Predictors of return to work following motor vehicle related orthopaedic trauma.
BACKGROUND
Work disability following motor vehicle related orthopaedic trauma is a significant contributor to the burden of injury and disease. Early identification of predictors for return to work (RTW) is essential for developing effective interventions to prevent work disability. The study aim was to determine the predictors (including compensation related factors) of time to RTW following motor vehicle related orthopaedic trauma.


METHODS
Admitted patients were recruited prospectively from two trauma hospitals with upper and/or lower extremity fractures following a motor vehicle crash. Baseline and follow up data were collected by written questionnaire. For baseline, this occurred in person within 2 weeks of injury. For follow up, this occurred by mail at six, 12 and 24 months. Additional demographic and injury-related information was retrieved from hospital databases. Analysis involved: descriptive statistics; logrank test to detect survival distributions of categorical variables; and Cox proportional hazards regression models for risks of time to RTW using baseline characteristic and compensation related variables (at 6 months).


RESULTS
Of 452 study participants 334 (74%) were working pre-injury: results are based on this subset. Baseline characteristics were mean age 36 years (13.9 Standard Deviation [SD]), 80% male; 72% self-assessed very good-excellent pre-injury health, 83% household income > AU$40,000 (Australian Dollar). Follow up data was available for 233 (70%), 210 (63%), and 182 (54%) participants at six, 12 and 24 months respectively. Significant risks of a longer time to RTW were greater injury severity, as measured by the New Injury Severity Score (NISS) (Hazards Rate Ratio [HRR] = 0.54, 95% CI 0.35-0.82); and lower occupational skill levels (HRR = 0.53, 95% CI 0.34-0.83). Significant risks of a shorter time to RTW were: recovery expectations for usual activities within 90 days (HRR = 2.10, 95% CI 1.49-2.95); full-time pre-injury work hours (HRR = 1.99, 95% CI 1.26-3.14); and very good self-assessed pre-injury health status (HRR = 1.41, 95% CI 0.98-2.02). Legal representation (analysed at six months only) was not associated with time to RTW. At each time period, there were 146 (63%), 149 (71%), and 137 (76%) working participants.


CONCLUSIONS
A longer time to RTW was associated with greater injury severity and lower occupational skill levels; while a shorter time to RTW was associated with recovery expectations for usual activities within 90 days, full-time pre-injury work hours, and very good self-assessed pre-injury health status. Our findings reinforce existing research. There is an opportunity to trial interventions that address potentially modifiable factors. The issues surrounding legal representation are complex and require further research.
John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, Sydney, NSW, Australia.
Darnel F
DF
Murgatroyd
South Western Sydney Clinical School, UNSW Australia, Liverpool, Sydney, Australia.|Ingham Institute for Applied Medical Research, Sydney, Australia.|South Western Sydney Local Health District, Liverpool, Sydney, Australia.
Ian A
IA
Harris
John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, Sydney, NSW, Australia.
Yvonne
Y
Tran
John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, Sydney, NSW, Australia.
Ian D
ID
Cameron
John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW, 2065, Australia. dmur0062@uni.sydney.edu.au.
Darnel
D
Murgatroyd
D000063:Accidents, Traffic / Q000639:trends*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D062707:Return to Work / Q000639:trends*; D018582:Sick Leave / Q000639:trends; D055815:Young Adult
Compensation and redress; Multiple trauma; Return to work; Wounds and injury