Abstract
Objectives
To assess the impact of return-to-work (RTW) status on health-related quality of life
(HRQOL) over a 2-year period in workers with traumatic limb injuries and to elucidate
factors that may contribute to the association of RTW with HRQOL.
Design
A 2-year repeated-measurements follow-up study using the generalized estimating equations
approach for model fitting to account for within-subject correlations of HRQOL.
Setting
One teaching hospital.
Participants
Injured patients (N=966, 61% men) with a mean age of 44.7 years.
Interventions
Not applicable.
Main Outcome Measures
The RTW status, HRQOL (assessed by the EuroQol five-dimensional questionnaire), and
activity/participation were repeatedly surveyed at 2 weeks and 1, 3, 6, 12, 18, and
24 months after injury. A series of regression models was used to examine the associations
between HRQOL and RTW, with sequential adjustment for explanatory variables such as
personal and environmental factors, body structure and function, activity/participation,
and postinjury period.
Results
Over a 2-year study period, 81.2% of the study participants had 1 or more RTW episodes;
38.2% of them successfully maintained their RTW status until the end. A significant
positive association was found between RTW status and HRQOL. The association could
largely be explained by the domains of activity/participation. A higher HRQOL was
associated with a shorter length of hospital stay, better coping ability, frequent
participation in activities of daily living, and a longer postinjury period. A reduced
HRQOL, however, was observed for participants with more depressive symptoms.
Conclusions
RTW showed a positive and independent influence on HRQOL in workers with limb injury.
In addition, the activity/participation domains and the elapsed time since injury
largely explained the association between RTW and HRQOL.
Keywords
List of abbreviations:
ADL (activities of daily living), BSRS-5 (5-item Brief Symptom Rating Scale), EQ-5D (EuroQol five-dimensional), FAI (Frenchay Activities Index), GEE (generalized estimation equation), HRQOL (health-related quality of life), ICF (International Classification of Functioning, Disability and Health), LOS (length of hospital stay), PRO (patients' self-reported outcomes), PSS (Perceived Stress Scale), RTW (return to work), WC (work compensation)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Selected major risk factors and global and regional burden of disease.Lancet. 2002; 360: 1347-1360
- Global burden of disease in young people aged 10-24 years: a systematic analysis.Lancet. 2011; 377: 2093-2102
- Measuring the global burden of disease and epidemiological transitions: 2002-2030.Ann Trop Med Parasitol. 2006; 100: 481-499
- Lost working days, productivity, and restraint use among occupants of motor vehicles that crashed in the United States.Inj Prev. 2004; 10: 314-319
- Cost and determinants of morbidity from work-related disabling injuries in Taiwan.Occup Environ Med. 1995; 52: 138-142
- Outcomes in work-related injuries: a comparison of older and younger workers.Am J Ind Med. 2005; 47: 104-112
- Estimation of life expectancies and loss-of-life expectancies for workers with permanent occupational disabilities of the extremities – a 21-year follow-up study.Scand J Work Environ Health. 2012; 38: 70-77
- Return to work and quality of life in severely injured patients.Disabil Rehabil. 2006; 28: 1399-1404
- Self-rated health as a predictor of return to work among employees on long-term sickness absence.Disabil Rehabil. 2006; 28: 289-297
- The error of using returns-to-work to measure the outcomes of health care.Am J Ind Med. 1996; 29: 632-641
- International Classification of Functioning, Disability and Health (ICF).World Health Organization, Geneva2001
- Long-term multidimensional functional consequences of severe multiple injuries two years after trauma: a prospective longitudinal cohort study.J Trauma. 2007; 62: 461-470
- Returning to work after severe multiple injuries: multidimensional functioning and the trajectory from injury to work at 5 years.J Trauma. 2011; 71: 425-434
- Return to work after severe multiple injuries: a multidimensional approach on status 1 and 2 years postinjury.J Trauma. 2007; 62: 471-481
- A systematic review of early prognostic factors for return to work following acute orthopaedic trauma.Injury. 2010; 41: 787-803
- Factors influencing return to work following hospitalization for traumatic injury.Am J Public Health. 1987; 77: 329-334
- Taiwanese version of the EQ-5D: validation in a representative sample of the Taiwanese population.J Formos Med Assoc. 2007; 106: 1023-1031
- EuroQol–a new facility for the measurement of health-related quality of life.Health Policy. 1990; 16: 199-208
- Valuations of EQ-5D health states: are the United States and United Kingdom different?.Med Care. 2005; 43: 221-228
- Modeling valuations for EuroQol health states.Med Care. 1997; 35: 1095-1108
- Type 2 diabetes increases and metformin reduces total, colorectal, liver and pancreatic cancer incidences in Taiwanese: a representative population prospective cohort study of 800,000 individuals.BMC Cancer. 2011; 11: 20
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Nursing diagnoses, diagnosis-related group, and hospital outcomes.J Nurs Admin. 2005; 35: 541-549
Standard Occupational Classification System of the Republic of China (Rev. 6). Available at: http://www.dgbas.gov.tw/public/Attachment/06211605771.xls. Accessed February 22, 2011.
