OTA 2006 Posters

Scientific Poster #39 Foot and Ankle

Determinants of Patient Satisfaction following Severe Lower Extremity Injuries
Robert O'Toole, MD1 (n); Renan Castillo, PhD2 (n);
Andrew Pollak, MD1 (n); Ellen MacKenzie, PhD2 (n); Michael Bosse, MD3 (n); The LEAP Study Group;
1R. Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical School, Baltimore, Maryland, USA;
2Center for Injury Research & Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
3Carolinas Medical Center, Charlotte, North Carolina, USA

Purpose: There is an increased emphasis in health care on patient-centered care yet no studies have examined what influences patient satisfaction following severe lower extremity trauma. The goal of this analysis was to examine how the patients' satisfaction with outcome correlates with other measures of outcome (clinical, functional, physical impairment, psychological, and pain), sociodemographic characteristics of the patient, and treatment decisions.

Methods: 569 patients treated for limb-threatening lower extremity injuries at eight level I trauma centers were followed prospectively. Multivariate regression techniques were used to identify factors correlating with variation in patients' self-reported satisfaction at 2 years after trauma. Outcomes tested in the model were: pain, range of motion, muscle strength, self-selected walking speed, depression, anxiety, the physical and psychosocial scores of the Sickness Impact Profile (SIP), return to work, and number of major complications. Patient characteristics tested in the model were: age, gender, education, poverty status, insurance status, occupation, race, and smoking history. Injury severity was tested in the model using both the Injury Severity Score and a score reflecting the probability of amputation. Treatment decisions tested were amputation versus reconstruction, type of fixation device, and time to treatment variables.

Results: No patient, treatment, or injury characteristics were statistically significant. Only outcome measures correlated with patient satisfaction at 2 years. Five of the outcome measures accounted for more than 35% of the overall variation in patient satisfaction: return to work (P <0.05), depression (P <0.05), physical functioning component of the SIP (P <0.01), self-selected walking speed (P <0.001), and pain intensity (P <0.001). The presence of major complications and anxiety were marginally significant (P <0.1).

Conclusions/Significance: Patient satisfaction after lower extremity trauma appears to be related more to function, pain, and the presence of depression at 2 years, than to underlying characteristic of the patient, injury, or treatment.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.