Folkard S S, Bloomfield T D, Page P R J, Wilson D, Ricketts D M, Rogers B A
Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
Department of Trauma and Orthopaedics. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
Injury. 2016 Dec;47(12):2664-2670. doi: 10.1016/j.injury.2016.09.040. Epub 2016 Sep 30.
The use of patient reported outcome measures (PROMs) in trauma is limited. The aim of this pilot study is to evaluate qualitative responses and factors affecting planned return to work following significant trauma, for which there is currently a poor evidence base. National ethical approval was obtained for routine prospective PROMs data collection, including EQ-5D, between Sept 2013 and March 2015 for trauma patients admitted to the Sussex Major Trauma Centre (n=92). 84 trauma patients disclosed their intended return to work at discharge. Additional open questions asked 'things done well' and 'things to be improved'. EQ-5D responses were valued using the time trade-off method. Statistical analysis between multiple variables was completed by ANOVA, and with categorical categories by Chi squared analysis. Only 18/68 of patients working at admission anticipated returning to work within 14days post-discharge. The injury severity scores (ISS) of those predicting return to work within two weeks and those predicting return to work longer than two weeks were 14.17 and 13.59, respectively. Increased physicality of work showed a trend towards poorer return to work outcomes, although non-significant in Chi-squared test in groups predicting return in less than or greater than two weeks (4.621, p=0.2017ns). No significant difference was demonstrated in the comparative incomes of patients with different estimated return to work outcomes (ANOVA r=0.001, P=0.9590ns). EQ-5D scores were higher in those predicting return to work within two weeks when compared to greater than two weeks. Qualitative thematic content analysis of open responses was possible for 66/92 of respondents. Prominent positive themes were: care, staff, professionalism, and communication. Prominent negative themes were: food, ward response time, and communication. This pilot study highlights the importance of qualitative PROMs analysis in leading patient-driven improvements in trauma care. We provide standard deviations for ISS scores and EQ-5D scores in our general trauma cohort, for use in sample size calculations for further studies analysing factors affecting return to work after trauma.
患者报告结局测量指标（PROMs）在创伤领域的应用有限。这项试点研究的目的是评估重大创伤后影响计划重返工作岗位的定性反应和因素，目前针对这方面的证据基础薄弱。2013年9月至2015年3月期间，获得了国家伦理批准，对入住苏塞克斯重大创伤中心的创伤患者（n = 92）进行常规前瞻性PROMs数据收集，包括EQ - 5D。84名创伤患者在出院时透露了他们打算重返工作岗位的意向。额外的开放性问题询问了“做得好的事情”和“有待改进的事情”。EQ - 5D反应采用时间权衡法进行评估。多个变量之间的统计分析通过方差分析完成，分类变量通过卡方分析完成。入院时工作的患者中，只有18/68预计在出院后14天内重返工作岗位。预测两周内重返工作岗位的患者和预测两周以上重返工作岗位的患者的损伤严重程度评分（ISS）分别为14.17和13.59。工作体力要求增加显示出重返工作岗位结果较差的趋势，尽管在预测两周内或两周以上重返工作岗位的组中卡方检验不显著（4.621，p = 0.2017无统计学意义）。不同预计重返工作岗位结果的患者在比较收入方面未显示出显著差异（方差分析r = 0.001，P = 0.9590无统计学意义）。与两周以上相比，预测两周内重返工作岗位的患者EQ - 5D评分更高。66/92的受访者对开放性回答进行了定性主题内容分析。突出的积极主题是：护理、工作人员、专业精神和沟通。突出的消极主题是：食物、病房响应时间和沟通。这项试点研究强调了定性PROMs分析在引领以患者为导向的创伤护理改进方面的重要性。我们提供了一般创伤队列中ISS评分和EQ - 5D评分的标准差，用于进一步分析创伤后影响重返工作岗位因素的研究的样本量计算。
