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OBJECTIVE: Surviving physical trauma can have a large impact on one's daily life. Patients are at increased risk for poor physical health, psychological complaints, and problems in role functioning - which is often experienced simultaneously. The present study explores the interconnectedness of physical, psychological, and role functioning during the first two years post-injury, both cross-sectionally and longitudinally from a network perspective. METHODS: 3785 trauma patients (Mage = 64.2 years, SDage = 18.9 years, 50.5% female) completed questionnaires on physical, psychological, and role functioning across six measurement occasions during the first two years post-injury. The Injury Severity Score (ISS) was retrieved from the local trauma registry. Mixed graphical network models and cross-lagged network models were estimated to examine which items of recovery played a central role and were mostly related to other items in cross-sectional and longitudinal networks respectively. RESULTS: The cross-sectional networks showed especially strong interconnections between impairments of physical and role functioning and also within post-traumatic stress symptoms. The longitudinal networks extended these results by showing that pain, impaired mobility, limitations in self-care, anxiety/depressive symptoms, and several post-traumatic stress symptoms were strong predictors for impairments in functioning at later stages of recovery. CONCLUSION: Our findings showed that impairments in physical, psychological, and role functioning experienced by trauma patients are largely intertwined across the two years following injury. Monitoring physical impairments and psychological complaints early in recovery might help to more promptly provide the best fitting aftercare for trauma patients, which can improve recovery on the long-term.
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INTRODUCTION: The incidence of patients with fractures is increasing and so is the impact on health care systems and society. To improve patient care, measurement of disabilities and impaired health experiences after traumatic musculoskeletal injuries are important. Next to objective clinical parameters, PROM(I)S can be used to map health domains important to patients. We aimed to objectify different aspects of (health-related) quality of life in fracture patients, including the ability to participate in social roles and activities using PROMIS among other PROMs. METHODS: An observational cohort study was performed in which health-related quality of life in fracture patients was measured. Patients aged 18 year and older either treated conservatively or surgically between November 2020 and June 2022 were included. Participants were followed for a maximum of one year and completed the following PROMs: PROMIS-CAT physical function, PROMIS-CAT pain interference, PROMIS-CAT ability to participate in social roles and activities and LEFS or QDASH. We applied a univariate linear mixed model to evaluate significance of improvement. RESULTS: Seven hundred-forty six patients with a mean age of 54.4 years were included. Mean PROMIS scores were structurally inferior in the lower extremity (LE) fracture group in comparison with the upper extremity (UE) fracture group. For "PROMIS physical function", UE fracture patients performed better and showed physical progression earlier. For "PROMIS pain interference", UE fracture patients experienced fewer limitations, but it took longer to experience improvement in this group. For "PROMIS ability to participate in social roles", significant improvement was only seen in the UE fracture group at one year follow up. CONCLUSION: Upper -and lower extremity fractures can have a significant impact on physical function and social health. Patients with UE fractures tend to have fewer limitations compared to LE fracture patients. Physical function and pain interference is most impaired shortly after the injury in all fracture patients and show significant changes over time, social health improves less over time. Moment of measurement should be based on type of fracture and can differ between individual patients, but when generic measures and outcomes are desirable, PROMIS questionnaires can potentially be used measurement.