Is There an Association Between History of Intimate Partner Violence and Reported Health Outcomes After Orthopaedic...

Intimate partner violence (IPV) is estimated to affect 15% to 71% of women and 10% to 14% of men in the United States, with musculoskeletal injuries being the second most common manifestation of IPV. Existing research on IPV has largely been conducted in White, English-speaking women, with little data on IPV in men, socioeconomically and ethnically diverse populations, and nonbinary individuals. Moreover, the scope of outcome measures has been limited, with few studies evaluating patient-reported and long-term outcomes in this area.

Do patients who screen positive for IPV after injury report lower health-related quality of life compared with those who screen negative in an orthopaedic hand and upper extremity clinic?

A prospective study was completed between August 2022 to May 2023 at an orthopaedic hand clinic within a large urban Level 1 trauma hospital. Inclusion criteria were all patients age 18 years and older who presented with acute upper extremity injury and had the ability to complete forms in English, Haitian Creole, or Spanish independently. We invited 713 patients to participate; 25% (178) did not consent, and data from 5% (35) were excluded because the data were incomplete, leaving a total enrollment of 500 patients. Fifty-eight percent (289 of 500) of the participants were men, 71% (357 of 500) were Hispanic, 48% (233 of 482) were not US citizens, 47% (236 of 498) were single, and 34% (170 of 500) were without healthcare insurance; the study group had a mean age of 45 years. Participants were screened for IPV using the Direct IPV screening tool and Extended Hurt, Insult, Threaten, Scream (E-HITS) tools. Participants then completed a study-specific clinical survey and the three-level EQ-5D-3L survey, a validated 5-question patient-reported outcome measure that assesses health-related quality of life. The overall calculated index ranges from 5 (best health) to 15 (worst health), with prior research reporting a minimum clinically important difference (MCID) of 0.074. Kruskal-Wallis tests were used for continuous and categorical data, chi-square or Fisher exact tests for categorical comparisons, and a logistic regression analysis to identify factors influencing positive IPV screening. We reported both unadjusted and adjusted ORs to assess variable influence.

The proportion of patients who screened positive for experiencing IPV within their lifetime in our study was 24% (120 of 500). Patients who screened positive for IPV reported lower health-related quality of life compared with those who screened negative in addition to reported differences in EQ-5D-3L scores (median 8.0 [IQR 6.0 to 10.0]) compared with those who did not report IPV (median 7.0 [IQR 6.0 to 9.0]; p = 0.003). The difference in EQ-5D-3L scores between positive and negative IPV disclosure groups, respectively, also surpassed the accepted MCID within the disability subcategories of mobility (mean ± SD 1.4 ± 0.6 versus 1.2 ± 0.5; p = 0.04), pain/discomfort (2.1 ± 0.7 versus 1.8 ± 0.6; p = 0.006), and anxiety/depression (1.9 ± 0.7 versus 1.4 ± 0.6; p < 0.001). We found no difference in the EQ-5D-3L disability subcategories of self-care (1.4 ± 0.6 versus 1.4 ± 0.6; p = 0.88) and usual activities (1.7 ± 0.6 versus 1.7 ± 0.7; p = 0.74) reported between groups.

To our knowledge, this is the first study that has been performed in a predominantly non-White, mixed-gender, socioeconomically underserved population. This study demonstrates that current standardized screening tools for IPV can be effectively used in a more general population. This screening is important, as our study found that patients who disclose IPV reported greater disability than their counterparts with EQ-5D-3L scores that surpassed the MCID both overall and within several subcategories. Based on these discoveries, orthopaedic surgeons might consider screening prospectively for IPV in all patients who present with hand and upper extremity injuries so that prompt referral to support services can be made. This may improve a patient's likelihood of obtaining satisfactory health outcomes after injury.

Level II, therapeutic study.