Association of longitudinal changes in patient-reported health status with return to work in the first 2 years after traumatic injury:A prospective cohort study in the Netherlands

OBJECTIVES: To determine the prognostic value of time driven changes in health status on return to work (RTW) in the first 2 years after traumatic injury. DESIGN: A prospective longitudinal cohort study. All patient-reported outcomes were measured at 1 week, 1, 3, 6, 12 and 24 months after injury. SETTING: Ten participating hospitals in the Netherlands. PARTICIPANTS: Employed adult clinical injury patients admitted to the hospital between August 2015 and November 2016 (N=1245 patients). MAIN OUTCOME MEASURES: Data about (first) RTW were used from the patient-reported questionnaires (1=yes, 0=no). RTW was measured as the first time a patient started working after hospital admission. Time until RTW was calculated in weeks. Health status was measured with the EuroQol Five Dimensions-3 Levels (EQ5D) including a dimension to measure cognition. RESULTS: At 24 months, 88.5% (n=1102) of the patients had returned to work. The median time to RTW was 6.6 weeks (IQR: 2–13). Patients’ health status was found to be an independent prognostic factor for RTW: a 0.1-unit increase in EQ5D (scale 0–1) translated into RTW being four times more likely (95% CI 1.60 to 11.94). Patients who had moderate or severe problems (0=no problems, 1=moderate or severe problems) with mobility (HR 0.91, 95% CI 0.84 to 0.98), anxiety/depression (HR 0.86, 95% CI 0.80 to 0.91), usual activities (HR 0.91, 95% CI 0.83 to 0.98), self-care (HR 0.90, 95% CI 0.79 to 0.99) and cognition (HR 0.90, 95% CI 0.85 to 0.94) were significantly less likely to RTW compared with patients with no problems. CONCLUSION: Increased self-reported health status over time is associated with a higher likelihood of RTW, independent of baseline risk factors, such as injury severity or education. Knowledge on patient-reported outcomes can contribute to the development of tailored RTW treatments. Furthermore, patient-reported outcomes could be used as monitoring tool to guide postinjury care in the clinical setting and RTW process. TRIAL REGISTRATION NUMBER: NCT02508675; Results

Experiences of recovery and posthospital care needs of working-age adults after physical trauma:A qualitative focus group study

OBJECTIVE: To explore experiences of recovery after physical trauma and identify long-term needs for posthospital care. DESIGN, PARTICIPANTS AND SETTING: A qualitative study was conducted consisting of seven online focus groups among working-age adults who sustained their injury between 9 months and 5 years ago. Trauma patients discharged from a level 1 trauma centre in the Netherlands were divided into three groups based on the type of their physical trauma (monotrauma, polytrauma and traumatic brain injury). Group interviews were transcribed verbatim, and thematic analysis was conducted. RESULTS: Despite differences in type and severity of their injuries, participants all struggled with the impact that trauma had on various aspects of their lives. They experienced recovery as an unpredictable and inconstant process aimed at resuming a meaningful life. Work was often perceived as an important part of recovery, though the value attributed to work could change over time. Participants struggled to bring the difficulties they encountered in their daily lives and at work to the attention of healthcare professionals (HCPs). While posthospital care needs varied between and across groups, all people stressed the need for flexible access to person-centred, multidisciplinary care and support after hospital discharge. CONCLUSIONS: This study reveals that people with a broad variety of injury experience recovery as a process towards resuming a meaningful life and report the need to expand trauma care to include comprehensive support to live well long term. Person-centred care might be helpful to enable HCPs to take people’s individual long-term needs and life situations into account. Furthermore, providing timely access to coordinated, multidisciplinary care after discharge is advocated. Integrated care models that span a network of multidisciplinary support around the person may help align existing services and may facilitate easy and timely access to the most suitable support for injured people and their loved ones

Evaluation of the necessity of clinical observation of high-energy trauma patients without significant injury after standardized emergency room stabilization

