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Moksnes HØ, Andelic N, Schäfer C, Anke A, Soberg HL, Røe C, Howe EI, Forslund MV, Røise O, Dahl HM, Becker F, Løvstad M, Perrin PB, Lu J, Sveen U, Hellstrøm T, Rasmussen MS. Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries. J Rehabil Med 2024; 56:jrm40078. [PMID: 38803207 DOI: 10.2340/jrm.v56.40078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/21/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. DESIGN Multicentre prospective cohort study. SUBJECTS Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. METHODS Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. RESULTS In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. CONCLUSION Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.
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Affiliation(s)
- Håkon Øgreid Moksnes
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christoph Schäfer
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway; Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Audny Anke
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ; Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway 2Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marit V Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Olav Røise
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Hilde Margrete Dahl
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Frank Becker
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Paul B Perrin
- School of Data Science, University of Virginia, Charlottesville, VA, USA; Department of Psychology, University of Virginia, Charlottesville, VA, USA; Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
| | - Juan Lu
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, USA
| | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Mari S Rasmussen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Ratter J, Wiertsema S, Ettahiri I, Mulder R, Grootjes A, Kee J, Donker M, Geleijn E, de Groot V, Ostelo RWJG, Bloemers FW, van Dongen JM. Barriers and facilitators associated with the upscaling of the Transmural Trauma Care Model: a qualitative study. BMC Health Serv Res 2024; 24:195. [PMID: 38350997 PMCID: PMC10865621 DOI: 10.1186/s12913-024-10643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND To assess the barriers and facilitators associated with upscaling the Transmural Trauma Care Model (TTCM), a multidisciplinary and patient-centred transmural rehabilitation care model. METHODS Semi-structured interviews were conducted with eight trauma surgeons, eight hospital-based physiotherapists, eight trauma patients, and eight primary care physiotherapists who were part of a trauma rehabilitation network. Audio recordings of the interviews were made and transcribed verbatim. Data were analysed using a framework method based on the "constellation approach". Identified barriers and facilitators were grouped into categories related to structure, culture, and practice. RESULTS Various barriers and facilitators to upscaling were identified. Under structure, barriers and facilitators belonged to one of five themes: "financial structure", "communication structure", "physical structures and resources", "rules and regulations", and "organisation of the network". Under culture, the five themes were "commitment", "job satisfaction", "acting as a team", "quality and efficiency of care", and "patients' experience". Under practice, the two themes were "practical issues at the outpatient clinic" and "knowledge gained". CONCLUSION The success of upscaling the TTCM differed across hospitals and settings. The most important prerequisites for successfully upscaling the TTCM were adequate financial support and presence of "key actors" within an organisation who felt a sense of urgency for change and/or expected the intervention to increase their job satisfaction. TRIAL REGISTRATION NL8163 The Netherlands National Trial Register, date of registration 16-11-2019.
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Affiliation(s)
- Julia Ratter
- Amsterdam UMC, location AMC, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Suzanne Wiertsema
- Amsterdam UMC, location AMC, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ilham Ettahiri
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Robin Mulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Anne Grootjes
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Julia Kee
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marianne Donker
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Amsterdam UMC, location VUmc, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Vincent de Groot
- Amsterdam UMC, location VUmc, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Epidemiology and Data Science, location VUmc, Amsterdam Movement Sciences, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Amsterdam UMC, location AMC, Department of Trauma Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Moksnes HØ, Schäfer C, Rasmussen MS, Soberg HL, Røise O, Anke A, Røe C, Næss PA, Gaarder C, Helseth E, Dahl HM, Hestnes M, Brunborg C, Andelic N, Hellstrøm T. Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries. J Clin Med 2023; 12:5300. [PMID: 37629342 PMCID: PMC10455533 DOI: 10.3390/jcm12165300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.
