1. Background
According to the World Health Organization, approximately 4.4 million people die yearly from injuries and trauma. Also, 10% of the total years lived with disability (YLD) is due to them (1). Usually, after trauma and injury, the injured limb is immobilized with techniques such as splints (2, 3). Splints are used to immobilize an injured limb to prevent further injury, heal the injured area, and complete the healing process (4). It is demonstrated that immobility caused by splints can reduce the quality of life (5). Quality of life refers to an individual's personal perception of their position in life, considering their personal values and goals (6). In other words, quality of life in a population or individual at a specific time means well-being according to the positive and negative criteria in that population or individual at that time (7). Quality of life is an important therapeutic goal, and research on quality of life is conducted to evaluate treatment and make policies to improve it (6). Fatal and non-fatal injuries and trauma rates are significantly higher in low-income countries and individuals (1). Immobility is associated with complications that generally reduce the quality of life (8).
2. Objectives
Due to many traumatic patients and their treatment with splints, this study aimed to measure the quality of life in traumatic patients with splint immobilization.
3. Methods
This study was a prospective study performed on 287 patients with trauma from May to September 2022 who used splints for immobilization treatment in Haft-e-Tir and Rasoul-e-Akram hospitals. People over 15 years old were included in the study. Exclusion criteria were being unable to cooperate, such as mentally disabled individuals, people with cerebral palsy, and people needing surgery or physiotherapy. Patients' score was assessed at two-time intervals at the beginning of treatment and one month after splinting. Splinting meant all types of splinting methods on patients, and there was no limit to the splinting method in the study. In this study, we used the SF-36 quality of life questionnaire, which has 8 dimensions: physical performance (10 questions range 0 - 30), physical limitation (4 questions range 0 - 8), emotional limitation (3 questions range 0 - 6), energy and vitality (4 questions range 0 - 14), emotional health (5 questions range 0 - 20), social performance (2 questions range 0 - 6), pain (2 questions range 0 - 6), and general health (5 questions range 0 - 13), and higher scores are better. The reliability and validity of the SF 36 questionnaire were measured and approved by Montazeri et al. (9). In this study, the reliability was 0.77, and validity was above 0.40, ranging from 0.58 to 0.95. A paired t-test was used to evaluate changes in quality-of-life scores. Statistical analysis was conducted using SPSS version 20, with a significance level of less than 0.05.
4. Results
Regarding gender, 189 participants (65.9%) were male, and 98 (34.1%) were female. As shown in Table 1, the mean age of men was higher than women (40.45 years in men vs. 36.62 years in women). In addition, the mean age of 287 participants in the study was 39.15 years.
By measuring and comparing 8 dimensions of quality of life in the SF36 questionnaire in two phases of the study, the changes were significant in five dimensions. The results are shown in Table 1. According to the results, physical health significantly decreased from 20.84 ± 7.19 to 18.89 ± 7.33 (P = 0.003). However, energy and vitality, emotional health, social performance, and general health were significantly increased from 11.74 ± 2.15 to 12.25 ± 2.24 (P < 0.01), 16.82 ± 2.21 to 17.34 ± 2.43 (P < 0.01), and 4.82 ± 0.95 to 5.01 ± 1.02 (P = 0.01), 10.74 ± 2.31 to 10.29 ± 2.33 (P = 0.001) respectively.
Table 1.Comparison of Mean Scores of Quality-of-Life Dimensions
| Dimension | Mean ± SD | t | P-Value |
|---|---|---|---|
| Physical performance | 3.05 | 0.003 | |
| Baseline | 20.84 ± 7.19 | ||
| One month | 18.89 ± 7.33 | ||
| Physical limitation | 0.28 | 0.78 | |
| Baseline | 5.27 ± 2.11 | ||
| One month | 5.23 ± 1.52 | ||
| Emotional limitation | - 0.07 | 0.94 | |
| Baseline | 2.83 ± 1.27 | ||
| One month | 2.84 ± 1.13 | ||
| Energy and vitality | - 4.45 | < 0.01 | |
| Baseline | 11.74 ± 2.15 | ||
| One month | 12.25 ± 2.24 | ||
| Emotional health | - 3.18 | < 0.01 | |
| Baseline | 16.82 ± 2.21 | ||
| One month | 17.34 ± 2.43 | ||
| Social performance | - 2.6 | 0.01 | |
| Baseline | 4.82 ± 0.95 | ||
| One month | 5.01 ± 1.02 | ||
| Pain | - 1.72 | 0.087 | |
| Baseline | 3.66 ± 2.99 | ||
| One month | 4.09 ± 2.29 | ||
| General health | 3.32 | 0.001 | |
| Baseline | 10.74 ± 2.31 | ||
| One month | 10.29 ± 2.33 |
Table 2 shows the mean of the overall dimensions. The physical dimension consists of dimensions of physical performance, physical limitation, pain, and general health, and the mental dimension consists of dimensions of emotional limitation, energy and vitality, emotional health, and social performance. Therefore, according to the results, the physical dimension decreased one month after the study, which reached 38.47 from 40.84 at the beginning of the study, but its mean mental score increased from 35.94 to 37.23. The mean changes in the overall score dimensions differed significantly, but this significance was not shown in their total score.
