Introduction
Methods
Study design
Participants
Data collection
Characteristics | Number (%) unless otherwise specified (n = 513) |
---|---|
Characteristics measured at recruitment
| |
Centre | |
Nottingham | 193 (37.6) |
Loughborough | 129 (25.2) |
Bristol | 150 (29.4) |
Surrey | 41 (8.0) |
Age | |
16–24 | 60 (11.7) |
25–44 | 125 (24.4) |
45–64 | 256 (49.9) |
≥65 | 72 (14.0) |
Sex | |
Female | 267 (52.1) |
Male | 246 (48.0) |
Pre-injury EQ-5D | [6] |
Mean (SD) | 0.92 (0.18) |
Median (IQR) | 1 (0.85, 1) |
Pre-injury pain VAS score | [2] |
Mean (SD) | 5.4 (13.3) |
Median (IQR) | 0 (0, 2) |
Number of psychiatric diagnoses in past | |
0 | 435 (84.8) |
1 | 51 (9.9) |
2+ | 27 (5.3) |
Pre-injury HADS depression score | [2] |
Mean (SD) | 1.5 (2.5) |
Median (IQR) | 0 (0, 2) |
Pre-injury HADS anxiety score | [2] |
Mean (SD) | 3.0 (3.5) |
Median (IQR) | 2 (0, 5) |
Pre-injury AUDIT score | [14] |
Mean (SD) | 4.7 (4.5) |
Median (IQR) | 4 (2, 6) |
Pre-injury DAST score | [4] |
Mean (SD) | 0.1 (0.5) |
Median (IQR) | 0 (0, 0) |
Long-standing illness | [5] |
No | 385 (75.8) |
Yes | 123 (24.2) |
Employment | [5] |
Paid employment | 299 (58.9) |
Not working due to illness or disability | 25 (4.9) |
Unemployed | 17 (3.4) |
At home and not looking for work | 13 (2.6) |
Retired | 111 (21.9) |
Other | 43 (8.5) |
Ethnic group | [2] |
White | 493 (96.5) |
Black or minority ethnic group | 18 (3.5) |
Deprivation score (IMD) | [12] |
Mean (SD) | 17.0 (13.4) |
Median (IQR) | 12.7 (7.2, 22.5) |
Marital status | [3] |
Single | 129 (25.3) |
Married/partnership | 296 (58.0) |
Divorced/widowed | 85 (16.7) |
Nights in hospital | [16] |
Mean (SD) | 7.3 (6.0) |
Median (IQR) | 6 (3, 10) |
Injury severity | [1] |
Minor | 25 (4.9) |
Moderate | 370 (72.3) |
Serious or worse | 117 (22.9) |
Number of injuries | |
1 | 247 (48.2) |
2 | 155 (30.2) |
≥3 | 111 (21.6) |
Body part injured | |
Other | 40 (7.8) |
Upper limb | 84 (16.4) |
Lower limb | 338 (65.9) |
Upper and lower limbs | 51 (9.9) |
Injury mechanism | |
Other | 38 (7.4) |
Falls | 341 (66.5) |
Traffic | 101 (19.7) |
Struck | 33 (6.4) |
Place of injury | [1] |
Other | 85 (16.6) |
Home | 104 (20.3) |
Work | 47 (9.2) |
Road | 151 (29.5) |
Countryside | 63 (12.3) |
Sports facilities | 62 (12.1) |
Characteristics measured at 1 month
| |
HADS depression score | [1] |
Mean (SD) | 6.1 (4.3) |
Median (IQR) | 5 (3, 9) |
HADS anxiety score | [1] |
Mean (SD) | 5.8 (4.4) |
Median (IQR) | 5 (2, 9) |
AUDIT score | [13] |
Mean (SD) | 3.4 (4.4) |
