Return to Work After Lower Extremity Trauma: An Analysis of Patient-Reported Outcomes

Friday, October 20, 2023

2:37 PM – 2:43 PM PST

Location: 4B

Presenting Author(s)

Natasha S. McKibben, MD

Oregon Health & Science University, United States

Disclosure(s): No financial relationships to disclose

Corresponding Author(s)

Lily R. Mundy, MD

Assistant Professor
Johns Hopkins University
Baltimore, Maryland, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

SW

Sabrina M. Wang, BS

Duke University
AK

Ahlam A. Khattab, BS, MS

Duke University
MN

Moreen W. Njoroge, BS

Duke University
FK

Franca Kraenzlin, MD

Johns Hopkins University
Nathan N. O'Hara, PhD

Assistant Professor
University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center
Baltimore, Maryland, United States
TD

Tim DeJong, MD

Radboud University Medical Center
Radboud University, Nijmegen Medical Centre
SH

Scott T. Hollenbeck, MD

Duke University
Mark J. Gage, MD

University of Maryland

Purpose: Lower extremity traumatic injuries are associated with significant pain, limitations in function, and prolonged non-weightbearing. As a result, return to work following injury is often delayed months to years, with some patients not returning at all. It is hypothesized that patients who return to work will have higher function and quality of life in comparison to patients who do not.

Methods: A cross-sectional study of patients from 25 countries after traumatic injury distal to the mid-femur, including limb salvage and amputation patients, was performed. Pre- and post-injury work status was self-reported, along with demographic, clinical, and patient-reported outcome (PRO) data. PRO data were collected with the LIMB-Q, a PRO instrument developed specifically for lower extremity trauma patients. Primary outcomes were return to work status and LIMB-Q scores. An adjusted multivariate regression controlled for age, gender, race/ethnicity, income, marital status, data collection site, and time from injury. Data were collected from 371 patients, where 258 patients worked at the time of injury.

Results: In patients who worked pre-injury, 67% of patients returned to work (n = 173) after an average of 21 months (standard deviation [SD] 42). On univariate analysis, patients who returned to work had higher LIMB-Q scales in Function, Symptoms, Life Impact, and Psychological Well-being. On multivariate analysis, return to work was significantly associated with marital status, unilateral injuries, pre-injury work type, along with LIMB-Q Function (P = 0.033; 95% confidence interval [CI]: –11.3, –0.49) and Life Impact (P = 0.008; 95% CI –13.5, –2.01) scores. The need for reconstruction or amputation was not associated with return to work on either univariate or multivariate analysis (P>0.05).

Conclusion: Return to work after injury is a critical metric in lower extremity trauma patients. Patients who returned to work reported higher function and overall life impact scores. In addition to the economic benefit of returning to work, patients may derive improved quality of life. Prospective studies are needed to determine the causality associated with working and higher function and quality of life.