Table 2.Comparison of Mean Quality of Life in Dimensions
| Variables | Baseline | One Month | t | P-Value |
|---|---|---|---|---|
| Quality of life | ||||
| Physical | 40.84 ± 7.24 | 38.47 ± 8.03 | 3.25 | 0.001 |
| Mental | 35.94 ± 4.16 | 37.23 ± 4.15 | - 4.53 | < 0.001 |
| Total | 76.31 ± 9.42 | 76.13 ± 8.98 | 0.22 | 0.84 |
5. Discussion
Quality of life is considered one of the treatment outcomes (6), but some interventions may decrease the patient’s quality of life until complete recovery. One of these treatments is splints, which are used in some injuries and traumas. Since a splint restricts the movement of a limb, evidence indicates that splints and immobility can reduce patients' quality of life (8, 10). This study investigated the quality of life of patients with immobility caused by splints. The results demonstrated that the quality of life of the patients, in general, did not significantly change during the splint treatment period. On the other hand, although the difference in the physical and mental dimensions was significant, it was small. However, studies on hospitalized patients show that complications such as pressure ulcers and pneumonia caused by immobility reduce patients' quality of life (8). The results obtained from WHOQOL-BREF, which is a quality-of-life assessment developed by the WHOQOL Group, demonstrated that immobility caused by stress and anxiety in PTSD patients significantly decreased their quality-of-life score (11). The immobility caused by splints differs slightly from immobility in hospitalized or PTSD patients. Therefore, the difference in the effect of immobility on the quality of life may be due to the nature of the immobility and the amount of immobility. Similarly, a systematic review demonstrated that splints had no significant effect on pain and function (12).
Although there was a difference in the quality of life of patients treated with splints in dimensions such as general health, physical performance, energy and vitality, and emotional health and social performance, there was no difference in the dimension of pain among hospitalized patients with immobility (8). Physical limitation, emotional limitation, and pain are items in which no difference has been observed a month after splint treatment. However, in a group with early-stage thumb carpometacarpal joint osteoarthritis, it was found that pain, stiffness, and physical limitation significantly decreased in the splint group compared to the non-splint group (13). Overall physical dimension was decreased one month after the start of splint treatment. This is consistent with the results of a six-month follow-up that showed patients’ physical performance was significantly worse compared to the time of injury (14). Although there is controversy in this field (15, 16), it seems that treatment with a splint and the resulting immobility reduces the physical dimension score, at least in the short term (17). This can be due to the individuals’ unfamiliarity with the limitations that a splint can create, and after a month and familiarity with the effects of a splint on the quality of life, the patient's responses to the questionnaire might have been affected. Unlike the physical dimension, we found that the mental status of patients improved one month after treatment with a splint. A 24-month study of an injured population group after treatment demonstrated improvement in the quality of life in the mental dimension (18). It seems that a month after injury and splint treatment, the psychological effects of trauma decrease. On the other hand, expecting improvement in physical condition due to treatment also makes the person feel mentally better one month after a trauma.
5.1. Conclusions
Based on the splint therapy intervention in the study, it can be concluded that this treatment method could improve the quality of life in patients with trauma as it improved the quality of life in 5 out of 8 dimensions. Splinting is a well-known treatment for trauma patients, and if there is an alternative to splinting, these methods can be compared to investigate their effectiveness and their effects on the quality of life. We propose that this study should be conducted with larger sample sizes in more than 2 hospitals. Also, this study could be conducted using other quality-of-life questionnaires.
