title: Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture: a prospective 1-year follow-up cohort study.
abstract: BACKGROUND
  To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture.
  
  
  METHODS
  The design was a prospective, follow-up cohort study. QOL was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs were recorded at 6 and 12 months.
  
  
  RESULTS
  Forty-nine patients were included. The mean age at the time of fracture was 43.1 years (18-79 years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95 % CI 0.747-0.837). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P < 0.001). Twelve months postoperatively, increasing relative difference in muscle strength during knee extension show a fair correlation to worse QOL (R = 0.541, P < 0.001).
  
  
  CONCLUSIONS
  Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Muscle strength in the non-injured leg improved over time and was higher after 6 and 12 months compared with the injured leg.
authors: Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark. peter.larsen@rn.dk.
authors: Peter
authors: P
authors: Larsen
authors: Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors: Rasmus
authors: R
authors: Elsoe
authors: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.|Physiotherapy Department, University College North Denmark (UCN), Aalborg, Denmark.
authors: Uffe
authors: U
authors: Laessoe
authors: Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors: Thomas
authors: T
authors: Graven-Nielsen
authors: Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors: Christian Berre
authors: CB
authors: Eriksen
authors: Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors: Sten
authors: S
authors: Rasmussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007537:Isometric Contraction; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intramedullary nailing; Muscle strength; QOL; Tibia shaft fracture