Background
Methods
Study design and setting
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admission to hospital within 2 weeks of injury;
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involvement in a motor vehicle crash;
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age 18 years or over; and
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an upper or lower extremity fracture (humerus, radius, ulna, pelvis, acetabulum, femur, patella, tibia, fibula, talus, calcaneus).
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dementia or a significant pre-existing cognitive impairment preventing the ability to consent;
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spinal cord injury;
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Glasgow Coma Score <12 on admission;
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amputation of a limb; or
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isolated clavicle, scapula, phalangeal, carpal, metacarpal, tarsal or metatarsal fractures not requiring admission to hospital.
Injury related factors
Socio-demographic factors
Health related factors
Compensation related measures
Outcome measure - return to work
Data analysis
Results
Baseline characteristics
Participation at six months | Participation at 12 months | Participation at 24 months | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | No (n = 101) | Yesa (n = 233) | P | No (n = 124) | Yesa (n = 210) | P | No (n = 151) | Yesa (n = 182) | p |
Age (years), Mean (SD) | 31.9 (12.0) | 38.2 (14.2) | ** | 31.7 (11.5) | 39.0 (14.4) | ** | 31.5 (11.7) | 40.3 (14.3) | ** |
New Injury Severity Score, No. (%) | NS | * | NS | ||||||
Minor - moderate 1-8 | 22 (21.8) | 41 (17.6) | 27 (21.8) | 36 (17.1) | 33 (21.9) | 30 (16.5) | |||
Serious 9-15 | 50 (49.5) | 94 (40.3) | 61 (49.2) | 83 (39.5) | 71 (47.0) | 73 (40.1) | |||
Severe - critical 16-75 | 29 (28.7) | 98 (42.1) | 36 (29.0) | 91 (43.3) | 47 (31.1) | 79 (43.4) | |||
Marital status, No. (%) | ** | ** | ** | ||||||
Single | 60 (60.0) | 87 (37.5) | 68 (54.8) | 79 (38.0) | 86 (57.0) | 61 (33.9) | |||
Married/defacto | 36 (36.0) | 131 (56.5) | 53 (42.7) | 114 (54.8) | 61 (40.4) | 105 (58.3) | |||
Divorced/widowed | 4 (4.0) | 14 (6.0) | 3 (2.4) | 15 (7.2) | 4 (2.6) | 14 (7.8) | |||
Occupation skill levelb, No. (%) | * | NS | * | ||||||
Managers/professionals | 20 (19.8) | 58 (25.0) | 23 (18.5) | 55 (26.3) | 60 (26.1) | 38 (17.1) | |||
Tradespersons | 26 (25.7) | 85 (36.6) | 36 (29.0) | 75 (35.9) | 71 (30.9) | 55 (24.8) | |||
Intermediate clerical | 17 (16.8) | 35 (15.1) | 21 (16.9) | 31 (14.8) | 27 (11.7) | 37 (16.7) | |||
Elementary related | 38 (37.6) | 54 (23.3) | 44 (35.5) | 48 (23.0) | 53 (23.0) | 72 (32.4) | |||
Body Mass Index (BMI)c (kg/m2) | * | NS | NS | ||||||
<18.50 (underweight) | 4 (4.0) | 2 (0.9) | 4 (3.2) | 2 (1.0) | 4 (2.6) | 2 (1.1) | |||
18.50-24.99 (normal) | 45 (44.6) | 78 (33.8) | 50 (40.3) | 73 (35.1) | 64 (42.4) | 58 (32.2) | |||
≥25.00 (overweight) | 35 (34.7) | 89 (38.5) | 47 (37.9) | 77 (37.0) | 53 (35.1) | 71 (39.4) | |||
≥30.00 (obese) | 17 (16.8) | 62 (26.8) | 23 (18.5) | 56 (26.9) | 30 (19.9) | 49 (27.2) | |||
Smoking history, No. (%) | * | NS | NS | ||||||
Current smoker | 38 (38.0) | 51 (22.0) | 40 (32.5) | 49 (23.4) | 48 (32.0) | 40 (22.1) | |||
Ex-smoker | 23 (23.0) | 67 (28.9) | 32 (26.0) | 58 (27.8) | 36 (24.0) | 54 (29.8) | |||
