Physical functionality two years after major trauma: predictors from a single center cohort study

Traumatic injuries are a major global public health concern, often leading to impaired physical function and disability. Long-term physical function impairments can greatly affect a patient's health related quality of life, influencing their emotional state and social interactions. This study examines patient-reported physical functionality before and after major trauma, identifying key predictors of poor functional recovery.

This retrospective single-center cohort study investigates physical functionality 23 months after a traumatic injury using standardized questionnaires combined with clinical data. Inclusion criteria were Injury Severity Score (ISS) ≥ 9, requiring ICU treatment, and age ≥ 18 resulting in an eligible sample of 515 patients. Health outcomes were assessed using the Trauma Outcome Profile (TOP), the Abbreviated Injury Scale (AIS), and the ISS.

Physical functionality significantly decreased from 94.8 (SD 11.5) to 72.9 (SD 26.7) 23 months post-trauma with almost half of participants still scoring below the critical cutoff of 80 points. The strongest predictor for functional physical impairment was pre-trauma physical functionality (OR 8.21, p < 0.001). Other determinants included age (age 50-59 versus 18-29 OR 2.75, p = 0.001), as well as an impacted lower extremity including pelvic (OR 1.60, p = 0.018).

The most important predictors for a post-trauma impaired physical function are pre-trauma functionality and age. Among trauma related factors, injuries involving the lower extremities remained significantly associated with poorer long-term outcomes, whereas overall injury severity was not independently associated with functional impairment.