[Rehabilitation after polytrauma : Definitions and treatment approaches]

[Trauma rehabilitation : Implementation and challenges]

The current state of posttraumatic rehabilitation in Germany is on the one hand shaped by the efforts of the primary care providers in the acute setting to transfer patients as soon as possible to rehabilitation in accordance with the requirement for a continuous chain of rehabilitation. On the other hand, there are still important treatment gaps due to a lack of options, specialized structures and financing. This has the consequence that severely injured patients sometimes experience substantial difficulties, setbacks and delays on their way back to social participation. This article presents the various phases of rehabilitation and the existing challenges in order to guarantee the universally acknowledged demand for a continuous rehabilitation chain. Reference is made to the missing structures and simultaneously to the necessary continuity of the processes, the quality assurance and the financial prerequisites for new forms of care. This is exemplified by how the continuum of posttraumatic rehabilitation of the German statutory accident insurance with the successful reintegration of trauma victims in work and social life could be a model for insured persons of the statutory health insurance and the German pension fund. The scientific societies of trauma surgery and rehabilitation medicine also promote the model of a differentiated trauma rehabilitation and sustain the idea of a trauma rehabilitation network to increase the chances of the severely injured for the best possible quality of life and social participation.

Patient experiences of rehabilitation following traumatic complex musculoskeletal injury – A mixed methods pilot study

Introduction

The aim of this pilot study was to measure patient reported outcomes and evaluate their rehabilitation experience following traumatic complex musculoskeletal (CMSK) injury.

Methods

A mixed methods prospective observational study was undertaken between December 2015 and March 2018 to explore patient reported outcomes following CMSK injury sustained as a result of major trauma and perception of their rehabilitation and its impact on their recovery. The participants were asked to complete a series of outcome measures at 18-months post-injury. The data was anonymised and analysed by the lead researcher.

Results

Thirty patients were recruited into the study (19 males, 11 females) between 23 and 76 years of age (median 52 years). Their injury profile was split between open fractures 30%, pelvic fractures 23%, multiple fractures 27% and polytrauma 20%. The majority (60%) reported moderate disability at 18-months post injury with 50% returning to full time employment. Patients with multiple or open fractures reported the worst outcomes. There was no relationship between frequency, quantity or duration of physiotherapy and outcome. However, 77% reported supplementing their NHS rehabilitation with other interventions such as gym membership, hydrotherapy and psychological therapies. The thematic analysis showed that patients considered intensity, quality and coordinated timely access to rehabilitation as the most important factors.

Conclusion

From a patient perspective, the current NHS rehabilitation provision does not appear to meet their complex needs. In addition to physical and vocational rehabilitation, patients wanted effective pain management and psychological support. Strengthening current therapy services and involving other sectors (e.g. Citizen’s Advice) could help achieve this. Early access to an intensive multidisciplinary rehabilitation programme was perceived to have positive benefits and improve outcomes.

Orthopaedic nursing challenges in poly-traumatised patient management: A critical analysis of an Orthopaedic and Trauma Unit

INTRODUCTION AND BACKGROUND

Trauma is the most frequent cause of death in people under 40 years old. It is an important problem not only because of the high mortality but also because of the consequential disability that can lead to serious economic consequences.

STUDY AIMS

This descriptive, comparative study investigates the definitive management of poly-traumatised patients in an Italian Orthopaedic Ward in order to highlight its strengths and weaknesses in comparison with the most recent literature. This has led to the development of a pre-established algorithm for evaluation, preventive care and management of the poly-trauma patient and a flow-chart for improved patient care.

RESEARCH METHODS

A five-step observational and exploratory approach was employed in this study which critically analysed the nursing management of 60 multiple trauma patients admitted to our Orthopaedic Unit from April 2013 to October 2014.

RESULTS

The findings highlight the need for adherence to plans of care, which can be approached by a shared management of poly-trauma patients that involves the medical team, the patient and his family/caregiver.

DISCUSSION

The protocols and guidelines in use in our Orthopaedic and Trauma Unit are in line with European standards, although there is still margin for improvement. The study has led to the development of an algorithm that allows health professionals to have reference values for the care of polytrauma patients.

CONCLUSIONS AND RECOMMENDATIONS

This study demonstrates the use of theoretical and practical tools for the evaluation and management of poly-traumatised patients during their hospital stay. We recommend the use of both proposed tools: the general algorithm and the flow-chart for the management of the poly-trauma patient, as they allow identification of barriers and facilitators related to the implementation of international guidelines, currently well-defined for Emergency Departments but not yet for Orthopaedic Units.