A threshold regression model to predict return to work after traumatic limb injury

Objective: The study aims to examine the severity of initial impairment and recovery rate of return-to-work (RTW) predictors among workers with traumatic limb injury. Methods: This 2-year prospective cohort study recruited 1124 workers with traumatic limb injury during the first 2 weeks of hospital admission. Baseline data were obtained by questionnaire and chart review. Patient follow-up occurred at 1, 3, 6, 12, 18, and 24 months post injury. The primary outcome was the time of first RTW. The impact of potential predictors on initial impairment and rate of recovery towards RTW was estimated by threshold regression (TR). Results: A total of 846 (75.27%) participants returned to work during the follow-up period. Our model revealed that the initial impairment level in elderly workers and lower limb injuries were 33% and 35% greater than their counterparts, respectively. Workers with >12 years of education, part-time job, and moderate and higher self-efficacy were less impaired at initial injury compared with their counterparts. In terms of the rate of recovery leading to RTW, workers with older age, part-time jobs, lower limbs, or combined injuries had a significantly slower recovery rate, while workers with 9-12 years of education and >12 years of education had a significantly faster recovery rate. Conclusions: Our study provides researchers and clinicians with evidence to understand the baseline impairment and rate of recovery towards RTW by explaining the predictors of RTW among workers with traumatic limb injuries.