Patient-reported outcomes after initial conservative fracture treatment in primary healthcare - a survey study

Stein Vabo; Knut Steen; Christina Brudvik; Steinar Hunskaar; Tone Morken

doi:10.1186/s12875-022-01799-4

Patient-reported outcomes after initial conservative fracture treatment in primary healthcare - a survey study

BMC Prim Care. 2022 Jul 30;23(1):191. doi: 10.1186/s12875-022-01799-4.

Authors

Stein Vabo^{1

2

3}, Knut Steen⁴, Christina Brudvik⁵, Steinar Hunskaar^{4

6}, Tone Morken⁴

Affiliations

¹ National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Box 22 Nygårdstangen, 5838, Bergen, Norway. stein.vabo@hotmail.com.
² Vennesla Health Care Center, Sentrumsvegen 41, 4700, Vennesla, Norway. stein.vabo@hotmail.com.
³ Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway. stein.vabo@hotmail.com.
⁴ National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Box 22 Nygårdstangen, 5838, Bergen, Norway.
⁵ Department of Clinical Medicine, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
⁶ Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.

Abstract

Background: Primary healthcare in Norway has first-line responsibility for medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care. However, some municipalities have X-ray facilities and handle minor fractures locally. We investigated patient-reported outcome measures after initial treatment of radiologically diagnosed fractures of the wrist, collarbone, and ankle at a primary healthcare centre in a rural municipality with a large ski resort. The patients' general satisfaction with the treatment was also investigated.

Methods: Validated questionnaires were sent to patients with fractures of the wrist or collarbone (Quick DASH-Disability of Arm, Shoulder and Hand) or the ankle (FAOS -The Foot and Ankle Outcome Score). Patients with wrist and collarbone fractures also answered the Quality-of-life questions that are a subscale of the FAOS questionnaire for ankle fractures. Patient satisfaction was measured for all fracture groups. The Quick DASH scale ranges from 0 (no disability at all) to 100 (great disability), while for FAOS a score of 100 indicates no symptoms and 0 indicates extreme disabilities.

Results: A total of 148 of 238 patients answered the questionnaire (62% response rate). Patients with distal radius fractures had a mean Quick DASH score of 5.1 (median 0, range 0-77), and scores were significantly lower for males (p = 0.013) and increased with age (p = 0.024). Patients with collarbone fractures had a mean Quick DASH score of 2.1 (median 0, range 0-32) with no significant age or gender differences. Patients with ankle fractures had the following mean subscale-scores: Pain, 93.8; Symptoms, 71.4; Activities of daily living, 97.4; Sport, 90.0; and Quality of life, 92.1. The scores did not differ significantly by specialization of the physician. A total of 88% of the patients were highly or very highly satisfied with the handling of their fracture.

Conclusions: The patients reported low rates of functional disability and high rates of satisfaction after initial radiological diagnosis and treatment of their fracture at the primary healthcare centre. Specialisation of the treating physician was not associated with the outcome in any of the fracture types.

Keywords: Conservative fracture treatment; Diagnosis; General practice; Primary healthcare; Teleradiology.

MeSH terms

Activities of Daily Living
Ankle Fractures* / diagnostic imaging
Humans
Male
Patient Reported Outcome Measures
Primary Health Care
Quality of Life
Surveys and Questionnaires
Treatment Outcome