A systematic review of studies measuring health-related quality of life of general injury populations
Suzanne Polinder
0
Juanita A Haagsma
0
Eefje Belt
0
Ronan A Lyons
2
Vicki Erasmus
0
Johan Lund
1
Ed F van Beeck
0
0
Erasmus Medical Centre, Department of Public Health
,
Rotterdam
,
the Netherlands
1
Faculty of Medicine, University of Oslo
,
Oslo
,
Norway
2
College of Medicine, Swansea University
,
Swansea
,
UK
Background: It is important to obtain greater insight into health-related quality of life (HRQL) of injury patients in order to document people's pathways to recovery and to quantify the impact of injury on population health over time. We performed a systematic review of studies measuring HRQL in general injury populations with a generic health state measure to summarize existing knowledge. Methods: Injury studies (1995-2009) were identified with main inclusion criteria being the use of a generic health status measure and not being restricted to one specific type of injury. Articles were collated by study design, HRQL instrument used, timing of assessment(s), predictive variables and ability to detect change over time. Results: Forty one studies met inclusion criteria, using 24 different generic HRQL and functional status measures (most used were SF-36, FIM, GOS, EQ-5D). The majority of the studies used a longitudinal design, but with different lengths and timings of follow-up (mostly 6, 12, and 24 months). Different generic health measures were able to discriminate between the health status of subgroups and picked up changes in health status between discharge and 12 month follow-up. Most studies reported high prevalences of health problems within the first year after injury. The twelve studies that reported HRQL utility scores showed considerable but incomplete recovery in the first year after discharge. Conclusion: This systematic review demonstrates large variation in use of HRQL instruments, study populations, and assessment time points used in studies measuring HRQL of general injury populations. This variability impedes comparison of HRQL summary scores between studies and prevented formal meta-analyses aiming to quantify and improve precision of the impact of injury on population health over time.
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Background
Worldwide, injuries are recognized as a major concern
in public health, being the predominant cause of deaths
in adults aged 1- 45 years, and an important cause of
disabilities [1,2]. The number of survivors of severe
injuries has rapidly grown due to substantial improvements
in trauma care. This has resulted in a shift of focus
from mortality towards disability of injury patients.
Disability (i.e. reduced levels of functioning resulting from
diseases or injuries [3]) is increasingly seen as an
important component of a populations health and for
the field of injury prevention and trauma care [4].
Disability is a complex construct and can be measured
using functional instruments or generic or disease
specific HRQL measures, where disability represents the gap
between measured and perfect HRQL. To enable
straightforward comparisons with other disease groups
and with general population norms, it is necessary to
measure the consequences of injuries using generic
health status measures (for instance the SF-36 or the
EQ-5D). Some HRQL instruments generate a summary
score (utility) that can contribute to a composite health
outcome measure [1]. It has become common practice
to quantify the impact of diseases and injuries on
population health with the help of composite health
outcome measures, such as quality-adjusted life years
(QALYs) and disability-adjusted life years (DALYs) [4,5].
Sound epidemiological data on the incidence, severity
and duration of the functional consequences of injuries
are needed to make valid estimates of the years lived with
disability due to injuries in the population. Data on all
dimensions of functioning relevant to injuries are needed
to describe the pattern of recovery or residual disability of
injury patients over time. With the help of these data, the
impact of injury on population health over time can be
quantified. Measuring the impact of injury is particularly
challenging due to the large variation in injury types and
severity. The European Consumer Safety Association has
published guidelines for the conduction of follow-up
studies measuring injury-related disability based on a
narrative literature search of papers from1995-2005 [1]. They
concluded that in the injury field there is lack of consensus
on preferred HRQL instruments and study designs [1].
However, this review only included 14 studies that
measured HRQL in general injury populations. Derrett et al
conducted a more recent systematic literature search of
injury specific and generic studies measuring outcome
after injury but restricted this to studies using the EQ-5D
outcome measure. They called for further comprehensive
population-level research exploring outcomes after injury,
and particularly for studies focusing on all injury [6]. It is
clear that there is a need to obtain greater insight in (...truncated)