OTA 2005 Posters

Scientific Poster #19 Polytrauma/Injury Prevention

The Association of Psychological Distress and Quality of Life in Trauma Patients: An Observational Study

Mohit Bhandari MD, MSc, FRCS(C)^1,2 (a-AO North America);

Jason W. Busse, DC, MSc¹ (n); Beate P. Hanson, MD, MPH³ (n);

Pamela Leece, BSc¹ (n); Olufemi R. Ayeni, MD² (n);

Emil H. Schemitsch, MD, FRCS(C)⁴ (n);

¹Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

²Division of Orthopaedic Surgery, McMaster University,

Hamilton, Ontario, Canada

³AO Clinical Investigation and Documentation, Davos, Switzerland

⁴Division of Orthopaedic Surgery, University of Toronto,

Toronto, Ontario, Canada

Purpose: Little is known about the impact of psychological morbidity associated with orthopaedic trauma. Our study investigated the extent of psychological symptoms that patients experience following orthopaedic trauma, and whether these are associated with quality of life.

Methods: All patients attending 10 orthopaedic fracture clinics at 3 university-affiliated hospitals between January and October 2003 were screened for study eligibility. Eligible patients included those who met the following four criteria: age 16 years, English-speaking, actively being followed for fracture(s), and provision of informed consent. All consenting patients completed a baseline assessment form, a 90-item psychological symptom checklist (SCL-90R), and a health-related quality of life questionnaire (SF-36) at the time of their fracture clinic visit. We conducted regression analyses to determine variables associated with quality of life among study patients.

Results: 250 patients were eligible, of whom 215 agreed to participate; 59% were male at a mean age of 44.5 years (standard deviation ±18.8). Over half (54%) of patients had lower extremity fractures. One in five patients met the threshold for psychological distress. Patient Physical Function Summary Scores were significantly associated with older age (P<0.001), ongoing litigation (P=0.02), fracture location (P=0.01), and the intensity of psychological symptoms (P=0.003). Somatization was negatively associated with Physical Function Summary Scores (P= 0.02). Reduced Mental Health Summary Scores were associated with ongoing litigation (P=0.03) and Global Severity Index of psychological symptoms (P<0.001).

Conclusions: Only ongoing litigation and psychological symptoms were significantly associated with both SF-36 Physical Function and Mental Health Summary Scores.