Trajectories and predictors of return-to-work after traumatic limb injuries

Objectives: To explore the trajectories of RTW and examine the predictors of different trajectories among workers after traumatic limb injury. Methods: A total of 804 participants were recruited during hospital admission for a two-year prospective study. The RTW outcome was repeatedly assessed at 1, 3, 6, 12, 18, and 24 months after the injury. A group-based trajectory model (GBTM) was employed to identify trajectories of RTW among the participants. Comparisons of group characteristics of different trajectories were performed based on a multinomial logistic regression. Results: GBTM identified three distinct trajectories of RTW: (a) Fast RTW consisted of workers with early and stable RTW status from the first month after the injury; (b) Average RTW consisted of workers who achieved and remained at a stable RTW status within 6 months; and (c) Slow RTW consisted of workers who had slow and unsustainable RTW status within the 2-year follow-up period. The estimated proportions were 21.5 %, 50.7 %, and 27.8%respectively. Workers with slowly slow and unsustainable RTW after injury were found to be older, married, less educated, employed as repair personnel/operators/labourers, seriously injured, and depressed; and to feel more disturbance in daily life, have less self-efficacy, and perceive worse quality-of-life. Conclusion: Individual workers after traumatic limb injury showed three distinct RTW trajectories, each of which was associated with different categories of bio-psycho-social factors. An understanding of how different factors contribute to increasing the likelihood of RTW for injured workers in each trajectory group should aid policy making in worker-oriented vocational rehabilitation programs.