A1626 Predictors and Trajectories of Return-to-work (RTW) after Traumatic Limbs Injuries

Tuesday, March 20, 2012
Ground Floor (Cancun Center)
Wen-hsuan Hou, Department of Physical Medicine and Rehabilitation, E-da Hospital /i-shou University, Kaohsiung, Taiwan, Kaohsiung, Taiwan
Ching-fan Sheu, Institute of Education, College of Social Science, National Cheng Kung University, Tainan, Taiwan
Huey-wen Liang, Department of Physical Medicine and Rehabilitation, National Taiwan UniversityHospital and National Taiwan University College of Medicine, Taipei, Taiwan
Yen Lee, Department of Psychology, College of Social Science, National Cheng Kung Universit, Tainan, Taiwan
Hung-yi Chuang, Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
Introduction
Several studies have examined the bio-psycho-social factors related to whether patients with traumatic limbs injuries returned to work (RTW). Research treating RTW as the primary end point often ignored the dynamic work environments leading to and after this outcome occurred. The aim of this study is to explore the trajectories of RTW and to examine predictors of different trajectories of RTW in patients with various kinds of traumatic limbs injuries.

Methods
A total of 734 participants (18-85 years old) were recruited during admission from a teaching hospital for a two-year prospective study. The RTW outcome was assessed within 2 weeks of the injury, and at 1, 3, 6, 12, 18, and 24 months after the traumatic limbs injuries. The group-based trajectory modeling (GBTM) was employed to identify different trajectories of RTW. Comparisons of group characteristics of patients belonging to different trajectories were performed based on a multinominal logistic regression.

Results
Three distinct trajectories of RTW were identified in the sample: progressive, accelerated, and persistent RTW. The estimated proportions were 27.9%, 50.4%, 21.7%, respectively. The latter two groups achieved above 85% RTW 6 months after injuries. Patients found to be less likely to return to work were those who were older, less educated, suffered from lower limbs injuries or were seriously injured, less self-efficacy, felt more disturbance in daily life, had worse quality-of-life, and had poorer mental health. These predictors combined to account for about 36.0% of the total variance in the data.

Discussion
This study showed that the patterns of RTW among traumatic limbs injuries follow three distinct trajectories. It might be desirable for clinicians to monitor patients’ RTW status for as least one and half years in order to identify risk factors associated with patients who would require vocational rehabilitation programs intervention to promote their likelihood of returning to work.

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