Intimate partner violence (IPV), also known as domestic abuse, is a leading cause of non-fatal injury in women worldwide. 1 in 6 women attending surgical fracture clinics have a history of IPV in the past year. Given the high prevalence and costs associated with IPV, there is a need to identify health outcomes associated with IPV, the incidence of new and worsening cases of IPV, and resource use among IPV victims. This prospective cohort study of women with fractures and dislocations will assess differences in injury-related outcomes (time to fracture healing, injury-related complications, and return to pre-injury function) between abused and non-abused women. This study will also determine whether a musculoskeletal injury can lead to new or worsening abuse by an intimate partner and how patterns of IPV change over time following musculoskeletal injuries.Finally, the proposed study will also inform the feasibility of a larger multinational cohort study.
Number of Participants: 250 Primary Research Objectives: Feasibility Secondary Research Objective: The secondary objectives are to determine: 1. How a history of IPV affects injury-related complications; 2. How a history of IPV affects return to pre-injury function; 3. Incident cases of IPV after a musculoskeletal injury, if the injury was not the result of IPV; 4. How a history of IPV affects health care and support service use after a musculoskeletal injury; 5. How a history of IPV affects health-related quality of life after a musculoskeletal injury; 6. How patterns of IPV change over time after a musculoskeletal injury; 7. How abused women's stage of change changes over time after a musculoskeletal injury Diagnosis and Main Inclusion Criteria: The inclusion criteria are: 1. adult females (at least 16 or 18 years of age depending on local ethics requirements); 2. patients presenting to participating fracture clinics within 6 weeks of their musculoskeletal injury; 3. patients presenting with a fracture or dislocation which is being managed with either surgical or non-surgical treatment. The exclusion criteria are: 1. unwilling to or unable to provide consent; 2. unable to complete the study questionnaires in a private location, due to safety and confidentiality; 3. unwilling or unable to follow the study protocol or their attending surgeon has concerns about their ability or willingness to follow study protocols; 4. does not speak and write in English or the dominant language of the local clinic Study Outcomes: The primary outcome is feasibility. Secondary outcomes are injury-related complications, return to function, incidence of IPV, quality of life, abuse type and severity, and stage of change. Duration of Patient Follow-Up: Study participants will be followed for 12 months
Study Type
OBSERVATIONAL
Enrollment
250
McMaster University
Hamilton, Ontario, Canada
Feasibility - Recruitment rate
Number of patients recruited at each site during a 12 month period
Time frame: 12 months
Feasibility - Proportion of Missed and/or out of window visits
Proportion of missed and out of window visits
Time frame: 12 months
Feasibility - Collection of secondary outcomes (Proportion of included patients followed at 12 months for the primary and secondary outcomes)
Proportion of included patients followed at 12 months for the primary and secondary outcomes
Time frame: 12 months
Feasibility - Completion of data collection (proportion of case report forms, including patient questionnaires, completed at 12 months)
The proportion of case report forms, including patient questionnaires, completed at 12 months.
Time frame: 12 months
Proportion of patients with injury-related complications assessed by central adjudication
Compare proportion of patients experiencing a composite of injury-related complications between patients who self-report a history of IPV and those who do not. Injury-related complications include non-union, malunion, infection, unplanned secondary procedure, mortality, hardware failure, etc. An independent, blinded adjudicator will determine whether the event is injury-related.
Time frame: 12 months
Return to function questionnaire
We will use the Return to Function Questionnaire (RTF) to compare the mean time to return to pre-injury function among women who disclose a history of IPV versus those who do not disclose IPV. The RTF is a 4 question tool that was used in a recently completed large FDA-regulated fracture trial.
Time frame: 12 months
IPV incidence questionnaire
Women's self-reported experience of IPV will be measured using a direct method of screening used by the PRAISE Investigators in 2 previous studies conducted in trauma populations. A participant will be considered to have disclosed IPV if she answers positively to at least 1 of the 3 direct screening questions.
Time frame: 12 months
Resource use questionnaire
Women's access to and use of health and support services will be measured by directly asking participants to self-report if they have accessed health care services, a social worker, mental health professional, women's shelter, helpline, violence against women website, or legal assistance.
Time frame: 12 months
Quality of life - EQ-5D
Participants' quality of life will be measured using the EuroQol-5 Dimensions (EQ-5D), a widely used and well-validated quality of life tool. The EQ-5D is a comprehensive, 5-item compact health status classification and health state preference questionnaire.
Time frame: 12 months
IPV frequency questionnaire
Using 3 questions from the Woman Abuse Screening Tool, which categorizes frequency of different types of violence, we will record and analyze changes in frequency of IPV experienced over time.
Time frame: 12 months
Stage of change questionnaire
Participants will complete the Domestic Violence Survivor Assessment (DVSA) Short Form questionnaire to determine her stage of change. The stages of change are based on the transtheoretical model of health behavior change applied specifically to survivors of abuse. We developed the DVSA Short Form for the purpose of this study, with the aim of making the self-administered form more accessible.
Time frame: 12 months
IPV type questionnaire
Using 3 questions from the Woman Abuse Screening Tool, which categorizes types of violence as physical, emotional, and/or sexual abuse, we will record and analyze changes in type of IPV experienced over time.
Time frame: 12 months
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