The Trajectory of Physical and Mental Health From Injury to 5 Years After Multiple Trauma: A Prospective, Longitudinal Cohort Study

Soberg HL, Finset A, Roise O, Bautz-Holter E. The trajectory of physical and mental health from injury to 5 years after multiple trauma: a prospective, longitudinal cohort study. Arch Phys Med Rehabil 2012;93:765-74. Objectives: To describe the trajectory of physical and mental health from injury to 5 years postinjury for patients with multiple trauma, and to examine predictors of recovery of physical and mental health. Design: A prospective, longitudinal cohort study with data from injury (baseline), the return home (t1), and 1 (t2), 2 (t3), and 5 (t4) years. Setting: Hospital and community setting. Participants: Patients (N=105; mean age +/- SD, 35.3 +/- 14.0y, age range, 18-67y; 83% men) with multiple trauma and a New Injury Severity Score (NISS) >= 16 treated at a regional trauma referral center. Mean NISS +/- SD was 34.6 +/- 12.6, and mean Glasgow Coma Scale (GCS) score +/- SD was 12.2 +/- 3.9. Interventions: Not applicable. Main Outcome Measures: Medical Outcomes Study 36-Item Short-Form Health Survey physical component summary (PCS) and mental component summary (MCS), injury severity parameters, and World Health Organization Disability Assessment Schedule II (WHODAS II) for activities and participation. Results: The proportion with poor physical health (<40 points on the PCS) stabilized at 56% at t4 from 81% at t1. The proportion with poor mental health (<40 points on the MCS) stabilized at 31% at t4 from 43% at t1. Generalized estimating equations showed that predictors of PCS were time points of measurement (Wald, 85.50; P<.001), GCS (B=-.48, P=.004), time in hospital/rehabilitation (B=-.22, P=.001), and the rank-transformed WHODAS II subscales Getting around (B=.16, P<.001) and Participation in society (B=.06, P=.015). Predictors of MCS were time points of measurement (Wald 13.46, P=.004), sex (men/women) (B=-4.24, P=.003), education (low/high) (B=3.43, P=.019), and WHODAS II cognitive function (B=.18, P<.001) and Participation in society (B=.18, P <=.001). Conclusions: Physical and mental health over the 5 years improved with time, but was still significantly below population means. The physical and mental health status stabilized, but the recovery trajectories differed for physical and mental health. Predictors of health were personal and injury-related factors and function in a biopsychosocial perspective.