Median (IQR) | 2 (0, 5) |
DAST score | [7] |
Mean (SD) | 0.1 (0.4) |
Median (IQR) | 0 (0, 0) |
IES avoidance score | [3] |
Mean (SD) | 7.8 (9.0) |
Median (IQR) | 5 (0, 12.6) |
IES intrusion score | [3] |
Mean (SD) | 8.3 (8.9) |
Median (IQR) | 5 (1, 13) |
SFQ score | [5] |
Mean (SD) | 7.5 (3.6) |
Median (IQR) | 7 (5, 9.6) |
CSS score | [2] |
Mean (SD) | 32.0 (6.1) |
Median (IQR) | 33 (28, 36) |
CIOP score | [4] |
Mean (SD) | 19.5 (6.5) |
Median (IQR) | 21 (16, 24) |
CION score | [4] |
Mean (SD) | 10.0 (5.1) |
Median (IQR) | 9 (5, 12) |
Life events since injury | [14] |
No | 426 (85.4) |
Yes | 73 (14.6) |
Pain VAS score | [4] |
Mean (SD) | 30.2 (22.6) |
Median (IQR) | 25 (12, 49) |
Seeking compensation | [31] |
No | 385 (79.9) |
Yes | 97 (20.1) |
Involved in litigation | [7] |
No | 435 (86.0) |
Yes | 71 (14.0) |
Statistical analysis
Measures | Model A (centre, age, sex, time) (n = 470) | Model B (A+ depression at 1 month) (n = 469) | Model C (B+ anxiety at 1 month) (n = 469) | Model D (C+ pre-injury psychological, demographic and injury characteristics) (n = 416) | Model E (D+ pain, social and legal factors at 1 month) (n = 373) | Final model (n = 436) |
---|---|---|---|---|---|---|
Adjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI) | |
Centre | ||||||
Nottingham | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Loughborough | 1.01 (0.43, 2.34) | 0.87 (0.38, 1.94) | 0.81 (0.37, 1.81) | 0.66 (0.30, 1.45) | 0.50 (0.21, 1.17) | 0.51 (0.24, 1.09) |
Bristol | 0.61 (0.27, 1.36) | 0.63 (0.29, 1.36) | 0.62 (0.29, 1.33) | 0.47 (0.22, 1.00) | 0.39 (0.17, 0.92) | 0.46 (0.22, 0.96) |
Surrey | 0.24 (0.07, 0.82) | 0.36 (0.11, 1.15) | 0.39 (0.12, 1.23) | 0.50 (0.16, 1.55) | 0.51 (0.16, 1.62) | 0.32 (0.11, 0.93) |
Age | ||||||
16–24 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
25–44 | 2.61 (0.80, 8.50) | 1.98 (0.64, 6.10) | 2.17 (0.71, 6.63) | 5.98 (1.56, 22.93) | 4.09 (0.98, 17.11) | 3.34 (1.08, 10.31) |
45–64 | 2.74 (0.95, 7.94) | 2.14 (0.77, 5.90) | 2.27 (0.83, 6.21) | 8.82 (2.27, 34.36) | 5.65 (1.35, 23.72) | 6.05 (2.07, 17.73) |
≥65 | 1.57 (0.45, 5.48) | 1.89 (0.57, 6.30) | 2.21 (0.67, 7.29) | 14.93 (2.57, 86.77) | 10.40 (1.61, 67.15) | 7.95 (1.87, 33.75) |
Sex | ||||||
Female | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Male | 0.76 (0.39, 1.46) | 1.14 (0.60, 2.17) | 1.21 (0.64, 2.27) | 0.85 (0.44, 1.69) | 0.97 (0.47, 2.00) | 1.07 (0.59, 1.95) |
Time post-injury | ||||||
2 months | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
