Health Outcomes of Adults 3 Months after Injury - Article Example

Injury is a major form of public health burden and there has been a rise in health care expenditure due to injury. While the number injured has been documented, the physical, mental, social and general health outcomes after an injury have seldom been studied which could help to study the effectiveness of the treatment given. Previous studies conducted had studied the health outcomes up to nearly 7 years post injury and had mostly reported poor health outcomes. This study, however, aimed to study the health related quality of life 3 months after injury using the SF-36 instrument and the study results were compared with that of non-injured individuals of the same age. A Queensland Trauma registry hospital was chosen where people admitted after injuries were followed-up post discharge. The inclusion criteria for the study required that the study participants should be 14 years or older, must have been admitted under the S00 and S99 or T00 and T78 categories of injuries. The participants who were admitted for more than 24 hrs ad given definitive treatment were grouped under primary those who were initially expected to remain in the hospital for more than 24 hrs but who were later discharged directly from the emergency formed the secondary study group. In both the groups only those individuals who were admitted as a result of trauma and other injuries were included in the study. The consent of study participants was obtained as was the approval from the Ethics committee of the concerned hospital. The participants were provided with the SF-36 questionnaire and also 13 demographic questions along with a cover letter which explained the study purpose. The SF-36 examined limitation in physical, mental and social functioning, body pain, emotional state, vitality and general health post-injury. From this data physical and mental component scores were also calculated. The extent and severity of injury was found out from the information obtained from the hospital registry using the abbreviated injury scale (AIS) and the injury severity score calculated from AIS. Excluding the individuals who did not respond to the questionnaire sent and those which where returned back due to unknown address, 145 individuals came under the secondary study group while 339 met the criteria for inclusion under the primary group. The primary group had 62% males and 37.5% females and their mean age was 48.8. Their injury severity score were between 1 and 50 with 22 participants having experienced major injuries and the remaining 312 with minor injuries. All the scores calculated for the participants were found to be lower compared to the normal scores. While this finding was evident among those who were younger no frequent variation in the scores were observed between participants aged above 65 years and normal individuals of the same age. Various factors that were analyzed for the physical component summary scores included age, sex, severity of injury, location of injury and cause and the mental scores. Of these, the severity, location and age were found to have a negative impact on the physical scores. Additionally, those who suffered injuries in the head, neck and abdomen had better physical scores compared to those who had upper and lower limb injuries. The SF-36 scores for the secondary group were also found to be lower compared to the normal population. Thus the quality of health analyzed 3 months after hospitalization due to a major or minor injury and a stay in the hospital for less than or greater than a 24 hour period was found to be lower compared to a normal population of the same age. Lack of difference between the two populations was observed only in the psychological scores and especially among older people as such people even in the normal population tend to have reduced health related psychology. The injury resulted in physical and social reductions in those participants aged between 35 to 64 years while reducing the general health and mental scores in those who were above 65 years. The major limitation of the study include the assumption that participants were functioning well prior to the injury which might result in reduced functioning when analyzed after just 3 months, low response rate and low number of participants with major injury and higher number with fracture injury. Thus in conclusion the authors state that significant reduction in the quality of health may be apparent up to 3 months post-injury. Additional studies need to be done alleviating the limitations of this study and also on a longer duration post-injury to ascertain the length of time during which quality of health is compromised. Reference Leanne Aitken, M et al. “Health Outcomes of adults 3 months after injury.” Injury 38 (2007):19-26. Unilateral Lower Limb Injury: Its Long-Term Effects on Quadriceps, Hamstring, and Plantar flexor Muscle Strength The article proposes to analyze the long-term strength of the lower limb muscle groups such as quadriceps, hamstrings and plantar flexor muscles after having suffered a musculoskeletal injury. It also analyzes the effect of the various types of contraction on muscle strength, the persistence of the injury that influences the long-term outcome and whether the site and nature of injury plays a role in the recovery process. The study included 48 subjects recruited from universities, general hospital and a sports clinic and who had suffered unilateral musculoskeletal injury at least 9 months earlier and had not received any medical or physical treatment during the previous 6 months. The type and time since the injury was noted and dominance was determined according to the leg preferred for kicking. All the 37 