BackgroundIt is important to obtain greater insight into health-related quality of life (HRQL) of injury patients in order to document people's pathways to recovery and to quantify the impact of injury on population health over time. We performed a systematic review of studies measuring HRQL in general injury populations with a generic health state measure to summarize existing knowledge.MethodsInjury studies (1995-2009) were identified with main inclusion criteria being the use of a generic health status measure and not being restricted to one specific type of injury. Articles were collated by study design, HRQL instrument used, timing of assessment(s), predictive variables and ability to detect change over time.ResultsForty one studies met inclusion criteria, using 24 different generic HRQL and functional status measures (most used were SF-36, FIM, GOS, EQ-5D). The majority of the studies used a longitudinal design, but with different lengths and timings of follow-up (mostly 6, 12, and 24 months). Different generic health measures were able to discriminate between the health status of subgroups and picked up changes in health status between discharge and 12 month follow-up. Most studies reported high prevalences of health problems within the first year after injury. The twelve studies that reported HRQL utility scores showed considerable but incomplete recovery in the first year after discharge.ConclusionThis systematic review demonstrates large variation in use of HRQL instruments, study populations, and assessment time points used in studies measuring HRQL of general injury populations. This variability impedes comparison of HRQL summary scores between studies and prevented formal meta-analyses aiming to quantify and improve precision of the impact of injury on population health over time.

A prospective study of male soccer injuries among 12 teams playing at the highest competition level was carried out in Finland in 1993. Overall, two out of three players were injured during the whole season. The injury incidence per 1000 playing hours among injured players and all players during games was higher than during practice, 14.2 vs. 11.3 and 2.3 vs. 1.8, respectively. The lower extremity was involved in 76% of the injuries. Thigh injuries were most frequent (22%), whereas overuse injuries were scarce (6%). Eighteen per cent of the injured players needed surgery and in most cases (58%) the reason for surgery was a knee injury. Sixteen per cent of all injured players were absent from soccer for more than 1 month after the injury. The mean absence time was 17 days for all and 84 days for operatively treated players.

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Priority setting in healthcare, surveillance and intervention is based increasingly on burden of disease and injury studies, which integrate mortality and disability. Injury, however, challenges the underlying methodology, not in the least because of the wide range of possible consequences and recovery patterns. INTEGRIS WP5 Injury disability indicators focused on the methodology concerning the disability component (years lived with disability; YLD) of the burden of injury. This is calculated by multiplying the number of injury cases, a disability weight and average duration of the health outcome. An inventory of available methods was made by addressing key questions that are raised when assessing the disability component of injury, namely (1) which injury cases should be included?, (2) how to distinguish cases by injury diagnoses? and (3) how to link injury diagnosis to disability information concerning the disability weights and the proportion lifelong consequences? With this inventory, for each of these methodological questions WP5 provided a theoretical framework and proposed recommendations to assess the disability component of the burden of injury. Additionally, an implementation tool including a set of 87 injury disability weights and proportions of lifelong consequences for 27 injury diagnoses have been determined. In the Netherlands, the WP5 tool has been applied in national injury estimations of the National Institute of Public Health, highly increasing the burden of injury compared the previously used, hampered, methodology. This allowed Dutch policy makers to base their decisions regarding resource allocation on a more complete burden of injury estimate.

In-home CGA has a modest positive effect on functional status and quality of life. Evidence suggest that in-home CGA might be most effective in elderly that have a relatively high level of functioning.