Prevalence and levels of disability post road traffic orthopaedic injuries in Rwanda

Background

Prolonged disability resulting from road traffic injuries (RTIs) contributes significantly to morbidity and disease burden. A good understanding of the prevalence and the level of disability of orthopaedic injuries in developing countries is crucial for improvement; however, such data are currently lacking in Rwanda.

Objectives

To determine the prevalence and levels of disability of 2 years post-road traffic orthopaedic injuries in Rwanda.

Method

A multicentre, cross-sectional study from five Rwandan referral hospitals of 368 adult RTI victims' sustained from accidents in 2019. Between 02 June 2022, and 31 August 2022, two years after the injury, participants completed the World Health Organization Disability Assessment Schedule (WHODAS 2.0) Questionnaire for the degree of impairment and the Upper Extremity Functional Scale and Lower-Extremity Functional Scale forms for limb functional evaluation. Descriptive, inferential statistics Chi-square and multinomial regression models were analysed using R Studio.

Results

The study's mean age of the RTOI victims was 37.5 (±11.26) years, with a sex ratio M: F:3: 1. The prevalence of disability following road traffic orthopedic injury (RTOI) after 2 years was 36.14%, with victims having WHODAS score > 25.0% and 36.31% were still unable to return to their usual activities. Age group, Severe Kampala Trauma Score and lack of rehabilitation contributed to disability. The most affected WHODAS domains were participation in society (33%) and life activities (28%).

Conclusion

The prevalence and levels of disability because of RTOI in Rwanda are high, with mobility and participation in life being more affected than other WHODAS domains. Middle-aged and socio-economically underprivileged persons are the most affected.

Contribution

This study showed that a good rehabilitation approach and economic support for the RTI victims would decrease their disabilities in Rwanda.

"No Man's Land": the experiences of persons injured in a road traffic crash wanting to return to work in Queensland, Australia

PURPOSE

This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI.

METHODS

The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants (n = 18) aged 18-65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data.

RESULTS

Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support.

CONCLUSIONS

Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme.IMPLICATIONS FOR REHABILITATIONThis study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme.Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury.Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI.Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work.

Exploring the perspectives of key stakeholders in returning to work after minor to serious road traffic injuries: a qualitative study

PURPOSE

This qualitative study conducted in Queensland, Australia aimed to explore various stakeholders' perspectives on (1) the barriers and facilitators of Return to Work (RTW) for injured persons following minor to serious Road Traffic Injuries (RTI) in a fault-based scheme, and to investigate the changes needed to better support RTW following RTI.

METHODS

The study was performed using the Interpretive Description methodological approach. Data were collected during interviews (n = 17), one focus group (n = 4), and an open-ended survey (n = 10) with five categories of stakeholders: treating health providers, workplace representatives, legal representatives, rehabilitation advisors, and insurers. Participants were eligible to participate if they had at least one year of employment history in their respective profession in Queensland, Australia, and were experienced in assisting the RTW of people with RTI. Thematic analysis was used to analyse the data.

RESULTS

Seven themes were extracted reflecting the barriers and facilitators of RTW along with stakeholders' recommendations to address these barriers. These themes were: (1) knowledge is power; (2) stakeholder expertise; (3) early and appropriate treatment matters; (4) insurers could do better; (5) necessity of employers' support; (6) fix the disjointed system; (7) importance of individual factors pre- and post- injury. The main barriers identified were stakeholders' insufficient communication and knowledge on RTW process following RTI.

CONCLUSIONS

Individual and system barriers identified in this study suggest that RTW after RTI occurs in a complex system requiring the commitment of all stakeholders. This is particularly important for managing knowledge-related barriers by provision of high quality and easily accessible information about the RTW process, disability schemes, and the nature of RTI.

Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis

OBJECTIVES

Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list.

CONTENT

The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers.

SUMMARY

The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability.

OUTLOOK

Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.

Health Professionals' Perspectives on the Efficacy of Using Comprehensive Care to Improve Outcomes in Patients With Traumatic Injury

Background

Barriers related to comprehensive posttrauma care and health outcome monitoring exist. The insights and perspectives of health professionals on this issue may help integrate care experiences to provide continuous care to patients with traumatic injury.

