|Year : 2018 | Volume
| Issue : 1 | Page : 49-53
Health-related quality of life in Nigerian patients following maxillofacial and orthopedic injuries: A comparative study
Ramat Oyebunmi Braimah1, Dominic Ignatius Ukpong2, Kizito Chioma Ndukwe3, A Lawrence Akinyoola4
1 Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Mental Health, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
3 Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
4 Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
|Date of Web Publication||17-Aug-2018|
Dr. Ramat Oyebunmi Braimah
Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto State
Source of Support: None, Conflict of Interest: None
Background: Less attention has been focused on patient psychological status and quality of life (QoL) following maxillofacial and orthopedic trauma, especially in underdeveloped countries, hence need for such studies. Patients and Methods: This was a prospective, repeated measure design study of recruited participants in Obafemi Awolowo University teaching hospital, Ile-Ife, State of Osun, Nigeria. A total of 160 participants (80 with maxillofacial bone fracture and 80 with long bone fractures) had repeated review follow-ups within 1 week of arrival in the hospital (Time 1), 4–8 weeks after initial contact (Time 2), and 10–12 weeks thereafter (Time 3), using WHO HRQoL-Bref questionnaire. Results: Road traffic accident remained the main cause of injury in both groups of participants (85% in the maxillofacial fracture and 91.5% in long bone fracture patients). Most were male (80% in facial injured and 72% in long bone fracture patients). Majority of the patients were young adult (75% in the maxillofacial fracture and 55% in the long bone patient). QoL was poor in all domains in both groups. However, there were statistically significant differences between the two groups when compared in the physical health domain at Time 1 (P = 0.006), psychological health domain at Time 2 (P = 0.017), and both physical and psychological health domains at Time 3. Conclusions: Long bone fracture group had poorer QoL scores than the maxillofacial fracture group in some domains of the QoL instrument. Management of these injuries should integrate multidisciplinary care that will address QoL and psychological concerns of patients.
Keywords: Fracture, maxillofacial, orthopedics, quality of life, trauma
|How to cite this article:|
Braimah RO, Ukpong DI, Ndukwe KC, Akinyoola A L. Health-related quality of life in Nigerian patients following maxillofacial and orthopedic injuries: A comparative study. J Orthop Traumatol Rehabil 2018;10:49-53
|How to cite this URL:|
Braimah RO, Ukpong DI, Ndukwe KC, Akinyoola A L. Health-related quality of life in Nigerian patients following maxillofacial and orthopedic injuries: A comparative study. J Orthop Traumatol Rehabil [serial online] 2018 [cited 2021 Sep 22];10:49-53. Available from: https://www.jotr.in/text.asp?2018/10/1/49/239262
| Introduction|| |
The face is usually involved in a host of important roles and functions in everyday life. The appearance and “attractiveness” of a person to other people is partly contributed by the person's face. As a result of maxillofacial trauma, the patient may suffer facial disfigurement, chronic facial pain, anosmia, dysosmia, speech, dental, and ophthalmological disabilities. Often times, attention is focused on the obvious physical aspect of maxillofacial trauma while the impact on the patient's psychological makeup and quality of life (QoL) is relegated to the background or even ignored. Most of the studies on psychological consequences and QoL in patients following maxillofacial injuries have been conducted in Western countries. Such studies in Sub-Saharan Africa are rare.
Similarly, several studies of patients with orthopedic trauma have focused on measures of functional recovery, complications, mortality, and costs.,,, Less attention has been focused on patient psychological status and QoL following orthopedic trauma – a common source of patient complaints and a clinically relevant outcome. The present study hopes to compare QoL during the course of treatment in these two groups of patients.
| Patients and Methods|| |
The patients were consecutive patients who presented at the Accident and Emergency unit, Oral/Maxillofacial Surgery and Orthopaedic and Traumatology Units of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Patients were recruited over 12 months from February 2012 to January 2013, after approval from the hospital's Ethics and Research Committee.
