Health related quality of life in trauma patients. Data from a one-year follow up study compared with the general population

Abstract

BackgroundTrauma patients have impaired health-related quality of life (HRQOL) after trauma. The aim of the study was to assess HRQOL during the first year after trauma and hospital stay in trauma patients admitted to an intensive-care unit (ICU) for >24 hours compared with non-ICU trauma patients and the general population, and to identify predictors of HRQOL.MethodsA prospective one-year follow-up study of 242 trauma patients received by the trauma team of a trauma referral centre in Norway was performed. HRQOL was measured using the Medical Outcomes Study Short Form 36 (SF-36) at 3 and 12 months.ResultsThe mean age of the cohort was 42.3 years (95% CI, 40.4-44.3 years). The median Injury Severity Score (ISS) was 10, interquartile range 16. The HRQOL improved significantly from the 3 to the 12 months follow up in the trauma patients. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients at 12 months were observed only for physical functioning and role physical subscales. Optimism was an independent predictor of good HRQOL at 12 months, in all dimensions (beta, 0.95-2.45). A higher depression score at baseline predicted lower HRQOL in four of eight dimensions (beta -1.1 to -1.70). In addition, better physical functioning was predicted by lower age (beta, -0.20), and having head injury (reference) as the most severe injury vs. spine or extremity injuries (beta, -9.49 and -10.85), and better mental health by higher age (beta, 0.21) and being employed or studying before the trauma (beta, 12.27). In addition to optimism good general health was predicted by lower score for post-traumatic stress (PTS) symptoms at baseline (beta, -0.27) and lower ISS score (beta -10.59).ConclusionsThe HRQOL improved significantly from the 3 to the 12 months follow up in our sample. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients were observed for only two subscales. Better HRQOL at 12 months was predicted mainly by optimism, low score for depression and PTS symptoms at baseline. High ISS predicted low general health exclusively.

Discharge from the acute hospital: trauma patients’ perceptions of care

“…Health-related quality of life following trauma has been shown to be predicted by optimism and low levels of depression and post-traumatic stress. 13 Schiller et al interviewed patients following hip fracture who described seeking support, moving more and preserving perspective as the fundamental factors in improving outcome, 26 whereas other studies reported that psychological health was considered by patients as an important marker of recovery. 27,28 Although we did not specifically target questions to determine quality of life factors or personality traits, interestingly, in this population, those discharged home commonly reported that family support and their own strength of mind and determination were the major factors in achieving their goals, whereas those discharged to in-patient rehabilitation seemed to focus on the importance of others in their recovery, often claiming that it was the rehabilitation staff who were the reason for their positive outcome.…”

“…Other studies report that factors such as optimism and low post-traumatic stress lead to improved quality of life following trauma, 13 with personality traits such as an internal locus of control also being shown to contribute to positive outcomes after various fracture types. 14,15 The factors that patients' believe most assisted in their recovery were investigated in the present study.…”

Effectiveness of an Early Mobilization Protocol in a Trauma and Burns Intensive Care Unit: A Retrospective Cohort Study

“…3,10,11 Patients in a trauma and burns ICU (TBICU) are at similar risk for these complications, 3,10,12 which may contribute to the body structure and function impairments, activity limitations, participation restrictions, and decreased quality of life seen in patients years after discharge from the TBICU. [13][14][15][16][17] Yet, no previous studies have investigated the safety, feasibility, or effectiveness of early mobilization in patients who are critically ill and who have sustained traumatic or burn injuries.…”

The relationship between physical and psychological complaints and quality of life in severely injured patients

“…Previous studies showed that the (HR)QOL of severely injured patients is lower than that of the general population. [2][3][4][5][6][7][8] This decrease in (HR)QOL seems to depend on both psychological complaints and physical limitations, but few studies measured these three parameters within the same study population.…”