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Table 2 Pre- and post-injury HRQL

From: Assessment of pre-injury health-related quality of life: a systematic review

Author, year, country Instrument Pre-injury HRQL Post-injury HRQL Change Findings
Post-injury vs pre-injury
General injury
Brussoni, 2013, Canada [31] EQ-5D Not admitted: 0.97
1-3d: 0.94
4 + d: 0.93
Not admitted: 0.90
1-3d: 0.76
4 + d: 0.61
Not admitted: −0.07
1-3d: −0.18
4 + d: −0.32
All categories of length of stay in hospital had significantly lower HRQL at follow-up than at baseline
Ulvik, 2008, Norway [42] EQ-5D 0.97 0.70 −0.27a Significant decrease in HRQL in all dimensions
Wilson, 2012, New Zealand [8] EQ-5D 0.94 5 m: 0.75
12 m: 0.78
5 m: −0.19
12 m: −0.16
Significantly higher pre-injury HRQL than New Zealand norms. Recovered had significantly higher post-injury HRQL than norms. Non-recovered had significantly lower HRQL than norms.
Watson, 2005, Australia [29] SF-36 PCS 55; MCS 55 1w: PCS 25; MCS 46
6w: PCS 34; MCS 53
12w: PCS 38; MCS 55
26w: PCS 43; MCS 52
52w: PCS 44; MCS 52
1w: PCS −30; MCS −9
6w: PCS −21; MCS −2
12w: PCS −17; MCS 0
26w: PCS −12; MCS −3
52w: PCS −11; MCS −3
Consistently higher pre-injury scores than Australian norms. Males had higher pre-injury PCS and MCS than females. 18-24y and 65-74y had highest pre-injury MCS. Those with pre-injury paid-employment had significantly higher pre-injury PCS than those without.
Innocenti, 2015, Italy [43] SF-12 PCS 53 (7), 24–64
MCS 55 (7), 28-63
6 m: PCS 41 (12), 14–64
6 m: MCS 46 (13), 16-67
PCS −12a
MCS −9a
93% pre-injury PCS and MCS in normal range according to Italian norms. Significant worse HRQL after 6 m.
Traumatic brain injury
Gross, 2012, Switzerland [44] EQ-5D
SF-36
TBI: 99 (4); no TBI: 95 (14)
TBI PCS 57 (6); MCS 50 (11)
no TBI PCS 56 (7); MCS 51 (12)
TBI: 65 (28); no TBI: 76 (21)
TBI - PCS: 44 (12); MCS: 39 (13)
no TBI - PCS: 45 (11); MCS: 48 (13)
TBI: −34; no TBI: −19
TBI PCS −13; MCS −11
no TBI PCS −11; MCS −3
TBI had significantly worse HRQL compared with no TBI (on EQ VAS, EQ-5D, MCS, but not on PCS)
Ponsford, 2011, Australia [27] SF-36 mTBI PCS 54 (6); MCS 49 (8)
no TBI PCS 54 (6); MCS 53 (7)
1w: mTBI PCS: 38 (10); MCS: 44 (11)
1w: no TBI PCS:36 (10); MCS: 49 (11)
3 m: mTBI PCS: 52 (9); MCS: 48 (10)
3 m: no TBI PCS: 50 (9); MCS: 53 (7)
1w: mTBI PCS: −16; MCS: −5
1w: no TBI PCS: −18; MCS: −4
3 m: mTBI PCS: −2; MCS: −1
3 m: no TBI PCS: −4; MCS: 0
mTBI had significantly poorer mental HRQL pre-injury. Significant change in PCS in mTBI and no TBI, MCS only in mTBI. Scores dropped dramatically at 1w, returned to pre-injury levels at 3 m.
Jimenez, 2013, US [22] PedsQL NHW: 86
Hispanic: 90
NR 0-3 m: NHW −5; Hispanic −16
0-12 m: NHW −5; Hispanic −13
0-24 m: NHW −5; Hispanic −13
0-36 m: NHW −5; Hispanic −16
Pre-injury scores were higher for Hispanic than NHW. Post-injury scores were significantly lower for Hispanic compared with NHW.
Pieper, 2014, US [25] PedsQL mTBI: 82 (13)
no TBI: 81 (14)
mTBI: 82 (15)
no TBI: 82 (16)
mTBI 0
no TBI: 1
No significant differences were identified among mTBI, NBI, and uninjured groups. Cognitive HRQL after mTBI trended lower from 3–12 months post-injury.
