title: Early predictors of long-term work disability after major limb trauma.
abstract: BACKGROUND
  A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing the high costs associated with these injuries.
  
  
  METHODS
  Patients (n = 423) who underwent amputation or reconstruction after limb threatening lower extremity trauma and who were working before the injury were prospectively evaluated at 3, 6, 12, 24, and 84 months. Time to first RTW was assessed. For individuals working at 84 months, the percentage of time limited in performance at work was estimated using the Work Limitations Questionnaire.
  
  
  RESULTS
  Estimates of the cumulative proportion returning to work at 3, 6, 12, 24, and 84 months were 0.12, 0.28, 0.42, 0.51, and 0.58. Patients working at 84 months were, on average, limited in their ability to perform the demands of their job 20 to 25% of the time. In the context of a Cox proportional hazards model, differences in RTW outcomes by treatment (amputation versus reconstruction) were not statistically significant. Factors that were significantly associated (p < 0.05) with higher rates of RTW include younger age, being White, higher education, being a nonsmoker, average to high self efficacy, preinjury job tenure, higher job involvement, and no litigation. Early (3 month) assessments of pain and physical functioning were significant predictors of RTW.
  
  
  CONCLUSIONS
  Return to work after severe lower extremity trauma remains a challenge. Although the causal pathway from injury to impairment and work disability is complex, this study points to several factors that influence RTW that suggest strategies for intervention.
authors.affiliation: Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. emackenz@jhsph.edu
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bosse
authors.forename: James F
authors.initials: JF
authors.lastname: Kellam
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Pollak
authors.forename: Lawrence X
authors.initials: LX
authors.lastname: Webb
authors.forename: Marc F
authors.initials: MF
authors.lastname: Swiontkowski
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Smith
authors.forename: Roy W
authors.initials: RW
authors.lastname: Sanders
authors.forename: Alan L
authors.initials: AL
authors.lastname: Jones
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Starr
authors.forename: Mark P
authors.initials: MP
authors.lastname: McAndrew
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Patterson
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Burgess
authors.forename: Thomas
authors.initials: T
authors.lastname: Travison
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000534:rehabilitation*; D006801:Humans; D007869:Leg Injuries / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D012959:Socioeconomic Factors; D014193:Trauma Centers; D014937:Work; D014938:Work Capacity Evaluation