Purpose

The purpose of this study was to explore the perspectives of health professionals with regard to comprehensive care to improve the outcomes of patients with traumatic injury.

Methods

Data were collected at two teaching hospitals in Taiwan. In total, 28 health professionals across various disciplines were interviewed in five focus groups.

Results

Six themes were delineated, including “wound care is a primary concern for patients,” “ineffective health education during the hospital stay,” “patients and families worry about postinjury conditions,” “current continuity of care is not effective,” “lack of standards for discharge planning,” and “incorporation of interdisciplinary care to improve patient outcomes.”

Conclusions

The experiences of health professionals are useful to the establishment of a foundation for trauma case management and interdisciplinary care for hospitals.

Embedded rehabilitation in major trauma: Retrospective pre-post observational study of service and patient outcomes

INTRODUCTION

Major trauma describes serious and often multiple injuries where there is a strong possibility of death or residual disability. There is little robust evidence on the effects of embedded rehabilitation within the trauma care pathway. Trauma rehabilitation services therefore remain fragmented and poorly integrated. This study aimed to determine changes in hospital length of stay (LoS), intensive care unit (ICU) LoS, 30-day mortality and Glasgow Outcome Scale following implementation of an embedded rehabilitation service into a Major Trauma Centre (MTC).

METHODS

Retrospective pre-post observational study of a rehabilitation service introduced into an MTC, consisting of a dedicated 10-bedded inpatient unit, co-ordinating rehabilitation hub, and specialist multi-disciplinary outpatient clinic. Overall hospital LoS, ICU LoS, 30-day mortality and GOS were selected as outcome measures. Patient characteristics (age, sex, injury mechanism, injury severity score, Glasgow Coma Scale, and most injured body region) were compared and controlled for when analysing outcomes.

RESULTS

The study cohort included 6,484 patients, of which 4,298 were pre-intervention and 2,186 post-intervention. Patients in the post-intervention cohort were older than those in the pre-intervention cohort (58.3 compared to 56.6, p<0.001) and had higher injury severity scores (48.7% >15 compared to 43.9% >15). Moderate but significant changes to the most injured body region were also observed (p<0.001), with fewer injuries affecting the limbs (25.8% to 24.9%), spine (15.3% to 12.1%), multiple locations (11.3% to 10.7%), abdomen (2.7% to 2.4%) and face/other (1.9% to 1.5%) and more injuries affecting the head (27.5% to 31.5%) and chest (15.6% to 16.9%). Controlling for changes to patient characteristics between the two time periods, there was a reduction in overall hospital LoS of 2.56 days (b=-2.56, p<0.001) and ICU LoS of 0.94 days (b=-0.96, p<0.001). There was a 31% reduced chance of 30-day mortality in post-intervention patients (OR=0.69, 95%CI=0.54 to 0.88), and almost two times higher relative chance of GOS Good Recovery (RR=1.94, CI=1.51 to 2.49).

DISCUSSION

Embedded rehabilitation is an important and necessary component of an effective trauma system that is associated with improved service and patient outcomes. Future research should examine prospectively how a dedicated rehabilitation service affects medium- and long-term patient-centred outcomes.

A population-based study of treated mental health and persistent pain conditions after transport injury

BACKGROUND

Persistent pain and mental health conditions often co-occur after injury, cause enormous disability, reduce social and economic participation, and increase long-term healthcare costs. This study aimed to characterise the incidence, profile and healthcare cost implications for people who have a treated mental health condition, persistent pain, or both conditions, after compensable transport injury.

METHODS

The study comprised a population cohort of people who sustained a transport injury (n = 74,217) between 2008 to 2013 and had an accepted claim in the no-fault transport compensation system in Victoria, Australia. Data included demographic and injury characteristics, and payments for treatment and income replacement from the Compensation Research Database. Treated conditions were identified from 3 to 24-months postinjury using payment-based criteria developed with clinical and compensation system experts. Criteria included medications for pain, anxiety, depression or psychosis, and services from physiotherapists, psychologists, psychiatrists, and pain specialists. The data were analysed with Cox Proportional Hazards regression to examine rates of treated conditions, and general linear regression to estimate 24 month healthcare costs.

