Returning to work after severe multiple injuries: multidimensional functioning and the trajectory from injury to work at 5 years.
BACKGROUND
The process of returning to work (RTW) after multiple injuries is lengthy. Prospective studies with follow-up times of up to 5 years are necessary but lacking. The aim of this study was to describe the trajectory of RTW and to examine the factors that predicted RTW over 5 years for patients with multiple injuries using a prospective cohort design.


METHODS
One-hundred one patients aged 18 years to 67 years who had been admitted to a trauma referral center with a New Injury Severity Score >15 starting January 2002 through June 2003 were included. The follow-up rate at 5 years was 79%. Outcomes were assessed 6 weeks after discharge and at 1 year, 2 years, and 5 years postinjury. The instruments used to assess patient status were the Short Form 36, the World Health Organization Disability Assessment Schedule II cognitive subscale, a Cognitive Function Scale, and the Brief Approach/Avoidance Coping Questionnaire. Repeated measures analyses of categorical correlated data were applied.


RESULTS
Patient's mean age was 34.5 years (SD, 13.5); 83% were men and 25% had a university or college education; 66% were blue-collar workers. Mean New Injury Severity Score was 35.1 (SD, 12.7). RTW rates were 28% at 1 year, 43% at 2 years, and 49% at 5 years postinjury. There were differences among patients in RTW status, and personal factors and physical and psychosocial functioning. Predictors of RTW were as follows: measurement occasion, education (high/low), coping, and physical and cognitive functioning. The proportion of unexplained variation between subjects in the models was 31% to 55%.


CONCLUSIONS
Of the patients included in this study, 49% achieved RTW, and 23% received full disability benefits. Higher education; better physical, social, and cognitive functioning; and coping strategies all predicted RTW.
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. h.l.soberg@medisin.uio.no
Helene L
HL
Soberg
Olav
O
Roise
Erik
E
Bautz-Holter
Arnstein
A
Finset
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D004651:Employment; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000534:rehabilitation*; D015999:Multivariate Analysis; D011446:Prospective Studies; D055815:Young Adult