Guidelines for the Conduction of Follow-up Studies Measuring Injury-Related Disability

Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
The Journal of trauma (Impact Factor: 2.96). 03/2007; 62(2):534-50. DOI: 10.1097/TA.0b013e31802e70c7
Source: PubMed


Scientific knowledge on functional outcome after injury is limited. During the past decade, a variety of measures have been used at various moments in different study populations. Guidelines are needed to increase comparability between studies.
A working group of the European Consumer Safety Association conducted a literature review of empirical studies into injury-related disability (1995-2005). We included injury from all levels of severity and selected studies using generic health status measures with both short-term and long-term follow up. The results were used as input for a consensus procedure toward the development of guidelines for defining the study populations, selecting the health status measures, selecting the timings of the assessments, and data collection procedures.
The group reached consensus on a common core of health status measures and assessment moments. The group advises to use a combination of EuroQol-5D and Health Utilities Mark III in all studies on injury-related disability. This combination covers all relevant health domains, is applicable in all kinds of injury populations and in widely different age ranges, provides a link with utility scores, and has several practical advantages (e.g., brevity, availability in different languages). For specific types of injury, the common core may be supplemented by injury-specific measures. The group advises a common core of assessments at 1, 2, 4, and 12 months after injury.
Our guidelines should be tested and may lead to improved and more consistent epidemiologic data on the incidence, severity, and duration of injury-related disability.


Available from: Marie-Louise Essink-Bot
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    • "For example, it has been shown that even injuries of low severity (i.e., without threat to life) may lead to sustained suffering and that far more healthy life-years are lost by non-fatal injuries than by mortality [12] [13]. These insights were obtained with the Euro-Qol-5D questionnaire (EQ-5D), a generic HRQoL measure recommended for broad application in the injury field by several international consensus groups [8] [9]. This measure is well fitted for application in comprehensive patient populations covering a broad range of injuries [14] and has also been validated and applied in specific groups of injury patients, such as burns [15] [16], lower extremity injuries [17] and specific upper extremity fracture groups [18] [19] [20] [21] [22] [23] [24] [25] [26] [27]. "
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    ABSTRACT: Results: For non-hospitalized UEI patients, a substantial loss in HRQoL was observed after 2.5 months which improved to the level of the general population norms by 24 months. For hospitalized UEI patients, HRQoL improved from 2.5 to 24 months but remained far below population norms. The more proximal UEI had a lower HRQoL and a slower recovery of HRQoL than distal injuries. At all time points, the proportion of UEI patients with limitations on the health domains self-care, usual activities and complaints of pain and/or discomfort was higher than in the group of all injuries. Female gender, higher age, low educational level, co-morbidity, shoulder or upper arm injury, multiple injuries and hospitalization are independent predictors for long-term loss in HRQoL.
    Injury 07/2014; 45(11). DOI:10.1016/j.injury.2014.07.016 · 2.14 Impact Factor
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    • "After each interview participants were asked if they consented to further follow-up. The follow-up period of 1 and 4 months was selected based on recommendations from the literature [16]. This study was registered and approved by the UBC Behavioral Research Ethics Board and the Vancouver Coastal Health Research Institute, which represents Vancouver General Hospital. "
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    ABSTRACT: Background Screening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice. Methods Prospective cross-sectional observational study of a sample of hospitalized trauma patients over a four-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal ASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric consultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD Checklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected. Results Routine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at one month in comparison to ad hoc referral (0.14) and also at four months (0.17, 0.33 versus 0.17). Ad hoc referral had greater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and SASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29). Conclusions Ad hoc psychiatric referral process for acute stress is a more conservative approach than employing routine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known limitations of available measures, routine patient screening would increase identification of trauma survivors at risk of mental health sequelae and better position trauma centers to respond to the circumstances that affect mental health during recovery.
    Journal of Trauma Management & Outcomes 05/2014; 8(1):5. DOI:10.1186/1752-2897-8-5
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    • "The EuroQol-5D is a validated questionnaire for measuring health-related quality of life [39,40]. Its use is recommended for assessing quality of life in trauma patients, especially for economic assessments [41,42]. The EQ-5D descriptive system consists of five dimensions of health (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). "
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    ABSTRACT: Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an unresolved problem. As no high-quality comparative randomized or observational studies are available, a recent Cochrane review concluded there is no evidence of sufficient scientific quality available to inform the decision to operate or not. Since randomized controlled trials for this injury have shown feasibility issues, this study is designed to provide the best achievable evidence to answer this unresolved problem. The primary aim of this study is to evaluate functional recovery after operative versus non-operative treatment in adult patients who sustained a humeral shaft fracture. Secondary aims include the effect of treatment on pain, complications, generic health-related quality of life, time to resumption of activities of daily living and work, and cost-effectiveness. The main hypothesis is that operative treatment will result in faster recovery.Methods/design: The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, AO type 12A or 12B. Treatment decision (i.e., operative or non-operative) will be left to the discretion of the treating surgeon. Critical elements of treatment will be registered and outcome will be monitored at regular intervals over the subsequent 12 months. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcome measures are the Constant score, pain level at both sides, range of motion of the elbow and shoulder joint at both sides, radiographic healing, rate of complications and (secondary) interventions, health-related quality of life (Short-Form 36 and EuroQol-5D), time to resumption of ADL/work, and cost-effectiveness. Data will be analyzed using univariate and multivariable analyses (including mixed effects regression analysis). The cost-effectiveness analysis will be performed from a societal perspective. Successful completion of this trial will provide evidence on the effectiveness of operative versus non-operative treatment of patients with a humeral shaft fracture.Trial registration: The trial is registered at the Netherlands Trial Register (NTR3617).
    BMC Musculoskeletal Disorders 02/2014; 15(1):39. DOI:10.1186/1471-2474-15-39 · 1.72 Impact Factor
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