4 months | 0.30 (0.18, 0.51) | 0.28 (0.16, 0.48) | 0.28 (0.17, 0.48) | 0.28 (0.16, 0.50) | 0.30 (0.16, 0.55) | 0.28 (0.16, 0.48) |
12 months | 0.05 (0.03, 0.10) | 0.05 (0.03, 0.09) | 0.05 (0.03, 0.09) | 0.04 (0.02, 0.09) | 0.04 (0.02, 0.09) | 0.04 (0.02, 0.08) |
Quintiles of HADS depression score at 1 month (range)* | ||||||
1 (0–2) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |
2 (2.3–4) | 5.83 (2.31, 14.71) | 4.28 (1.71, 10.72) | 4.73 (1.975, 11.38) | 4.00 (1.59, 10.06) | 3.25 (1.37, 7.71) | |
3 (5–6) | 4.71 (1.79, 12.38) | 2.71 (1.00, 7.30) | 2.17 (0.83, 5.70) | 1.25 (0.44, 3.54) | 1.33 (0.52, 3.37) | |
4 (7–10) | 15.63 (5.72, 42.72) | 6.31 (2.14, 18.58) | 7.98 (2.73, 23.31) | 5.72 (1.84, 17.81) | 5.58 (1.95, 16.03) | |
5 (11–21) | 16.71 (5.37, 52.05) | 3.14 (0.74, 13.26) | 7.77 (1.84, 32.77) | 3.29 (0.62, 17.43) | 3.12 (0.69, 14.15) | |
HADS anxiety score at 1 month | 1.19 (1.07, 1.33)†
| 1.25 (1.12, 1.40)†
| 1.22 (1.08, 1.38)†
| 1.19 (1.07, 1.32)†
| ||
Number of psychiatric morbidities at recruitment | ||||||
0 | 1.00 | 1.00 | 1.00‡
| |||
1 | 3.77 (1.28, 11.12) | 3.82 (1.26, 11.61) | 1.90 (0.72, 4.98) | |||
≥2 | 8.60 (1.42, 52.09) | 5.80 (0.86, 39.15) | 2.81 (0.59, 13.36) | |||
Pre-injury HADS depression score | 0.81 (0.68, 0.96)†
| 0.78 (0.65, 0.93)†
| 0.77 (0.67, 0.89)†
| |||
Pre-injury HADS anxiety score | 0.95 (0.83, 1.09)†
| 0.98 (0.85, 1.12)†
| ||||
Pre-injury AUDIT score | 1.05 (0.97, 1.15)†
| 1.02 (0.93, 1.11)†
| ||||
Pre-injury DAST score | 0.50 (0.24, 1.03)†
| 0.53 (0.25, 1.15)†
| ||||
Long-standing illness | ||||||
No | 1.00 | 1.00 | 1.00 | |||
Yes | 0.24 (0.10, 0.54) | 0.18 (0.07, 0.45) | 0.18 (0.08, 0.38) | |||
Employment status at recruitment | ||||||
Employed | 1.00 | 1.00 | 1.00 | |||
Unable due to illness/disability | 0.05 (0.01, 0.28) | 0.06 (0.01, 0.34) | 0.06 (0.01, 0.29) | |||
Unemployed | 3.42 (0.25, 47.47) | 2.53 (0.15, 42.75) | 2.27 (0.22, 22.89) | |||
At home and not looking for work | 0.49 (0.07, 3.59) | 0.34 (0.03, 3.72) | 0.19 (0.03, 1.23) | |||
Retired | 0.54 (0.19, 1.52) | 0.71 (0.24, 2.14) | 0.67 (0.26, 1.73) | |||
Other | 3.75 (0.97, 14.47) | 5.83 (1.37, 24.84) | 2.83 (0.85, 9.36) | |||
Ethnic group | ||||||
White | 1.00 | 1.00 | ||||
Black or minority ethnic group | 3.60 (0.36, 36.15) | 7.11 (0.55, 91.57) | ||||
Quintiles of deprivation score (range)* | ||||||
Least deprived (1.6–6.8) | 1.00 | 1.00 | ||||
2 (6.9–10.5) | 1.31 (0.55, 3.10) | 1.57 (0.64, 3.85) | ||||
3 (10.6–16.1) | 1.53 (0.63, 3.71) | 1.56 (0.62, 3.89) | ||||
