Helmet Use, Return to Work, and Health-Related Quality of Life among Motorcycle Riders with Head Injury

Head injuries cause about a half of deaths among traumatic patients, and motorcycle riders with head injuries are 10 times more likely to die than those with nonhead injuries. Although helmets are effective in reducing head injuries among motorcycle riders, it is not uncommon to observe the use of nonstandard helmets in Taiwan (e.g., unfastening the chin strap or putting the helmet on the occipital area). Furthermore, it remains unclear if different types of helmet have the same effectiveness in reducing head injuries and if helmet use is effective in reducing all kinds of head injuries (e.g., brain injury, concussion, and skull fracture). Since patients after a head injury often have changes in physical, psychological, and social functioning, it is important to track longitudinal outcomes such as health profile, return-to-work, activities of daily living (ADLs), and depression for understanding their healthcare needs. Health profile measures can help detect a comprehensive, multidimensional heath status as well as subjective well-being, and the return-to-work is an integrative outcome of physical, psychological, and social changes. Finally, the health utility can be incorporated into survival function to estimate quality-adjusted life years for explicitly making clinical decision or evaluating healthcare programs; however, no study has evaluated the utility for patients with head injuries. Four methods, including the rating scale, standard gamble, time trade-off, and person trade-off, are used to measure health utility; however, it is unknown for which of these methods is suitable for this population. Moreover, the accuracy of the utility estimated by caregiver is also overriding, since a substantial part of head-injury patients are physically and mentally unable to respond utility questions. This 3-year project is proposed to address the above issues. In the first year, a case-control study will be conducted to examine differences in reducing head injuries between different types of helmet and between standard and nonstandard helmet use. We will recruit 2400 motorcycle riders, including 600 with newly diagnosed head injuries from emergency rooms, 600 with nonhead injuries from emergency rooms (emergency room controls), and 1200 from gas stations (population-based controls). In the second year, for the 600 cases, longitudinal outcomes such as health profile, return-to-work, ADLs, cognition, and depression will be tracked at 6 month and 12 month after head injury, and factors associated with each of these outcomes will be identified as well. In the third year, the utility on head injury will be measured for 200 persons with head injuries, 200 persons with nonhead injuries, and 200 caregivers. The suitability of the four utility measures for people with head injuries will be determined using practicality, discriminant ability, stability, and test-retest reliability. The agreement in head-injury utility between head-injury patients and caregivers will also be examined.