Functional status following injury: what recovery pathways do people follow?
OBJECTIVE
Functional status can be affected for considerable time after injury. Individual's functional status trajectories, or pathways, following injury may provide insights into achieving, or not achieving, optimal functional status. This study aims to (1) investigate functional status trajectories of injured individuals over two years by multiple dimensions and, (2) determine whether there are differences in functional status trajectories between those hospitalised and non-hospitalised.


METHODS
Data from the Prospective Outcomes of Injury Study, a longitudinal cohort (n=2856) of injured New Zealanders, was used. Functional status was assessed using the EQ-5D (plus a cognitive dimension) at 3, 12 and 24 months post injury. For each dimension (mobility, self-care, usual activities, pain/discomfort anxiety/depression and cognition), individual-level trajectories were created based on whether participants had attained (or exceeded) their pre-injury functional status at each time-point.


RESULTS
Participants had varied pathways to attaining their pre-injury functional status which was not revealed by cross-sectional group-level data. When all dimensions were considered together, 24% of participants attained their pre-injury functional status but did not maintain it at a subsequent phase. By EQ-5D dimension, this varied from 5% (self-care) to 22% (pain/discomfort). Twenty-six percent of non-hospitalised participants attained, but did not maintain, their pre-injury status compared to 18% of those hospitalised.


CONCLUSIONS
Cross-sectional group-level prevalence does not adequately depict the underlying pathways experienced by individual participants. Our analyses indicate the importance of following up all study participants in longitudinal studies, including those reporting to have attained 'recovery' and of not under-estimating the impact of non-hospitalised injuries.
Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand.
Helen
H
Harcombe
Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand.
John
J
Langley
Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand. Electronic address: gabrielle.davie@ipru.otago.ac.nz.
Gabrielle
G
Davie
Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand.
Sarah
S
Derrett
D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D003289:Convalescence; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010146:Pain / Q000523:psychology / Q000534:rehabilitation*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation
Health status; Longitudinal studies; Quality of life; Recovery of function; Wounds and injuries