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

Presented in part at the 30th International Conference of Industrial Hygiene and Occupational Medicine, April 28–29, 2012, Kaohsiung, Taiwan.
https://doi.org/10.1016/j.apmr.2012.10.033Get rights and content

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.

Section snippets

Participants

We conducted a 2-year repeated-measurements study because most of the persons with limb injuries achieve their first RTW within 2 years postinjury.16 Moreover, the RTW is not a permanent status because secondary injury or work incapability may occur after their RTW.13 Inclusion criteria were patients older than 18 years diagnosed with limb injuries and hospitalized in a teaching hospital within 14 days postinjury. Those unable to read or answer the questionnaires, foreign workers, and those

Results

The characteristics of study participants at baseline are described in table 1. Table 2 shows the difference in PRO measures between RTW and non-RTW episodes. Participants with an RTW status at a particular time tended to report significantly higher scores in the EQ-5D questionnaire (.98 vs .76). RTW status was also significantly associated with fewer depressive symptoms (.35 vs 1.47), greater self-efficacy (32.53 vs 29.51), better coping ability (56.49 vs 52.55), and a higher frequency of

Discussion

Over a 2-year span with 5 observational time periods, 81.2% of the participants returned to work at least once, but only 38.2% successfully maintained their RTW status till the end of the study period. A significant association was found between the RTW status and a higher level of HRQOL. This association was greatly diminished by taking into account the activity/participation domains and the elapsed time since injury. In addition to the RTW status, a shorter LOS at baseline, lesser depressive

Conclusions

In conclusion, the activity/participation domains and elapsed time since injury may largely explain the positive association of RTW with HRQOL. Despite that, RTW may still exert a positive and independent influence on HRQOL, suggesting a need for successful RTW in injured workers. Rehabilitation strategies that may successfully maintain a worker's RTW status should also be considered.

Supplier

  • a.

    SAS Institute Inc, 100 SAS Campus Dr, Cary, NC 27513-2414.

References (47)

  • R.B. Post et al.

    Return to work and quality of life in severely injured patients

    Disabil Rehabil

    (2006)
  • M. Post et al.

    Self-rated health as a predictor of return to work among employees on long-term sickness absence

    Disabil Rehabil

    (2006)
  • M.L. Baldwin et al.

    The error of using returns-to-work to measure the outcomes of health care

    Am J Ind Med

    (1996)
  • WHO

    International Classification of Functioning, Disability and Health (ICF)

    (2001)
  • H.L. Soberg et al.

    Long-term multidimensional functional consequences of severe multiple injuries two years after trauma: a prospective longitudinal cohort study

    J Trauma

    (2007)
  • H.L. Soberg et al.

    Returning to work after severe multiple injuries: multidimensional functioning and the trajectory from injury to work at 5 years

    J Trauma

    (2011)
  • H.L. Soberg et al.

    Return to work after severe multiple injuries: a multidimensional approach on status 1 and 2 years postinjury

    J Trauma

    (2007)
  • E.J. MacKenzie et al.

    Factors influencing return to work following hospitalization for traumatic injury

    Am J Public Health

    (1987)
  • EuroQol–a new facility for the measurement of health-related quality of life

    Health Policy

    (1990)
  • J.A. Johnson et al.

    Valuations of EQ-5D health states: are the United States and United Kingdom different?

    Med Care

    (2005)
  • P. Dolan

    Modeling valuations for EuroQol health states

    Med Care

    (1997)
  • M.S. Lee et al.

    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)
  • J.M. Welton et al.

    Nursing diagnoses, diagnosis-related group, and hospital outcomes

    J Nurs Admin

    (2005)
  • Cited by (0)

    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.

    View full text