Background: Patients involved in a high-energy trauma (HET) are usually admitted for clinical observation, even when no significant injury is found after standard care in the emergency room (ER). The necessity of this observation period is not evidence based. The goal of this study was to identify patients who revealed an initially undiagnosed injury during the observation period. Methods: A retrospective study of consecutive HET patients was conducted in two Level I trauma centers. Patients after a HET with two minor injuries or less, diagnosed during the standard ER care, were included. Data were abstracted from patients' medical records. Results: Five hundred three patients were included. None of the patients developed any complications during the clinical observation period or were readmitted to their own hospital within a week after the trauma. Conclusion: There is no evidence for the necessity of clinical observation of HET patients with minimal or no injuries diagnosed after standard ER stabilization and evaluatio

Association of longitudinal changes in patient-reported health status with return to work in the first 2 years after traumatic injury: A prospective cohort study in the Netherlands

Objectives: To determine the prognostic value of time driven changes in health status on return to work (RTW) in the first 2 years after traumatic injury. Design: A prospective longitudinal cohort study. All patient-reported outcomes were measured at 1 week, 1, 3, 6, 12 and 24 months after injury. Setting: Ten participating hospitals in the Netherlands. Participants: Employed adult clinical injury patients admitted to the hospital between August 2015 and November 2016 (N=1245 patients). Main outcome measures: Data about (first) RTW were used from the patient-reported questionnaires (1=yes, 0=no). RTW was measured as the first time a patient started working after hospital admission. Time until RTW was calculated in weeks. Health status was measured with the EuroQol Five Dimensions-3 Levels (EQ5D) including a dimension to measure cognition. Results: At 24 months, 88.5% (n=1102) of the patients had returned to work. The median time to RTW was 6.6 weeks (IQR: 2–13). Patients’ health status was found to be an independent prognostic factor for RTW: a 0.1-unit increase in EQ5D (scale 0–1) translated into RTW being four times more likely (95% CI 1.60 to 11.94). Patients who had moderate or severe problems (0=no problems, 1=moderate or severe problems) with mobility (HR 0.91, 95% CI 0.84 to 0.98), anxiety/depression (HR 0.86, 95% CI 0.80 to 0.91), usual activities (HR 0.91, 95% CI 0.83 to 0.98), self-care (HR 0.90, 95% CI 0.79 to 0.99) and cognition (HR 0.90, 95% CI 0.85 to 0.94) were significantly less likely to RTW compared with patients with no problems. Conclusion: Increased self-reported health status over time is associated with a higher likelihood of RTW, independent of baseline risk factors, such as injury severity or education. Knowledge on patient-reported outcomes can contribute to the development of tailored RTW treatments. Furthermore, patient-reported outcomes could be used as monitoring tool to guide postinjury care in the clinical setting and RTW process

Experiences of recovery and posthospital care needs of working-age adults after physical trauma: A qualitative focus group study

Objective: To explore experiences of recovery after physical trauma and identify long-term needs for posthospital care. Design, participants and setting: A qualitative study was conducted consisting of seven online focus groups among working-age adults who sustained their injury between 9 months and 5 years ago. Trauma patients discharged from a level 1 trauma centre in the Netherlands were divided into three groups based on the type of their physical trauma (monotrauma, polytrauma and traumatic brain injury). Group interviews were transcribed verbatim, and thematic analysis was conducted. Results: Despite differences in type and severity of their injuries, participants all struggled with the impact that trauma had on various aspects of their lives. They experienced recovery as an unpredictable and inconstant process aimed at resuming a meaningful life. Work was often perceived as an important part of recovery, though the value attributed to work could change over time. Participants struggled to bring the difficulties they encountered in their daily lives and at work to the attention of healthcare professionals (HCPs). While posthospital care needs varied between and across groups, all people stressed the need for flexible access to person-centred, multidisciplinary care and support after hospital discharge. Conclusions: This study reveals that people with a broad variety of injury experience recovery as a process towards resuming a meaningful life and report the need to expand trauma care to include comprehensive support to live well long term. Person-centred care might be helpful to enable HCPs to take people’s individual long-term needs and life situations into account. Furthermore, providing timely access to coordinated, multidisciplinary care after discharge is advocated. Integrated care models that span a network of multidisciplinary support around the person may help align existing services and may facilitate easy and timely access to the most suitable support for injured people and their loved ones

