Risks of Poor Outcome From the Prospective Outcomes of Injury Study Sarah Derrett ACHRF 2012

Outcomes 3 and 12 months after injury

Prospective Outcomes of Injury Study (POIS)

New Zealand

2nd Australasian Compensation Health Research Forum

Sarah Derrett Injury Prevention Research Unit

7 November 2012

What is POIS?

2856 participants (18-64 years)

20% Mori (n=566)

Via ACCs entitlement claims register

Interviewed to 2 years after injury

Excluded: sensitive claims & self-harm

POIS study overview

Injury event

Interview 3 months n=2856

Interview 12 months n=2282 (80%)

NMDS data ACC data

Disability

Injury-related

Pre-injury demographic &

social

Interview 24 months n=2256 (79%)

Today To identify factors associated with

increased odds of disability among hospitalised and non-hospitalised, 3 and 12 months after injury

Snapshots of paid work outcomes

Outcomes for injury compared to illness

What is known? Disability outcomes

Gender, stress, hospital, depression and injury characteristics predict outcomes

Few considered pre-injury characteristics Poor follow-up rates Hospitalised, serious injury, return to work

outcomes only Accident Compensation Corporation (ACC)

DISABILITY OUTCOME 3 MONTHS AFTER INJURY

Outcome: Disability WHODAS II 12-item

Standing Household Learning new task Joining in

community activities

Emotionally affected Concentrating

WHODAS score 10

Walking Washing body Getting dressed Dealing with people Friendships Day to day work

Pre-injury and injury-related characteristics included

Pre-injury socio-demographic: Age Education Paid employment Sex Living arrangements Household income

Pre-injury health and psychosocial: General health Faith or spiritual belief Sleep Chronic conditions Family involvement Body mass index Depressive-type episodes Social relationships Smoking Optimism Sense of community Alcohol use Self-efficacy Physical activity Recreational drug use

Injury-related: Assault Threat of disability 12 injury categories (ICD-10) Threat to life Healthcare services access Injury severity (NISS)

Results: Disability Outcomes Pre-injury disability: 4.5% & 5.3% respectively Disability at 3 months: 2752 (96%)

53.6% disability (hospitalised group ) 39.4% disability (non-hospitalised group)

Disability at 12months: 2202 (80%) 17.1% disability (hospitalised group) 14.0% disability (non-hospitalised group)

Associated with disability at 3 months

Pre-injury socio-demographic: Female

Pre-injury health and psychosocial: 2+ chronic conditions Obesity

Injury-related: Threat of disability Injury severity Lower extremity fracture

Pre-injury WHODAS disability

Hospitalised Non-hospitalised

Pre-injury WHODAS disability

Pre-injury socio-demographic: Age Inadequate household income Pre-injury health and psychosocial: Obesity

Injury-related: Assault Injury severity Threat to life Poor access to healthcare services Spine or lower extremity sprain

Not associated with disability at 3 months in either group

Pre-injury socio-demographic: Education Paid employment Living arrangements

Pre-injury health and psychosocial: General health Family involvement Smoking Depressive-type episodes Social relationships Alcohol use Optimism Sense of community Recreational drug use Self-efficacy Physical activity Faith or spiritual belief Sleep

Injury-related: 9 of the 12 injury categories

Summary of 3-month results For both the hospitalised and non-

hospitalised groups the following factors were associated with increased odds of disability: Pre-injury disability Obesity More severe injuries (NISS)

Other factors associated with disability in one group only e.g: Assault among the non-hospitalised group

DISABILITY OUTCOME 12 MONTHS AFTER INJURY

Summary of 12-month results

Only one factor, pre-injury disability, was commonly associated with increased odds of disability for both the hospitalised and non-hospitalised groups

Other factors were associated with disability but in one group only e.g: Being older or being female among the non-

hospitalised group only

Provisional 12-month analyses

Conclusions: Disability With few exceptions, factors associated

with disability were not common to the hospitalised and non-hospitalised groups

Disability was prevalent in both groups 3-months after injury (54% & 39%) 12-months (17% & 14%)

A considerable proportion of those not admitted to hospital have a disability burden

Ref: Derrett S, Samaranayaka A, Wilson S, Langley J, Ameratunga S, et al. (2012) Prevalence and Predictors of Sub-Acute Phase Disability after Injury among Hospitalised and Non-Hospitalised Groups: A Longitudinal Cohort Study. PLoS ONE 7(9): e44909

Work after injury? 92% of POIS were in paid employment before their

injury (n=2626) 3 months after injury:

73% were back in paid work Of those not back in paid work the majority (71%) anticipate

recovery to usual work

12 months after injury: 84% were back at work

What affected work at 3-months? Associated with not working 3-months after

injury: Pre-injury low income Blue collar occupations

Financial insecurity Painful/tiring work Pre-injury obesity Standing at work Threat to life Temporary contracts Being hospitalised Long work week

What affected work at 3-months? Not associated with not working 3-months

after injury: Age Prior chronic conditions Sex Pre-injury general health Education Pre-injury psychosocial factors (depression,

optimism, self-efficacy) Ref: Lilley R, Davie G, Ameratunga S, Derrett S. (2012) Factors predicting work status three months after injury: results from the Prospective Outcomes of Injury Study. BMJ Open; 2: doi:10.1136/bmjopen-2011-000400

Recent discussions scheme extension in New Zealand

Injury & illness Are there differences in outcome between:

Those with an injury (ACC) Those with an acute onset illness? Both groups matched for functional difficulty

Who is more likely to be in paid employment 12-months later? Earnings-related compensation (80% of wages) Those with means-tested benefits?

Rehabilitation/Back at work People with an injury are much more likely to be

back at work 12 months later compared to those with stroke

Suggests ACC support is effective in returning

people to work

Durability of return to work and relationships with disability now being investigated

Funders: The Health Research Council of New

Zealand (2007-2013) and the Accident Compensation Corporation (2007-2010)

POIS Team: John Langley, Brendan

Hokowhitu, Shanthi Ameratunga, Gabrielle Davie, Paul Hansen, Emma Wyeth, Gabrielle Davie, Rebbecca Lilley, Ari Samaranayaka, Suzanne Wilson

Contact: [email protected]

Outcomes 3 and 12 months after injuryProspective Outcomes of Injury Study (POIS)New Zealand 2nd Australasian Compensation Health Research Forum What is POIS?POIS study overviewTodayWhat is known? Disability outcomesDISABILITY Outcome 3 months after injuryOutcome: Disability WHODAS II 12-itemPre-injury and injury-related characteristics included Results: Disability OutcomesAssociated with disability at 3 monthsNot associated with disability at 3 months in either groupSummary of 3-month resultsDISABILITY Outcome 12 months after injurySummary of 12-month resultsConclusions: DisabilityWork after injury?What affected work at 3-months?What affected work at 3-months?Recent discussions scheme extension in New ZealandRehabilitation/Back at workSlide Number 21