title: Patient-reported health-related quality of life after a displaced intra-articular calcaneal fracture: a systematic review.
abstract: BACKGROUND
  A displaced intra-articular calcaneal fracture (DIACF) is known for having a negative influence on the daily activities of patients. A health-related quality of life (HRQoL) outcome instrument is used to quantify the impact of DIACF. It seems that these studies used restrictive inclusion criteria and observe specific patient groups; consequently, an increased risk of bias that results in incorrect estimation of the impact. Therefore, we will systematically review the current literature.
  
  
  METHODS
  A systematic search was performed in PubMed, Embase and Cochrane library. Inclusion criteria were studies reporting DIACF and HRQoL, measured with SF-36, SF-36v2, EQ-5D or EQ-6D. The identified articles were critically appraised for their relevance and validity. The overall risk of bias was determined. The studies with a low to medium risk of bias were used for data extraction.
  
  
  RESULTS
  32 articles were available for the critical appraisal. 13 articles had a medium risk of bias. All studies reported the SF-36 and two studies also reported the EQ-5D.
  
  
  CONCLUSIONS
  This systematic review indicates that DIACF is a life-changing event for most patients. The HRQoL is substantially lower in comparison to the period before the trauma and to the general population, in particular the subdomains related to the physical domain are affected. In addition, this review reveals that the identified studies have a medium to high risk of bias. Consequently, it is challenging to make reliable and valid conclusions. Therefore, we provided recommendations to decrease the risk of bias in order to improve future research.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Alexandridis
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Gunning
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: L P H
authors.initials: LP
authors.lastname: Leenen
keywords: Displaced intra-articular calcaneal fracture; EQ-5D; Long-term follow up; Quality of life; SF-36; Systematic review