title: Health-related quality of life after upper extremity injuries and predictors for suboptimal outcome.
abstract: OBJECTIVE
  The purpose of this study was to examine the impact of upper extremity injuries (UEIs) on health-related quality of life (HRQoL) in adult patients compared with victims of other types of injuries and with the general population, in order to establish recovery patterns of different types of UEIs and determine predictors for suboptimal outcome in the long term.
  
  
  METHODS
  Data were obtained from the Dutch Injury Surveillance System, from the National Hospital Discharge Registry, and from a patient follow-up survey. A total of 608 patients (aged ≥18 years) with an UEI were included. The main outcome measure was HRQoL measured at 2.5, 5, 9 and 24 months after UEI according to the EuroQol-5D (EQ-5D). The predictors for the suboptimal outcome were examined by multivariate linear regression analyses.
  
  
  RESULTS
  For non-hospitalized UEI patients, a substantial loss in HRQoL was observed after 2.5 months which improved to the level of the general population norms by 24 months. For hospitalized UEI patients, HRQoL improved from 2.5 to 24 months but remained far below population norms. The more proximal UEI had a lower HRQoL and a slower recovery of HRQoL than distal injuries. At all time points, the proportion of UEI patients with limitations on the health domains self-care, usual activities and complaints of pain and/or discomfort was higher than in the group of all injuries. Female gender, higher age, low educational level, co-morbidity, shoulder or upper arm injury, multiple injuries and hospitalization are independent predictors for long-term loss in HRQoL.
  
  
  CONCLUSIONS
  The impact of UEI exceeds the health consequences of the group with all injuries, for both non-hospitalized and hospitalized patients. The presence of UEI substantially reduces HRQoL in the short and long term, mainly due to limitations on the health domains self-care, usual activities and complaints of pain and/or discomfort.
  
  
  CONCLUSIONS
  The impact of UEIs on HRQoL exceeds the health consequences of the group with all injuries. Proximal UEIs had a lower HRQoL and slower recovery than distal injuries. The predictors for the outcome on specific UEIs need to be further investigated in clinical studies, to understand how these differences affect patient-reported outcome measures. These data provide additional insight into treatment outcome and are needed to improve quality of care.
authors.affiliation: Department of Plastic-, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands. Electronic address: ddeputter@gmail.com.
authors.forename: C E
authors.initials: CE
authors.lastname: de Putter
authors.affiliation: Department of Plastic-, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, Rotterdam, The Netherlands. Electronic address: r.selles@erasmusmc.nl.
authors.forename: R W
authors.initials: RW
authors.lastname: Selles
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. Electronic address: j.haagsma@erasmusmc.nl.
authors.forename: J A
authors.initials: JA
authors.lastname: Haagsma
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. Electronic address: s.polinder@erasmusmc.nl.
authors.forename: S
authors.initials: S
authors.lastname: Polinder
authors.affiliation: Consumer and Safety Institute, Amsterdam, The Netherlands. Electronic address: m.panneman@veiligheid.nl.
authors.forename: M J M
authors.initials: MJ
authors.lastname: Panneman
authors.affiliation: Department of Plastic-, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands. Electronic address: s.e.r.hovius@erasmusmc.nl.
authors.forename: S E R
authors.initials: SE
authors.lastname: Hovius
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. Electronic address: a.burdorf@erasmusmc.nl.
authors.forename: A
authors.initials: A
authors.lastname: Burdorf
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. Electronic address: e.vanbeeck@erasmusmc.nl.
authors.forename: E F
authors.initials: EF
authors.lastname: van Beeck
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D004185:Disability Evaluation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D059348:Peripheral Nerve Injuries / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D034941:Upper Extremity / Q000293:injuries* / Q000601:surgery; D014947:Wounds and Injuries / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery
keywords: Adults; Health-related quality of life; Injuries; Upper extremity