4 (16.2–27.2) | 1.58 (0.61, 4.14) | 1.37 (0.51, 3.80) | ||||
Most deprived (27.3–67.7) | 1.65 (0.55, 4.92) | 1.73 (0.54, 5.56) | ||||
Marital status | ||||||
Single | 1.00 | 1.00 | ||||
Married/partnership | 0.88 (0.34, 2.25) | 0.91 (0.33, 2.47) | ||||
Divorced/widowed | 0.56 (0.18, 1.75) | 0.49 (0.14, 1.66) | ||||
Nights in hospital | 1.07 (1.01, 1.13)†
| 1.07 (1.01, 1.14)†
| 1.08 (1.02, 1.15)†
| |||
Injury severity | ||||||
Minor | 1.00 | 1.00 | 1.00 | |||
Moderate | 0.85 (0.12, 5.96) | 0.89 (0.12, 6.80) | 4.35 (1.10, 17.19) | |||
Serious | 2.63 (0.34, 20.61) | 2.43 (0.28, 21.29) | 9.90 (2.12, 46.26) | |||
Number of injuries | ||||||
1 | 1.00 | 1.00 | ||||
2 | 1.97 (0.96, 4.05) | 1.71 (0.81, 3.66) | ||||
≥3 | 1.34 (0.51, 3.51) | 1.28 (0.46, 3.60) | ||||
Body part injured | ||||||
Other | 1.00 | 1.00 | 1.00 | |||
Upper limb | 5.12 (1.46, 18.00) | 6.47 (1.68, 24.84) | 4.77 (1.43, 15.96) | |||
Lower limb | 10.36 (3.26, 32.94) | 12.30 (3.57, 42.44) | 8.14 (2.73, 24.31) | |||
Upper and lower limb | 4.86 (1.11, 21.34) | 4.24 (0.87, 20.57) | 4.66 (1.21, 17.94) | |||
Injury mechanism | ||||||
Other | 1.00 | 1.00 | ||||
Falls | 1.20 (0.17, 8.35) | 1.23 (0.15, 9.93) | ||||
Traffic | 2.84 (0.35, 22.87) | 2.32 (0.24, 22.16) | ||||
Struck | 0.50 (0.06, 4.36) | 0.47 (0.05, 4.73) | ||||
Penetrating | 0.08 (0.01, 0.98) | 0.08 (0.005, 1.17) | ||||
Exertion | 1.21 (0.07, 20.44) | 0.73 (0.04,13.65) | ||||
Place of injury | ||||||
Other | 1.00 | 1.00 | ||||
Home | 1.17 (0.44, 3.14) | 1.81 (0.61, 5.37) | ||||
Work | 2.94 (0.81, 10.63) | 4.72 (1.13, 19.67) | ||||
Road | 1.08 (0.39, 3.00) | 1.29 (0.43, 3.87) | ||||
Countryside | 1.66 (0.55, 5.06) | 1.64 (0.51, 5.25) | ||||
Sports facilities | 1.00 (0.33, 3.03) | 1.07 (0.33, 3.48) | ||||
Quintiles of pain VAS at 1 month (range)* | ||||||
1 (0–8) | 1.00 | 1.00 | ||||
2 (9–20) | 1.95 (0.77, 5.01) | 2.67 (1.16, 6.11) | ||||
3 (21–33) | 3.02 (1.15, 7.95) | 2.83 (1.20, 6.65) | ||||
4 (34–51) | 6.74 (2.13, 21.31) | 5.49 (2.01, 14.94) | ||||
5 (52–91) | 1.63 (0.56, 4.76) | 1.86 (0.71, 4.89) | ||||
SFQ score at 1 month | 1.14 (0.99, 1.32)†
| 1.17 (1.04, 1.32)†
| ||||
CSS score at 1 month | 1.02 (0.95, 1.09)†
| |||||
CIOP score at 1 month | 0.97 (0.92, 1.03)†
| |||||
CION score at 1 month | 1.00 (0.90, 1.11)†
| |||||
Life events in first month after injury | ||||||
No | 1.00 | |||||
Yes | 0.82 (0.28, 2.36) | |||||
Seeking compensation | ||||||
No | 1.00 | |||||
Yes | 0.47 (0.13, 1.71) | |||||
