| Summary: | 博士 === 高雄醫學大學 === 職業安全衛生研究所 === 100 === Background and Objectives: Return-to-work (RTW) for workers with traumatic limb injury is a worldwide issue in the field of vocational rehabilitation. However, few comprehensive longitudinal repeated follow-up studies on traumatic limb injury have focused on workers in Taiwan. Therefore, the purpose of this study is to explore the RTW condition, health-related quality of life (HRQoL), trajectory patterns, and disability-adjusted leave days (DALD) of workers in Taiwan.
Methods: Patients diagnosed with limb injuries and hospitalized in the orthopedic and plastic surgery ward of E-Da hospital were recruited from January to December 2009 and followed until December 2011. Repeated measures, at 2 weeks post-injury and at 1, 3, 6, 12, 18, and 24 months post-injury, were conducted in order to assess the primary outcome of the time to RTW and the RTW status. Domain factors of the International Classification of Functioning, Disability, and Health (ICF) model (i.e., body function; activity/participation; and personal and environmental factors) were evaluated as our secondary outcomes.
Results: The results revealed that only 38% of workers maintained work status after RTW. We identified three RTW trajectories: persisted, accelerated, and progressive RTW. The estimated proportions were 21.5%, 50.7%, and 27.8%, respectively. Workers who are older, married, and less educated, and those having blue-collar jobs, severe injury, low self-efficacy, and low HRQoL, have more difficulty with RTW. As for the outcome of HRQoL, RTW is the most influential factor in comparison with other domains of ICF. The RTW status was positively associated with an increased score of HRQoL (??=0.215, p<0.0001, R2=0.234). In addition, women and older workers tended to have longer LDs than men and younger workers, with increases in percentage change of 16.0% and 139.5%, respectively. After adjusting for DI, the corresponding figures for DALDs were both increased, to 28.7% and 186.6%. The percentages for the less-educated workers and blue-collar workers were 185.7% and 155.8%. The expected DALDs showed statistically significant differences in all subgroup analyses.
Conclusions: Our two-year longitudinal repeated follow-up study concluded that RTW is an independent and significant factor in HRQoL, that the predictors of RTW trajectories are distinct, and that the DALD novel indicator may provide further implications for occupational health policy.
Keywords: return-to-work, health-related quality-of-life, disability, traumatic limb injuries, International Classification of Functioning, Disability, and Health
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