Never smoked | 39 (39.0) | 114 (49.1) | 51 (41.5) | 102 (48.8) | 66 (44.0) | 87 (48.1) | |||
Self-reported chronic illnesses (yes) No. (%) | 17 (16.8) | 76 (32.6) | ** | 26 (21.0) | 67 (31.9) | * | 35 (23.2) | 58 (31.9) | NS |
Medication use (current), No. (%) | 11 (10.9) | 56 (24.1) | ** | 13 (10.5) | 54 (25.8) | ** | 19 (12.6) | 48 (26.5) | ** |
Vehicle type, No. (%) | * | * | * | ||||||
Motor vehicle | 61 (60.4) | 114 (48.9) | 71 (57.3) | 104 (49.5) | 87 (57.6) | 88 (48.4) | |||
Motorcycle | 31 (30.7) | 109 (46.8) | 42 (33.9) | 98 (46.7) | 53 (35.1) | 87 (47.8) | |||
Bicycle | 9 (8.9) | 10 (4.3) | 11 (8.9) | 8 (3.8) | 11 (7.3) | 7 (3.8) |
Characteristics of return to work
Predictors of time to return to work
Variable | No. (%) | Median time to RTW | Logrank Test
p value |
---|---|---|---|
Age | 334 | ||
Injury Severity Score | 0.09 | ||
Minor - moderate 1-8 | 84 | 204 | |
Serious 9-15 | 198 | 240 | |
Severe - critical 16-75 | 52 | 259 | |
New Injury Severity Score | 0.002 | ||
Minor - moderate 1-8 | 63 | 204 | |
Serious 9-15 | 144 | 203 | |
Severe - critical 16-75 | 127 | 305 | |
Index of Relative Socioeconomic Disadvantagea
| 0.57 | ||
Most disadvantaged | 89 | 215 | |
Disadvantaged | 34 | 365 | |
Average | 64 | 270 | |
Advantaged | 78 | 207 | |
Most advantaged | 69 | 198 | |
Sex | 0.69 | ||
Female | 67 | 199 | |
Male | 267 | 244 | |
Marital status | 0.47 | ||
Single | 147 | 244 | |
Married/de facto | 167 | 212 | |
Divorced/widowed/separated | 18 | 270 | |
Education skill levelb
| 0.13 | ||
Bachelor degree and above | 60 | 138 | |
Certificate and advanced diploma | 143 | 213 | |
Secondary education | 118 | 305 | |
Pre-primary and primary education | 10 | 229 | |
Occupation skill levelb
| 0.01 | ||
Managers/administrators/professionals/associate professionals | 78 | 125 | |
Tradespersons/advanced clerical and service workers | 111 | 229 | |
Intermediate clerical/sale/service production/transport workers | 52 | 396 | |
Elementary clerical/sales/service/labourers/related workers | 92 | 340 | |
Work level before injury | 0.87 | ||
Full Duties | 321 | 231 | |
Part Duties | 13 | 213 | |
Work hours before injuryc
| 0.14 | ||
Full-time | 273 | 215 | |
Part-time | 57 | 302 | |
Pre-injury job satisfactiond
| 0.28 | ||
Satisfied | 320 | 231 | |
Not Satisfied | 14 | 342 | |
Recovery expectations for work | 0.08 | ||
Yes | 298 | 212 | |
No | 32 | 280 | |
Recovery expectations for usual activities | <0.001 | ||
≤90 | 202 | 177 | |
>90 | 111 | 455 | |
Language other than English | 0.08 | ||
Yes | 108 | 250 | |
No | 226 | 231 | |
Total yearly household incomee (before tax, AU) excluding number of people in household | 0.17 | ||
≤$39,999 | 53 | 302 | |
$40,000-$79,999 | 110 | 250 | |
≥$80,000 | 148 | 194 | |
Total adjusted yearly household incomee (before tax, AU) including number of people in household | 0.47 | ||
≤$39,999 | 153 | 240 | |
$40,000-$79,999 | 121 | 250 | |
≥$80,000 | 37 | 154 | |
Body Mass Index (BMI)f (kg/m2) | 0.54 | ||
<18.50 (underweight) | 6 | 407 | |
18.50-24.99 (normal) | 123 | 213 | |
≥25.00 (overweight) | 124 | 203 | |
≥30.00 (obese) | 79 | 302 | |
Smoking history | 0.02 | ||
Current smoker | 89 | 394 | |
Ex-smoker | 90 | 207 | |
Never smoked | 153 | 199 | |
Self-reported chronic illnesses | 0.88 | ||
Yes | 93 | 215 | |
No | 241 | 240 | |
Medication use | 0.93 | ||
Yes | 67 | 229 | |
