Factors associated with independence in activities at hospital discharge, three and six months after injury in humanitarian settings: A multicenter, prospective cohort study

In humanitarian settings, resuming daily activities after injury is a pivotal aspect of recovery, though under-reported. This study aimed to describe recovery of functioning and identify factors associated with independence in activities up to 6 months after injury in 4 humanitarian settings.

This prospective cohort study included patients older than 5 years, admitted for acute injury to 4 health facilities managed or supported by Médecins Sans Frontières, located in Cameroon, Central African Republic, Burundi, and Haiti. Aspects of functioning, including independence in activities, were assessed using the Activity Independence Measure-Trauma at hospital admission and discharge, and at 3 and 6 months after injury. Multivariable logistic regression models were run at each time point to identify factors associated with independence.

Between June 2020 and January 2022, 554 patients were included, with follow-up data available for 477 and 486 patients at 3 and 6 months respectively. At 6 months, 257 patients were independent from human and material assistance. Factors associated with independence at several time points included being a child, having visceral injury, having no fracture, higher independence at the previous time point, and having received early physiotherapy.

Nearly half of patients continued to experience difficulties in functioning at 6 months, emphasising the necessity for trauma care beyond lifesaving procedures. Early physiotherapy was significantly associated with recovery of independence, indicating its potential to enhance recovery after injury in humanitarian settings.

This publication relates to R2HC funded study; Determinants of functional outcomes after trauma in humanitarian settings