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

Abstract

ObjectivesTo determine the prognostic value of time driven changes in health status on return to work (RTW) in the first 2 years after traumatic injury.DesignA prospective longitudinal cohort study. All patient-reported outcomes were measured at 1 week, 1, 3, 6, 12 and 24 months after injury.SettingTen participating hospitals in the Netherlands.ParticipantsEmployed adult clinical injury patients admitted to the hospital between August 2015 and November 2016 (N=1245 patients).Main outcome measuresData 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.ResultsAt 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.ConclusionIncreased 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 numberNCT02508675; Results.

The Cross-Sectional and Longitudinal Interconnectedness of Physical, Psychological, and Role Functioning following Physical Trauma: A Network Analysis

“…For instance, symptoms of post-traumatic stress, anxiety, and depression have been linked to physical complaints such as chronic pain and functional limitations [12,13,15]. Moreover, problems with returning to work and social dysfunction have been associated with a higher likelihood of physical complaints as well [3,[12][13][14]. Altogether, these studies support the idea that recovery is a complex process concerning different life domains that likely influence each other.…”

“…The Cross-Sectional and Longitudinal Interconnectedness of Physical, Psychological and Role Functioning Following Physical Trauma: A Network Analysis Surviving injury-induced physical trauma (hereafter: physical trauma) can have a longlasting impact on one's daily life. Even though most physical complaints improve during the first three months post-injury [1], trauma patients can still experience impaired functioning in the months thereafter, such as poor physical health, psychological complaints, and problems in daily life and work activities (i.e., role functioning [2]) [3][4][5][6][7][8][9]. Importantly, these limitations can be experienced independent of the Injury Severity Score (ISS) [3,[10][11][12] and type of injury [3], which begs the conclusion that there is more to trauma recovery than injury characteristics alone.…”

“…Even though most physical complaints improve during the first three months post-injury [1], trauma patients can still experience impaired functioning in the months thereafter, such as poor physical health, psychological complaints, and problems in daily life and work activities (i.e., role functioning [2]) [3][4][5][6][7][8][9]. Importantly, these limitations can be experienced independent of the Injury Severity Score (ISS) [3,[10][11][12] and type of injury [3], which begs the conclusion that there is more to trauma recovery than injury characteristics alone. Indeed, evidence suggests that trauma recovery -the time period following injury in which patients recover from their injury in terms of functioning (hereafter: recovery) -is a complex, multifaceted process.…”

“…Indeed, evidence suggests that trauma recovery -the time period following injury in which patients recover from their injury in terms of functioning (hereafter: recovery) -is a complex, multifaceted process. Patients with poor outcomes in one life domain are often more likely to have poor outcomes in other domains as well [3,[12][13][14]. For instance, symptoms of post-traumatic stress, anxiety, and depression have been linked to physical complaints such as chronic pain and functional limitations [12,13,15].…”

The cross-sectional and longitudinal interconnectedness of physical, psychological and role functioning following physical trauma: A network analysis

“…Associations between physical, psychological, and role functioning may not only exist because of the underlying injury, but also because of co-occurring complaints that mutually influence each other. Given previous research suggesting that limitations in physical, psychological, and role functioning experienced by trauma patients are associated cross-sectionally and longitudinally [3,[12][13][14], it is conceivable that impairments mutually influence each other both within the same moment of recovery as over time.…”