title: Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries.
abstract: OBJECTIVE
  To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI).
  
  
  METHODS
  A total of 181 adults' age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1-2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI.
  
  
  RESULTS
  Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1-2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction.
  
  
  CONCLUSIONS
  LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give sufficient prognostic information to patients and different stakeholders. Future investigations should aim to investigate specific minor extremity injuries and identify factors that facilitate recovery and return to work.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Red Cross University College, Stockholm, Sweden. Electronic address: kerstin.sluys@ki.se.
authors.forename: Kerstin Prignitz
authors.initials: KP
authors.lastname: Sluys
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, School of Medicine, Philadelphia, PA, USA.
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.affiliation: Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
authors.forename: Therese S
authors.initials: TS
authors.lastname: Richmond
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000293:injuries* / Q000601:surgery; D008297:Male; D059348:Peripheral Nerve Injuries / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery; D011379:Prognosis; D011788:Quality of Life; D062707:Return to Work / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D034941:Upper Extremity / Q000293:injuries* / Q000601:surgery; D014947:Wounds and Injuries / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery
keywords: Extremity; Functional status; Health-related quality of life; Injury; Lower extremity; Minor injury; Recovery; Trauma; Upper extremity; Work