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Assessment of pre-injury health-related quality of life: a systematic review

机译：评估伤害前与健康有关的生活质量：系统评价

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BackgroundInsight into the change from pre- to post-injury health-related quality of life (HRQL) of trauma patients is important to derive estimates of the impact of injury on HRQL. Prospectively collected pre-injury HRQL data are, however, often not available due to the difficulty to collect these data before the injury. We performed a systematic review on the current methods used to assess pre-injury health status and to estimate the change from pre- to post-injury HRQL due to an injury. MethodsA systematic literature search was conducted in EMBASE, MEDLINE, and other databases. We identified studies that reported on the pre-injury HRQL of trauma patients. Articles were collated by type of injury and HRQL instrument used. Reported pre-injury HRQL scores were compared with general age- and gender-adjusted norms for the EQ-5D, SF-36, and SF-12. ResultsWe retrieved results from 31 eligible studies, described in 41 publications. All but two studies used retrospective assessment and asked patients to recall their pre-injury HRQL, showing widely varying timings of assessments (soon after injury up to years after injury). These studies commonly applied the SF-36 ( n =?13), EQ-5D ( n =?9), or SF-12 ( n =?3) using questionnaires ( n =?14) or face-to-face interviews ( n =?11). Two studies reported prospective pre-injury assessment, based on prospective longitudinal cohort studies from a sample of initially non-injured patients, and applied questionnaires using the SF-36 or SF-12. The recalled pre-injury HRQL scores of injury patients consistently exceeded age- and sex-adjusted population norms, except in a limited number of studies on injury types of higher severity (e.g., traumatic brain injury and hip fractures). All studies reported reduced post-injury HRQL compared to pre-injury HRQL. Both prospective studies reported that patients had recovered to their pre-injury levels of physical and mental health, while in all but one retrospective study patients did not regain the reported pre-injury levels of HRQL, even years after injury. ConclusionsSo far, primarily retrospective research has been conducted to assess pre-injury HRQL. This research shows consistently higher pre-injury HRQL scores than population norms and a recovery that lags behind that of prospective assessments, implying a systematic overestimation of the change in HRQL from pre- to post-injury due to an injury. More prospective research is necessary to examine the effect of recall bias and response shift. Researchers should be aware of the bias that may arise when pre-injury HRQL is assessed retrospectively or when population norms are applied, and should use prospectively derived HRQL scores wherever possible to estimate the impact of injury on HRQL.
机译：背景洞悉创伤患者从受伤前的健康相关生活质量（HRQL）的变化对于得出损伤对HRQL的影响的估计很重要。然而，由于难以在受伤前收集这些数据，因此常常无法获得预先收集的受伤前HRQL数据。我们对当前用于评估受伤前健康状况并估计由于受伤导致的HRQL从受伤前到受伤后的变化的方法进行了系统的回顾。方法在EMBASE，MEDLINE和其他数据库中进行系统的文献检索。我们确定了报道创伤患者受伤前HRQL的研究。根据受伤类型和所使用的HRQL仪器整理文章。将报告的损伤前HRQL得分与EQ-5D，SF-36和SF-12的一般年龄和性别校正后的规范进行比较。结果我们检索了41篇出版物中描述的31项合格研究的结果。除两项研究外，所有研究均使用回顾性评估，并要求患者回顾其受伤前的HRQL，显示评估的时机差异很大（受伤后不久至受伤后数年）。这些研究通常使用问卷（n =？14）或面对面访谈来应用SF-36（n =？13），EQ-5D（n =？9）或SF-12（n =？3） （n ＝ 11）。有两项研究报告了前瞻性损伤评估，该评估基于对最初未受伤患者的样本进行的前瞻性纵向队列研究，并使用SF-36或SF-12进行了问卷调查。召回的受伤患者受伤前的HRQL分数始终超过年龄和性别校正的人群标准，但有关严重程度较高的伤害类型（例如，脑外伤和髋部骨折）的有限研究数量有限。所有研究均报告说，与损伤前HRQL相比，损伤后HRQL降低。两项前瞻性研究均报告说，患者的身体和精神健康已恢复到损伤前的水平，而除一项回顾性研究外，在所有损伤后甚至数年内，患者均未恢复报道的HRQL损伤前的水平。结论到目前为止，已经进行了主要的回顾性研究来评估损伤前HRQL。这项研究表明，受伤前HRQL得分始终高于人群标准，并且恢复率落后于前瞻性评估，这意味着系统地高估了受伤前HRQL从受伤前到受伤后的变化。为了检验召回偏见和反应转移的影响，需要进行更多的前瞻性研究。研究人员应意识到，当对伤前HRQL进行回顾性评估或应用人群规范时，可能会产生偏差，并应尽可能使用前瞻性得出的HRQL评分来估计伤害对HRQL的影响。

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