Changes and Determinants of Health-Related Quality of Life in Patients with Work-Related Traumatic Musculoskeletal Injuries: A Longitudinal Analysis of HRQoL and the EQ-VAS

Abstract

Purpose: This study aims to analyze change over time in health-related quality of life and the current overall health status of patients with severe musculoskeletal injuries, specifically focusing on those who have undergone inpatient rehabilitation following work-related injuries.

Methods: Data were sourced from the icfPROreha research project (DRKS-ID: DRKS00014857), involving a multicenter longitudinal study conducted across ten German clinics. The study population comprised patients who had sustained severe musculoskeletal work-related injuries. The EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) was used to assess changes in health-related quality of life (HRQoL) measured at admission (t1), discharge (t2), and four follow-up periods up to 78 weeks after discharge. Descriptive analyses were conducted to illustrate the development of HRQoL across all time points. In addition, the current overall health status was measured using the EuroQol Visual Analogue Scale (EQ-VAS) at the same time points. Multilevel growth models were used to analyze change over time in EQ-VAS scores, considering the biopsychosocial perspective of health as indicated by the International Classification of Functioning, Disability, and Health (ICF), developed by the WHO.

Results: In total, 698 patients [males: 75.2%; mean age 47.5 years (SD ± 12.3)] with severe musculoskeletal work-related injuries were included in the analyses. The mean EQ-VAS at baseline was 50.3 and the mean EQ-5D-5L index was 0.6. Descriptive analyses of the EQ-5D-5L showed significant improvements across all five dimensions of HRQoL after discharge, with the most pronounced changes observed in mobility and usual activities. Moreover, the study demonstrated a significant improvement in the EQ-VAS over time. Baseline EQ-VAS had a substantial influence on subsequent changes, with various factors such as psychological well-being, visible consequences and severity of injury affecting recovery outcomes. Notably, differences in health status over time were observed across different injury types.

Conclusion: The study demonstrates significant enhancements in the current overall health status among patients with traumatic musculoskeletal injuries following workplace or commuting accidents during inpatient rehabilitation. Furthermore, these findings emphasize the application of the ICF framework in capturing the multidimensional aspects of patient recovery. Despite improvements, patients' health status did not reach the levels observed in the general population, indicating the need for ongoing support and targeted interventions to ensure long-term recovery.

Keywords: Biopsychosocial; Fracture; Occupational accident; Polytrauma; Quality of life.