australia
| | - Fiona Blyth
- c Pain Management Research Institute, Sydney Medical School, University of Sydney , Australia
- d School of Public Health , University of Sydney , Australia
| | - Christopher G Maher
- e George Institute for Global Health, Sydney Medical School, University of Sydney , Australia
| | - Ian D Cameron
- a John Walsh Centre for Rehabilitation Studies , Kolling Institute of Medical Research, University of Sydney , Australia
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Scholten AC, Haagsma JA, Steyerberg EW, van Beeck EF, Polinder S. Assessment of pre-injury health-related quality of life: a systematic review. Popul Health Metr 2017; 15:10. [PMID: 28288648 PMCID: PMC5348891 DOI: 10.1186/s12963-017-0127-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 02/28/2017] [Indexed: 12/15/2022] Open
Abstract
Background Insight into the change from pre- to post-injury health-related quality of life (HRQL) of trauma patients is important to derive estimates of the impact of injury on HRQL. Prospectively collected pre-injury HRQL data are, however, often not available due to the difficulty to collect these data before the injury. We performed a systematic review on the current methods used to assess pre-injury health status and to estimate the change from pre- to post-injury HRQL due to an injury. Methods A systematic literature search was conducted in EMBASE, MEDLINE, and other databases. We identified studies that reported on the pre-injury HRQL of trauma patients. Articles were collated by type of injury and HRQL instrument used. Reported pre-injury HRQL scores were compared with general age- and gender-adjusted norms for the EQ-5D, SF-36, and SF-12. Results We retrieved results from 31 eligible studies, described in 41 publications. All but two studies used retrospective assessment and asked patients to recall their pre-injury HRQL, showing widely varying timings of assessments (soon after injury up to years after injury). These studies commonly applied the SF-36 (n = 13), EQ-5D (n = 9), or SF-12 (n = 3) using questionnaires (n = 14) or face-to-face interviews (n = 11). Two studies reported prospective pre-injury assessment, based on prospective longitudinal cohort studies from a sample of initially non-injured patients, and applied questionnaires using the SF-36 or SF-12. The recalled pre-injury HRQL scores of injury patients consistently exceeded age- and sex-adjusted population norms, except in a limited number of studies on injury types of higher severity (e.g., traumatic brain injury and hip fractures). All studies reported reduced post-injury HRQL compared to pre-injury HRQL. Both prospective studies reported that patients had recovered to their pre-injury levels of physical and mental health, while in all but one retrospective study patients did not regain the reported pre-injury levels of HRQL, even years after injury. Conclusions So far, primarily retrospective research has been conducted to assess pre-injury HRQL. This research shows consistently higher pre-injury HRQL scores than population norms and a recovery that lags behind that of prospective assessments, implying a systematic overestimation of the change in HRQL from pre- to post-injury due to an injury. More prospective research is necessary to examine the effect of recall bias and response shift. Researchers should be aware of the bias that may arise when pre-injury HRQL is assessed retrospectively or when population norms are applied, and should use prospectively derived HRQL scores wherever possible to estimate the impact of injury on HRQL. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0127-3) contains supplementary material, which is available to authorized users.
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