OTA 2005 Posters
Scientific Poster #20 Polytrauma/Injury Prevention
"How are You Now?" A Description of the Discordance between Patients' and Clinicians' View of Outcome after a Fracture
Purpose: Clinicians ask patients "How are you now?" to ascertain treatment outcomes and to set a plan for subsequent care. However, sometimes patient views differ from those of clinicians. Discordances exist between the clinical view of success (usually healing rates and clinical impression) and the patients' perspective related to their response to the question "How are you now?". The purpose of this study was to evaluate whether such a discordance exists in patients presenting with isolated, operatively managed fractures at two trauma centers and to describe outcomes in those with concordant and discordant views of recovery.
Methods: This was a cross-sectional study of patients' perspective of recovery from an extremity fracture. Patients were eligible for inclusion in the study if they were of working age (16 to 64 years) and underwent primary operative fixation of an extremity fracture between September 1, 2000 and April 30, 2002. Patients were excluded if there was an inability to complete a written questionnaire in English; multiple trauma (defined as injury severity score (ISS) of >16); nontraumatic fractures, such as pathologic fractures (eg, neoplasms); concurrent upper and lower extremity fractures; or fractures to the head, spine, or pelvis. Patients were recruited from two tertiary care centers and completed a mail-back questionnaire that included measures of health (DASH, SMFA), self-rated recovery, burden of illness (illness intrusiveness, loss of self), symptoms, and work status. These were linked with clinical records of radiologic and clinical recovery.
Results: 255 patients returned usable questionnaires. Mean age was 42 years and 42% were female. 67 patients said that they were completely better (CB), 134 almost better (AB), and 54 not completely better (NCB). Significant differences were found between groups. In 4 variables, NCB was distinct from AB/CB, while in all other variables, such as pain, disability, and disruption of their personal and work lives, all 3 groups were unique (Duncan's post hoc). There was a discordance rate of 30% overall all between the patient's view and the clinician's view of recovery after fracture. Of those patients who said they were not better, 68% were reported "healed" by the clinician. In 20% of the cases in which the patient reported complete recovery, the clinician reported the fracture as "not healed" on the last recorded examination. In all instances, disability, pain, and return to work corresponded more with patient perception than the clinician's.
Conclusions/Significance: Our findings have shown a discordance rate of 30% overall all between the patient's view and the clinician's view of recovery after fracture. The discordance appeared associated with disruptions to personal life that may not be accounted for in a clinician's view of outcome. The clinical implication of our study is to alert physicians to the important discordance between clinical and patient perspectives of recovery. Further analyses are required to model an understanding of recovery from the patients' perspective, and thereby try to explain the discordances we observed.