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Background: Injuries can have detrimental impacts on mental health, even after physical recovery. In our Prospective Outcomes of Injury Study (POIS), 25% of participants experienced psychological distress (assessed using the Kessler 6) three months after a sentinel injury event (SIE), declining to 16% at 24 months post-SIE. Internationally, studies of hospitalised patients found distress persisted beyond 24 months post-injury and remained higher than the general population. However, most studies only assessed distress at one timepoint, relied on long-term recall, or were limited to small samples or specific injury types. Therefore, we aim to describe the prevalence of psychological distress 12 years post-SIE and to investigate pre-injury, injury-related and early post-injury characteristics associated with long-term distress. Methods: POIS is a longitudinal cohort study of 2856 New Zealanders injured between 2007 and 2009, who were on the national injury insurer, Accident Compensation Corporation entitlement claims' register. Of these, 2068 POIS participants completed an interview at 24 months and agreed to further contact. They were invited to a follow-up interview 12 years post-SIE which included the Kessler-6 (K6), the psychological distress outcome of interest. Data about a range of pre-injury, injury-related and early (3 months) post-injury characteristics were collected via earlier interviews or administrative data sources (e.g. hospital discharge data). Results: Twelve years post-SIE, 1543 (75%) people were re-interviewed and 1526 completed the K6; n = 177 (12%) reported psychological distress. Multivariable modified Poisson regression models found pre-injury characteristics were associated with an increased risk of clinically relevant distress at 12 years, i.e. having inadequate income, identifying as Māori, Pacific or Asian and having one mental health condition. Early post-injury psychological distress and dissatisfaction with social relationships also increased risk. However, being older was associated with a reduced risk of distress. Conclusion: Clinically relevant distress persists long-term post-injury among adults with varying injury severity, types and causes, and at higher prevalence than in the general population. Early identification of injured people at risk of long-term psychological distress provides opportunities for timely interventions to reduce psychological distress. [ABSTRACT FROM AUTHOR]

Background: Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain).Methods: Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to 'any' or 'full duties' paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates.Results: Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury.Conclusions: Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW.Trial Registration: This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752). [ABSTRACT FROM AUTHOR]

Background: The impact of multiple medication exposure on health outcomes among older patients with end-stage kidney disease (ESKD) is unknown.Objective: The objective of this study was to identify the impact of medicine exposure on hospitalisation rates and mortality in a prospective longitudinal observational study of older dialysis patients.Methods: Patient demographics, medication use, hospitalisation, mortality and co-morbidity data were collected through the prospective longitudinal cohort study DOS65 + (Dialysis Outcomes in those aged ≥ 65 years Study) (n = 225). Medication exposure was measured by the total number of individual medications and the number of predetermined ‘medication groups’. Associations between medications prescribed at recruitment and health outcomes as measured by hospitalisation and mortality were assessed by univariate and multivariable regression analyses.Results: Older ESKD patients were exposed to a median of ten (0-20) medications and eight (0-15) medication groups. Multivariate analyses estimate each additional medication increased mortality risk by 8% (relative risk [RR] = 1.08; 95% confidence interval [CI] 1.07-1.09); each medication group increased mortality risk by 11% (RR = 1.11; 95% CI 1.09-1.12). Similar trends were observed for hospitalisation. Certain medication groups were associated with reduced hospitalisation rates, namely angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (RR = 0.62; 95% CI 0.53-0.72) and dihydropyridines (RR = 0.64; 95% CI 0.54-0.76). Warfarin, gastric acid suppressants, diuretics and β-blockers were associated with increased hospitalisation rates. Warfarin was associated with an increased mortality rate (RR = 1.40; 95% CI 1.19-1.65).Conclusions: Multiple medication exposure was prevalent in this older ESKD population, and was associated with an increased risk of mortality and hospitalisation. While this study is not able to determine the cause of these relationships, review of medication use is warranted in this population.Trial Registration: ACTRN12611000024943. [ABSTRACT FROM AUTHOR]

