Somato-psycho-social aspects of recovery after traffic injuries

Abstract

Injuries, including those related to traffic, are an important cause of long-term morbidity among people in productive ages. This thesis focuses on self-perceived recovery after traffic related minor musculoskeletal injuries. The aims of the studies were to characterize the variation in recuperation time using sick-leave and self-perceived non-recovery as markers of residual illness, to identify prognostic factors of delayed recovery (Paper I), to relate self-perceived recovery to functional health status, as measured by the Short Form-36 (Paper II), to develop a new instrument - the Prediction of Prolonged Self-perceived recovery after musculoskeletal injuries questionnaire, the PPS - and to evaluate its predictive ability regarding self-perceived recovery by applying it on a new group of patients (Paper III), and finally, to evaluate the efficacy of a multidisciplinary intervention program in terms of by patient reported recovery at 12 months (Paper IV).

This thesis is based on two prospective studies on patients with traffic related musculoskeletal injuries. In the first study, 318 patients were included (Papers I and II). All patients received medical and surgical treatment according to the hospital routines. Information about the patient's background and the injuries were collected and the patients were asked to assess their functional health status during the week that had preceded the accident using the SF-36. The patients were followed up at 1 month and at 6 months by means of a mailed questionnaire and asked to report if they felt recovered, to report their duration of sick leave and to rate their functional health status (SF-36) In the second study (Papers III and IV) 387 patients were enrolled and followed up in the same manner. The PPS questionnaire was filled in by all enrolled patients and the ones predicted to have a high risk of non-recovery were randomized to an intervention (n=65) or to a control group (n=62). The intervention program consisted of four group sessions and focused on information about injuries and pain management and called attention to self-care and physical activity. All patients were followed up at 6 months (Paper III) and 12 months (Paper IV).

Self-perceived non-recovery was reported by about 60% at 1 month and by about 40% at 6 months. The injury-type, working status and educational level were associated with selfperceived non-recovery at 1 month, while only working status and educational level were associated with self-reported non-recovery at 6 months (Paper I). Patients who reported recovery had significantly higher SF-36 subscores than those who reported non-recovery, even if not all of the recovered patients had reached their pre-injury levels. The physical dimensions of the SF-36 were more strongly associated with feeling of recovery both at 1 month and at 6 months (Paper II). The PPS questionnaire identified patients at high risk of non-recovery more accurately than a prediction that was based solely on information about the injury (Paper III). A significantly larger proportion of the patients in the intervention group than in the control group reported self-perceived recovery at 12 months (Paper IV).

In conclusion, the injury in combination with, social, and emotional factors interact in the recovery process after an injury. The PPS questionnaire might be useful in identifying patients at risk of delayed recovery. Intervention focusing on somato-psycho-social support in the early phase after an injury seems to enhance self-perceived recovery in selected patient groups but need to be verified in future studies.