Social determinants of outcomes in nonoperatively treated proximal humerus fractures

© 2023 The Authors.

Bibliographische Detailangaben
Veröffentlicht in:JSES international. - 2020. - 7(2023), 5 vom: 20. Sept., Seite 743-750
1. Verfasser: Chua, Shaun Kai Kiat (VerfasserIn)
Weitere Verfasser: Soh, Qian Ying, Lim, Chien Joo, Ring, David, Chua, Ivan Tjun Huat, Kwek, Ernest Beng Kee, Tan, Bryan Yijia
Format: Online-Aufsatz
Sprache:English
Veröffentlicht: 2023
Zugriff auf das übergeordnete Werk:JSES international
Schlagworte:Journal Article Conservative Nonoperative Proximal humerus fractures Social determinants of health Social factors Trauma
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100 1 |a Chua, Shaun Kai Kiat  |e verfasserin  |4 aut 
245 1 0 |a Social determinants of outcomes in nonoperatively treated proximal humerus fractures 
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520 |a Background: Proximal humerus fractures (PHFs) are common fractures especially in the elderly, with most fractures being managed nonoperatively. Traditional biomedical factors such as radiological alignment have not been able to meaningfully predict comfort and capability after PHFs. Conversely, recent literature has increasingly recognized the role of psychological factors in determining comfort and capability after PHFs. Nonetheless, less is known about the impact of social factors. Additional study of these potentially modifiable social factors as targets for enhancing recovery from injury is merited. Among people recovering from a nonoperatively- treated proximal humerus fracture (PHF) we studied the social factors associated with patient-reported outcomes at 6 months and 1 year 
520 |a Methods: One hundred seventy-one patients who received nonoperative management of a PHF completed baseline measures of sociodemographic characteristics (age, gender, race, employment status, household income, educational level, presence of domestic workers, housing type, and smoking status). Six and 12 months after fracture, participants completed the Oxford Shoulder Score (OSS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and EuroQol-5-Dimensions (EQ5D) measures of comfort and capability. The relationship between capability and social factors was assessed using linear regression modelling, accounting for potential confounding from age, fracture severity assessed using Neer classification, premorbid comorbidities measured by Charlson Comorbidity Index, and premorbid functional status measured by Parker Mobility Index and Barthel Index 
520 |a Results: Lower capability (higher QuickDASH scores) 6 months and 1 year after fracture were associated with being unemployed (coef: -5.02 [95% CI: -9.96 to -0.07]; P = .047) and having domestic workers at home (coef: 8.63 [95% CI: 1.39 to 15.86]; P = .020), but not with Neer classification. Both greater shoulder discomfort and magnitude of incapability (lower OSS scores) and worse general quality of life (lower EQ5D scores) were associated with having domestic workers (coef: -4.07 [95% CI: -6.62 to -1.53]; P = .002 and coef: -0.18 [95% CI: -0.29 to -0.07]; P = .001 respectively) or living in an assisted care facility (coef: -14.82 [95% CI: -22.24 to -7.39]; P < .001 and coef: -0.59 [95% CI: -0.90 to -0.29] P < .001) 
520 |a Conclusions: The finding that people recovering from PHF experience less incapability in proportion to their social independence (employment, absence of a caregiver such as domestic workers at home and living outside care facilities) emphasizes the important associations of social factors to musculoskeletal health, and the utility of accounting for social factors in the development and assessment of care strategies 
650 4 |a Journal Article 
650 4 |a Conservative 
650 4 |a Nonoperative 
650 4 |a Proximal humerus fractures 
650 4 |a Social determinants of health 
650 4 |a Social factors 
650 4 |a Trauma 
700 1 |a Soh, Qian Ying  |e verfasserin  |4 aut 
700 1 |a Lim, Chien Joo  |e verfasserin  |4 aut 
700 1 |a Ring, David  |e verfasserin  |4 aut 
700 1 |a Chua, Ivan Tjun Huat  |e verfasserin  |4 aut 
700 1 |a Kwek, Ernest Beng Kee  |e verfasserin  |4 aut 
700 1 |a Tan, Bryan Yijia  |e verfasserin  |4 aut 
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773 1 8 |g volume:7  |g year:2023  |g number:5  |g day:20  |g month:09  |g pages:743-750 
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