Purpose: To determine, in a cohort with injuries classified anatomically as mainly minor or moderate and for which only 25% were hospitalised acutely, the prevalence of ongoing problems attributed by participants to their injury 2 years prior, and to examine whether three-month post-injury experiences and expectations predict such problems.Methods: Participants (N = 2231; 18-64 years at injury) were those in the Prospective Outcomes of Injury Study who completed the initial three-month and final two-year interviews. The outcome measure was whether participants reported ongoing injury-related problems at 2 years. Possible early post-injury predictors were identified from the first interview; pre-injury and injury-related potential confounders from the first interview, insurer records and hospital discharge records. Multivariable models estimated relative risks.Results: Almost half the participants reported injury-related problems at 2 years. Participants reporting non-recovery at 3 months were more likely than those reporting recovery to have ongoing problems at 2 years, ranging from participants expecting to get better soon [adjusted RR 2.2, 95% CI (1.7,2.8)) to those expecting to never get better (aRR 3.1, 95% CI (2.4,4.0)]. Several three-month post-injury experiences also predicted ongoing problems at 2 years. Participants at highest risk included those with extreme pain [aRR 2.1, 95% CI (1.7,2.5)], and less involvement in usual activities [aRR 1.7, 95% CI (1.5,1.9)].Conclusions: Findings indicate that early post-injury characteristics predict longer-term recovery among this cohort, most of who were not classified as seriously injured, and provide guidance for future studies on interventions to reduce poor outcome prevalence, particularly focussing on pain management and enabling return to independence and social participation. [ABSTRACT FROM AUTHOR]

Background. Physical inactivity is a risk factor for noncommunicable diseases. Incurring an injury has been identified as a barrier to physical activity. However, it is not known which factors, if any, are associated with reduced activity among general injury populations. Objective. The 2 study objectives were: (1) to investigate changes in physical activity frequency from before an injury to 3 months after the injur)' and (2) to examine the association of preinjury, injury-related, and postinjury factors with reduced physical activity frequency in participants with a range of injury types. Design. This was a cohort study. Methods. Participants (N=2,856) who were 18 to 64 years of age were asked about preinjuiy demographic and health factors, injury-related factors, and postinjury factors. Data were collected through telephone interviewing (88%), a postal questionnaire (11%), and face-to-face interviewing (0.5%) 3 months after the injury. Results. Of the 2,793 participants for whom complete physical activity data were available, 55% (n= 1,536) had reduced physical activity 3 months after the injury event. Preinjury and injury-related factors associated with a greater risk of reduced physical activity included living with non-family members; a lower extremity dislocation, sprain, or strain; and an injury with greater anatomical severity. Postinjury factors associated with reduced physical activity included greater disability, pain or discomfort, poor general health, not having returned to work, and having a worse-than-expected recovery 3 months after the injur)'. A large proportion (61%) of this cohort with injuries was seen by physical therapists. Limitations. Data collection was retrospective and based on participant recall. Conclusions. A large proportion of participants had reduced physical activity 3 months after the injury. Knowledge about preinjury, injury-related, and postinjury characteristics associated with reduced physical activity may help health care professionals identify people at risk of not returning to their preinjury physical activity frequency. [ABSTRACT FROM AUTHOR]

Background The application of disability weights by nature of injury is central to the calculation of disabilityadjusted life years (DALYs). Such weights should represent injury diagnosis groups that demonstrate homogeneity in disability outcomes. Existing classifications have not used empirical data in their development to inform groups that are homogeneous for disability outcomes, limiting the capacity to make informed recommendations for best practice in measuring injury burden. Methods The Validating and Improving injury Burden Estimates (Injury-VIBES) Study includes pooled data from over 30 000 injured participants recruited to six cohort studies. The International Classification of Disease 10th Revision (ICD-10) diagnosis codes were mapped to existing injury burden study groupings and prediction models were developed to measure the capacity of the injury groupings and ICD-10 diagnoses to predict disability outcomes at 12 months. Models were adjusted for age, gender and data source and investigated for discrimination using area under the receiver operating characteristic curve (AUC) and calibration using Hosmer- Lemeshow statistics and calibration curves. Results Discrimination and calibration of models varied depending on the outcome measured. Models using full four-character ICD-10 diagnosis codes, rather than groupings of codes, demonstrated the highest discrimination ranging from an AUC (95% CI) of 0.627 (0.618 to 0.635) for the pain or discomfort item of the EQ-5D to 0.847 (0.841 to 0.853) for the extended Glasgow Outcome Scale independent living outcome. However, gain over other groupings was marginal. Conclusions Prediction performance was best for measures of function such as independent living, mobility and self-care. The classifications were poorer predictors of anxiety/depression and pain/discomfort. There was no clearly superior classification. [ABSTRACT FROM AUTHOR]