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Affiliation(s)
- Håkon Øgreid Moksnes
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
| | - Christoph Schäfer
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, P.O. Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, N-9038 Tromsø, Norway
| | - Mari Storli Rasmussen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway
| | - Olav Røise
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
| | - Audny Anke
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, P.O. Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, N-9038 Tromsø, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
| | - Pål Aksel Næss
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Traumatology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Christine Gaarder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Traumatology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Neurosurgery, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Hilde Margrete Dahl
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Child Neurology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Morten Hestnes
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
- Oslo University Hospital Trauma Registry, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
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Campagner A, Milella F, Guida S, Bernareggi S, Banfi G, Cabitza F. Assessment of Fast-Track Pathway in Hip and Knee Replacement Surgery by Propensity Score Matching on Patient-Reported Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13061189. [PMID: 36980497 PMCID: PMC10047673 DOI: 10.3390/diagnostics13061189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Total hip (THA) and total knee (TKA) arthroplasty procedures have steadily increased over the past few decades, and their use is expected to grow further, mainly due to an increasing number of elderly patients. Cost-containment strategies, supporting a rapid recovery with a positive functional outcomes, high patient satisfaction, and enhanced patient reported outcomes, are needed. A Fast Track surgical procedure (FT) is a coordinated perioperative approach aimed at expediting early mobilization and recovery following surgery and, accordingly, shortening the length of hospital stay (LOS), convalescence and costs. In this view, rapid rehabilitation surgery optimizes traditional rehabilitation methods by integrating evidence-based practices into the procedure. The aim of the present study was to compare the effectiveness of Fast Track versus Care-as-Usual surgical procedures and pathways (including rehabilitation) on a mid-term patient-reported outcome (PROs), the SF12 (with regard both to Physical and Mental Scores), 3 months after hip or knee replacement surgery, with the use of Propensity score-matching (PSM) analysis to address the issue of the comparability of the groups in a non-randomized study. We were interested in the evaluation of the entire pathways, including the postoperative rehabilitation stage, therefore, we only used early home discharge as a surrogate to differentiate between the Fast Track and Care-as-Usual rehabilitation pathways. Our study shows that the entire Fast Track pathway, which includes the post-operative rehabilitation stage, has a significantly positive impact on physical health-related status (SF12 Physical Scores), as perceived by patients 3 months after hip or knee replacement surgery, as opposed to the standardized program, both in terms of the PROs score and the relative improvements observed, as compared with the minimum clinically important difference. This result encourages additional research into the effects of Fast Track rehabilitation on the entire process of care for patients undergoing hip or knee arthroplasty, focusing only on patient-reported outcomes.
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Affiliation(s)
| | - Frida Milella
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milano, Italy
| | | | | | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milano, Italy
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Federico Cabitza
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milano, Italy
- Dipartimento di Informatica, Sistemistica e Comunicazione, University of Milano-Bicocca, 20126 Milano, Italy
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Jones SM, West C, Rappoport J, Akhtar K. Rehabilitation outcomes based on service provision and geographical location for patients with multiple trauma: A mixed-method systematic review. Injury 2023; 54:887-895. [PMID: 36801069 DOI: 10.1016/j.injury.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Previous research has highlighted the benefit of regionalised trauma networks in relation to decreased mortality. However, patients who now survive increasingly complex injuries continue to navigate the challenges of recovery, often with a poor view of their experiences of the rehabilitation journey. Geographical location, unclear rehabilitation outcomes and limited access to the provision of care are increasingly noted by patients as negatively influencing their view of recovery. STUDY DESIGN This mixed-methods systematic review included research that addresses the impact of service provision and geographical location of rehabilitation services for multiple trauma patients. The primary aim of the study was to analyse functional independence measure (FIM) outcomes. The secondary aim of the research was to examine the rehabilitation needs and experiences of multiple trauma patients by identifying themes around the barriers and challenges to rehabilitation provision. Finally, the study aimed to contribute to the gap in literature around the rehabilitation patient experience. METHODS An electronic search of seven databases was undertaken against pre-determined inclusion/exclusion criteria. The Mixed Methods Appraisal Tool was utilised for quality appraisal. Following data extraction, both quantitative and qualitative analysis methods were utilised. In total, 17,700 studies were identified and screened against the inclusion/exclusion criteria. Eleven studies met the inclusion criteria (five quantitative, four qualitative, two mixed method). RESULTS FIM scores showed no significant difference in all studies after long-term follow-up. However, statistically significantly less FIM improvement was noted in those with unmet needs. Patients with physiotherapist assessed unmet rehabilitation needs were statistically less likely to improve than patients whose needs were reportedly met. In contrast, there was a differing opinion regarding the success of structured therapy input, communication and coordination, long-term support and planning for home. Common qualitative themes revealed lack of rehabilitation post-discharge, often with long waiting times. CONCLUSION Stronger communication pathways and coordination within a trauma network, particularly when repatriating outside of a network catchment area is recommended. This review has exposed the many rehabilitation variations and complexities a patient may experience following trauma. Furthermore, this highlights the importance of arming clinicians with the tools and expertise to improve patient outcomes.
