Functional status following injury: what recovery pathways do people follow?

Helen Harcombe; John Langley; Gabrielle Davie; Sarah Derrett

doi:10.1016/j.injury.2015.04.004

Functional status following injury: what recovery pathways do people follow?

Injury. 2015 Jul;46(7):1275-80. doi: 10.1016/j.injury.2015.04.004. Epub 2015 Apr 14.

Authors

Helen Harcombe¹, John Langley¹, Gabrielle Davie², Sarah Derrett¹

Affiliations

¹ Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand.
² Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand. Electronic address: gabrielle.davie@ipru.otago.ac.nz.

PMID: 25920372
DOI: 10.1016/j.injury.2015.04.004

Abstract

Objectives: Functional status can be affected for considerable time after injury. Individual's functional status trajectories, or pathways, following injury may provide insights into achieving, or not achieving, optimal functional status. This study aims to (1) investigate functional status trajectories of injured individuals over two years by multiple dimensions and, (2) determine whether there are differences in functional status trajectories between those hospitalised and non-hospitalised.

Methods: Data from the Prospective Outcomes of Injury Study, a longitudinal cohort (n=2856) of injured New Zealanders, was used. Functional status was assessed using the EQ-5D (plus a cognitive dimension) at 3, 12 and 24 months post injury. For each dimension (mobility, self-care, usual activities, pain/discomfort anxiety/depression and cognition), individual-level trajectories were created based on whether participants had attained (or exceeded) their pre-injury functional status at each time-point.

Results: Participants had varied pathways to attaining their pre-injury functional status which was not revealed by cross-sectional group-level data. When all dimensions were considered together, 24% of participants attained their pre-injury functional status but did not maintain it at a subsequent phase. By EQ-5D dimension, this varied from 5% (self-care) to 22% (pain/discomfort). Twenty-six percent of non-hospitalised participants attained, but did not maintain, their pre-injury status compared to 18% of those hospitalised.

Conclusions: Cross-sectional group-level prevalence does not adequately depict the underlying pathways experienced by individual participants. Our analyses indicate the importance of following up all study participants in longitudinal studies, including those reporting to have attained 'recovery' and of not under-estimating the impact of non-hospitalised injuries.

Keywords: Health status; Longitudinal studies; Quality of life; Recovery of function; Wounds and injuries.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living / psychology*
Adolescent
Adult
Convalescence
Cross-Sectional Studies
Disability Evaluation
Female
Hospitalization
Humans
Male
Middle Aged
New Zealand / epidemiology
Pain / psychology
Pain / rehabilitation*
Prevalence
Prospective Studies
Quality of Life / psychology*
Recovery of Function
Socioeconomic Factors
Wounds and Injuries / complications*
Wounds and Injuries / psychology
Wounds and Injuries / rehabilitation