Journal of Rehabilitation Medicine 51-3 | Page 79
J Rehabil Med 2019; 51: 225–233
ORIGINAL REPORT
CLINICAL CHARACTERISTICS AND PHYSICAL FUNCTIONING IN PERSONS
HOSPITALIZED FOLLOWING THE NORWEGIAN TERROR ATTACKS IN JULY
2011: A FOLLOW-UP STUDY
Grethe MÅNUM, MD, PhD 1,2 *, Marianne LØVSTAD, Cand Psychol, PhD 1,3 , Kristin WISLØFF-AASE, MD 2,4 , Johan RÆDER,
MD, PhD 2,4 , Anne Kristine SCHANKE, Cand Psychol, PhD 1,3 , Ingar Larsen, Cand Psychol 1 , Grete DYB, MD, PhD 2,5 , Øivind
EKEBERG, MD, PhD 6,7 and Johan K. STANGHELLE, MD, PhD 1,2
From the 1 Department of Research, Sunnaas Rehabilitation Hospital, 2 Institute of Clinical Medicine, Faculty of Medicine, 3 Department of
Psychology, University of Oslo, 4 Department of Anesthesiology, Oslo University Hospital, 5 Norwegian Centre for Violence and Traumatic
Stress Studies, University of Oslo, 6 Division of Mental Health and Addiction, Oslo University Hospital and 7 Department of Behavioral
Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
Objective: To describe the clinical characteristics
and physical functioning in persons hospitalized af
ter 2 terror attacks in Norway in 2011.
Design: Cross-sectional study with retrospective
acute medical data.
Subjects: Surviving persons hospitalized with phy
sical injuries.
Methods: Medical and psychological assessments
3–4 years after injury, with data on injury type and
severity collected from medical records.
Results: A total of 30 out of 43 potential subjects
participated (19 women, 11 men; age range 17–71
years (median 23 years)). Eighteen participants had
suffered a severe injury, with New Injury Severity
Scale (NISS) scores > 15. All body parts were affec
ted. The number of surgical procedures ranged from
0 to 22 (median 3), and days in intensive care rang
ed from 0 to 59 (median 2.5), of which 16 had more
than 24 h intensive care. Three to 4 years later, a
majority of the participants had a broad spectrum
of somatic and psychological problems and reduced
physical functioning. Two-thirds of the participants
reported their physical health to be unsatisfacto
ry, and continuous need for healthcare and unmet
needs were identified for all except 4 of the parti
cipants.
Conclusion: Persons hospitalized following a terror
attack experience a broad spectrum of somatic and
psychological problems and need long-term physical
and psychological follow-up. This study indicates
specific needs for rehabilitation after injuries acqui
red under psychological traumatic circumstances.
Key words: terrorism; multiple trauma; health status; reha-
bilitation.
Accepted Jan 15, 2019; Epub ahead of print Feb 27, 2019
J Rehabil Med 2019; 51: 225–233
Correspondence address: Grethe Månum, Sunnaas Rehabilitation Hos-
pital, Bjørnemyrvn. 11, 1450 Nesoddtangen, Norway. E-mail: grethe.
[email protected]
T
error attacks can result in loss of life and large
numbers of severely injured persons (1–6). Prior
research after terrorist attacks has focused primarily
LAY ABSTRACT
Victims of terror are at major risk of long-term post-
traumatic stress disorder (PTSD) and physical sequelae.
Prior research after terrorist attacks has focused prima-
rily on PTSD and the need for mental health services,
where being injured has been seen as an indicator of
high exposure to the traumatic event and a predictor
of the level of psychological distress, rather than as a
risk factor for function and healthcare needs. Similar
to survivors of natural disasters, the impairments after
terror attacks vary in severity, and might include spinal
cord injuries, traumatic brain injury, limb amputation,
fractures, soft-tissue injuries, and psychological seque-
lae. This study investigated the medical characteristics,
physical functioning, and life satisfaction of people hos-
pitalized with physical injuries due to the 2011 Norway
terror events approximately 3 years after the attacks.
The assessments revealed a broad spectrum of somatic
and psychological problems, reduced physical functio-
ning, and a continuous need for healthcare.
on post-traumatic stress disorder (PTSD) and other
mental health issues and, correspondingly, the need
for mental health services (7–10). To our knowledge,
few studies have addressed long-term somatic health
characteristics and physical functioning in physically
injured terror victims.
On 22 July 2011, an extremist attacked the Govern-
mental Quarter in Oslo and a youth organization’s
summer camp on Utøya Island, Norway, killing 77
people and severely injuring many others (1–3). Pre-
vious studies on the injured survivors have focused
on their acute medical treatment (2, 3). Many victims
underwent multiple surgeries; 18 patients underwent
194 surgical procedures (3). The fragmenting bullets
resulted in progressive necrosis and destruction of soft
tissue with the risk of sepsis (3). These patients exhibi-
ted repetitive debridement; tissue loss was among the
primary challenges in the acute phase, and 2 patients
were amputated at the elbow or ex-articulated at the
shoulder and hip, respectively (3).
The Norwegian Centre for Violence and Traumatic
Stress has conducted a longitudinal survey investigating
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2521