Health related quality of life following injury in low-and middle-income countries

Introduction:  Health-related quality of life (HRQoL) is an important aspect to consider when assessing the non-fatal impact of injuries.  The aim of this review was to critically appraise the range of generic instruments employed in the assessment of HRQoL following injury in low-and middle-income countries (LMICs). As a prelude to subsequent research examining longer-term outcomes following motor vehicle crash injuries in Fiji, we also examined how commonly used measures align with the List of All Deficits (LOAD) framework for injury and the Fonofale model of Pacific health and well-being.  Methods:  A systematic search of four databases was conducted to identify injury outcome studies undertaken in low-and middle-income countries (LMICs) that used a generic health status outcome measure(s).  Two separate content analyses were undertaken, to assess how identified HRQoL measures aligned with the LOAD framework and the Fonofale model. Findings:  Thirty two studies from thirteen LMICs examined variably defined aspects of HRQoL following a range of traumatic injuries (e.g. spinal cord, brain). The measures most commonly focused on the ‘impact on individual’ aspect of the LOAD framework and the ‘physical and mental’ aspects of the Fonofale model.  While the emerging literature from LMICs provides valuable information about the HRQoL of trauma patients, the commonly used generic measures provided limited insights regarding societal impacts, culture and spirituality, domains of relevance to injury research and Pacific health and well-being.  Conclusion: Theoretical frameworks relevant to Pacific contexts should be considered when selecting appropriate outcome measures for injury studies in the region.