The Mind Continues to Matter: Psychologic and Physical Recovery 5 Years After Musculoskeletal Trauma

OBJECTIVES: Posttraumatic psychopathology may complicate recovery from musculoskeletal injury. This article details the 5-year follow-up of a cohort study examining the relationship between posttraumatic psychopathology and recovery after musculoskeletal trauma. DESIGN: A prospective cohort study of patients with musculoskeletal injuries (Grampian Trauma Outcomes Study) assessed 5 years after their injury. SETTING: Orthopaedic trauma unit, Level I equivalent. PATIENTS: One hundred four of the initial group of 200 patients with musculoskeletal injuries. INTERVENTION: Trauma care and prospective evaluation of physical and psychologic recovery. MAIN OUTCOME MEASURES: Development of psychopathology (measured by the General Health Questionnaire GHQ) and functional outcome (measured by Short Form-36 SF-36 and Musculoskeletal Function Assessment MFA). RESULTS: Follow-up at 5 years was 104 patients (52%). GHQ caseness was predictive of physical dysfunction (SF-36, MFA), which had not returned to baseline levels by 5 years. Although injury severity was strongly predictive of psychological disturbance (GHQ caseness) at 5 years, linear regression analysis demonstrated that GHQ score was an important predictor of outcome, whereas Injury Severity Score contributed very little. CONCLUSIONS: Psychologic disturbance after musculoskeletal trauma is related to adverse functional outcome. This is not influenced by preinjury state, but constitutes a sustained posttraumatic effect that is only weakly related to severity of injury.