5194.0: Wednesday, November 15, 2000 - 3:30 PM

Abstract #3333

Risk factors for disability discharge after anterior cruciate ligament injury in active-duty Army personnel

Andrew E Lincoln, ScD, MS1, Warren R Dunn, MD2, Richard Y Hinton, MD, MPH, MEd, PT2, Gordon S Smith, MD, MPH1, and Paul J Amoroso, MD, MPH3. (1) Center for Injury Research and Policy, Johns Hopkins School of Hygiene and Public Health, 624 North Broadway, #512, Baltimore, MD 21205-1996, 410-614-4023, alincoln@jhsph.edu, (2) Department of Orthopaedic Surgery, The Union Memorial Hospital, The Johnson Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218, (3) U.S. Army Research Institute of Environmental Medicine, Attn: MCMR-UE-MPD, 42 Kansas Street, Natick, MA 01760-5007

To date, no large population-based studies have focused on work-related permanent disability after anterior cruciate ligament (ACL) hospitalization. We studied 2,192 active-duty Army personnel from their initial ACL hospitalization (1989 to 1996) to the development of physical disability as indicated by a disability-related discharge. Using the Total Army Injury and Health Outcomes Database, we assessed (via survival analysis) medical, demographic, occupational, and behavioral factors potentially associated with the development of permanent disability. Overall, 209/2192 (9.5%) initial ACL hospitalizations resulted in permanent disability discharge. In bivariate analyses, the following factors were related to development of disability: lower job satisfaction (p < 0.0001), lower education level (p < 0.0001), shorter length of service (p < 0.0001), lower pay grade/rank (p < 0.0001), older age (p < 0.01), cigarette smoking (p=0.01), and greater work stress (p=0.02). Although associated chondromalacia (p=0.07) and occupational physical demands (p=0.08) approached significance, other variables hypothesized to contribute to the development of disability, such as sex (p=0.85), ACL reconstruction (p=0.52), and other secondary knee comorbidities demonstrated no association. Proportional hazards regression analysis confirmed that pay grade/rank, job satisfaction, age, and length of service were independent predictors of disability discharge. Results revealed a multifactorial risk profile in which psychosocial factors were more predictive of disability than clinical factors, in keeping with risk profiles of several other musculoskeletal injuries, such as low back pain.

Learning Objectives: At the conclusion of the session, the participant will be able to: 1.Identify medical, psychosocial, and other non-clinical factors that influence the risk of disability following hospitalization for anterior cruciate ligament (ACL) injury in a young, active population; 2.Determine the effect of ACL reconstruction on the likelihood of physical disability; 3.Identify consistencies between predictors of disability following ACL injury and other musculoskeletal disorders

Keywords: Disability Studies, Workplace Stressors

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA