Original article| Volume 94, ISSUE 4, P703-710, April 2013

Return to Work and Quality of Life in Workers With Traumatic Limb Injuries: A 2-Year Repeated-Measurements Study

  • Wen-Hsuan Hou
    Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan

    School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, E-Da Hospital, Kaohsiung, Taiwan
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  • Huey-Wen Liang
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Ching-Fan Sheu
    Institute of Education, College of Social Science, National Cheng Kung University, Tainan, Taiwan
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  • Ching-Lin Hsieh
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Hung-Yi Chuang
    Corresponding author Hung-Yi Chuang, MD, ScD, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, 100, Shih Chuan 1st Road, Kaohsiung City 80708, Taiwan.
    Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

    Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Published:December 03, 2012DOI:



      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.


      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.


      One teaching hospital.


      Injured patients (N=966, 61% men) with a mean age of 44.7 years.


      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.


      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.


      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.


      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)
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