Date of Award

Spring 2022

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Redeker, Nancy


Traumatic orthopaedic injuries (TOIs), musculoskeletal injuries that result from physical trauma, affect millions of Americans, and cost more than cancer, diabetes, or heart disease annually. Post-injury symptoms of anxiety, depression, pain, sleep disturbance, and stressor-related disorders are common and associated with negative long-term outcomes. Individuals rarely experience a single symptom, but often experience them in clusters of 2 or more co-occurring symptoms. Symptom clusters can be phenotypically characterized by symptom cluster profiles that describe the common ways a group experiences a set of symptoms. Symptom cluster profiles may share biological underpinnings, yet research examining biological underpinnings of symptom cluster profiles in TOI survivors is sparse. Examining potential biomarkers of symptom cluster profiles among TOI survivors will inform precision-health symptom management among TOI survivors. This dissertation focuses on the presentation, clinical, demographic, and treatment correlates, and biological underpinnings of co-occurring symptoms among TOI survivors. The first paper is a systematic review of anxious symptoms in TOI survivors. The second paper is the protocol for my dissertation study in which I present a detailed discussion of the materials and methods and potential implications of the study. I present the results of my dissertation study in the third paper in which I discussed the results of latent profile analysis to identify and describe symptom cluster profiles among 150 hospitalized TOI survivors. I identified the sociodemographic and clinical characteristics and biomarkers associated with symptom cluster profile membership with unadjusted and adjusted multinomial logistic regression. Findings from this dissertation paper are foundational to understanding TOI survivors’ early experiences with multiple symptoms and provide support for future longitudinal and precision-health studies.