PSYCHOLOGICAL EFFECTS OF ORTHOPEDIC TRAUMA

BACKGROUND: Orthopedic trauma has not only impact on physical activity of trauma patients, but it also induces the post-traumatic psychological morbidity. Despite of the mounting evidences that non-injury factors are important in recovery phase of trauma, specific factors associated with clinical outcomes are still poorly understood . Lack of knowledge further complicates the situation to improve the care of orthopedic polytrauma patient. OBJECTIVE: To evaluate psychological effects among patients with orthopedic trauma STUDY DESIGN : This observational Cross Sectional Study for assessment of psychological symptoms in orthopedic trauma patients and its effects on health related quality of life was conducted in department of orthopedic surgery Services Hospital Lahore. STUDY SETTING: Department of orthopaedic surgery Services Hospital Lahore INCLUSION CRITERIA: Patients having age 18 – 75 years with orthopaedic trauma who were educated up to secondary school and were able to complete the questionares provided to them. EXCLUSION CRITERIA: Polytrauma patients with age less than 18 years and more than 75 years. METHODS: A total number of 125 patients having orthopedic trauma with age between 18-75 years were included in the study. After consent, the baseline assessment form having symptoms checklist – 90 – revised (SCL - 90 - R) and health related quality of life questionnaire (SF - 36) was given to each patient . A regression analysis was performed to determine the health related quality of life was done in the patients under study. RESULTS: Out of 125 patients , 110 patients agreed to participate in the study . Among 110 patients , 90 were males while 20 were females . 56 patients had lower extremity fractures , 24 with upper extremity fractures , 20 patients had pelvis injury while the remaining 10 patients presented with spine fractures . Patient physical component summary score was associated with old age (p < 0.01) , fracture location ( p = 0.03 ) and positive symptoms distress ( p < 0.003 ) . This predicts the 25.45 % of variance in patients with physical component summary score . Emotional upset related to physical disability was considered as important psychological symptoms although it was associated with the physical component score . Conclusion: The study concluded that orthopaedic polytrauma patients, there is a significant relationship between psychological aspects, mental components and the physical components scores. The degree of distress arising from the perception of body dysfunction i.e. is pain with dysfunction of musculoskeletal system is significantly associated with their physical component summary score Similarly patient mental component summary score was also associated with their interpersonal sensitivity, phobia, anxiety and emotional upsets. Psychosocial factors, poor socio economic status, female sex, litigation, location of fractures, and psychosocial morbidity were associated with reduced health related quality of life.