Involved in litigation | ||||||
No | 1.00 | |||||
Yes | 3.52 (0.70, 17.60) |
Measures | Final model in 1-month responders (n = 513) | Final model in all participants recruited to the study (n = 668) |
---|---|---|
Adjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI) | |
Centre | ||
Nottingham | 1.00 | 1.00 |
Loughborough | 0.62 (0.33–1.19) | 0.71 (0.40–1.28) |
Bristol | 0.53 (0.29–0.99) | 0.59 (0.32–1.06) |
Surrey | 0.43 (0.17–1.08) | 0.43 (0.18–1.06) |
Age | ||
16–24 | 1.00 | 1.00 |
25–44 | 2.40 (0.98–5.87) | 1.71 (0.77–3.78) |
45–64 | 3.12 (1.36–7.19) | 2.17 (1.03–4.58) |
≥65 | 3.28 (1.02–10.56) | 2.33 (0.80–6.78) |
Sex | ||
Female | 1.00 | 1.00 |
Male | 1.00 (0.60–1.67) | 1.07 (0.68–1.68) |
Time post-injury | ||
2 months | 1.00 | 1.00 |
4 months | 0.33 (0.20–0.55) | 0.42 (0.24–0.73) |
12 months | 0.09 (0.05–0.17) | 0.14 (0.08–0.25) |
Quintiles of HADS depression score at 1 month (range)* | ||
1 (0–2) | 1.00 | 1.00 |
2 (2.3–4) | 1.80 (0.87–3.74) | 1.66 (0.86–3.21) |
3 (5–6) | 0.93 (0.43–2.00) | 1.10 (0.54–2.26) |
4 (7–10) | 1.83 (0.79–4.23) | 1.84 (0.82–4.15) |
5 (11–21) | 1.62 (0.48–5.51) | 1.83 (0.59–5.69) |
HADS anxiety score at 1 month | 1.14 (1.04–1.24)†
| 1.09 (1.01–1.18)†
|
Number of psychiatric morbidities at recruitment | ||
0 | 1.00 | 1.00 |
1 | 1.26 (0.56–2.82) | 1.15 (0.57–2.35) |
≥2 | 2.09 (0.60–7.25) | 2.10 (0.72–6.17) |
Pre-injury HADS depression score | 0.80 (0.71–0.90)†
| 0.81 (0.73–0.90)†
|
Long-standing illness | ||
No | 1.00 | 1.00 |
Yes | 0.23 (0.13–0.43) | 0.27 (0.15–0.46) |
Employment status at recruitment‡ | ||
Employed | 1.00 | 1.00 |
Unemployed/unable to work | 0.32 (0.14–0.74) | 0.38 (0.17–0.83) |
Retired | 0.81 (0.37–1.77) | 0.83 (0.41–1.68) |
Other | 1.68 (0.60–4.71) | 1.40 (0.58–3.41) |
Nights in hospital | 1.05 (1.00–1.10)†
| 1.04 (1.00–1.09)†
|
Injury severity | ||
Minor | 1.00 | 1.00 |
Moderate | 2.64 (0.92–7.55) | 1.91 (0.75–4.85) |
Serious | 4.35 (1.33–14.22) | 2.51 (0.89–7.08) |
Body part injured | ||
Other | 1.00 | 1.00 |
Upper limb | 2.49 (0.93–6.69) | 2.39 (0.99–5.77) |
Lower limb | 4.60 (1.89–11.21) | 3.76 (1.79–7.91) |
Upper and lower limb | 3.50 (1.12–10.93) | 2.99 (1.14–7.86) |
Quintiles of pain VAS at 1 month (range)* | ||
1 (0–8) | 1.00 | 1.00 |
2 (9–20) | 2.00 (0.99–4.06) | 1.88 (1.00–3.54) |
3 (21–33) | 2.01 (0.97–4.14) | 1.92 (0.98–3.77) |
4 (34–51) | 2.97 (1.30–6.81) | 2.75 (1.25–6.03) |
5 (52–91) | 2.12 (0.93–4.85) | 2.09 (0.98–4.45) |
SFQ score at 1 month | 1.18 (1.06–1.30)†
| 1.14 (1.04–1.25)†
|