Objectives: The aims are to: (1) Determine the cumulative incidence of self-reported subsequent injury (of any anatomical site or injury type) occurring between 3 months and 12 months after a sentinel injury among participants in the Prospective Outcomes of Injury Study in New Zealand and (2) Examine the preinjury and injury-related predictors of subsequent injury. Methods: Prospective Outcomes of Injury Study participants (n=2282) were interviewed 3 months, 5 months and 12 months after a sentinel injury event. Data were collected about a range of preinjury and injury-related factors at the 3-month interview and about subsequent injury at the 5-month and 12-month interviews. Poisson regression modelling was used to determine the preinjury and injury-related predictors of subsequent injury. Results: Between the 3-month and 12 month interviews 28% of the participants reported at least one subsequent injury. Subsequent injury was 34% more likely among participants with a prior injury affecting them at the time of the sentinel injury compared with participants without a prior injury affecting them, and more likely among non-workers (31% more likely) and trade/manual workers (32% more likely) compared with professionals. Participants whose sentinel injury was due to assault were 43% more likely to report a subsequent injury compared with those whose sentinel injury was accidental. A subsequent injury was 23% less likely if the sentinel injury was a lower extremity fracture compared with other injuries, and 21% less likely if the sentinel injury event involved hospitalisation. Conclusions: Among general injury populations it may be possible to identify people at increased risk for subsequent injury. [ABSTRACT FROM AUTHOR]

Background: Priority setting, identification of unmet and changing healthcare needs, service and policy planning, and the capacity to evaluate the impact of health interventions requires valid and reliable methods for quantifying disease and injury burden. The methodology developed for the Global Burden of Disease (GBD) studies has been adopted to estimate the burden of disease in national, regional and global projects. However, there has been little validation of the methods for estimating injury burden using empirical data. Objective: To provide valid estimates of the burden of non-fatal injury using empirical data. Setting: Data from prospective cohort studies of injury outcomes undertaken in the UK, USA, Australia, New Zealand and The Netherlands. Design and participants: Meta-analysis of deidentified, patient-level data from over 40 000 injured participants in six prospective cohort studies: Victorian State Trauma Registry, Victorian Orthopaedic Trauma Outcomes Registry, UK Burden of Injury study, Prospective Outcomes of Injury study, National Study on Costs and Outcomes of Trauma and the Dutch Injury Patient Survey. Analysis: Data will be systematically analysed to evaluate and refine injury classification, development of disability weights, establishing the duration of disability and handling of cases with more than one injury in burden estimates. Developed methods will be applied to incidence data to compare and contrast various methods for estimating non-fatal injury burden. Contribution to the field: The findings of this international collaboration have the capacity to drive how injury burden is measured for future GBD estimates and for individual country or region-specific studies. [ABSTRACT FROM AUTHOR]

Little is known of injury outcomes among non-hospitalised injured populations. This study examined the occurrence of poor outcomes 3 months after injury among the 2856 participants in the Prospective Outcomes of Injury Study, most of whom had sustained injuries considered of minor severity (by injury severity scoring) and had not received treatment at a hospital facility. The prevalence of poor outcomes was high across all health, physical functioning and social functioning domains and expectation characteristics examined, including for those participants with the 'least severe' injuries. Approximately half of the cohort reported experiencing moderate to high pain or psychological distress and reduced social participation, and three-quarters did not consider themselves recovered. Our findings demonstrate that, to obtain an accurate understanding of injury burden, injury outcome research should not focus only on those injured persons who are hospitalised. [ABSTRACT FROM AUTHOR]

