Abstract | April 14, 2023

Orthopaedic Hand Patients Who Screen Positive for Intimate Partner Violence (IPV) Self-Report Lower Health Outcome Scores and Higher Disability Scores

Nicolette Schurhoff, BS

Nicolette Schurhoff, BS, Medical Student, 1st Year, University of Miami Miller School of Medicine, FL; Danielle C. Marshall, MD, Orthopedics, PGY4, University of Miami Miller School of Medicine, FL; Nikhil Patel, BS, Medical Student, 2nd Year, University of Miami Miller School of Medicine, FL; Seth Dodds, MD, Professor, Orthopaedic Surgery Hand and Wrist, Jackson Memorial Hospital/University of Miami and University of Miami Miller School of Medicine, FL; Giselle Hernandez, MD, Assistant Professor, Orthopaedic Surgery Trauma, Jackson Memorial Hospital/University of Miami and University of Miami Miller School of Medicine, FL; John D. Marshall, Collaborator, University of California, Berkeley, CA; Miriyam Ghali, BA, Medical Student, 3rd Year, University of Miami Miller School of Medicine, FL

Learning Objectives

  1. Describe the impact of IPV on orthopaedic injury recovery and patient-reported outcomes.
  2. Identify the prevalence of IPV and the demographics associated.
  3. Discuss the role of orthopaedic surgeons in aiding vulnerable populations.

BACKGROUND: Musculoskeletal injuries are the second most common manifestation of Intimate Partner Violence (IPV), with a staggering 12-month prevalence rate of 15-32% in female participants who present to an orthopaedic fracture clinic. IPV has also been shown to negatively affect recovery from orthopaedic injury. This study compared patient-reported outcomes (PROs) and self-reported disability scores among patients who prospectively screened positive for IPV versus those that did not in orthopaedic hand clinic.

METHODS: A prospective observational cohort study involving patients presenting to orthopaedic hand clinic at an urban Level 1 trauma hospital in Miami, Florida was performed. Eligible participants completed two validated IPV screening tools (Direct IPV and E-HITS), three clinical PROs scales (EQ-5D-3L, Visual Analog Scale (VAS) State of Health, and Return to Function (RTF) Score), and a study specific clinical survey. A multivariate ordinal regression analysis was performed, and chi-squared test compared categorical variables with significance of p<0.05. RESULTS: Over 3 months, 120 patients (49% men) with a mean age of 45.5 (±16.9) were enrolled. 27 patients (22.5%) screened positive for IPV (Group 1), and 93 screened negative (Group 2). 12 patients (10%) disclosed undocumented citizenship status, while another 9 patients (7.5%) disclosed non-resident status. 44 patients (37%) were uninsured. Types of IPV experienced by gender in the prior year and patient’s lifetime are reported in Table 1. Positive IPV disclosure was strongly associated with VAS scores less than 25 (coef=2.11, p=0.044) and EQ-5D-3L summary scores greater than 10 (coef=3.90; p=0.005). Among patients who screened positive for IPV, female gender was significantly associated with low RTF Summary Scores (RTF = 1) when controlling for race, sexual orientation, and relationship status (coef = 1.23, p=0.001).

CONCLUSION: Orthopaedic hand and upper extremity patients who screened positive for IPV consistently report lower health outcomes and higher disability scores. These findings highlight a lower health-related quality of life in orthopaedic patients disclosing IPV, which may result in delayed recovery from injury. Orthopaedic surgeons are presented with a unique opportunity to aid a particularly vulnerable patient population and modify a factor that may be limiting return to pre-injury function and optimal health outcomes.

References

  1. Sprague S, Bhandari M, et al, PRAISE Investigators. Prevalence of abuse and intimate partner violence surgical evaluation (praise) in orthopaedic fracture clinics: a multinational prevalence study. Lancet 2013;382:866–76.
  2. Bhandari M, Sprague S, Tornetta P, et al. (Mis)Perceptions About Intimate Partner Violence in Women Presenting for Orthopaedic Care: A Survey of Canadian Orthopaedic Surgeons. The Journal of Bone and Joint Surgery-American Volume. 2008;90(7):1590-1597. doi:10.2106/JBJS.G.01188
  3. Madden K, Sprague S, Petrisor B, et al. Intimate Partner Violence During Recovery from an Orthopaedic Injury. Journal of Bone and Joint Surgery. 2022;104(6):512-522. doi:10.2106/JBJS.21.00421
  4. Leopold SS. Editorial: Protecting Patients from Intimate-partner Violence—What the Orthopaedic Surgeon Can Do. Clinical Orthopaedics & Related Research. 2016;474(9):1895-1896. doi:10.1007/s11999-016-4978-x
  5. Madden K. Prospective evaluation of intimate partner violence in fracture clinics (PRAISE-2): protocol for a multicentre pilot prospective cohort study. Pilot and Feasibility Studies. 2018;4(1):115. doi:10.1186/s40814-018-0301-9





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