Participants were patients with facial trauma (soft-tissue injuries or fractured facial bones or both) and orthopedic trauma (long bone fracture only) who gave informed consent for the study. The inclusion criteria were age 18 years and above and Glasgow Coma Scale of 12 and above on admission. Baseline interview was conducted within 1 week of arrival in the hospital (Time 1). Follow-up interviews were conducted at intervals of 4–8 weeks after initial contact (Time 2) and 10–12 weeks thereafter (Time 3).
Sociodemographic and clinical data
The data were obtained using a specially prepared questionnaire. Documentation at baseline included age, gender, educational status, employment status, and marital status. The clinical information includes cause of injury, site of injury, and type of injury.
Quality of life
The health-related QoL of the patients was assessed using the 26-item World Health Organization-Quality of life assessment instrument (WHOQoL-Bref). This short version QoL assessment tool is a generic measure designed for use within a wide range of psychological and physical disorders. It is a multidimensional instrument and was developed for cross-cultural use; it assesses subjective QoL. It contains 26 questions and uses a five-point interval Likert response scale. For this study, the four-domain model was applied. The four domains are those of physical health, psychological health, social relationships, and environment. Scores for domains were transformed on a scale of 4–20, with 20 being the highest and 4 being the lowest. Scores were scaled in a positive direction. Higher scores denote high QoL and low scores show low QoL. The WHOQoL-Bref has been widely used in Nigeria.
Data were analyzed with SPSS version 16 (SPSS 16 Inc., Chicago, IL, USA). Results were calculated as frequencies (%), means, and standard deviations (SDs) for normally distributed variables. Independent-samples t-test was used to compare mean score values for the domains of the WHOQoL and between-group differences. P < 0.05 was accepted as statistically significant.
| Results|| |
The total study population was 160 (80 with facial injuries and 80 with long bone fractures). Of the 80 patient in the facial injury group, 76 of them completed the study at Time 3 while in the long bone fracture group 69 participants completed the study out of the 80 patients at Time 3. There were 122 (76.3%) male and 38 (23.7%) female. The mean age of the sample was 33.2 ± 12.5, range 18–70 years. The facial injury group was younger than the long bone fracture group with the mean age of 30.9 ± 11.3 and 37.6 ± 12.8, respectively. Road traffic accidents were responsible for a sizeable proportion of injuries in both groups, 68 (85%) in the facial injured and 73 (91.3%) in the long bone fracture group. The sociodemographic characteristics of the study population are shown in [Table 1]. Only 21 patients where admitted in the facial injured group and most of them were discharged home within 1 week of hospital stay (16 [76.2%]), while 71 patients were admitted in the long bone fracture group and majority stayed over 12 weeks on admission (59 [83.1%]) as shown in [Table 2].
Mandibular fracture was the most frequently fractured facial bone (n = 46) followed by mandible + maxillary fracture (n = 14). The distribution of these is shown in [Figure 1]. Tibiofibular fracture (n = 23) is the most frequently occurring long bone fracture followed by fracture of the femur (n = 22). The distributions of these are shown in [Table 3].
|Figure 1: Bar chart showing distribution of maxillofacial bone fractures|
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[Table 4] shows the mean QoL domain scores at different time intervals. When both groups of patients were compared, HRQoL was significantly lower in the long bone fracture group in the physical health domain at Time 1 (P = 0.006), psychological health domain at Time 2 (P = 0.017), and physical and psychological health domains at Time 3 (P = 0.027 and P = 0.002, respectively).
|Table 4: Changes in mean quality of life-BREF score according to domains at times 1, 2, and 3|
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| Discussion|| |
The present study recorded male preponderance for both the facial and the long bone injured patients. The reason for this observation is that motorcycle operators were predominantly males. This pattern is in agreement with previous findings where male preponderance was reported.,, The overall mean age for the study population was 33.2 (SD ± 12.5) years. This finding is also in agreement with previous studies where young adults are frequently involved in road traffic accidents., This age group is the period of high activity and individuals in this age group are more likely to take part in dangerous and risky exercises and sports, drive motor vehicle and motorcycles carelessly and are likely to be involved in violence. More than half of the participants who sustained both the facial and long bone fracture were either unemployed or involved in unskilled jobs. These findings echoed previous findings that patients with orofacial injuries have psychosocial problems such as unemployment, lower educational level, and poor social support.