men and 11 women participants were healthy and pain free at the time of the study. Prior to the actual isokinetic muscle tests, the participants were required to perform active and passive movements with the injured limb to ensure that there was no tension or pain experienced in the muscles by comparing the results with that of the uninjured limb. They were later made to flex and extend their knee and hip and also plantar flex the ankle with their eyes closed all the time and report the direction of movement and position of the joint. These movements were carried out with single non-continuous maneuvers and the muscle strength was measured using a dynamometer. The isometric, concentric and eccentric measurements of the three muscle groups were recorded by flexing the knee at different degrees. The study recorder significant differences in the dynamic tests conducted to determine the strength of the quadriceps and plantar flexor muscles while no strength related differences was found for the hamstring muscles of the injured and uninjured limbs. Thus the study showed that the quadriceps muscle strength is affected after an injury and does not get better with time and deficits of about 20% may continue to persist for a very long time. Limb dominance was found to have no relation with regaining the muscle strength while the type and location of the injury did affect the muscle strength recovery process. Fractures and dislocation in areas which are involved in quadriceps mechanism lead to greater deficits compared to other areas. Alteration in the pull angle or distance of insertion of the quadriceps tendon in to the joint axis may contribute to the long-tem deficit even after rehabilitation. The study also identified certain limitations such as the inclusion young and active study subjects, who might not be a representative of the general population, and hence the results might be different in case of a different set of population. On the positive front the study participants were voluntary and interested to be part of the study and as they were pain free at the time of testing and without any other complications they provided for an ideal study group with greater chances of recovery. However this was not the case to be as even after rehabilitation muscle strength did not return to the pre-injury state. The findings of the study suggest that either the rehabilitation provided is not adequate or complete recovery is unlikely. Considering that many subjects had not returned to their pre-injury activity levels, further research could be carried out on whether additional rehabilitation would help the subjects achieve a good amount of muscle strength recovery. Reference: Holder-Powell, Heather M and O. M. Rutherford. “Unilateral Lower Limb Injury: Its Long-Term Effects on Quadriceps, Hamstring, and Plantar flexor Muscle Strength.” Arch Phys Med Rehabil 80 (1999): 717-720 Sports injuries in an accident and emergency department Sports is generally considered to be beneficial to the health, however, there is also a risk of injury due to which many sports injury clinics have been started. The present study aims to assess the proportion of athletes who are admitted to the accident and emergency department due to organized sports related injuries. As sports is supposed to protect an individual against injuries the subjects were questioned about the sport played, the training frequency and the frequency of occurrence of such injuries apart from the standard data relating to the age and sex of the study participant. The cause and site of the injury and the subsequent treatment received were also recorded and the results were cross tabulated to compare the variables. A total of 2270 men and women participants who reported injury during sporting activity were included in the study. Among these 97% injuries occurred in those aged under 40 years, 87% under 30 years, 78% under 26 years and 52% under 21 years. The major three sports that caused injuries were football, rugby and skiing and lesser injuries were observed during the holiday season. About 74% reported training for once or more per week while 85% trained for at least once a week and hence injuries were reported by those who were well versed with the sport and cross tabulation of training against injury did not demonstrate any difference between injuries sustained irrespective of training. With respect to the cause of injury, the data revealed that foul play was less likely to give rise to serious injuries. The lower limb was the site of injury in a majority of subjects followed by upper limb, head and neck and the types of injury included soft tissue sprains, strains, fractures, dislocations, lacerations and head injuries. Symptomatic treatment like prescription of pain killers and dressing was given to 64% of subjects, while 34% required more active treatment such as suturing with only 7% requiring to be admitted to the hospital and about 36% were asked to come for follow-up. Only 6% of subjects were attended by the accident and emergency department while the rest were referred to GP or other clinics. The study has however also identified its limitations such as non inclusion of children, exclusion of eye injuries, and lack of assessment of injury due to a particular sport. The authors conclude by stating that sporting related injuries should not be taken lightly and the hospital staffs need to be well-trained to attend to soft tissue injuries through proper training and education and more special clinics catering to such injuries need to be opened for the benefit of sports athletes. Reference: Watters, D.A et al. “Sports injuries in an accident and emergency department.” Archives of Emergency Medicine 2 (1984):105-112. Read More