Hip fracture
 Beaupre, 2012, Canada [30] EQ-5D 0.62 (0.20)
Survived 0.63 (0.20)
Deceased 0.61 (0.20)
Survivors 3 m: 0.42 (0.25)
6 m: 0.46 (0.24)
12 m: 0.42 (0.30)
3 m: −0.21
6 m: −0.17
12 m: −0.21
At 1y, those alive had higher pre-injury HRQL than those that died. Significant loss in HRQL at 3 m that remained relatively unchanged 6 m and 12 m postoperatively.
 Buecking, 2014, Germany [35] EQ-5D 0.71 Discharge: 0.46 Discharge: −0.25 Significantly reduced HRQL during hospitalization.
 Griffin, 2015, UK [36] EQ-5Db 0.56 4w: 0.28
4 m: 0.32
12 m: 0.36
4w: −0.28
4 m: −0.24
12 m: −0.2
Significantly lower HRQL at one year than pre-injury. HRQL significantly improved after 4w in those aged ≤80y, but not in >80y.
 Hagino, 2009, Japan [37] EQ-5D 0.80 (0.17) 2w: 0.37 (0.27)
3 m: 0.64 (0.16)
6 m: 0.63 (0.18)
12 m: 0.68 (0.24)
  Hip fracture had lower pre-injury HRQL than wrist facture (significant) or vertebral fracture.
 Sugeno, 2008, Japan [38] EQ-5D 0.77 (0.24) Discharge: 0.67 (0.21)
12 m: 0.81 (0.17)
Discharge: −0.10
12 m: 0.04
HRQL decreased post-injury, but recovered to pre-facture levels 1y following hospitalization.
 Tidermark, 2002, Sweden [39] EQ-5D 0.78 (0.21)
Survived 0.79 (0.21)
Deceased 0.73 (0.22)
Survivors 1w: 0.44 (0.33)
4 m: 0.55 (0.37)
12 m: 0.51 (0.36)
1w: −0.34
4 m: −0.23
12 m: −0.27
Similar pre-injury HRQL compared to Swedish population norms. Decrease in HRQL from pre- to post-injury. Patients did not regain their pre-injury HRQL.
 Jaglal, 2000, Canada [34] SF-36 PF 74 (24); RP 68 (46); BP 92 (16); GH 79 (20); VT 63 (22); SF 86 (21); RE 86 (34); MH 73 (20) 6w: PF 44 (18); RP 2 (7); BP 68 (20); GH 75 (19); VT 54 (18); SF 75 (23); RE 85 (36); MH 79 (16)
6 m: PF 59 (22); RP 63 (48); BP 78 (24); GH 77 (25); VT 59 (23); SF 77 (25); RE 96 (21); MH 82 (13)
6w: PF −30a; RP −66a; BP −24a; GH −4;
VT −9; SF −11a; RE −1a; MH 6
6 m: PF −15a; RP −5a; BP −14a; GH −2;
VT −4; SF −9; RE 10; MH 9a
Significant decrease in HRQL from pre- to post-injury in all domains (ex GH, VT, MH). Significantly lower PF, RP, BP but higher MH at 6 m than pre-injury.
 Peterson, 2008, US [24] SF-36 Survived PF 56 (36); RP 81 (33);
BP 84 (24); GH 75 (21); VT 65 (22); SF 86 (23); RE 93 (26); MH 76 (20)
Died PF 41 (29); RP 60 (43); BP: 82 (24); GH 62 (26); VT 55 (23); SF 84 (24); RE 85 (32); MH 79 (22)
NA   At recruitment, no differences in domain scores between those living at 5 years and those dead (though small N, large SD). At 5y, significantly higher PF, RP and GH in those alive than those that died.
Extremity injury
Ding, 2006, US [19] (Extremity) PedSQL 89 3 m: 73
12 m: 80
3 m: −16
12 m: −9
Similar pre-injury HRQL for upper- and lower- extremity fractures. Significantly lower HRQL post-injury than pre-injury.
 Busse, 2012, Canada [32] (Tibia) SF-36 PCS 53 (9)
MCS 54 (9)
2w: PCS 28 (8); MCS 46 (13)
12 m: PCS 43 (11); MCS 52 (12)
2w: PCS −25; MCS −8
12 m: PCS −10; MCS −2
Decrease in HRQL from pre- to post-injury. Patients did not regain their pre-injury HRQL.
