Health-related quality of life in trauma patients who sustained a calcaneal fracture

Abstract

Background: Calcaneal fractures are known to cause a considerable long-term disability; disability influences the public health negatively in terms of personal suffering and monetary losses. Health-related quality of life (HRQoL) in general is influenced by various patient-specific factors, and possibly trauma and fracture characteristics. Previous studies might have underestimated the impact of this injury because of several injury and patient specific exclusion criteria. In this study we provide an overview of the patient characteristics and outcome of patients with a calcaneal fracture in a Dutch level I trauma population.

Methods: We have performed a retrospective cohort study in a trauma level 1 centre. All patients who sustained a calcaneal fracture and were 16 years or older at time of admission were included. We have retrieved the relevant patient and fracture characteristics from the medical status and evaluated current health status with a questionnaire. We have used the EQ-6D for quantification of the HRQoL. Moreover, the patient's capability to work was evaluated.

Results: 125 patients with 151 calcaneal fractures were identified of which 93 patients with 114 calcaneal fractures participated in this study. The median EQ-5D index value is 0.78. All dimensions of the EQ-6D are affected in particular the dimensions 'mobility', 'pain/discomfort' and 'usual activity'. 85% is capable to work. Female patients or patients with a relevant comorbidity or a psychiatric history have a significantly lower HRQoL score. In this study population no difference in HRQoL results was demonstrated among different socio-economic status, associated injuries, or severity of injury.

Conclusions: This study demonstrates that patients who sustained a calcaneal fracture have a significantly lower HRQoL than the Dutch reference population and suffer from a chronic disability. Moreover, patients that have a comorbidity, a relevant psychiatric history or are female have significantly lower HRQoL scores. Furthermore, this study shows that socio-economic status, associated injuries, or severity of injury did not influence the HRQoL in this study population.

Level of evidence: Prognostic level II.

Keywords: Calcaneal fracture; EQ-5D; EQ-6D; Health-related quality of life; Long-term follow-up.