Health Related Quality of Life after serious occupational injuries and long term disability Presenter: Ibishi Nazmie MD,PhD University Clinical Center of Kosovo Clinic Of Psychiatry Selmani Xhemajl, Zajic-Stojanovic –Vlasta,Tolaj Arber

Disclosure We have no potential conflict of interest to declare.

Issue  Work-related injuries constitute an important public health problem.  They can be disabling, leading to major adverse social and economic consequences for the worker and his/her family.

Description  Work plays an essential role in life and health conditions of individuals, families and the population in general.  Occupational injury occur during work tasks, causing physical lesion or functional disorder that leads to temporary or permanent reduction of work capacity.

Description  Occupational injuries are the most reported injuries to workers' health all over the world, even taking into account under- notification.  The research investigating specifically HRQoL, in injured workers, and extent to which occupational accidents impact the HRQoL, are rare.

Complex interplay

Many factors influence QoL after traumatic work injury QoL domains  Physical well-being  Social well-being.  Development and activity.  Emotional well-being.  Psychological well-being.  Life satisfaction.  Domain specific satisfaction.  Engaging activities and work.  patient care interventions,  injury type,  disability,  mental health, and  socioeconomic status.

Instruments  Currently there are many instruments available to quantify the physical, functional, and psychological aspects of recovery from traumatic work injury.  The most widely used instruments for Health-related Quality of Life in the studies are:  Short Form-36 (SF-36) which assess physical, functional, social, and psychological well being,  European Quality of Life -Five Dimensions (EQ-5D) and  Quality of Well-being scale (QWB).

Independent predictors  Independent predictors of good HRQoL and return to work at 3 months were:  low age,  low ISS,  absence of depression symptoms.  At 12 months, independent predictors of good HRQoL and return to work were:  low ISS,  low depression score and  an optimistic life orientation, and better coping strategies  frequent participation in daily activities.

HRQoL decline  Results confirm that occupational injuries cause significant deficits in the physical component of HRQOL, (Baragaba et al.2016) While another study confirm that:  reduced HRQOL, was observed for occupational injured workers, with more depressive symptoms. ( Wen-Hsuan Hou et al.2012).

Coping strategy  Survivors of working trauma have the challenge of coping with both the physical and emotional consequences of the injury as the association between life orientation and HRQOL in trauma patients is mediated by coping strategy.  Depression at baseline was a predictor of lower HRQOL in four dimensions:  physical functioning,  mental health,  bodily pain and  vitality.

Description  As depression is a psychological symptom, it is not surprising that it predicts mental health conditions and functioning.  More surprisingly, was that depression predicted physical functioning.  This might be because depressed patients have little energy, which influences their ability to exercise and to regain their previous level of function after the injury.

Results  Overall HRQoL scores in most of studies remain significantly below population norms.  This QoL decline, is both associated with and predicted by functional and psychological parameters.  However, some are potentially modifiable.  According to this, it is important to identify and understand not only those factors associated with poor quality of life, but to identify factors that are predictive and potentially modifiable to improve QoL in the trauma injured workers.

Results  The level of physical, psychological and social HRQoL during the time period of sick leaves should take into account in measuring the impact of certain injuries on occupational health.  The approach to integrating both the injury related sick leave /days before return to work, and the HRQoL decline in assessing of impact of work injuries has not been investigated until now, enough.

Results  To improve HRQOL, patients with a pessimistic life orientation should be identified and interventions targeting and better coping should be offered. A helpless/hopeless strategy can be improved using cognitive behavioral therapy.  This means that patients could be screened for depression after trauma and that depressed patients could be offered treatment for this condition. They might benefit from being taught coping strategies to manage physical training, despite the depression.

Lessons  Increased knowledge of HRQOL predictors after work related trauma may enable us to optimize and individually tailor interventions at an early stage in treatment and rehabilitation.  Although psychological consequences of physical injury may contribute to long-term disability, all significant risk factors and predictors of HRQoL decline, for long-term disability after occupational injury, have yet to be identified in the future.

Lessons  Once these factors are known, interventions to ameliorate their effect on injury outcomes can be developed to maximize recovery in patients with serious work-related traumatic injuries.  The timely and accurate ability to predict long- term disability shortly after injury would make it possible to recognize patients at high risk and efficiently implement interventions to limit the duration and severity of long-term disability.

Thank you for your attention.