Background: One third of women experience intimate partner violence (IPV) in their lifetime. Orthopaedic health care professionals are in a good position to identify women experiencing escalating physical violence and act to promote their immediate safety, connect them to IPV resources, and reduce the risk of further harm. However, there have been no studies that explore whether experiencing a musculoskeletal injury can trigger or worsen IPV, and there have been no studies on how experiences of IPV affect orthopaedic outcomes. The primary objective of the PRAISE-2 pilot study is to assess the feasibility of conducting a large cohort study to determine the association between IPV and injury-related complications. The secondary clinical objectives are to preliminarily explore how a history of IPV affects orthopaedic outcomes and how patterns of IPV change over time following an orthopaedic injury.
Methods: We will complete a pilot multicentre prospective cohort study of 250 women with musculoskeletal injuries to determine the feasibility of a multinational prospective cohort study that will determine if prior or ongoing IPV affects orthopaedic outcomes following an injury, and how patterns of IPV change over time. Our primary outcome is feasibility measured using recruitment rate (success criterion 50 patients/site in 12 months), adherence to visit windows (success criterion 75%), participant retention (success criterion 85%), and data completeness (success criterion 80%). Our secondary exploratory clinical outcomes are injury-related complications, return to function, new IPV disclosures, utilization and cost of support services, changes in abuse patterns, quality of life, and readiness to make relationship changes. We will assess feasibility based on pre-defined criteria for feasibility success and we will analyze secondary outcomes in an exploratory fashion.
Discussion: The PRAISE-2 pilot study is the first step toward determining how experiences of IPV affect orthopaedic outcomes such as injury-related complications. This study will determine feasibility and assist in the development of large-scale multinational prospective IPV studies for our future IPV research program. This study will engage health care professionals from around the world to increase awareness of how IPV affects patients' musculoskeletal and injury outcomes.
Trial registration: clinicaltrials.gov NCT02529267. Registered 20 Aug 2015.
Keywords: Cohort studies; Domestic violence; Feasibility; Intimate partner violence; Orthopaedic surgery; Protocol.
Conflict of interest statement
We have received ethics approval from the Hamilton Integrated Research Ethics Board (project # 15–383). Each additional clinical site will obtain local ethics approval before beginning the study. Participants will give written informed consent before participating.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study.Lancet. 2013 Sep 7;382(9895):866-76. doi: 10.1016/S0140-6736(13)61205-2. Epub 2013 Jun 12. Lancet. 2013. PMID: 23768757
PRevalence of Abuse and Intimate Partner Violence Surgical Evaluation (P.R.A.I.S.E.): rationale and design of a multi-center cross-sectional study.BMC Musculoskelet Disord. 2010 Apr 23;11:77. doi: 10.1186/1471-2474-11-77. BMC Musculoskelet Disord. 2010. PMID: 20416039 Free PMC article. Clinical Trial.
Examining the Impact of Trauma-Informed Cognitive Behavioral Therapy on Perinatal Mental Health Outcomes Among Survivors of Intimate Partner Violence (The PATH Study): Protocol for a Feasibility Study.JMIR Res Protoc. 2018 May 25;7(5):e134. doi: 10.2196/resprot.9820. JMIR Res Protoc. 2018. PMID: 29802091 Free PMC article.
Intimate partner violence and musculoskeletal injury: bridging the knowledge gap in orthopaedic fracture clinics.BMC Musculoskelet Disord. 2013 Jan 15;14:23. doi: 10.1186/1471-2474-14-23. BMC Musculoskelet Disord. 2013. PMID: 23316813 Free PMC article. Review.
Intimate Partner Violence: Prevalence Among U.S. Military Veterans and Active Duty Servicemembers and a Review of Intervention Approaches [Internet].Washington (DC): Department of Veterans Affairs (US); 2013 Aug. Department of Veterans Affairs (US). 2013. PMID: 25232637 Free Books & Documents. Review.
- World Health Organization. Violence against women fact sheet. http://www.who.int/mediacentre/factsheets/fs239/en/ Updated November 2017. Accessed 5 Dec 2017.
- Statistics Canada Homicide in Canada. Juristat. 2009;30(3):14.
- Zhang T, Hoddenbagh J, McDonald S, Scrim K. An estimation of the economic impact of spousal violence in Canada, 2009. Ottawa: Department of Justice Canada; 2013. http://www.justice.gc.ca/eng/rp-pr/cj-jp/fv-vf/rr12_7/index.html. Accessed 5 Dec 2017.