Examining Predictors of Disability and Return to Usual Activities among Patients with Road Traffic Injuries in Bangladesh
Open AccessRoad traffic crashes cause 20 to 50 million injuries each year globally. Non-fatal road traffic injuries (RTIs) are a leading cause of disability in low and middle-income countries, causing a major drain on health systems. Despite this burden, there is a lack of robust surveillance data on the consequences of RTIs, specifically the level of disability among survivors of road traffic crashes and its impact on their everyday lives.This study aims to 1) develop and implement a questionnaire that measures disability and related consequences among patients with RTIs post-hospitalization and 2) identify factors contributing to disability and its consequences in Bangladesh using a prospective observational design.The study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation in Dhaka. The study population included adult patients with RTIs admitted to the hospital for at least 24 hours. Data was collected using a hospital-based surveillance tool and a telephone-based follow-up questionnaire administered one month, three months, and six months after discharge. To develop the follow-up questionnaire, a literature search was conducted to identify disability instruments which were evaluated according to the International Classification of Functioning, Disability and Health framework. Items from two instruments were selected, modified, translated to Bengali, and administered among the sample of trauma patients. Instrument construct validity and reliability were tested using one-month data via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Descriptive analysis and multivariable models were performed cross-sectionally and longitudinally to estimate the contribution of different factors in predicting disability and return to usual activities.The literature search identified 15 follow-up instruments that met the inclusion criteria for evaluation. World Health Organization Disability Assessment Schedule (WHODAS) 2.0 12-item short form and Craig Hospital Inventory of Environmental Factors were selected to develop our follow-up questionnaire. The study enrolled 836 patients whose mean age was 36.0 years (SD = 14.3). Most participants (88.6%) were men, 19.7% were pedestrians, and 44.4% underwent an operation. A total of 696 patients participated in the one-month follow-up. CFA for WHODAS 2.0 showed a single-factor structure with mixed results (CFI = 0.99, TLI = 0.97, SRMR = .05, RMSEA = .15). The instrument had excellent internal consistency (α = 0.96).The average disability score (0-48) decreased from 37.8 (SD = 10.4) at one month to 20.2 (SD = 17.9) at six months; 40.3% of respondents experienced environmental barriers at three months and 14.7% at six months. Factors contributing to disability score included undergoing an operation (β 2.79, p < .05) and experiencing moderate to extreme environmental barriers (β 5.63, p < .01). Disability score and experiencing environmental barriers were strong predictors of not returning to usual activities (AOR 0.72, p < 0.01 and AOR 0.09, p < 0.01, respectively).Findings suggest that the Bengali WHODAS 2.0 is reasonably valid and reliable for measuring disability among patients with RTIs. Despite improvement in functional level over time, there is a need for comprehensive post-hospitalization interventions to increase functional ability through rehabilitation and creating an accessible environment to facilitate faster participation in society.
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