Objective To identify factors associated with non-participation at the 12-month and 24-month follow-up phases of a prospective cohort study of injury outcomes. Methods Associations between non-participation at follow-up phases and a range of sociodemographic, injury, health, outcome and administrative factors were examined. Results An individual's non-participation at 12 months did not necessarily mean non-participation at 24 months. Sociodemographic factors were the most salient for non-participation, regardless of the number of follow-up phases or specific phase considered. Conclusions Retention rates in prospective cohort studies of injury outcome may be improved by follow-up of everyone irrespective of previous non-participation, focusing resources to retain men, young adults, indigenous people and those living with people other than family members, and by ensuring that multiple alternative participant contacts are obtained. There is sufficient evidence to be concerned about potential bias given that several of the factors we, and others, have identified as associated with non-participation are also associated with various functional and disability outcomes following injury. This suggests detailed investigations are warranted into the effect non-participation may be having on the estimates for various outcomes. [ABSTRACT FROM AUTHOR]

Background: Māori, the indigenous population of New Zealand, experience numerous and consistent health disparities when compared to non-Māori. Injury is no exception, yet there is a paucity of published literature that examines outcomes following a wide variety of injury types and severities for this population. This paper aims to identify pre-injury and injury-related predictors of life satisfaction three months after injury for a group of injured Māori. Methods: The Māori sample (n = 566) were all participants in the Prospective Outcomes of Injury Study (POIS). POIS is a longitudinal study of 2856 injured New Zealanders aged 18-64 years who were on an injury entitlement claims' register with New Zealand's no-fault compensation insurer. The well-known Te Whare Tapa Whā model of overall health and well-being was used to help inform the selection of post-injury life satisfaction predictor variables. Multivariable analyses were used to examine the relationships between potential predictors and life satisfaction. Results: Of the 566 Māori participants, post-injury life satisfaction data was available for 563 (99%) participants. Of these, 71% reported satisfaction with life three months after injury (compared to 93% pre-injury). Those with a higher injury severity score, not satisfied with pre-injury social relationships or poor self-efficacy pre-injury were less likely to be satisfied with life three months after injury. Conclusions: The large majority of Māori participants reported being satisfied with life three months after injury; however, nearly a third did not. This suggests that further research investigating outcomes after injury for Māori, and predictors of these, is necessary. Results show that healthcare providers could perhaps put greater effort into working alongside injured Māori who have more severe injuries, report poor self-efficacy and were not satisfied with their pre-injury social relationships to ensure increased likelihood of satisfaction with life soon after injury. [ABSTRACT FROM AUTHOR]

Abstract: Background: In New Zealand, people unable to work due to an illness may be eligible for a means-tested benefit whereas injured people are eligible for a wide range of support including earnings-related compensation through the no-fault Accident Compensation Corporation (ACC). The effect of this difference on socio-economic outcomes has not been investigated before. Methods: A comparative cohort study was undertaken of stroke versus injury. Individuals aged 18–64, who had a first-stroke (n = 109) were matched by age, sex and functional impairment with injured individuals (n = 429) participating in the Prospective Outcomes of Injury Study. Data were collected by interview 3.5 and 12 months after stroke or injury. Logistic regression adjusting for the matching variables at 3.5 months, and functional impairment at 12 months, was undertaken. Results: Median personal income declined by 60% over 12 months for the Stroke Group compared to 13% decline in the Injury Group. Decline in income was greater for those in both groups who had a higher income initially, and for those who had not returned to work. The proportion of the Stroke Group reporting ‘Fairly low/low’ standard of living increased from 8% to 28% and ‘Just/not enough’ income increased from 35% to 61% whereas the Injury Group increased only from 5% to 12% and 33%–44% respectively. The odds of reporting low standard of living and income inadequacy at 12 months were significantly less for the Injury Group. Despite earnings-related compensation (80% of income), the odds of being back at work were greater for the Injury Group compared to the Stroke Group (Adjusted Odds Ratio 3.1; 95% CI 1.7–5.6). Conclusions: These findings support the conclusions that earnings-related compensation and rehabilitative support, available to injured people via ACC, largely prevents the downward spiral into poverty and ill health. It also appears to enhance return to work though residual confounding cannot be ruled out. [Copyright &y& Elsevier]

