Clinical Presentation of Adults with Traumatic Orthopedic Injuries Enrolled in a Multisite Psychosocial Trial.

Objectives: Traumatic orthopedic injuries are a top cause of hospital visits in the U.S. The Toolkit for Optimal Recovery (TOR) is a brief mind-body intervention that targets catastrophic thinking and pain anxiety following orthopedic injury. This study examines the baseline presentation of adults with traumatic orthopedic injuries who were enrolled in our recent multisite feasibility RCT of TOR versus usual care at four geographically distinct Level 1 trauma centers. We also examine whether patient presentation varies by site.

Methods: We recruited 181 adults (M_age=44.16, SD=16.5) from four Level I trauma centers located in the northeast (Site A; N=63), southwest (Site B; N=44), southeast (Site C; N=44), and southeast (Site D; N=30). At baseline, participants provided information about sociodemographic factors, pain and physical function, and physicians completed the Abbreviated Injury Scale (AIS). Descriptive statistics were used to characterize the sample, and one-way analysis of variance (ANOVA) and Chi-square tests were used to compare variables between sites.

Results: The majority of the sample (88.4%) sustained a fracture, and the mean AIS score was 2.31 (SD=0.55). Age, race, sex, gender, occupation, or marital status did not differ across sites (ps>.05). Over half (63%) of the sample was treated surgically, and 28.7% endorsed taking narcotic pain medications. More participants at Sites B (75%) and D (96.7%) received surgery than participants at Sites A (41%) and C (61.4%). More participants at Sites D and B reported narcotic usage than participants at Sites C and A. Participants at Site D demonstrated greater functional impairment than participants at the other sites.

Conclusion: Although sites were largely comparable, we did find key differences in surgical management, narcotic use, and functional disability which may have important implications for treatment response. This information will be used to iterate and refine TOR for a future multisite efficacy trial.