Adaptation, self-motivation and support services are key to physical activity participation three to five years after major trauma: a qualitative study

Long-term functional outcomes in polytrauma: a fundamentally new approach is needed in prediction

PURPOSE

Modern trauma care has reduced mortality but poor long-term outcomes with low follow-up rates are common with limited recommendations for improvements. The aim of this study was to describe the impact of severe injury on the health-related quality of life, specifically characterise the non-responder population and to identify modifiable predictors of poorer outcomes.

METHODS

Five-year (2012-2016) prospective cohort study was performed at a level 1 trauma centre. Baseline Short-Form Health Survey (SF36) was collected at admission, and at 6 and 12 months postinjury together with demographics, injury mechanism and severity, psychosocial wellbeing, and return to work capacity.

RESULTS

Of the 306 consecutive patients [age 52 ± 17 years, male 72%, ISS 21 (17, 29), mortality 5%], 195 (64%) completed questionnaires at baseline, and at 12 months. Preinjury physical health scores were above the general population (53.1 vs. 50.3, p < 0.001) and mental health component was consistent with the population norms (51.7 vs. 52.9, p = 0.065). One year following injury, both physical health (13.2, 95% CI 14.8, 11.6) and mental health scores (6.0, 95% CI 8.1, 3.8) were significantly below age- and sex-adjusted preinjury baselines. Non-responders had similar ISS but with a lower admission GCS, and were more likely to be younger, and without comorbidities, employment, or university education.

CONCLUSION

Contrary to their better than population norm preinjury health status, polytrauma patients remain functionally impaired at least 1 year after injury. The identified high risk for non-responding group needs more focused efforts for follow-up. A fundamentally different approach is required in polytrauma research which identify modifiable predictors of poor long-term outcomes.

Social and community participation following traumatic lower limb amputation: an exploratory qualitative study

PURPOSE

To explore barriers and facilitators to social and community participation experienced by people following traumatic lower limb amputation (LLA).

METHODS

An exploratory qualitative study was conducted with nine adults with traumatic LLA in Victoria, Australia. Participants were a minimum of 18 months post amputation. Interview data was analysed using thematic analysis.

RESULTS

Participants referenced the inaccessibility of the built environment and physical challenges associated with prosthetic mobility as barriers to participation. Chronic and complex health concerns due to their injuries resulted in physical and emotional distress for some, further limiting their social and community engagement. Participants highlighted the benefit of peer-support networks and the value of supportive community groups in assisting the transition to their pre-amputation family, work and social roles. Participants also felt that a strong, positive attitude and being self-motivated were important to aid in their return to social and community participation.

CONCLUSION

People following traumatic LLA experience a number of physical, psychological and environmental challenges to participation. The role of peer-support networks, community groups and personal attitudes are important facilitators to assist a return to family, work and life roles. The findings of this study have informed the development of recommendations to guide clinical practice.IMPLICATIONS FOR REHABILITATIONPeer-support groups for people following traumatic lower limb amputation (LLA) may assist to improve their long-term adjustment to disability and community participationRetraining skills in an individual's own community should be considered when planning community-based therapy services for people following traumatic LLA.Ongoing psychosocial support including strategies to develop self-efficacy and positive mindset may improve social and community participationRegular medical and allied health reviews can be beneficial to promote early intervention for any complications that arise to minimise time off prosthesis.

'It Makes Me Feel Old': Understanding the Experience of Recovery From Ankle Fracture at 6 Months in People Aged 50 Years and Over

Ankle fracture is a common injury, and depending on injury severity, treatment may be a support boot, cast or surgery. Older people, particularly those with severe injuries who are asked to restrict weight bearing, struggle with early recovery. To elicit older peoples' experience of recovery 6 months after injury, we drew on a phenomenological approach using interviews. Findings revealed that getting on with life was a way of accepting what it feels like to 'be vulnerable', needing to 'be safe' while determinedly working hard to 'be myself'. Being vulnerable identified endurance of inactivity, loneliness and dependency in the non-weight bearing period of recovery, followed by a struggle to weight bear while lacking confidence and being fearful of falling and causing further damage. Being safe conveyed fragility where sensations, pain and stiffness acted as bodily reminders of injury. Lack of function and awareness of danger led to carefulness where planning or curtailing of activities ensured their safety. Being myself showed a determination to push away from a disrupted self-identify of being older or disabled while being challenged by the continuous process of learning to be more mobile. A lack of readiness for old age created a drive to age well. Despite loss of ability, participants hoped to regain their pre-injury way of living. This study challenges practice that disregards the hard work required to recover from ankle fracture. As comorbidity increases with age, failure to consider this aspect may contribute to frailty in this group of older people.

Evolution led humans to bipedalism, but we live in a sedentary society: Will "Sunday running" protect us from NCDs at no cost?

Evolution led humans to bipedal stance and movement. However, we live in a sedentary society that strongly challenges our willingness to be physically active. We (mis)understand that being at least a Sunday runner could protect us from sedentary-related diseases, but what if this compromises the healthier life expectancy anyway? Citing Paul Gauguin, we know where we come from and what we are, the question arises about where we are going. And also, how.

Measuring long-term outcomes after injury: current issues and future directions

Maximizing long-term outcomes for patients following injury is the next challenge in the delivery of patient-centered trauma care. The following review outlines three important components in trauma outcomes: (1) data gathering and monitoring, (2) the impact of traumatic brain injury, and (3) trajectories in recovery and identifies knowledge gaps and areas for needed future research.

Internet of things-based intelligent physical support framework using future internet of things

BACKGROUND

Physical exercise programs are required to improve students' physical ability, physical fitness, self-responsibility, and satisfaction to remain physically active for a lifetime. The supporting system's demanding characteristics include lack of school leadership support, and lack of communication skills among students is considered an essential factor in the physical education system.

OBJECTIVE

In this paper, an Internet of Things (IoT)-based intelligent physical support framework (IoT-IPSF) has been proposed to encourage education leadership and student social interaction in the physical education system.

METHOD

Training service analysis is introduced to improve adequate leadership support, helping in the physical education system's growth. Self-determination analysis is integrated with IoT-IPSF to enhance effective communication among school teachers, educational experts, and curriculum officers in the physical education system.

RESULTS

The simulation results show that the proposed method achieves a high accuracy ratio of 98.7%, an efficiency ratio of 95.6, student performance 97.8%, fitness level 82.3%, activity involvement 94.5% compared to other existing models.