Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia.
Australian Centre for Justice Innovation, Faculty of Law, Monash University, Clayton, Victoria, 3800, Australia.
BMC Public Health. 2022 Aug 5;22(1):1498. doi: 10.1186/s12889-022-13884-5.
Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain).
Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to 'any' or 'full duties' paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates.
Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury.
Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW.
This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752).
道路交通伤害（RTIs）主要是肌肉骨骼性质的，是全球意外伤害的主要原因，给个人和社会带来了巨大的负担。需要对大型代表性队列进行调查，以验证 RTI 后长期丧失工作能力的早期可识别预测因素。因此，直到 RTI 后两年，我们旨在：评估 RTW 的绝对发生率和按伤害赔偿索赔人状况的发生率；评估早期因素（例如，生物心理社会和伤害相关因素）对 RTW 的纵向影响；并确定可能通过干预（例如，心理困扰和疼痛）改变的因素。
对 2019 名成年人进行前瞻性队列研究，这些参与者在澳大利亚新南威尔士州的非灾难性 RTI 后 28 天内招募，主要为轻度至中度严重程度。生物心理社会、伤害和赔偿数据通过电话访谈在受伤后一个月内（基线）收集。工作状况在基线、6 个月、12 个月和 24 个月时自我报告。分析仅限于报告受伤前有带薪工作的参与者（N=1533）。使用类型 3 全局 p 值评估因素亚类中返回“任何”或“全职”带薪工作的解释因素。使用修正泊松回归模型评估与 RTW 相关的因素，同时调整潜在的协变量。
只有约 30%的 RTI 患者在受伤后一个月内恢复全职工作，但大多数（76.7%）在 6 个月内恢复全职工作。相当一部分参与者（约 10%）在 6、12 和 24 个月时从事修改后的工作或根本不工作。女性、低教育程度、低收入、体力要求高的职业、受伤前合并症和高伤害严重程度与 RTW 呈负相关。在当时运行的基于过错的赔偿计划中提出伤害赔偿索赔，以及受伤后早期发现的疼痛和心理困扰，是与 RTW 持续至受伤后两年的关键负相关因素。
20%的 RTI 患者长期丧失工作能力。我们的研究结果表明，需要审查伤害赔偿计划和流程的设计，使用经过验证的疼痛和心理健康评估工具尽早识别那些可能延迟 RTW 的人，并采取改善干预措施来应对风险，这可能有助于可持续的 RTW。
本研究前瞻性注册于澳大利亚和新西兰临床试验注册中心（ACTRN12613000889752）。
