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Gohy B1,2, Van den Bergh R3, Brus A4, Brodin N2
1Handicap International, Brussels, Belgium, 2Karolinska Institute, Stockholm, Sweden, 3Médecins Sans Frontières, Brussels, Belgium, 4Handicap International, Lyon, France
Background: Trauma is a major contributor to the burden of morbidity and mortality, particularly in crisis situations, where health structures and actors are often overwhelmed. Major trauma can result in long-term disabilities, affecting not only the patient, but also his/her family and the community. Existing studies on trauma in humanitarian settings focus on surgical procedures and/or medical outcomes, but increasingly, the necessity to monitor functional outcomes is recognized. However, there are currently no validated functional outcome measures for trauma patients in humanitarian settings, leading to limitations in monitoring the quality and impact of rehabilitation activities, as well as in the ability to compare rehabilitation programmes across contexts. A pragmatic score for functional outcomes, consisting of scoring of activities of daily life, was designed and implemented by Médecins Sans Frontières (MSF) and Handicap International (HI).
Purpose: This research aims to develop a functional score for trauma patients in emergency settings and assess aspects of its validity.
Methods: This was a cross-sectional study, using routine programme data from trauma patients across 5 MSF projects (Tabarre, Aden, Burundi, Baghdad and Gaza) from August 2017 to August 2018. Routine data included the functional score at inpatient and outpatient admission and discharge. This functional score is composed of 20 activities of daily life, divided in 2 subscores (lower limb and upper limb subscores) and was previously described (Gohy et al, 2016).
Floor- and ceiling-effects of the score were assessed for each item by verifying the proportion of maximum or minimum values. For the internal redundancy, pairs of items with a Spearman correlation coefficient>0.90 were considered redundant.
Results: 790 patients were included in the study, of whom 120 (15%) were female. The mean age was 26,5. 53% of the patients had lower limb injuries, 26% upper limb injuries, 11% injuries in other sites (abdomen, chest, head, spine), and 10% had injuries at multiple sites. Lower limb subscore items performed better regarding floor- and ceiling-effects and redundancy than upper limb items. In total, 7 items were found to be redundant.
Conclusion(s): The original functional score should be further refined by removing redundant items. Content validity, construct validity and inter-rater reliability will be addressed in a subsequent stage.
Implications: This study contributes to the development and validation of a cross-culturally valid and reliable tool to assess functional limitations of trauma patients, contributing to the improvement of the quality and monitoring of trauma care and rehabilitation care.
Keywords: Functional outcome measure, Humanitarian, Trauma
Funding acknowledgements: This research was conducted through a R2HC-Elrha grant, supported by Karolinska Institute, MSF and HI.
Purpose: This research aims to develop a functional score for trauma patients in emergency settings and assess aspects of its validity.
Methods: This was a cross-sectional study, using routine programme data from trauma patients across 5 MSF projects (Tabarre, Aden, Burundi, Baghdad and Gaza) from August 2017 to August 2018. Routine data included the functional score at inpatient and outpatient admission and discharge. This functional score is composed of 20 activities of daily life, divided in 2 subscores (lower limb and upper limb subscores) and was previously described (Gohy et al, 2016).
Floor- and ceiling-effects of the score were assessed for each item by verifying the proportion of maximum or minimum values. For the internal redundancy, pairs of items with a Spearman correlation coefficient>0.90 were considered redundant.
Results: 790 patients were included in the study, of whom 120 (15%) were female. The mean age was 26,5. 53% of the patients had lower limb injuries, 26% upper limb injuries, 11% injuries in other sites (abdomen, chest, head, spine), and 10% had injuries at multiple sites. Lower limb subscore items performed better regarding floor- and ceiling-effects and redundancy than upper limb items. In total, 7 items were found to be redundant.
Conclusion(s): The original functional score should be further refined by removing redundant items. Content validity, construct validity and inter-rater reliability will be addressed in a subsequent stage.
Implications: This study contributes to the development and validation of a cross-culturally valid and reliable tool to assess functional limitations of trauma patients, contributing to the improvement of the quality and monitoring of trauma care and rehabilitation care.
Keywords: Functional outcome measure, Humanitarian, Trauma
Funding acknowledgements: This research was conducted through a R2HC-Elrha grant, supported by Karolinska Institute, MSF and HI.
Topic: Disaster management; Disaster management; Disability & rehabilitation
Ethics approval required: No
Institution: Médecins Sans Frontières
Ethics committee: MSF Ethics Review Board
Reason not required: The study fulfilled the exemption criteria set by the Ethics Review Board (ERB) of MSF (Geneva, Switzerland) for a-posteriori analyses of routinely collected data and thus did not require formal MSF ERB review. It was conducted with permission from the Medical Director of MSF Operational Centre Brussels, Belgium.
All authors, affiliations and abstracts have been published as submitted.
