title: Factors affecting planned return to work after trauma: A prospective descriptive qualitative and quantitative study.
abstract: The use of patient reported outcome measures (PROMs) in trauma is limited. The aim of this pilot study is to evaluate qualitative responses and factors affecting planned return to work following significant trauma, for which there is currently a poor evidence base. National ethical approval was obtained for routine prospective PROMs data collection, including EQ-5D, between Sept 2013 and March 2015 for trauma patients admitted to the Sussex Major Trauma Centre (n=92). 84 trauma patients disclosed their intended return to work at discharge. Additional open questions asked 'things done well' and 'things to be improved'. EQ-5D responses were valued using the time trade-off method. Statistical analysis between multiple variables was completed by ANOVA, and with categorical categories by Chi squared analysis. Only 18/68 of patients working at admission anticipated returning to work within 14days post-discharge. The injury severity scores (ISS) of those predicting return to work within two weeks and those predicting return to work longer than two weeks were 14.17 and 13.59, respectively. Increased physicality of work showed a trend towards poorer return to work outcomes, although non-significant in Chi-squared test in groups predicting return in less than or greater than two weeks (4.621, p=0.2017ns). No significant difference was demonstrated in the comparative incomes of patients with different estimated return to work outcomes (ANOVA r2=0.001, P=0.9590ns). EQ-5D scores were higher in those predicting return to work within two weeks when compared to greater than two weeks. Qualitative thematic content analysis of open responses was possible for 66/92 of respondents. Prominent positive themes were: care, staff, professionalism, and communication. Prominent negative themes were: food, ward response time, and communication. This pilot study highlights the importance of qualitative PROMs analysis in leading patient-driven improvements in trauma care. We provide standard deviations for ISS scores and EQ-5D scores in our general trauma cohort, for use in sample size calculations for further studies analysing factors affecting return to work after trauma.
authors.affiliation: Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK. Electronic address: samuel.folkard@googlemail.com.
authors.forename: S S
authors.initials: SS
authors.lastname: Folkard
authors.affiliation: Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: T D
authors.initials: TD
authors.lastname: Bloomfield
authors.affiliation: Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: P R J
authors.initials: PRJ
authors.lastname: Page
authors.affiliation: Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: D
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Ricketts
authors.affiliation: Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: B A
authors.initials: BA
authors.lastname: Rogers
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D062707:Return to Work; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*
keywords: EQ-5D; ISS; Qualitative thematic content analysis; Return to work; Trauma