A Novel Clinical Instrument for Predicting Delayed Recovery After Musculoskeletal Injuries

Abstract

Early identification of patients at risk for delayed recovery after an injury is important to effectively target rehabilitation. This study presents a new instrument, the Prediction of Prolonged Self-Perceived Recovery After Musculoskeletal Injuries questionnaire (PPS), for prediction of self-perceived nonrecovery after musculoskeletal injuries. On the basis of a historic cohort (model building set, n = 557), we constructed the PPS consisting of two demographic variables (educational level and working status), a crude injury classification, and patient-rated physical and mental complaints during the acute phase of the injury. We evaluated the PPS's ability to predict self-perceived nonrecovery at 6 months in a new group of patients with minor musculoskeletal traffic-related injuries (validation set, n = 279). Our findings demonstrate that the PPS foresees an unfavorable course with a greater accuracy than prediction based exclusively on information about the injury. The overall percentage of correct predictions in the model building set was 77%. The overall percentage of correct predictions in the validation set was 67%. The sensitivity and specificity in relation to nonrecovery at 6 months was 55% and 73%, respectively. This is the first prospective clinical study in which an instrument is used for prediction purpose. On the basis of our results, we think that the PPS, even if not fully developed, can be used by clinicians as a tool for early identification of patients at risk for delayed recovery after trauma. A nonnegligible proportion of the patients who would benefit from additional rehabilitation are missed by the instrument in its present form. Further research is needed to verify our results.