PHYSICAL IMPAIRMENT AND FUNCTIONAL OUTCOMES 6 MONTHS AFTER SEVERE LOWER-EXTREMITY FRACTURES

To determine functional outcomes after lower extremity fracture (LEF), a prospective follow-up study of patients admitted to three level I t rauma centers for treatment of unilateral LEFs was conducted. In this paper we describe outcomes at 6 months after discharge from the initia l hospitalization and examine the relationship between impairment and disability. A total of 444 patients met the entry criteria for the stu dy. Of these 376 (85%) were successfully located and interviewed at 6 months; 302 (68%) returned to the trauma center at 6 months for a clin ical assessment by a physical therapist. Study patients were predomina ntly young (mean age = 32.4), white (72%) men (70%) who were working b efore the injury (77%). The fractures resulted primarily from motor ve hicle crashes (71%); mean hospital LOS was 12 days. Disability was mea sured using the Sickness Impact Profile (SIP), a well validated patien t assessment of health status. The overall SIP score averaged for all patients was 10.2, denoting a moderate level of dysfunction or disabil ity. Analysis of the 12 subscores that constitute the SIP indicate par ticularly high scores for ambulation (16.7 postdischarge vs. 1.2 prein jury), sleep and rest (14.0 vs. 5.1), emotional behavior (10.5 vs. 2.2 ), home management (15.1 vs. 2.6), recreation and pastimes (19.0 vs. 4 .4), and most notably, work (33.2 vs. 8.3). Further analysis of the su bgroup of patients working before the injury shows that 48% had return ed to work at 6 months. Correlations between lower extremity impairmen t (range of motion, muscle strength, and pain) and the ambulation subs core of the SIP were high. However, correlations between impairment an d more global areas of activity such as home management, work, and rec reation were considerably lower. These results suggest that other fact ors, over and above the extent of physical impairment, significantly i nfluence broader disability outcomes such as return to work. Further r esearch is needed to define these factors so that effective interventi ons after acute care can be identified and appropriately targeted.