Severity and Quality of Life Among Adult Hand Injury Patients Seen at Kenyatta National Hospital

Abstract

Background: Hand injuries encompass a wide range of conditions, including fractures, dislocations, lacerations, crush injuries, amputations, and nerve or tendon injuries. The severity of these injuries can vary significantly, with some requiring simple first aid and others necessitating complex surgical interventions and extensive rehabilitation. Majority of these being occupational based injuries. This means that these injuries have a direct impact on patient financial, social and psychological wellbeing. The severity of the injury has also been found to have a greater influence on individual wellbeing. The quality of life among hand injury patients has not been fully investigated in the local context with existing literature showing fractures as common type of hand injury. Purpose of the study: To determine the association between level of severity and quality of life among hand injury patients attending orthopaedic clinic at Kenyatta national hospital Methodology: This was an analytical cross-sectional study conducted at Kenyatta National hospital. A consecutive sampling technique was used to sample 76 patients attending clinic after three months since injury to the hand occurred. The Modified Hand Severity Score (MHISS) and the World Health Organization Quality of Life (WHOQOL) were used to measure severity and quality of life respectively. A structured questionnaire including these validated tools and patient specific information such as demographic characteristics, cause of injury and nature of injury were used. Data analysis: Median with interquartile range were used to describe characteristics of the study participants. Categorical data were analyzed using frequencies and percentages. Logistic regression analysis was used to investigate factors associated with quality of life among hand injury patients. P value <0.05 was considered statistically significant. A Stata version 16 was used to analyze data. Results: The median age was 33 (IQR: 27 – 42.5) years with 61.8% (n =47) of them aged ≤35 years and 80.3% (n =61) were male. In investigating the mechanism of injury, 31.6%(n =24) of hand injuries were caused by machinery while 21.1%(n =16) had motor vehicle accident, 69.7%(n =53) were injured on right hand. The median MHISS score was 56(IQR: 33.5 – 90.8). The categorization of the MHISS established that 40.8%(n =31) had severe injury, 35.5%(n =27) had moderate injury, 13.2%(n =10) had major injury while 10.5%(n =8) had minor injury. The mean quality of life based on the WHOQOL tool was 46.7±11.12 with 38.2%(n =29) classified as good quality of life while majority 61.8%(n =47) classified as having poor quality of life. Female patients, OR =5.16, 95%CI:1.07 – 24.86, p =0.041, having secondary level, OR =6.72, 95%CI:1.17 – 38.50, p=0.032, patients who had fracture injuries, OR =6.91, 95%CI:2.39 – 19.95, p<0.001 and those with minor or moderate injury, OR =8.22, 95%CI:2.84 – 23.82, p<0.001 were significantly associated with poor quality of life. Conclusion and recommendations: Most of the hand injury patients had severe or major injuries with many of the patients having poor quality of life. Female patients, having secondary level of education, fracture injury and severe or major injuries were significantly associated with poor quality of life. Provide counselling sessions to hand injury patients by focusing on their physical, psychological, social and environmental wellbeing.