Implications for practice and research

• Disability among participants hospitalised for injury is prevalent 12 months after injury.

• Opportunities exist for research into improved screening for pain and psychiatric symptoms among injured patients, and also to test interventions for their capacity to inform policy and improve disability outcomes.

Context

Internationally, there is increasing interest in understanding disability following injury.1 ,2 Much research has been concentrated on physical rather than mental disability outcomes. O’Donnell and colleagues aimed to document the level of disability experienced 12 months after an injury that resulted in hospitalisation for a period of over 24 h. They also examined the interactions between acute and 12-month injury characteristics, pain, psychiatric symptoms and disability according to the 12-item version of the WHO Disability Assessment Schedule (WHODAS II).

Findings

The prevalence of disability 12 months postinjury was up to four times that reported by the general population. Injury characteristics and pain both contributed to disability, but psychiatric symptoms (12 months postinjury) had the strongest relationship with disability.

Commentary

The researchers suggest that a limitation of their research was the use of self-reported measures, suggesting that a clinician-assessment of disability or other ‘objective’ measures such as return to work would be an improvement. While clinical outcomes are undoubtedly important, the measure of disability used in this study was appropriate. It is difficult to envisage how, in the context of clinic visits, clinicians can better ascertain disability outcomes than the participants themselves. Also, while it would be interesting to see research investigating paid employment outcomes, employment is not necessarily a more ‘objective’ measure, being affected by the existence of vocational rehabilitation programmes, trade agreements, the vagaries of global recession and social capital available to the injured.

It would be useful if the authors had provided additional detail about the model development. In contrast to their prior research,3 weak relationships exist between early psychiatric symptoms and disability at 12 months, yet strong indirect relationships are apparent between concurrent 12-month psychiatric symptoms and disability. However, rather than ‘psychiatric symptoms (being) an important driver of long-term disability in injury patients’ (p141), perhaps disability is driving concurrent psychiatric symptoms?

The researchers help address a gap in our understanding of disability following injury. Their finding that disability outcomes were not largely explained by injury characteristics, including the ISS,4 an anatomical measure of injury severity, resonates with results emerging from another longitudinal study.5 Given that measures such as the ISS are calculated in response to mortality outcomes rather than disability outcomes, this is not altogether surprising. Instead we see that relationships exist between disability and pain and psychiatric symptoms. Both pain and psychiatric symptoms provide opportunities for intervention. The researchers’ call for research into improved screening and interventions to inform policy efforts in the important, but too-often overlooked, area of injury-related disability is timely.