Three-year clinical characteristics of hospitalized terror victims
health to be unsatisfactory. Of these, 13 were referred
further, while 2 had already been referred by their GP.
DISCUSSION
This study describes the long-term clinical characteris-
tics of those hospitalized with physical injuries after the
2011 terror attacks in Oslo. The assessments revealed
a broad spectrum of somatic and psychological pro-
blems, reduced physical functioning, and a continuous
need for healthcare. More than two-thirds of the study
participants (n = 22) reported their physical health to be
unsatisfactory, and only 6 reported both their physical
and psychological health to be satisfactory 3–4 years
after the terrorist attacks. Taken together, the findings
shed light on the particular mechanism at play in
persons who acquire physical injuries under extreme
psychological conditions, and also indicate long-term
rehabilitation needs in this group.
Previous publications pertaining the same terror
events have described the injury severity of hospita-
lized survivors (2, 3). Our assessments indicate that
the injuries caused by the terror events represented
a causal factor for most of the study participants’
long-term somatic complaints and reduced physical
functioning. The clinical investigations revealed that
neurological deficits causing paresis or neuropathic
pain, amputations, gastrointestinal disorders, tinnitus,
and skin complaints were in accordance with the injury
sites. However, more non-specific complaints, such
as dizziness and headache, were also identified; sup-
porting the knowledge that emotional symptoms may
predispose for somatic symptoms (12, 13, 35). Our
results are in accordance with the studies by Stene et
al. (10) and Bugge et al. (13) on the Utøya survivors,
stating that somatic symptoms could be related directly
to the physical injuries.
As this study investigated those hospitalized with
physical injuries, reduced physical functioning was
expected. The failure to detect significant correlations
between physical functioning and injury severity, but
significant correlation with pain, is noteworthy. The
non-significant correlation between NISS and physical
function seems reasonable, since the initial NISS score
did not reflect the clinical findings of later amputations,
peripheral or central paresis, and reduced sensibility.
A previous study on patients with non-terror-related
multiple injuries has reported similar results (36),
where acute injury-severity of gunshots did not predict
60 patients’ SF-36 scores 8 months after discharge.
The authors suggested that the anatomical region of
the injury (particularly central nervous system (CNS)
and extremity injuries) is more predictive of long-term
outcome than initial life-threatening lesions. Twelve
231
participants reported clinically significant pain, of
which healthcare needs concerning the pain condition
was identified for 10 of these (e.g. neuropathic pain).
The positive correlation between mean pain last week
and PTS symptoms is in concordance with previous
publications (37), and supports the need for a compre-
hensive approach for those with both psychological
and physical trauma.
Several studies have reported a significant associa-
tion between PTS symptoms and impaired physical
health. Bugge et al. (13) reported that PTS symptoms
might play a role in the development of somatic
complaints among non-hospitalized injured trauma
survivors, but also found that both hospitalized and
non-hospitalized injured participants reported signi-
ficantly higher levels of somatic complaints than the
uninjured population.
The self-reported concentration and memory diffi-
culties probably reflected the high levels of psycholo-
gical and physical symptom load (including pain and
sleep problems), as neuropsychological test measures
were normal. Similar findings have been reported
previously (38), in that no significant associations bet-
ween subjective perception of cognitive difficulties and
objective test measures were seen in Utøya survivors.
A major aim of healthcare services is to restore da-
maged body structures and functions and to prevent
or limit difficulties in performing activities and roles
within the context of an individual’s environment (39).
We found that most of the unmet healthcare needs
were related to somatic health, which might indicate
that the main priority of the outreach programme (to
alleviate mental health issues) did not adequately meet
the needs of injured persons with somatic health issues
(9, 10). A survey of the Utøya survivor population (9)
identified several who had not been reached as plan-
ned. In addition to the causes discussed by Dyb et al.
(e.g. non-Norwegian origin, high level of exposure
and post-traumatic stress, depression/anxiety), a lack
of coordinated efforts in addressing injury-related so-
matic illnesses, such as pain and physical restrictions,
could have contributed. In accordance with this, Dyb
et al. (9) found that the hospitalized participants had
been contacted by their local health services less often
than individuals who had not been hospitalized. Since
our study recruited a majority of those with short stays
at the acute hospital, this might reflect that those with
short hospital stays and/or transfers to their local hos-
pitals were at risk of reduced follow-up. In the current
study, data collection was performed in an outpatient
setting, and healthcare needs were based on a clinical
decision process from experienced rehabilitation pro-
fessionals, while the study by Stene et al. (11) recorded
the survivors’ subjective opinions.
J Rehabil Med 51, 2019