RESULTS

Overall, the incidence of treated mental health conditions (n = 2459, 3.3%) and persistent pain (n = 4708, 6.3%) was low, but rates were higher in those who were female, middle aged (35-64 years), living in metropolitan areas or neighbourhoods with high socioeconomic disadvantage, and for people who had a more severe injury. Healthcare costs totalled more than $A707 M, and people with one or both conditions (7.7%) had healthcare costs up to 7-fold higher (adjusting for demographic and injury characteristics) in the first 24 months postinjury than those with neither condition.

CONCLUSIONS

The incidence of treated mental health and persistent pain conditions was low, but the total healthcare costs for people with treated conditions were markedly higher than for people without either treated condition. While linkage with other public records of treatment was not possible, the true incidence of treated conditions is likely to be even higher than that found in this study. The present findings can be used to prioritise the implementation of timely access to treatment to prevent or attenuate the severity of pain and mental health conditions after transport injury.

Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries

BACKGROUND

Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been commonly employed in the field of occupational safety and health to increase the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability.

OBJECTIVES

To assess the effects of vocational rehabilitation programmes for enhancing RTW in workers with traumatic upper limb injuries.

SEARCH METHODS

This is an update of a Cochrane review previously published in 2013. We updated our searches of the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9), MEDLINE (to 30 August 2017), EMBASE (to 3 September 2017), CINAHL (to 6 September 2017), and PsycINFO (to 6 September 2017), and we handsearched the references lists of relevant review articles.

SELECTION CRITERIA

We aimed to include all randomised controlled trials (RCTs) comparing vocational rehabilitation with an alternative (control) intervention such as standard rehabilitation, a limited form of the vocational rehabilitation intervention (such as advice on RTW, referral information, or liaison with employer), or waiting-list controls.

DATA COLLECTION AND ANALYSIS

Two authors independently inspected abstracts, and we obtained full papers when necessary. When the two authors disagreed about the inclusion of a study, we resolved disagreements by discussion. A third author arbitrated when necessary.

MAIN RESULTS

Our updated search identified 466 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of five records; however, none met our inclusion criteria.

AUTHORS' CONCLUSIONS

There is currently no high-quality evidence to support or refute the efficacy of vocational rehabilitation for enhancing RTW in workers with traumatic upper limb injuries. Since injured people in occupational settings frequently receive vocational rehabilitation with the aim of decreasing work disability, enhancing RTW, increasing productivity, and containing the welfare cost, further high-quality RCTs assessing the efficacy of vocational rehabilitation for workers with traumatic upper limb injury are needed to fill this gap in knowledge.

One-year functional outcomes following major trauma: experience of a UK level 1 major trauma centre

OBJECTIVE

To pilot a method for routine outcome data collection one year after admission to a major trauma centre, to determine current outcomes, and to identify possible methodological improvements.

DESIGN

A postal questionnaire audit.

SETTING

A major trauma centre in the United Kingdom.

SUBJECTS

In total, 355 patients known to be alive 12 months after admission with major trauma (Injury Severity Score (ISS) of 9 or more).

INTERVENTIONS

All patients received standard trauma and rehabilitation services available to them.

MAIN MEASURES

The main measures used are as follows: ISS; EuroQol, five dimensions five levels (EQ-5D-5L); single questions about accommodation, mobility, and self-care; demographic and injury data collected from hospital records; and outcome data by postal questionnaire.

RESULTS

In total, 429 patients were registered over six months: at one year, 64 had died and 10 had no UK address. In total, 355 questionnaires were sent out: 179 (50%) were never returned, 154 (43%) were returned with complete data, 11 forms were incomplete, 7 patients were dead, and 4 were not at the address contacted. Of the 154 with complete data, 91 had new mobility problems and 54 had new problems with personal activities. Of the 68 previously employed, 19 were unemployed, 38 were fully employed in the same job, and 13 had altered jobs. There was no association between Injury Severity Score and any of the outcome scores.

CONCLUSION

A short simple questionnaire sent only once achieved a complete data set response rate of 43%. The outcome data are consistent with experience in other studies. Collection of data on specific functional outcomes might be most sensitive.