UBC Theses and Dissertations
Measuring the long-term impact of childhood injury : a longitudinal study of health related quality of life Schneeberg, Amy
In Canada, unintentional injuries are a leading cause of hospitalization for children aged 5-19 years old. The need for longitudinal studies examining the impact of non-fatal childhood injuries across age groups and injury types has been identified internationally. Health related quality of life (HRQoL) measures assess functional limitations in multiple health domains making HRQoL an interesting and appropriate outcome to measure the impact of injury. The overarching goal of this dissertation was to advance the understanding of HRQoL among children following injury and the appropriate analysis of longitudinal HRQoL data. A systematic review was performed to summarize the findings of research on HRQoL following pediatric injury, and to examine the methods used to measure and analyze HRQoL data in the childhood injury context. In addition, primary research was conducted with 365 children 0-16 years old and their parents who presented with an injury at a tertiary care pediatric hospital in Vancouver, British Columbia. Children aged between 5-16 years old and all parents completed questionnaire measures at the time of presentation for the injury and again at one-, four- and 12-months post-injury. How childhood injury and the process of recovery impacts children’s HRQoL from both the child’s and parent’s perspective was investigated. Four different longitudinal models were explored to determine the model that best fit the data. Analyses revealed that injuries among older children, children requiring hospitalization and children with lower extremity fractures had more significant impact on HRQoL at one-month post-injury. By four-months post-injury differences in HRQoL were minimal. On average, parents rated their children’s HRQoL lower at one-month post-injury relative to the children’s self-perceived HRQoL. Most injured children regained HRQoL baseline status by four-months post-injury. Non-linear quantile regression provided the best fitting model as it is robust to skewness and outliers and free from any assumptions regarding the distribution of errors. Older children, those hospitalized, and children with lower extremity fractures were at higher risk of having lower HRQoL in the early part of recovery relative to younger children, those seen in the ED and children with other types of injuries.
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