Impact of disability in the quality of life of patients with traumatic brachial plexus injuries based on a questionnaire survey in a tertiary center in South India.

Abstract

Objectives: The aim of the study was to assess the disability and its impact in the health-related quality of life (HRQOL) and its various domains in patients with traumatic brachial plexus injury (TBPI).

Materials and methods: A descriptive cross-sectional questionnaire survey was conducted on 41 patients with TBPI in a tertiary care center in South India. The assessment of disability and HRQOL was done as per the guidelines of the Gazette of India (2001) and WHO BREF questionnaire, respectively. The association between disability and HRQOL was determined using Chi-square test.

Results: All patients were males in the age group 16-60 years (mean age 36.8 ± 14.4 years). Etiology was road traffic accident in 90.2% of cases. About 51.2% had pan-plexus injuries and 53.7% had their dominant limb affected. The mean total disability was 80.39 ± 13.86% and the mean total HRQOL score was 188.46 ± 83.44 out of 400. It was found that disability due to TBPI significantly reduced the HRQOL (Fisher's exact P = 0.005) and the psychological domain was the most significantly affected (P = 0.017, Kruskal-Wallis test). Pan-plexus injuries with an involvement of dominant upper limb had significant impact in the HRQOL. Twenty-one patients (51.2%) complained of neuropathic pain and they had a significantly reduced quality of life (QOL) (mean QOL = 23.3, P < 0.001). It was also found that productive age group (26-55 years) had a significantly reduced QOL as compared to the extreme age groups (P = 0.000). Unemployed patients had a significantly reduced QOL as compared to those with permanent/temporary job (P = 0.024). Marital status was found to have no significant relationship with the total HRQOL (P = 0.647). Those belonging to the poor socioeconomic strata (below poverty line) had poor HRQOL as compared to those above poverty line and the relationship was found to be significant (P = 0.000).

Conclusion: TBPIs significantly affected all domains of QOL, especially in unemployed patients in the productive age group in the poor socioeconomic strata. The pan-brachial plexus involvement of dominant upper limb and associated neuropathic pain were the most important factors which negatively affected the QOL. Among the codomains of the QOL, psychological domain was the most significantly affected irrespective of the severity of the injury.