Review PaperThe impacts of injury at the individual, community and societal levels: a systematic meta-review
Introduction
There is substantial and robust published literature on the impacts of injury on the injured person including commonly reported outcomes such as mortality,1, 2 morbidity,3 and quality of life.4, 5 These and other impacts have been systematically studied, and form the basis of estimates of injury burden that influence government investment in injury prevention, treatment and rehabilitation programs.6
In contrast, knowledge of the impacts of injury beyond the injured person is relatively sparse. Individual studies suggest that families,7, 8, 9 work colleagues and employers,10 health systems,6 and social services11 are all affected by an injury incurred by another. In other words, injury has a ‘ripple effect’ that can extend far beyond the injured person.12, 13, 14 Despite this knowledge, there have been few systematic attempts to describe these broader impacts. This study seeks to describe this breadth of research using a meta-review methodology.
In the past decade a number of conceptual frameworks that describe the impacts of injury have been established. While some are context specific (e.g., workplace injury12), others attempt to conceptualize and categorize the multidimensional nature of the full injury burden.14, 16 Such frameworks can provide important guidance for public policy development by providing direction and structure to discussions on key issues, through streamlining communication of ideas using a defined framework, providing a medium on which to translate ideas between jurisdictions, and identifying expected outcomes both positive and negative of action or inaction. Frameworks can also inform outcome measurement, and be used to establish a clear understanding of the impact of preventive, treatment and rehabilitation strategies. In the field of injury research, existing frameworks do not sufficiently capture the multidimensional impacts of injury. Some are narrowly focussed and, as such, have substantial depth in one area, but limited breadth. For example, the International Classification of Functioning (ICF) is primarily concerned with impacts on the individual (body structure, body function, activity and participation).14 The ICF framework appears to be an ideal model for conceptualizing the impact of injury in the context of the individual and their direct and indirect network. However, it maintains at every level a focus on the individual, and how that individual is affected rather than the broader impacts at community and societal levels. Similarly, the framework described by Dembe and colleagues is focussed exclusively on the impacts of workplace injury.12 Other frameworks cover multiple domains but fail to incorporate important outcomes in some areas (i.e., they have breadth but lack depth). For example, the List of All Deficits (LOAD) framework describes 20 potential areas of outcome across the three broad domains of the individual, family and societal levels. However, the LOAD framework does not include impacts on co-workers or employers, now recognized as a significant outcome of many injuries.12, 17 This framework has also been developed by expert consensus rather than by systematic capture and analysis of published, peer reviewed research literature. We propose that a systematic approach to the description and capture of injury outcome information is necessary to advance the field.
To address this objective, this study sought to: first, summarize the published research literature in the field of injury outcomes using a meta-review methodology and; second, to describe an injury outcome framework that both captures the impacts of injury arising from the meta-review and is sufficiently flexible to allow extension and elucidation as further research evidence emerges.
Section snippets
Search strategy and selection criteria
The literature search sought to identify peer-reviewed literature reviews describing adolescent and adult injury outcomes. Injury was operationally defined to include cases of harm inflicted on an individual through unintentional (e.g., falls, motor vehicle crash) actions and included both physical (e.g., fracture, soft-tissue injury) and psychological harm (i.e., mental health conditions). Six on-line databases [Medline, Psychinfo, Embase, International Bibliography of Social Sciences (IBSS),
Results
The literature search identified 3178 abstracts. Following application of the inclusion and exclusion criteria, 78 studies were included in the final set for analysis. A summary of the included articles is shown in Table 1. Of the 78 reviews included, there were 32 systematic reviews, 28 narrative reviews and 18 meta-analyses. Six of these studies included information relevant to more than one domain (as noted by an * in Table 2, Table 3, Table 4), and a total of 96 distinct impacts were
Discussion
The results identified that the vast majority of injury outcomes literature identified in this meta-review focused on the impacts of injury on the injured person. More than 83% of included reviews reported individual level impacts including changes in body function, activity, participation and mortality. The remaining literature reported on the community and societal impacts of injury. Literature identified in the individual and community domains was dominated by serious injuries, such as TBI
Practical applications
The study has important implication for the design of injury surveillance systems. Most injury surveillance systems collect data relating to the injured person, but include relatively little information on community and societal factors, despite these factors being substantial predictors of injury outcome. For example, databases used in work-related injury compensation systems collect detailed information on injury type and mechanism, person-specific demographic information such as age, gender
Limitations
The framework is currently limited by its reliance on review papers. In practice, this means that some primary studies that identify outcomes beyond those reported in the review literature have not been included in the draft framework. For example, we did not identify some outcomes in the LOAD framework, such as the development of secondary conditions subsequent to a primary injury. However, as already noted the framework is designed to be extended and revised as this evidence is added, and as
Conclusion
In summary, this meta-review has identified a substantial body of knowledge at the individual level, and a relative lack of information regarding the community and societal impacts of injury. The results have allowed translation of the evidence into an injury outcome framework that provides a foundation for understanding the impacts of injury beyond the injured person. Such information is crucial for effective public policy development and implementation, and for systems and strategies to
Ethical approval
Not required.
