title: Health-related quality of life two years after injury due to terrorism.
abstract: BACKGROUND
  During the past few decades, terrorist acts have been an unfortunate reality worldwide. There is a striking paucity of research investigating the multitude of long-term outcomes after severe physical injury due to terrorist attacks, a unique subgroup of trauma patients. The purpose of this study was to provide a profile of the long-term health-related quality of life (HR-QOL) after injury due to terrorist attacks and to explore the relationships between Post Traumatic Stress Disorder (PTSD), occupational status and injury severity with HR-QOL.
  
  
  METHODS
  We included 35 survivors of terrorist attacks living in the community, two years on average after the injury, mean age at follow-up = 32.1 (±13.8), mean Injury Severity Score (ISS) = 27 (±14.2). The subjects were recruited from consecutive admissions to a rehabilitation department in a tertiary care center between September 2000 - June 2004. Most of the subjects suffered multiple trauma. The main outcome measures were the Short-Form Health Survey (SF-36), Post Traumatic Diagnostic Scale and return to work rates.
  
  
  RESULTS
  The mean scores on 6/8 of the SF-36 subscales were significantly lower among the survivors compared to normative population norms. Post Traumatic Stress Disorder (PTSD) was found in 39% of the sample and 43% did not resume their main occupation two years after the injury. Multivariate analysis of variance of PTSD and occupational status (returned vs. did not return to work) on quality of life scores revealed significant main effects for both PTSD (p=. 000) and occupational status (p=. 005) with no interaction effect (p=. 476). No significant correlations were found between injury severity and the SF-36 scores.
  
  
  CONCLUSIONS
  This study demonstrated the long-term impact of injury due to terrorism. Results showed independent effects of PTSD and occupational status on health related quality of life, two years after injury. These findings suggest that this group may benefit from intervention focusing on their emotional and occupational status in order to improve their quality of life.
authors.affiliation: School of Occupational Therapy, Hadassah and Hebrew University of Jerusalem, Jerusalem, Israel. mayat@hadassah.org.il
authors.forename: Maya
authors.initials: M
authors.lastname: Tuchner
authors.forename: Zeev
authors.initials: Z
authors.lastname: Meiner
authors.forename: Shula
authors.initials: S
authors.lastname: Parush
authors.forename: Adina
authors.initials: A
authors.lastname: Hartman-Maeir
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D004651:Employment / Q000523:psychology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D018434:Sickness Impact Profile; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017741:Survivors / Q000523:psychology*; D023481:Terrorism; D016896:Treatment Outcome