Biopsychosocial factors associated with poor health-related quality of life after minor to moderate transport-related injuries: Insights into the Victorian compensable population

Abstract

Transport-related injuries are a leading cause of disability and mortality. The literature indicates that while some of these injuries are severe and catastrophic, most are classified as minor and moderate. In practice, it is expected that patients with minor and moderate injuries will recover with no serious consequences. However, recent research shows that, while half of patients recover relatively quickly, the other half experience long-term physical and mental health disabilities. The current study found multiple biopsychosocial factors impacting patients' outcomes. The use of the biopsychosocial conceptual framework, previous systematic review and qualitative study enabled assessment of specific biopsychosocial factors impacting recovery in patients claiming compensation for minor and moderate transport-related injuries. The identification of specific biopsychosocial factors identified as affecting recovery in this cohort will enable the development of a screening instrument to identify those of highest risk of poor recovery and to further develop strategies to facilitate enhanced outcomes. Objective: To investigate whether a range of previously identified biopsychosocial risk factors were associated with poorer health-related quality of life after transport-related injuries. Methods: This study involved 1,574 participants who sustained a transport-related injury, claimed compensation through the Victorian compensation scheme (in the Australian state of Victoria), and contributed to their cross-sectional outcome survey. Health-related quality of life was assessed using the EQ-5D-3L instrument. Results: Of the 1,574 participants (mean age 44.8 (standard deviation 16.6) years, 61% reported poor recovery expectations, 55% reported high pain intensity, 54% reported poor satisfaction with care provided, and 41% reported no improvement in their recovery. Poor quality of life was defined as EQ-5D-3L summary score 0-0.70. Predictors of selfreported poor health-related quality of life included older age (65+ years) patients (adjusted odds ratios (aOR) = 1.73, 95% confidence interval (95% CI) 1.04-2.87), higher pain intensity (aOR = 2.17, 95% CI 1.27-3.71), self-reported pre-injury chronic pain (aOR = 1.47, 95% CI 1.00-2.17), self-reported pre-injury mental health issues (aOR = 2.62, 95% CI 1.80-3.82), no improvement in recovery in the last 3 months (aOR = 1.54, 95% CI 1.15-2.06), longer hospital stay (>7 days) (aOR = 2.34, 95% CI 1.43-4.21) and no support from the family (aOR = 2.37, 95% CI 1.62-3.46). Conclusion: Biopsychosocial risk factors were associated with poorer health-related quality of life, regardless of the time since injury. Early assessment of these risk factors and tailored interventions will go some way towards improving outcomes among compensable patients with minor to moderate transport-related injuries.

Are There Any Differences in Road Traffic Injury Outcomes between Older and Younger Adults? Setting the Grounds for Posttraumatic Senior Personal Injury Assessment Guidelines

“…Associated with ageing, there is a gradual loss of cognitive abilities, explained by several factors, including changes in brain plasticity [ 2 ]. Traumatic events, even mild ones, can trigger or accelerate senile evolution due to the decrease in neurocognitive capacity; thus, cognitive changes can appear, such as distorted consciousness, confusion, altered attention, thought, perception, and memory [ 20 , 32 , 46 , 47 , 48 , 49 ]. A return to the previous mental state often occurs within a few days of the causal event.…”

“…A return to the previous mental state often occurs within a few days of the causal event. Nevertheless, it can also initiate neuropsychological dysfunction, which can progress to pseudodementia or dementia and can unmask previously unknown mental health conditions, leading to a significant reduction in health and functional status, with loss of autonomy and independence, and, consequently, a decrease in quality of life after trauma [ 20 , 46 , 50 ]. Studies have also shown a relationship between physical impairment and adverse psychiatric outcomes in people with a prior history of mental illness [ 50 ], with an increased disability expected in these cases [ 32 , 47 , 48 , 49 ].…”

“…Studies have also shown a relationship between physical impairment and adverse psychiatric outcomes in people with a prior history of mental illness [ 50 ], with an increased disability expected in these cases [ 32 , 47 , 48 , 49 ]. In addition, the loss of skills and functionality, affecting daily activities, can complicate and exacerbate the already existing mental issues [ 46 ], working like a snowball mechanism.…”

“…We consider that this, perhaps, the most difficult part of the older person assessment and of causal link discussion because even without brain injuries, intellectual functions (such as attention, memory, spatial perception, orientation, judgement capacity, ability to expose and solve problems, language and psycho-affective framework, maintenance of interests, sleep quality, mood, and sense of well-being) may decline or be aggravated by injuries, trauma experience, hospitalisation, removal from home and family, and the interruption of life routines, among others. This functional mental damage will affect daily life, social and leisure, and relational activities [ 20 , 42 , 46 , 47 , 48 ].…”

The role of specific sources of social support on postinjury psychological symptoms.

“…Specifically, Prang et al (2015) revealed a hierarchy of support following a transport-related accident such that injured patients relied the most on closer and more stable circles (e.g., family structure and spouses), followed by less stable circles (e.g., friends and neighbors); being married or in a relationship and support from family and friends were associated with better physical health. However, this prior work is limited and has primarily focused on hospitalized patients (Holeva et al, 2001; Kendrick et al, 2018; Nickerson et al, 2017; Perry et al, 1992), on trauma survivors months to years after the inciting event (Clapp & Beck, 2009; Kaniasty & Norris, 2008; Ozer et al, 2003), or on physical health or functional outcomes versus psychological outcomes (Prang et al, 2015; Samoborec et al, 2020). Taken together, the relationship between specific sources of perceived social support and psychological outcomes following injury remains relatively unexplored, particularly among those with acute but relatively mild to moderate noninterpersonal, accidental injury.…”