- Reconceptualizing the nature and consequences of part-time work.Acad Manage Rev. 1990; 15: 103-112
- Lifetime principal occupation and risk of cognitive impairment among the elderly.Ind Health. 2002; 40: 7-13
- Worker's compensation and return-to-work following orthopaedic injury to extremities.J Rehabil Med. 2008; 40: 440-445
- A Rasch analysis of the Frenchay Activities Index in patients with spinal cord injury.Spine (Phila Pa 1976). 2007; 32: 437-442
- Assessment of older people: self-maintaining and instrumental activities of daily living.Gerontologist. 1969; 9: 179-186
- Measurement properties of the Frenchay Activities Index among individuals with a lower limb amputation.Clin Rehabil. 2004; 18: 414-422
- Measuring health-related quality of life in patients with venous leg ulcers.Qual Life Res. 1999; 8: 327-336
- The five-item Brief-Symptom Rating Scale as a suicide ideation screening instrument for psychiatric inpatients and community residents.BMC Psychiatry. 2008; 8: 53
- Development and verification of validity and reliability of a short screening instrument to identify psychiatric morbidity.J Formos Med Assoc. 2003; 102: 687-694
- Validity of the five-item Brief Symptom Rating Scale among subjects admitted for general health screening.J Formos Med Assoc. 2005; 104: 824-829
- The assessment of optimistic self-beliefs: comparison of the German, Spanish, and Chinese versions of the General Self-efficacy Scale.Appl Psychol. 1997; 46: 69-88
- A global measure of perceived stress.J Health Soc Behav. 1983; 24: 385-396
- Extending the simple linear regression model to account for correlated responses: an introduction to generalized estimating equations and multi-level mixed modelling.Stat Med. 1998; 17: 1261-1291
- Prevalence and determinants of disabilities and return to work after major trauma.J Trauma. 2005; 58: 126-135
- Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study.Eur Spine J. 2007; 16: 641-655
- A cohort study of short-term functional outcomes following injury: the role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare.Health Qual Life Outcomes. 2011; 9: 68
- Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands.J Trauma. 2007; 62: 133-141
- Multiple injuries: an overview of the outcome.J Trauma. 1995; 38: 681-686
- First return to work following injury: does it reflect a composite or a homogeneous outcome?.Occup Environ Med. 2010; 67: 730-736
- BSRS-5 (5-item Brief Symptom Rating Scale) scores affect every aspect of quality of life measured by WHOQOL-BREF in healthy workers.Qual Life Res. 2011; 20: 1469-1475
- The impact of psychological symptoms on return to work in workers after occupational injury.J Occup Rehabil. 2012 Aug 5; ([Epub ahead of print])
- The relationship between employment-related self-efficacy and quality of life following traumatic brain injury.Rehabil Psychol. 2009; 54: 299-305
- Personal control over aversive stimuli and its relationship to stress.Psychol Bull. 1973; 80: 286-303
Article info
Publication history
Published online: December 03, 2012
Footnotes
Supported by research grants from the National Science Council (NSC 99-2314-B-650-001-MY2) and the E-Da Hospital (EDAHP-98009 and EDAHP-99001).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
