Factors associated with independence in activities at hospital discharge, 3 and 6 months after injury in humanitarian settings: A multicenter, prospective cohort study.

Abstract

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, using the Activity Independence Measure-Trauma, were assessed at hospital admission and discharge, and at 3 and 6 months after injury. Multivariable logistic regression models were run at discharge, and 3 and 6 months after injury to identify factors associated with independence in activities. 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 of the time points included being a child, having visceral injury, not having any fracture, having a higher independence at the previous time point, and/or having received early physiotherapy, when adjusted for covariates (P < .05). Nearly half of patients continued to experience difficulties in functioning at 6 months, emphasizing 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.