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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)