 Skoog, 2001, Sweden [40] (Tibia) SF-36b PF 72; RP 83; BP 80; GH 80; VT 75;
SF 83; RE 88; MH 82
4 m: PF 60; RP 45; BP 63; GH 74; VT 62; SF 70; RE 58; MH 77
12 m: PF 68; RP 58; BP 66; GH 70; VT 57;
SF 70; RE 76; MH 73
4 m: PF −12a; RP −38a; BP −17; GH −6;
VT −13; SF −13a; RE −30a; MH −5
12 m: PF −4; RP −25; BP −14a; GH −10a; VT −18a; SF −13; RE −12; MH −9
Pre-injury HRQL was comparable to Swedish healthy population. SF-36 domain scores were lower at 4 m and 12 m, compared to pre-injury HRQL.
 Lyrtzis, 2012, Greece [41] (Ankle) SF-36 89 (6); 68–97
PF 96; RP 95; BP 91; GH 76; VT 79;
SF 92; RE 93; MH 87
10d: 68 (11); 52–82
PF: 64; RP: 72; BP: 71; GH: 54; VT: 78;
SF: 77; RE: 82; MH: 68
10d: −21
PF −32; RP −23; BP −20; GH −22; VT −1;
SF −15; RE −11; MH −19
Significant worsening of HRQL 10d after injury, compared to pre-injury HRQL.
 McGuine, 2014, US [23] (Knee) SF-12 PCS 56 (5)
MCS 56 (7)
Diagnosis: PCS 41 (11); MCS 51 (12)
3 m: PCS 48 (9); MCS 53 (10)
6 m: PCS 53 (7); MCS 53 (9)
12 m: PCS 54 (6); MCS 54 (8)
Diagnosis: PCS −15; MCS −5
3 m: PCS −8; MCS −3
6 m: PCS −3; MCS −3
12 m: PCS −2; MCS −2
Pre-injury HRQL was higher than population norms in all domains. HRQL change from preinjury through an entire 12 m after injury.
 Hagino, 2009, Japan [37] (Wrist) EQ-5D 0.93 (0.13) 2w: 0.72 (0.14)
3 m: 0.81 (0.18)
6 m: 0.87 (0.15)
12 m: 0.88 (0.15)
2w: −0.21
3 m: −0.12
6 m: −0.06
12 m: −0.05
Hip fracture had lower pre-injury HRQL than wrist facture (significant) or vertebral fracture. Scores showed recovery after 6 m. After 1y, scores were not significantly different from pre-fracture.
Other injury
Pons-Villanueva, 2011, Spain [46] (MVC) SF-36 MVC PCS 53; MCS 47
PF 95; RP 87; BP 74; GH 73; VT 65;
SF 89; RE 80; MH 71
No MVC PCS 53; MCS 49
PF 95; RP 91; BP 79; GH 76;
VT 66; SF 92; RE 87; MH 76
MVC PCS 51; MCS 48
PF 93; RP 83; BP 69; GH 71; VT 63; SF 91; RE 82; MH 73
No MVC PCS 53; MCS 50
PF 95; RP 92; BP 78; GH 77; VT 66; SF 94; RE 90; MH 77
MVC PCS −2; MCS 1
PF −2; RP −4; BP −5; GH −2; VT −2; SF −2; RE 2; MH 2
No MVC - PCS 0; MCS 1
PF 0; RP 1; BP −1; GH 1; VT 0; SF 2; RE 3; MH 1
All physical scales declined in participants reporting a MVC, while mental health dimensions increased. Patients who did not have any MVC had significantly higher HRQL than those who suffered a MVC on RP, BP, GH, RE, MH, MCS and PCS.
Alghnam, 2014, US [18] (MVC) SF-12 MVC PCS 50; MCS 49
No MVC PCS 50; MCS 51
MVC PCS 47; MCS 49
No MVC PCS 50; MCS 51
MVC PCS −3; MCS 0
No MVC PCS 0; MCS 0
Similar baseline PCS in MVC and no MVC. Significant lower baseline MCS in MVC than no MVC.
 Ottosson, 2007, Sweden [45] (Muscosk) SF-36b Recovered 1 m: PF 93; RP 93; BP 92; GH 85; VT 75; SF 92; RE 94; MH 85
Not recovered: PF 85; RP 83; BP 80; GH 83; VT 73; SF 91; RE 83; MH 85
1 m: Rec 1 m PF 95; RP 93; BP 89;
GH 85; VT 73; SF 95; RE 93; MH 85
No rec PF 63; RP 30; BP 43; GH 68; VT 45; SF 68; RE 85; MH 67
6 m: No rec PF 70; RP 45; BP 53; GH 65; VT 51; SF 76; RE 60; MH 70
1 m: Rec 1 m PF 2; RP 0; BP −3; GH 0; VT −2;
SF 3; RE −1; MH 0
No rec PF −22; RP −53; BP −37; GH −15;
VT −28; SF −23; RE −30; MH −18
6 m: No rec PF −15; RP −38; BP −27; GH −18; VT −22; SF −15; RE −23; MH −15
Pre-injury HRQL was comparable to Swedish norm population. At 1 m patients who reported no recovery had significantly lower
scores on all domains, compared to those
reporting recovery.
