RECOVERY IN SELECTED HEALTH STATUS AFTER LOWER LIMB FRACTURES

O.O. Oyewole¹, L.O. Thanni², A.A. Adebanjo²

Background: Functioning and psychosocial indicator are mostly significantly impacted following lower limb fracture (LLF) and define the outcomes of the management. However, this is seldomly documented in the spectrum of its’ management.

Purpose: To assess the health status of daily activity, emotional status, mobility function, disability, physical and mental health over a 6-month period after LLF.

Methods: A prospective observational study assessing the health status’ progress of individuals with LLF over a 6-month period. Short musculoskeletal function assessment questionnaire was used to assess daily activity, emotional status and mobility function. Short form-12 was used to assess physical and mental health while disability was assessed with World Health Organization disability assessment schedule 2.0 at 4-point times (pre-injury retrospectively and at one, 3 and 6 months post-injury). The lower the score the better the health status but it is the reverse for physical and mental health. Data were subjected to descriptive and Friedman’s analysis.

Results: Participants were 42 (25males) aged 48.8±17.9 years. At one-month, the health status of daily activity (89.0±10.6), emotional status (34.7±15.2), mobility function (74.5±15.2), disability (70.9±13.3), physical (17.0±10.3) and mental health (44.6±19.3) scores differed significantly with those at pre-injury (p = 0.0001). This suggests that sustaining LLF significantly impacted health status. Significant disability was reported by 97.5%, 84.2% and 56% at 1-month, 3-month and 6-month, respectively. The participants improved progressively in their health status from 1-month through 6-month. The health status of daily activity, emotional status, mobility function, disability, physical and mental health scores improved at 3-month (73.9±18.0, 26.0±11.2, 52.7±19.2, 52.7±14.1, 30.4±13.1 and 60.7±18.1) and 6-month (47.9±28.3, 22.0±14.5, 32.8±13.9, 37.9±18.2, 45.0±18.6 and 68.8±18.0), respectively. The % improvement in health status (1-month baseline) ranges between 16% and 104% at 3-month while it is 48% to 212% at 6-month. However, only 19%, 53%, 56%, 78%, 53% and 59% achieved minimal clinical important difference in daily activity, emotional status, mobility function, disability, physical and mental health, respectively at 3-month. These were further improved at 6-month (71%, 63%, 96%, 96%, 71% and 79%, respectively). Participants were unable to achieve pre-injury health status at 6-month (p<0.01).

Conclusion(s): Sustaining LLF impacted health status with 63-96% achieving clinically important differences at 6-month but unable to achieve pre-injury health status.

Implications: Insight into the change from pre- to post-injury health status of patients with LLF is not only important to derive estimates of the impact of injury on health status but also to provide prognostic information about recovery after fracture. Early recovery to pre-injury status will not only reduce the disease burden but will enhance productivity and health status. Therefore, identifying/assessing factors that facilitate/impede recovery and return to work of people with LLF will contribute positively along this direction.

Funding, acknowledgements: The work was unfunded.

Keywords: Health status, Lower limb fracture, Recovery

Topic: Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: Olabisi Onabanjo University Teaching Hospital

Committee: Health Research Ethics Committee of Olabisi Onabanjo University Teaching Hospital

Ethics number: OOUTH/HREC/192/2018