In both the facial injury and long bone fracture participants, road traffic accidents accounted for most of the injuries, 85% and 91.3%, respectively. These findings are similar to those of previous reports ,,, where 84% of injuries resulted from road traffic accidents. Road traffic accident remains the most common cause of maxillofacial injury because of inadequate vehicular maintenance, lack of traffic laws enforcement, and poor educational status of drivers. In Europe, United States of America, and other developed parts of the world, the mandatory uses of seat belts, crash helmets, traffic law enforcement, and increase in the use of vehicles with airbags have reduced the incidence of maxillofacial injuries due to road traffic accident.,
Majority of the road traffic accident were motorcycle related in both groups, 76.6% in facial injured patients and 54.1% in long bone fracture patients. This is because motorcycle is still a major means of transportation in this part of the world and riders do not often wear protective helmets making them more prone to head and facial injuries. Frequent traffic congestion because of poor road maintenance/network has made this mode of transportation attractive in most communities because motorcycles can navigate through narrow ways. Whereas, motorcycle-related facial trauma has been on the increase in Nigeria, a study in Europe, however, showed a decline in the incidence of such injuries in motorcycle-related accident. Enforcement and use of appropriate crash helmets and increasing vehicle ownership due to increase in wealth were the reasons given for this decrease.
Assault-related maxillofacial injuries remain the main cause of maxillofacial trauma in industrialized nations.,, This was not observed in this study as assault accounted for only 6 (7.5%) cases of facial trauma.
Quality of life
It is important to note that both groups of patients are comparable in QoL scores in social and environment domains throughout the study period, but they, however, differ in the domains of physical health and psychological health. These differences became highly significant, especially at Time 1 for the physical health domain and at Time 2 for the psychological health domain and at Time 3 for the psychological health and physical health domains. One can speculate that these differences could have been the problem of restricted mobility for the long bone fracture patient and that majority of the long bone fracture participant had surgical treatments such as open reduction and rigid internal fixation that prolongs hospital stay and ultimately increase the cost of treatment. Lower HRQoL after physical trauma has been reported in other studies., In addition, it is probable that the physical dysfunction caused by these injuries may adversely affect the patients' ability to undertake their daily activities and lower their mood and sense of self-esteem.
This study confirms previous findings that psychological complications are common among orthopedic trauma patients., In a study, it was reported that one in every five patient satisfied the criteria for psychosocial distress following orthopedic trauma with a prevalence rate of 22%. This present study has shown that long bone fracture group had poorer QoL scores as compared to facial injured group. The reason for this observation is that most of the long bone fracture patients were admitted 88.8% (71 patients) as compared to facial injured 16.8% (21 patients). Out of the 21 patients admitted because of facial injury, 76.2% (16 patients) were discharged from the hospital within 1 week, while majority, 83.1% (59 patients), of the admitted long bone fracture patients were still on admission after 12 weeks [Table 2]. This long hospital stay in the long bone fracture group and also because of the physical injury, mobility is affected and ability to carry out daily activities becomes a challenge with overall poor QoL.
| Conclusions|| |
Sociodemographic characteristics and QoL scores in social and environment domains throughout the study period between the two groups were comparable. However, QoL score in the domains of physical health and psychological health differ between the two groups. Although, our study is single-center study, nevertheless, the prospective nature of the study can serve as a baseline data to highlight QoL changes after maxillofacial trauma and orthopedic injuries which has not been previously documented in this part of the world. Management of these injuries should integrate multidisciplinary care that will address quality of life and psychological concerns of patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]