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Early predictors of long-term work disability after major limb trauma.

Authors
MacKenzie-EJ; Bosse-MJ; Kellam-JF; Pollak-AN; Webb-LX; Swiontkowski-MF; Smith-DG; Sanders-RW; Jones-AL; Starr-AJ; McAndrew-MP; Patterson-BM; Burgess-AR; Travison-T; Castillo-RC
Source
J Trauma 2006 Sep; 61(3):688-694
NIOSHTIC No.
20037867
Abstract
BACKGROUND: A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing the high costs associated with these injuries. METHODS: Patients (n = 423) who underwent amputation or reconstruction after limb threatening lower extremity trauma and who were working before the injury were prospectively evaluated at 3, 6, 12, 24, and 84 months. Time to first RTW was assessed. For individuals working at 84 months, the percentage of time limited in performance at work was estimated using the Work Limitations Questionnaire. RESULTS: Estimates of the cumulative proportion returning to work at 3, 6, 12, 24, and 84 months were 0.12, 0.28, 0.42, 0.51, and 0.58. Patients working at 84 months were, on average, limited in their ability to perform the demands of their job 20 to 25% of the time. In the context of a Cox proportional hazards model, differences in RTW outcomes by treatment (amputation versus reconstruction) were not statistically significant. Factors that were significantly associated (p < 0.05) with higher rates of RTW include younger age, being White, higher education, being a nonsmoker, average to high self efficacy, preinjury job tenure, higher job involvement, and no litigation. Early (3 month) assessments of pain and physical functioning were significant predictors of RTW. CONCLUSIONS: Return to work after severe lower extremity trauma remains a challenge. Although the causal pathway from injury to impairment and work disability is complex, this study points to several factors that influence RTW that suggest strategies for intervention.
Keywords
Traumatic-injuries; Injuries; Physiological-function; Psychology; Psychological-reactions; Age-groups; Men; Women; Workers; Work-capability; Author Keywords: Return to work; Amputation; Reconstruction; Work disability; Musculoskeletal trauma
Contact
Ellen J. MacKenzie, PhD, The Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 482, Baltimore, MD 21205
CODEN
JOTRA5
Publication Date
20060901
Document Type
Journal Article
Email Address
emackenz@jhsph.edu
Funding Type
Grant
Fiscal Year
2006
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-T42-OH-008428
Issue of Publication
3
ISSN
0022-5282
Source Name
The Journal of Trauma: Injury, Infection, and Critical Care
State
FL; IL; MA; MD; MN; NC; OH; TX; WA
Performing Organization
Johns Hopkins University
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