title: Estimating pre-traumatic quality of life in patients with surgically treated acetabular fractures and pelvic ring injuries: Does timing matter?
abstract: OBJECTIVE
  Evaluation of patient-assessed functional outcome in traumatic conditions has specific challenges. To obtain pre-traumatic data to allow for comparison during follow-up, retrospective assessments are needed. How such data is affected by posttraumatic time-point chosen for evaluation is unknown. The primary purpose of this study was to investigate how the time-point chosen for retrospective assessment of pre-traumatic quality of life (QoL) in patients with surgically treated acetabular fractures and pelvic ring injuries influenced the results. A secondary purpose was to examine the pre-traumatic QoL-profile in patients with these injuries.
  
  
  METHODS
  73 patients were included, where 50 had an acetabular fracture and 23 a pelvic ring injury. Pre-traumatic QoL was evaluated using the generic instruments SF-36 and EQ5D in conjunction with the condition-specific Pelvic Trauma Questionnaire (PTQ). Questionnaires were completed at three time points: 0, 1 and 2 months post-surgery.
  
  
  RESULTS
  Number of responders were 73 patients at 0 months, 61 patients at 1 month and 53 patients at 2 months. 50 patients answered the questionnaires at all three time-points. A trend was observed with all instruments where patients estimated a better pre-traumatic status with narrower distributions when assessment was delayed. At 2 months, scores for 4 out of 8 SF-36 domains where significantly higher compared to 0 months. For EQ5D, EQ VAS improved at 1 and 2 months compared to month 0 results but no other significant differences between time-points were found. Results from the PTQ demonstrated no significant differences over time. Pre-traumatic quality of life was high and for SF-36 comparable to a population norm. A very low level of pre-existing discomfort from the pelvic region was reported through the PTQ.
  
  
  CONCLUSIONS
  Patients with surgically treated acetabular fractures and pelvic ring injuries estimate a higher pre-traumatic functional status when assessment is carried out at 1 or 2 months post-surgery compared to perioperative measurements. The SF-36 seems to be more sensitive than the EQ5D in this respect. Pre-traumatic QoL in patients with surgically treated acetabular fractures and pelvic ring injuries is generally high and pre-existing discomfort from the pelvic region is uncommon.
authors.affiliation: Department of Orthopedics, Uppsala University, Uppsala, Sweden. Electronic address: bjorn.hernefalk@akademiska.se.
authors.forename: Björn
authors.initials: B
authors.lastname: Hernefalk
authors.affiliation: Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Eriksson
authors.affiliation: Department of Orthopedics, Uppsala University, Uppsala, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Borg
authors.affiliation: Department of Orthopedics, Uppsala University, Uppsala, Sweden.
authors.forename: Sune
authors.initials: S
authors.lastname: Larsson
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors; D014193:Trauma Centers
keywords: Acetabular fracture; EQ5D; Functional outcome; Pelvic ring injury; Pre-trauma; Quality of life; SF-36; Self-assessment; Trauma