Using PROM(I)S to measure health-related quality of life in patients with a bone fracture:An observational cohort study

Introduction: The incidence of patients with fractures is increasing and so is the impact on health care systems and society. To improve patient care, measurement of disabilities and impaired health experiences after traumatic musculoskeletal injuries are important. Next to objective clinical parameters, PROM(I)S can be used to map health domains important to patients. We aimed to objectify different aspects of (health-related) quality of life in fracture patients, including the ability to participate in social roles and activities using PROMIS among other PROMs. Methods: An observational cohort study was performed in which health-related quality of life in fracture patients was measured. Patients aged 18 year and older either treated conservatively or surgically between November 2020 and June 2022 were included. Participants were followed for a maximum of one year and completed the following PROMs: PROMIS-CAT physical function, PROMIS-CAT pain interference, PROMIS-CAT ability to participate in social roles and activities and LEFS or QDASH. We applied a univariate linear mixed model to evaluate significance of improvement. Results: Seven hundred-forty six patients with a mean age of 54.4 years were included. Mean PROMIS scores were structurally inferior in the lower extremity (LE) fracture group in comparison with the upper extremity (UE) fracture group. For “PROMIS physical function”, UE fracture patients performed better and showed physical progression earlier. For “PROMIS pain interference”, UE fracture patients experienced fewer limitations, but it took longer to experience improvement in this group. For “PROMIS ability to participate in social roles”, significant improvement was only seen in the UE fracture group at one year follow up.Conclusion: Upper -and lower extremity fractures can have a significant impact on physical function and social health. Patients with UE fractures tend to have fewer limitations compared to LE fracture patients. Physical function and pain interference is most impaired shortly after the injury in all fracture patients and show significant changes over time, social health improves less over time. Moment of measurement should be based on type of fracture and can differ between individual patients, but when generic measures and outcomes are desirable, PROMIS questionnaires can potentially be used measurement.</p

Using PROM(I)S to measure health-related quality of life in patients with a bone fracture:An observational cohort study

Introduction: The incidence of patients with fractures is increasing and so is the impact on health care systems and society. To improve patient care, measurement of disabilities and impaired health experiences after traumatic musculoskeletal injuries are important. Next to objective clinical parameters, PROM(I)S can be used to map health domains important to patients. We aimed to objectify different aspects of (health-related) quality of life in fracture patients, including the ability to participate in social roles and activities using PROMIS among other PROMs. Methods: An observational cohort study was performed in which health-related quality of life in fracture patients was measured. Patients aged 18 year and older either treated conservatively or surgically between November 2020 and June 2022 were included. Participants were followed for a maximum of one year and completed the following PROMs: PROMIS-CAT physical function, PROMIS-CAT pain interference, PROMIS-CAT ability to participate in social roles and activities and LEFS or QDASH. We applied a univariate linear mixed model to evaluate significance of improvement. Results: Seven hundred-forty six patients with a mean age of 54.4 years were included. Mean PROMIS scores were structurally inferior in the lower extremity (LE) fracture group in comparison with the upper extremity (UE) fracture group. For “PROMIS physical function”, UE fracture patients performed better and showed physical progression earlier. For “PROMIS pain interference”, UE fracture patients experienced fewer limitations, but it took longer to experience improvement in this group. For “PROMIS ability to participate in social roles”, significant improvement was only seen in the UE fracture group at one year follow up.Conclusion: Upper -and lower extremity fractures can have a significant impact on physical function and social health. Patients with UE fractures tend to have fewer limitations compared to LE fracture patients. Physical function and pain interference is most impaired shortly after the injury in all fracture patients and show significant changes over time, social health improves less over time. Moment of measurement should be based on type of fracture and can differ between individual patients, but when generic measures and outcomes are desirable, PROMIS questionnaires can potentially be used measurement.</p

Health status and psychological outcomes after trauma: A prospective multicenter cohort study.

IntroductionSurvival 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.MethodsHospitalized 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.ResultsA 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.DiscussionHS 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 registrationClinicalTrials.gov identifier: NCT02508675