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 exami ne 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 functionin g continuum (range, 0 = death to 1.000 = optimum functioning). Functio nal limitation was also measured using a standard ADL scale (range, 17 = full function to 41 = maximum dysfunction). Risk factors measured w ere injury severity, body region, depression (CES-D) scale, and social support. Follow-up was achieved in 42 patients (70%). The mean age wa s 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. Th e QWB scores improved between discharge and follow-up; discharge mean = 0.457 (+/-0.048), follow-up mean = 0.613 (+/-0.118), but the mean QW B score at follow-up still reflected a significant degree of functiona l 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 t hat most patients at follow-up reported near-perfect ADL functioning. Injury severity, body region, and social support were not associated w ith FL. Depression was significantly associated with FL; discharge rat e = 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 follo w-up. The ADL scale did not adequately measure FL; the follow-up mean was close to full ADL function. The high incidence of posttrauma depre ssion may be an important predictor of FL.