Factors influencing outcome after orthopedic trauma.
BACKGROUND
Some recent studies have suggested that certain types of orthopedic trauma result in ongoing disability and that factors other than injury severity or location may influence outcome. This study aimed to evaluate outcome 12 months and 2 years after severe orthopedic trauma, as measured on the Short Form (SF)-36 Health Survey, relative to a control group, to examine change over time and to examine which demographic, injury-related and psychological factors are associated with persisting disability.


METHODS
One hundred thirteen orthopedic trauma patients, recruited during rehabilitation, and 61 demographically similar uninjured controls were followed up at 1 and 2 years postinjury. Measures included the SF-36 Health Survey, Symptom Checklist-90-R, Brief Pain Inventory, Hospital Anxiety and Depression Scales, and Posttraumatic Stress Disorder Checklist-Specific.


RESULTS
Results indicated presence of significant ongoing disability in all SF-36 physical and mental health domains, significant ongoing psychologic adjustment problems, including posttraumatic stress disorder (PTSD) symptoms, and pain, with little or no improvement between 1 and 2 years postinjury. The presence of ongoing pain, anxiety, depression or PTSD symptoms were the strongest predictors of outcome on most variables, with older age also contributing to negative outcomes. Injury severity and type did not predict outcome, although those with lower limb fractures had greater pain and poorer physical outcomes that those with fractures in other locations.


CONCLUSIONS
This study has highlighted pain and PTSD symptoms as frequent and disabling factors after othropedic trauma. There is clearly a need to focus on alleviating these problems as part of the rehabilitation process.
Ponsford
Jennie
J
Department of Psychology, Monash University, Melbourne, Australia. jennie.ponsford@med.monash.edu.au
Hill
Bridget
B
Karamitsios
Mary
M
Bahar-Fuchs
Alex
A
D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D012016:Reference Values; D018434:Sickness Impact Profile; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D013997:Time Factors; D014947:Wounds and Injuries / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*