Medically graded reduced capacity to work (RCW) following significant injury as explained by patient related outcome measures (PROMs): A prospective trauma center evaluation

Abstract

BackgroundData is limited how well patient-reported longer-term outcome measures (PROMs) explain medically graded reduced capacity for work (RCW). ObjectiveThis prospective study investigates the association of RCW with several PROMs in addition to demographic and injury-related variables in significantly injured of working age. MethodsPatients (New Injury Severity Score, NISS ≥ 8) were recruited consecutively. RCW, as registered by the largest Swiss accident insurer, was tested against demographic, trauma and treatment characteristics, and patients’ contemporaneous two year rating of functional outcome and quality of life following trauma with measures such as the Short-Form (SF)-36 or Trauma Outcome Profile (TOP), using uni- and multivariable analysis. Results140 patients (mean 42 years, 2-year RCW rate 21%) participated in the longer-term follow-up of self-rated outcome. In multivariable analysis, all investigated baseline factors together accounted for 48% of the variance explaining 2-year postinjury RCW with 31% contributed by demographic, injury or treatment related variables, and 17% by patients' condition at hospital discharge. Patients’ self-rated longer-term outcome provided 61% of the information on concurrent RCW, whereby 53% identified worsening of physical function (SF-36) and additional 8% constraints in daily activities (TOP). Four variables (Glasgow Outcome Scale at the time of hospital discharge and SF-36 physical functioning, TOP daily activities, SF-36 role physical at two years) explained 71% of RCW, corresponding to an area under the curve (AUC) of 0.95. ConclusionsObjectively graded RCW 2 years after injury was found to be well explained by the combined information of patients' subjective longer-term outcome together with basic patient, trauma and treatment characteristics.