Return to work following injury: the role of economic, social, and job-related factors.
OBJECTIVE
This study examined factors influencing return to work (RTW) following severe fracture to a lower extremity.


METHODS
This prospective cohort study followed 312 individuals treated for a lower extremity fracture at 3 level-1 trauma centers. Kaplan-Meier estimates of the proportion of RTW were computed, and a Cox proportional hazards model was used to examine the contribution of multiple risk factors on RTW.


RESULTS
Cumulative proportions of RTW at 3, 6, 9, and 12 months post-injury were 0.26, 0.49, 0.60, and 0.72. After accounting for the extent of impairment, characteristics of the patient that correlated with higher rates of RTW included younger age, higher education, higher income, the presence of strong social support, and employment in a white-collar job that was not physically demanding. Receipt of disability compensation had a strong negative effect on RTW.


CONCLUSIONS
Despite relatively high rates of recovery, one quarter of persons with lower extremity fractures did not return to work by the end of 1 year. The analysis points to subgroups of individuals who are at high risk of delayed RTW, with implications for interventions at the patient, employer, and policy levels.
MacKenzie
E J
EJ
Center for Injury Research and Policy, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD., USA. emackenz@jhsph.edu
Morris
J A
JA
Jurkovich
G J
GJ
Yasui
Y
Y
Cushing
B M
BM
Burgess
A R
AR
DeLateur
B J
BJ
McAndrew
M P
MP
Swiontkowski
M F
MF
D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000534:rehabilitation*; D006801:Humans; D007869:Leg Injuries / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014193:Trauma Centers