Background New Zealand offers a unique opportunity for cost-of-injury research due to its comprehensive, no-fault injury compensation insurance scheme, which is managed by the government-controlled Accident Compensation Corporation (ACC).Objectives To estimate the costs of injury in New Zealand with respect to ACC's spending for entitlement claimants (ie, people with injuries requiring more that 'treatment only'), as well as injured individuals' out-of pocket-personal spending and non-pecuniary costs in terms of effects on health-related quality of life (HRQoL).Methods A prospective cohort study of people injured between June 2007 and May 2009 was followed for12 months after injury. ACC's spending for each participant (n = 2215) was estimated from ACC data.Out-of-pocket personal spending and quality-adjusted life years (QALYs) lost were estimated based on interviews conducted at 3, 5 and 12 months post injury.Results For the cohort studied, most of the reported financial costs of injury were met by ACC. ACC spending was higher for individuals with more severe injuries and ones admitted to hospital. There was no difference in mean personal spending between people who were hospitalised or not, or between those with minor or moderate injuries, although individuals with more severe injuries reported higher personal spending.Conclusions Overall, the ACC appears to be performing well supporting injured people financially. Nonetheless, people with more severe injuries incur substantial out-of pocket-expenses. Costs are higher for hospitalised and more severe injuries, but non-hospitalised and less severe cases can still incur substantial costs. The HRQoL effects of injured naturally, borne by injured individualsthemselvesdare relatively large on average. [ABSTRACT FROM AUTHOR]

ABSTRACT:This paper estimates the incidence (all ages) of spinal cord neurological impairment (SCI; traumatic and non traumatic) in New Zealand and describes pre-SCI characteristics and early post-SCI outcomes for participants (16-64 years) in this longitudinal study. Demographic and clinical data on all people admitted to New Zealand's two spinal units (mid-2007 to mid-2009 )were included for the estimate of incidence. Participants in this longitudinal study were asked at first interview about pre-SCI socio-demographic, health and behavioural characteristics, and about post-SCI symptoms, general health status (EQ-5D) and disability (WHODAS 12-item). Age-adjusted incidence rates (95% CI) for European,Maori, Pacific and 'Other' ethnicities were 29 (24-34), 46 (30-64), 70 (40-100) and 16 (9-22) per million, respectively. Interviews with 118 (73%) participants (16-64 years), occurred 6.5 months post-SCI. Most reported bother with symptoms, and problems with health status and disability. Compared with Europeans, the incidence of SCI is high among Maori and particularly high among Pacific people. Six months after SCI, proximate to discharge from the spinal units, considerable symptomatic, general health and disability burden was borne by people with SCI. [ABSTRACT FROM AUTHOR]

