Does Patient Cognition Predict Time Off From Work After Life-Threatening Accidents?
Schnyder U, Moergeli H, Klaghofer R, Sensky T and Buchi S;
Commented by , 21 Nov 2003
Aim of the study
To identify predictors of the number of days off from work in patients after a life-threatening accident.
Method
A consecutive series of 100 patients with accidental injuries that caused a life-threatening or critical condition requiring their referral to the intensive care unit of the trauma department at the University Hospital of Zurich were assessed within 1 month of the accident. Data were collected on 9 variables with a potential to predict the number of days of sick leave (assessed 12 months after the accident) attributable to the accident:
1) the Injury Severity Score, 2) sex, 3) age, type of accident i.e. 4) traffic, 5) sports or leisure, 6) workplace, 7) posttraumatic psychological symptoms (intrusions), and patients’subjective appraisal of 8) the severity of the accident (using a Likert scale, ranging from 1=very low to 5=very high) and 9) their abilities to cope with the accident and its job-related consequences (using a Likert scale, ranging from 1=very poor to 5=very good).
Statistical analyses included calculation of Pearson correlation coefficients between all potential predictor variables and days off from work because of the accident, as well as linear multiple regression analysis.
Results
Time taken off from work varied between 4 and 9 months. Four of the nine predictor variables contributed significantly to the predictive model: injury severity, type of accident, patients’ appraisals of accident severity and patients’ appraisals of their abilities to cope with the accident and its job-related consequences.
Discussion
The main finding of this study is that severity of the injury is not the only predictor of the number of days of leave taken because of an accident. Apart from and independent of the severity of the accident, three other variables predicted time off from work after life-threatening accidents:
- Patients resumed work earlier after injuries that had been sustained during sports or leisure activities then after injuries that had been sustained at their workplace or in traffic accidents.
- Patients’ appraisal of the severity of their accident made a substantial contribution to the duration of their time off work
- Patients’ appraisal of their abilities to cope with the accident and its job-related consequences also played an important part in the duration of days off from work after an accident
The study has several limitations. In particular, the investigation did not include the full spectrum of accident victims, the patients’ self-appraisals were not assessed with validated instruments, and patients’ reports may have been influenced by pain or sleep medication.
Although the results of the study need to be replicated, they may have important implications not only for the understanding but also for the treatment of patients after life-threatening accidents. Higher appraisals of accident severity as well as pessimistic and negative appraisals of coping abilities may be amenable to change, e.g. through treatment with antidepressant drugs or cognitive behavior therapy.