Intimate partner violence in orthopaedic surgery: lessons learned and future directions

Kim Madden (
Clinical Epidemiology & Biostatistics, McMAster University
August, 2014
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The overarching theme of this thesis is to discuss the research to date on intimate
partner violence (IPV) in orthopaedic surgery and to begin to study selected issues
that have been understudied in orthopaedic surgery and IPV. This thesis outlines the
current state of knowledge in the field of IPV and orthopaedic surgery and provides
some insight into three selected “emerging issues” in the field which warrant future
research including: education of orthopaedic surgeons and residents to reduce barriers
and improve perceptions; IPV perpetrators; and outcomes for victims of IPV. The
findings demonstrate that a short course on IPV for orthopaedic trainees led to an
improvement and retention of knowledge three months after the course. IPV
education should be integrated into training programs for orthopaedic surgeons. Our
systematic review on IPV perpetrator factors indicates that using alcohol or drugs,
experiencing child abuse, witnessing interparental aggression, low socioeconomic
status, and psychological conditions like depression and anxiety were commonly
associated with IPV perpetration. Perpetrator treatment programs should take into
consideration modifiable and preventable factors that are associated with IPV
perpetration. This thesis proposes a pilot prospective cohort study as the first step
toward determining how experiences of IPV affect orthopaedic outcomes such as
injury-related complications. The proposed study will determine feasibility and assist
in the development a larger-scale multinational prospective cohort study that will
engage health care professionals from around the world to increase awareness of how
IPV affects patients’ musculoskeletal outcomes. In the past decade, the field of
orthopaedic surgery has become more aware of the issue of IPV, but there are many
questions that remain. Future research into the above issues will be an excellent first
step to fully understanding the issue of IPV in orthopaedic patients, and may lead to
improved support of victims of IPV in the future.

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