Introduction: To reduce the burden on injury survivors and their supporters, factors associated with poor outcomes need to be identified so that timely post-injury interventions can be implemented. To date, few studies have investigated outcomes for both those who were hospitalised and those who were not. Aim: To describe the prevalence and to identify pre-injury and injury-related predictors of disability among hospitalised and non-hospitalised people, three months after injury. Methods: Participants in the Prospective Outcomes of Injury Study were aged 18-64 years and on an injury entitlement claims register with New Zealand's no-fault injury compensation insurer, following referral by healthcare professionals. A wide range of pre-injury demographic, health and injury-related characteristics were collected at interview. Participants were categorised as 'hospitalised' if they were placed on New Zealand's National Minimum Data Set within seven days of the injury event. Injury severity scores (NISS) and 12 injury categories were derived from ICD-10 codes. WHODAS assessed disability. Multivariable analyses examined relationships between explanatory variables and disability. Results: Of 2856 participants, 2752 (96%) had WHODAS scores available for multivariable analysis; 673 were hospitalised; 2079 were not. Disability was highly prevalent among hospitalised (53.6%) and non-hospitalised (39.4%) participants, threemonths after injury. In both groups, pre-injury disability, obesity and higher injury severity were associated with increased odds of post-injury disability. A range of other factors were associated with disability in only one group: e.g. female, ≥2 chronic conditions and leg fracture among hospitalised; aged 35-54 years, trouble accessing healthcare, spine or lower extremity sprains/dislocations and assault among non-hospitalised. Significance: Disability was highly prevalent among both groups yet, with a few exceptions, factors associated with disability were not common to both groups. Where possible, including a range of injured people in studies, hospitalised and not, will increase understanding of the burden of disability in the sub-acute phase. [ABSTRACT FROM AUTHOR]

The Prospective Outcomes of Injury Study aims to identify predictors of disability following injury. Participants were selected from the entitlement claims register of New Zealand's no-fault compensation insurer, the Accident Compensation Corporation, and followed up by interview for 2 years. This report describes changes to intended Prospective Outcomes of Injury Study methods and key characteristics of the cohort, with an emphasis on general health and disability before injury and soon afterwards. There were 2856 injured participants in the first interview, which occurred 3.2 months (median) after injury. The recruitment period was extended to enable inclusion of sufficient Mori participants. At the first interview, most participants were experiencing worse health status and increased disability compared to before injury, despite less than one-third reporting admission to hospital because of their injury. Analysis of outcome predictors related to post-injury function, disability and return-to-work soon after injury and 1 year later is now under way. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials have investigated aspects of postal survey design yet cannot elaborate on reasons behind participants' decision making and survey behaviour. This paper reports participants' perspectives of the design of, and participation in, a longitudinal postal cohort survey. It describes strengths and weaknesses in study design from the perspectives of study participants and aims to contribute to the: 1) design of future cohort surveys and questionnaires generally and, 2) design of cohort surveys for people with musculoskeletal disorders (MSDs) specifically. Methods: In-depth interviews explored the design of postal surveys previously completed by participants. Interviews used open ended questioning with a topic guide for prompts if areas of interest were not covered spontaneously. Thematic data analysis was undertaken based on the framework method. A second researcher verified all coding. Results: Data from fourteen interviews were analysed within three main themes; participation, survey design and survey content. One of the main findings was the importance of clear communication aimed at the correct audience both when inviting potential participants to take part and within the survey itself. Providing enough information about the study, having a topic of interest and an explanation of likely benefits of the study were important when inviting people to participate. The neutrality of the survey and origination from a reputable source were both important; as was an explanation about why information was being collected within the survey itself. Study findings included participants' impressions when invited to take part, why they participated, the acceptability of follow-up of non-responders and why participants completed the follow-up postal survey. Also discussed were participants' first impression of the survey, its length, presentation and participants' views about specific questions within the survey. Conclusions: Ideas generated in this study provide an insight into participants' decision making and survey behaviour and may enhance the acceptability of future surveys to potential participants. As well as clear communication, participants valued incentives and survey questions that were relevant to them. However, opinions varied as to the preferred format for responses with some advising more opportunity for open-ended feedback. We also found that some standard format questions can raise quandaries for individual participants. [ABSTRACT FROM AUTHOR]

