FUNCTIONAL LIMITATION AFTER MAJOR TRAUMA - A MORE SENSITIVE ASSESSMENT USING THE QUALITY OF WELL-BEING SCALE THE TRAUMA RECOVERY PILOT PROJECT

Little is known about the degree of disability and quality of life of patients after major trauma. We conducted a prospective study to examine the incidence and predictors of functional limitation (FL). Between January 1, 1990 and March 30, 1990, 61 eligible trauma patients were enrolled in the study (admission GCS score greater-than-or-equal-to 12, LOS > 24 hours). Functional limitation after trauma was measured at discharge and 3 months after discharge using the Quality of Well-being (QWB) scale, a more sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Functional limitation was also measured using a standard ADL scale (range, 17 = full function to 41 = maximum dysfunction). Risk factors measured were injury severity, body region, depression (CES-D) scale, and social support. Follow-up was achieved in 42 patients (70%). The mean age was 30 years, 74% were male, 52% white, 41% hispanic, and 3% other. The mean ISS was 15, with 69% blunt injuries and a mean LOS of 12 days. The QWB scores improved between discharge and follow-up; discharge mean = 0.457 (+/-0.048), follow-up mean = 0.613 (+/-0.118), but the mean QWB score at follow-up still reflected a significant degree of functional limitation. The mean percentage of change in QWB scores was 34.5% (+/-25.5%) with a range of -6.34% to 103.8%. The discharge mean FDS was 29 (+/-6.2) while the follow-up FDS mean was 17 (+/-3.8), reflecting that most patients at follow-up reported near-perfect ADL functioning. Injury severity, body region, and social support were not associated with FL. Depression was significantly associated with FL; discharge rate = 81% and follow-up rate = 43%. The relative risk for depression for the lowest versus highest tertile of QWB% change was 1.9 (p < 0.05). Functional limitation as assessed by the QWB was much greater at follow-up. The ADL scale did not adequately measure FL; the follow-up mean was close to full ADL function. The high incidence of posttrauma depression may be an important predictor of FL.