No | 266 | 237 | |
Recent injury other than crash | 0.40 | ||
Yes | 16 | 365 | |
No | 316 | 231 | |
Risk of long term harm due to alcohol consumptiong (standard drinksh/week) | 0.92 | ||
Low risk - ≤28 male or ≤14 female | 311 | 231 | |
Risky - 29–42 male or 15–28 female | 13 | 358 | |
High risk - ≥43 male or ≥29 female | 9 | 244 | |
Risk of short term harm due to alcohol consumptiong (yes) | 0.14 | ||
Yes | 116 | 297 | |
No | 218 | 215 | |
Self-reported at-fault | 0.04 | ||
Yes | 125 | 203 | |
No | 208 | 250 | |
Vehicle type | 0.02 | ||
Motor vehicle | 175 | 276 | |
Motorcycle | 140 | 199 | |
Bicycle | 19 | 182 | |
Pre-morbid neck pain in last 6 months | 0.70 | ||
Yes | 15 | 203 | |
No | 319 | 237 | |
Post-morbid neck pain | 0.74 | ||
Yes | 59 | 215 | |
No | 275 | 231 | |
Crash on a public road | 0.06 | ||
Yes | 297 | 240 | |
No | 37 | 156 | |
Self-assessed pre-injury health statusij, | 0.03 | ||
Excellent | 103 | 240 | |
Very good | 137 | 199 | |
Good | 78 | 250 | |
Fair-Poor | 16 | - | |
Claim made by 6 months | 0.08 | ||
Yes | 140 | 178 | |
No | 91 | 120 | |
Legal representation at 6 months | 0.007 | ||
Yes | 95 | 199 | |
No | 136 | 122 |
Factor | R-squared | C-index |
---|---|---|
Recovery expectations for usual activities | 0.087 | 0.605 |
Occupation skill levela
| 0.104 | 0.643 |
New injury severity score | 0.121 | 0.656 |
Self-assessed pre-injury health statusb
| 0.154 | 0.662 |
Work hours before injuryc
| 0.177 | 0.671 |
Smoking history | 0.194 | 0.678 |
Education skill levela
| 0.197 | 0.679 |
Recovery expectations for work | 0.206 | 0.687 |
Injury severity score | 0.212 | 0.687 |
Total yearly household incomed
| 0.225 | 0.695 |
Self-reported at fault | 0.227 | 0.695 |
Language other than English | 0.240 | 0.699 |
Crash on public road | 0.241 | 0.700 |
Risk of short term harm due to alcohol consumptione
| 0.244 | 0.700 |
Age | 0.251 | 0.704 |
Sex | 0.252 | 0.707 |
Factor | B | SE | P value | HRR | 95 % CI |
---|---|---|---|---|---|
Age | 0.009 | 0.006 | 0.10 | 1.010 | 0.998–1.021 |
Sex (Male) | −0.038 | 0.202 | 0.851 | 0.963 | 0.648–1.430 |
New Injury Severity Score | 0.007 | ||||
Minor - moderate 1-8 | - | - | - | - | - |
Serious 9-15 | −0.170 | 0.202 | 0.401 | 0.844 | 0.568–1.254 |
Severe - critical 16-75 | −0.619 | 0.216 | 0.004 | 0.539 | 0.353–0.822 |
Occupation skill levela
| 0.05 | ||||
Managers/administrators/professionals/associate professionals | - | - | - | - | - |
Tradespersons/advanced clerical and service workers | −0.355 | 0.204 | 0.081 | 0.701 | 0.470–1.045 |
Intermediate clerical/sale/service production/transport workers | −0.311 | 0.249 | 0.211 | 0.733 | 0.450–1.193 |
Elementary clerical/sales/service/labourers/related workers | −0.632 | 0.227 | 0.003 | 0.532 | 0.341–0.829 |
Work hours before injury (Full-time)b
| 0.688 | 0.232 | 0.003 | 1.989 | 1.261–3.136 |
Recovery expectations for usual activities (≤90 days) | 0.741 | 0.174 | <0.001 | 2.099 | 1.494–2.949 |
Self-assessed pre-injury health statusc
| 0.005 | ||||
Excellent | - | - | - | - | - |
Very good | 0.343 | 0.184 | 0.062 | 1.409 | 0.983–2.019 |
Good | −0.111 | 0.219 | 0.612 | 0.895 | 0.582–1.376 |
Fair-Poor | −1.029 | 0.476 | 0.031 | 0.357 | 0.141–0.908 |
0.090 | |||||
Current smoker | - | - | - | - | - |
Ex-smoker | 0.368 | 0.222 | 0.097 | 1.445 | 0.936–2.232 |
Never smoked | 0.434 | 0.201 | 0.031 | 1.543 | 1.041–2.288 |