Change of Functioning in Persons With Severe Musculoskeletal Injuries Over Time: A Multilevel Analysis

Background: The World Health Organization (WHO) recommends the WHO Disability Assessment Schedule (WHODAS) 2.0 as a generic assessment instrument to collect data on functioning and disability. The questionnaire was developed specifically to capture the activities and participation domain as defined by the International Classification of Functioning, Disability and Health (ICF). Evidence on the most relevant factors predicting WHODAS 2.0 outcome in the context of musculoskeletal injuries are controversial. This study aims to assess change in functioning of patients with severe musculoskeletal injuries undergoing inpatient rehabilitation over time.Methods: A longitudinal multicentre study was conducted, following up 571 participants with severe musculoskeletal injuries over the course of a first inpatient rehabilitation stay until 3 months after discharge. At admission, data on sociodemographic, health-related aspects, functioning and contextual factors were collected. WHODAS 2.0 assessed functioning. Data were analysed using a multilevel model approach.Results: The mean WHODAS 2.0 declined from admission to discharge and 3-month follow-up, indicating an improvement in functioning. Multilevel analyses revealed age, duration of inpatient rehabilitation, severity of the injury, injury localizations, number of comorbidities, emotional functioning, pain, being informed about the injury, subjective prognosis on return to work and agreement on treatment targets as factors influencing change in functioning over time.Conclusions: In a rehabilitation setting, a healthcare professional can promote an increase in functioning, for example, by ensuring that there are treatment targets defined and agreed on with the patient and that the patient feels sufficiently informed about the injury. The identified factors could potentially be used for a short screening at admission to rehabilitation to estimate the patient’s change of functioning over time. Trial registration number and date of registration: DRKS00014857; July 04, 2018.