Funding
ARC-Linkage project.
Competing interests
None declared.
References (94)
- et al.
Family consequences of chronic back pain
Soc Sci Med
(2004) - et al.
Long-term cognitive outcome in moderate to severe traumatic brain injury: a meta-analysis examining timed and untimed tests at 1 and 4.5 or more years after injury
Arch Phys Med Rehabil
(2008) - et al.
Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis
Am J Kidney Dis Off J Natl Kidney Found
(2009) - et al.
Depression following traumatic brain injury
Arch Phys Med Rehabil
(1998) - et al.
Prospective memory in patients with closed head injury: a review
Neuropsychologia
(2011) - et al.
Depression in survivors of burn injury: a systematic review
Gen Hosp Psychiatry
(2006) Sexuality after spinal cord injury: a critical review
Clin Psychol Rev
(1987)- et al.
Return to work after head injury: a review of post-war studies
Injury
(1980) Pain following spinal cord injury
Phys Med Rehabil Clin N Am
(2007)- et al.
AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews
J Clin Epidemiol
(2009)
Long-term mortality following injury in working-age adults: a systematic review
Int J Inj Control Saf Promot
Distant sequelae of traumatic brain injury: premature mortality and intracranial neoplasms
J Head Trauma Rehabil
Long term health outcomes after injury in working age adults: a systematic review
J Epidemiol Community Health
Prevalence of chronic pain after traumatic spinal cord injury: a systematic review
J Rehabil Res Dev
Quality of life after spinal cord injury: a literature critique and meta-analysis (1983–1992)
J Am Paraplegia Soc
The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020
The impact of occupational injury on injured worker and family: outcomes of upper extremity cumulative trauma disorders in Maryland workers
Am J Ind Med
A longitudinal analysis of psychological impact and coping strategies following spinal cord injury
Br J Health Psychol
Systematic review of the qualitative literature on return to work after injury
Scand J Work Environ Health
Social and economic consequences of workplace injury: a population-based study of workers in British Columbia, Canada
Am J Ind Med
The social consequences of occupational injuries and illnesses
Am J Ind Med
Economic consequences of workplace injuries and illnesses: lost earnings and benefit adequacy
Am J Ind Med
International classification of functioning
The injury list of all deficits (LOAD) framework – conceptualising the full range of deficits and adverse outcomes following injury and violence
Int J Inj Control Saf Promot
Prediction of occupational disability: disability: models, factors and outcomes
A systematic review of post-deployment injury-related mortality among military personnel deployed to conflict zones
BMC Public Health
Changes in attention and information-processing speed following severe traumatic brain injury: a meta-analytic review
Neuropsychology
Cognitive functioning after whiplash injury: a meta-analysis
J Int Neuropsychol Soc
Cognitive outcome following traumatic brain injury
J Head Trauma Rehabil
Epidemiology of burn injuries in the East Mediterranean Region: a systematic review
BMC Public Health
Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis
J Int Neuropsychol Soc
Fertility following spinal cord injury: a systematic review
Spinal Cord Off J Int Med Soc Paraplegia
Long-term neurologic outcomes after traumatic brain injury
J Head Trauma Rehabil
Long-term psychiatric outcomes following traumatic brain injury: a review of the literature
J Head Trauma Rehabil
Neuropsychological performance following a history of multiple self-reported concussions: a meta-analysis
J Int Neuropsychol Soc
Neuropsychological studies of mild traumatic brain injury: a meta-analytic review of research since 1995
J Clin Exp Neuropsychol
Occupational musculoskeletal injuries in the health care environment and its impact on occupational therapy practitioners: a systematic review
Work
Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis
Spinal Cord
Psychological morbidity and spinal cord injury: a systematic review
Spinal Cord
Return to work following spinal cord injury: a review
Disabil Rehabil Int Multidiscip J
Social functioning after traumatic brain injury
J Head Trauma Rehabil
A meta-analysis of neuropsychological outcome after mild traumatic brain injury: re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab, et al. (2009)
Clin Neuropsychol
A quantitative review of the effects of traumatic brain injury on cognitive functioning
Int Rev Psychiatry
A systematic review of care needs of people with traumatic brain injury (TBI) on a cognitive, emotional and behavioural level
J Clin Nurs
A systematic review of early prognostic factors for return to work after traumatic brain injury
Brain Impair
Community reintegration following acquired brain injury
Brain Inj
Dementia after traumatic brain injury
Int Psychogeriatr
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