Harcombe Helen, Langley John, Davie Gabrielle, Derrett Sarah
Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand.
Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand.
Injury. 2015 Jul;46(7):1275-80. doi: 10.1016/j.injury.2015.04.004. Epub 2015 Apr 14.
Functional status can be affected for considerable time after injury. Individual's functional status trajectories, or pathways, following injury may provide insights into achieving, or not achieving, optimal functional status. This study aims to (1) investigate functional status trajectories of injured individuals over two years by multiple dimensions and, (2) determine whether there are differences in functional status trajectories between those hospitalised and non-hospitalised.
Data from the Prospective Outcomes of Injury Study, a longitudinal cohort (n=2856) of injured New Zealanders, was used. Functional status was assessed using the EQ-5D (plus a cognitive dimension) at 3, 12 and 24 months post injury. For each dimension (mobility, self-care, usual activities, pain/discomfort anxiety/depression and cognition), individual-level trajectories were created based on whether participants had attained (or exceeded) their pre-injury functional status at each time-point.
Participants had varied pathways to attaining their pre-injury functional status which was not revealed by cross-sectional group-level data. When all dimensions were considered together, 24% of participants attained their pre-injury functional status but did not maintain it at a subsequent phase. By EQ-5D dimension, this varied from 5% (self-care) to 22% (pain/discomfort). Twenty-six percent of non-hospitalised participants attained, but did not maintain, their pre-injury status compared to 18% of those hospitalised.
Cross-sectional group-level prevalence does not adequately depict the underlying pathways experienced by individual participants. Our analyses indicate the importance of following up all study participants in longitudinal studies, including those reporting to have attained 'recovery' and of not under-estimating the impact of non-hospitalised injuries.
受伤后相当长一段时间内，个体的功能状态可能会受到影响。受伤后个体的功能状态轨迹或路径，可能有助于了解能否实现最佳功能状态。本研究旨在：（1）从多个维度调查受伤个体两年内的功能状态轨迹；（2）确定住院和非住院个体在功能状态轨迹上是否存在差异。
使用了来自新西兰受伤者前瞻性结局研究的纵向队列（n = 2856）的数据。在受伤后3个月、12个月和24个月，使用EQ - 5D（加上一个认知维度）评估功能状态。对于每个维度（行动能力、自我护理、日常活动、疼痛/不适、焦虑/抑郁和认知），根据参与者在每个时间点是否达到（或超过）其受伤前的功能状态，创建个体水平的轨迹。
参与者达到受伤前功能状态的途径各不相同，这是横断面组水平数据所未揭示的。当综合考虑所有维度时，24%的参与者达到了受伤前的功能状态，但在随后阶段未维持。按EQ - 5D维度划分，这一比例从5%（自我护理）到22%（疼痛/不适）不等。26%的非住院参与者达到但未维持受伤前状态，而住院参与者这一比例为18%。
横断面组水平的患病率不能充分描述个体参与者所经历的潜在路径。我们的分析表明，在纵向研究中对所有研究参与者进行随访很重要，包括那些报告已实现“康复”的参与者，并且不要低估非住院受伤的影响。