Background Approximately 70-80 New Zealanders have spinal cord impairment (SCI) due to injury (2/3) or disease (1/3) each year. They had been socialised as non-disabled people. Following paralysis, interrelationships between body, self and society change. Little is known of the impact of these changes on life histories, life chances and life choices of people with SCI. This has negative implications for the design of rehabilitation and disability support services in New Zealand. Furthermore, the trajectory of disability is affected by previous socioeconomic conditions. How specific supports following SCI (eg, rehabilitation and compensation funded by the Accident Compensation Corporation; ACC) can change this trajectory is unknown. Objectives To explore the interrelationships of body, self and society for people with SCI and how these have shaped life chances, life choices and subjectivity. To investigate how entitlement to rehabilitation and compensation through ACC affects socioeconomic and health outcomes. Setting New Zealand. Design A prospective cohort study; mixed methods. Participants 112 people with SCI admitted for the first time to one of New Zealand's two spinal units without serious cognitive injury. Data Structured interviews with all participants (n=112); qualitative interviews with a selected subgroup (n=20); clinical data collected at the time of admission. Exposures include: demographics, comorbidity, previous health and socioeconomic status, SCI resulting from illness or injury, income support, health and social services. Outcome measures Socioeconomic status, health, participation and life satisfaction. Analysis Descriptive statistics; differences tested by paired t tests or McNemar tests; multiple regression and mixed models. Qualitative analysis will be interpretive. [ABSTRACT FROM AUTHOR]

Objectives: To describe: 1) settings, activities and types of injuries for an 'initial' (sentinel) injury and subsequent injuries over 24 months, and 2) concordance between sentinel and subsequent injury events.Methods: Participants (n = 2856) were recruited to the Prospective Outcomes of Injury Study (POIS) following their sentinel injury event, an injury event resulting in an Accident Compensation Corporation (ACC) entitlement claim. Subsequent injuries were those from additional ACC claims in the following 24 months. Injury settings, activities and types were from electronic ACC claims data. The risks of having a subsequent injury of the same type as the sentinel injury were estimated.Results: Overall, 1653 (58%) participants had 3444 subsequent injury events in 24 months, resulting in 4470 injury diagnoses. Twenty one percent had at least one subsequent injury event of the same type as their sentinel injury; 33% with a spine sprain/strain had at least one subsequent spine sprain/strain. Many participants had at least one subsequent injury event at same setting (26%) as their sentinel injury; of note, 36% of participants whose sentinel injury occurred at home had at least one subsequent injury at home. Seventeen percent of participants had at least one subsequent injury involving the same activity as their sentinel injury; 28% of those whose sentinel injury was a result of contact in sport had at least one subsequent injury also involving sport.Conclusions: Subsequent injuries among people presenting to healthcare providers are common. Greater emphasis should be placed on maximising such healthcare provider contact as an injury prevention opportunity. [ABSTRACT FROM AUTHOR]

Objectives: Functional status can be affected for considerable time after injury. Individual's functional status trajectories, or pathways, following injury may provide insights into achieving, or not achieving, optimal functional status. This study aims to (1) investigate functional status trajectories of injured individuals over two years by multiple dimensions and, (2) determine whether there are differences in functional status trajectories between those hospitalised and non-hospitalised. Methods: Data from the Prospective Outcomes of Injury Study, a longitudinal cohort (n = 2856) of injured New Zealanders, was used. Functional status was assessed using the EQ-5D (plus a cognitive dimension) at 3, 12 and 24 months post injury. For each dimension (mobility, self-care, usual activities, pain/discomfort anxiety/depression and cognition), individual-level trajectories were created based on whether participants had attained (or exceeded) their pre-injury functional status at each time-point. Results: Participants had varied pathways to attaining their pre-injury functional status which was not revealed by cross-sectional group-level data. When all dimensions were considered together, 24% of participants attained their pre-injury functional status but did not maintain it at a subsequent phase. By EQ-5D dimension, this varied from 5% (self-care) to 22% (pain/discomfort). Twenty-six percent of nonhospitalised participants attained, but did not maintain, their pre-injury status compared to 18% of those hospitalised. Conclusions: Cross-sectional group-level prevalence does not adequately depict the underlying pathways experienced by individual participants. Our analyses indicate the importance of following up all study participants in longitudinal studies, including those reporting to have attained 'recovery' and of not under-estimating the impact of non-hospitalised injuries. [ABSTRACT FROM AUTHOR]