 Andrew, 2012, Australia [26] (Ortho) SF-36 PCS 59 (4); MCS 55 (7)
PF 57 (3); RP 56 (4); BP 60 (6);
GH 60 (6); VT 60 (8); SF 56 (5);
RE 55 (5); MH 55 (7)
PCS 52 (10); MCS 53 (10)
PF 52 (8); RP 50 (10); BP 52 (10);
GH 55 (10); VT 52 (10); SF 52 (10);
RE 53 (7); MH 52 (9)
PCS −7; MCS −2
PF −5; RP −6; BP −7; GH −5;
VT −7; SF −4; RE −2; MH −3
Significant reductions in all SF-36 subscale scores, with RP and BP reporting the most reductions.
 Gabbe, 2007, Australia [6] (Ortho) SF-12 PCS 51; Men 53; Women 48
MCS 55; Men 55; Women 54
NA   Significantly higher PCS (stratified men 25-54y) and MCS (men 18-24y, women 18-24y, 25-34y or 45-54y) than Australian norms.
 Dvorak, 2005, Canada [33] (Spine) SF-36 PCS 49 (13)
MCS 52 (10)
PCS 43 (13)
MCS 49 (14)
PCS −6
MCS −3
No significant differences between patients’ recalled PCS and MCS and Canadian norms.
 Hagino, 2009, Japan [37] (Spine) EQ-5D 0.88 (0.17) 2w: 0.53 (0.17)
3 m: 0.76 (0.18)
6 m: 0.75 (0.16)
12 m: 0.84 (0.17)
2w: −0.35
3 m: −0.12
6 m: −0.13
12 m: −0.04
Hip fracture had lower pre-injury HRQL than wrist (significant) or vertebral fracture. Scores at 6 m were significantly lower than pre-injury. After 1y, scores were not significantly different from pre-fracture values.
 Fauerbach, 1999, US [20] (Burn) SF-36 PTD PF 87 (24); RP 85 (34);
BP 87 (28); GH 77 (25); VT 66 (20); SF 88 (24); RE 85 (32); MH 77 (14)
No PTD PF: 92 (20); RP 91 (22);
BP 81 (30); GH 87 (11); VT: 73 (20); SF 94 (19); RE 97 (16); MH 88 (9)
2 m: PTD PF 66 (27); RP 29 (39);
BP 41 (19); GH 68 (24); VT 52 (24);
SF 75 (30); RE 76 (38); MH 67 (22)
No PTD PF 85 (22); RP 56 (49);
BP 47 (21); GH 83 (15); VT 69 (23);
SF 92 (18); RE 92 (34); MH 87 (12)
2 m: PTD PF −21; RP −56; BP −46;
GH −9; VT −14; SF −13; RE −9; MH −10
No PTD PF −7; RP −35; BP −34; GH −4;
VT −4; SF −2; RE −5; MH −1
Higher pre-injury HRQL in PTD (BP) and non-PTD (MH, VT, RE, SF, GH) than US norms.
 Wasiak, 2014, Australia [28] (Burn) SF-36 PCS 56 (9)
MCS 52 (12)
PCS 52 (13)
MCS 52 (11)
PCS −4 (1)
MCS 0 (1)
Pre-burn PCS was higher than Australian norms, MCS was comparable. HRQL at 12 m were consistent with the Australian norms. Significant lower PCS at 12 m compared with pre-injury.
 Greenspan, 2002, US [21] (Gunshot) SF-36 PF 96 (14); RP 89 (29);
BP 93 (19); GH 85 (20); VT 70 (21);
SF 86 (27); RE 83 (34); MH 76 (24)
8 m: PF 71 (28); RP 43 (42);
BP 63 (32); GH 58 (27); VT 52 (28);
SF 67 (31); RE 64 (43); MH 68 (25)
PF −25; RP −46; BP −30; GH −27;
VT −18; SF −19; RE −19; MH −8
Pre-injury scores were similar to population norms, except for PF and GH (higher). Significant declines in PCS and MCS, and across all domains compared to pre-injury (especially PF, RP, BP, GH, and VT).
  1. (Bold author names are studies of children; Studies in bold and italics prospectively measured pre-injury HRQL)
  2. aSignificant change between pre- and post-injury HRQL scores
  3. bScores obtained from graph(s) (not reported in text or tables)