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Affiliation(s)
- Suzannah M Jones
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Physiotherapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Christopher West
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jacqueline Rappoport
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kash Akhtar
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2022; 49:747-761. [PMID: 36445397 PMCID: PMC10175342 DOI: 10.1007/s00068-022-02178-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
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Ekegren CL, Mather AM, Reeder S, Kimmel L, Ashe MC, Gabbe BJ. Can a new ward environment and intensive allied health staffing model enhance therapeutic opportunities in trauma care? A behavioural mapping study of patients' activities and interactions. Clin Rehabil 2022; 36:1314-1323. [PMID: 35712976 DOI: 10.1177/02692155221107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to assess changes in patient activities and interactions observed in response to a new trauma ward at a level 1 trauma centre, and subsequently, a new allied health staffing model. DESIGN Explorative case study using behavioural mapping. SETTING Level 1 trauma centre in Melbourne, Australia. PARTICIPANTS Hospitalised trauma patients. MAIN MEASURES Behavioural mapping of patients' activities and interactions was conducted by two observers over three 4-day observation phases: (i) at baseline, (ii) on the new ward and (iii) with the new staffing model. Changes in activities and interactions were assessed via negative binomial regression models and reported as incident rate ratios. RESULTS In total, 1264 patient observations were recorded over an 18-month period. After moving to the new ward, patients were observed performing activities of daily living at a 2.1-fold higher rate than at baseline (95% confidence interval: 1.18, 3.81) but walking/standing/climbing stairs 54% less (95% confidence interval: 0.22, 0.94). Subsequent to the new staffing model, patients were observed in the gym at a 4.1-fold higher rate (95% confidence interval: 1.60, 10.32) and interacting with allied health professionals at a 9.1-fold higher rate (95% confidence interval: 4.88, 16.98), than at baseline. After COVID-19 restrictions were introduced, patients were observed lying down 22% more (95% confidence interval: 1.04, 1.43), with 73% fewer visitor interactions (95% confidence interval: 0.17, 0.43). CONCLUSIONS Greater engagement in physical and social activities was observed following the implementation of the new allied health staffing model at a level 1 trauma centre. Whether these changes translate to improved trauma outcomes is important to investigate.
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Affiliation(s)
- Christina L Ekegren
- School of Primary and Allied Health Care, 2541Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Anne M Mather
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia
| | - Lara Kimmel
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Maureen C Ashe
- Department of Family Practice, 12358The University of British Columbia, Vancouver, Canada
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia
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Sinkler MA, Furdock RJ, Vallier HA. Treating trauma more effectively: A review of psychosocial programming. Injury 2022; 53:1756-1764. [PMID: 35491278 DOI: 10.1016/j.injury.2022.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation. OBSERVATIONS Studies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented. CONCLUSIONS AND RELEVANCE The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.
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Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan J Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH.
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9
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Cardoso R, Parola V, Neves H, Bernardes RA, Duque FM, Mendes CA, Pimentel M, Caetano P, Petronilho F, Albuquerque C, Sousa LB, Malça C, Durães R, Xavier W, Parreira P, Apóstolo J, Cruz A. Physical Rehabilitation Programs for Bedridden Patients with Prolonged Immobility: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116420. [PMID: 35682005 PMCID: PMC9180781 DOI: 10.3390/ijerph19116420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 12/04/2022]
Abstract
Bedridden patients usually stay in bed for long periods, presenting several problems caused by immobility, leading to a long recovery process. Thus, identifying physical rehabilitation programs for bedridden patients with prolonged immobility requires urgent research. Therefore, this scoping review aimed to map existing physical rehabilitation programs for bedridden patients with prolonged immobility, the rehabilitation domains, the devices used, the parameters accessed, and the context in which these programs were performed. This scoping review, guided by the Joanna Briggs Institute’s (JBI) methodology and conducted in different databases (including grey literature), identified 475 articles, of which 27 were included in this review. The observed contexts included research institutes, hospitals, rehabilitation units, nursing homes, long-term units, and palliative care units. Most of the programs were directed to the musculoskeletal domain, predominantly toward the lower limbs. The devices used included lower limb mobilization, electrical stimulation, inclined planes, and cycle ergometers. Most of the evaluated parameters were musculoskeletal, cardiorespiratory, or vital signs. The variability of the programs, domains, devices and parameters found in this scoping review revealed no uniformity, a consequence of the personalization and individualization of care, which makes the development of a standard intervention program challenging.
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Affiliation(s)
- Remy Cardoso
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Correspondence: (R.C.); (V.P.); (A.C.)
| | - Vitor Parola
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
- Correspondence: (R.C.); (V.P.); (A.C.)
| | - Hugo Neves
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Rafael A. Bernardes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Filipa Margarida Duque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Carla A. Mendes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Mónica Pimentel
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Pedro Caetano
- Centro Hospitalar Universitário Cova da Beira (CHUCB), 6200 Covilhã, Portugal;
| | - Fernando Petronilho
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- School of Nursing, University of Minho, 4710 Braga, Portugal
| | - Carlos Albuquerque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Health School, Polytechnic Institute of Viseu, 3500 Viseu, Portugal
| | - Liliana B. Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Cândida Malça
- Mechanical Engineering Department, Institute of Engineering (ISEC), Polytechnic Institute of Coimbra (IPC), 3030 Coimbra, Portugal;
- Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic Institute of Leiria (IPL), 2430 Marinha Grande, Portugal
| | - Rúben Durães
- ORTHOS SSI, Unipessoal LDA, 4809 Guimarães, Portugal;
| | | | - Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - João Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Arménio Cruz
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Correspondence: (R.C.); (V.P.); (A.C.)
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Røe C, Bautz-Holter E, Andelic N, Søberg HL, Nugraha B, Gutenbrunner C, Boekel A, Kirkevold M, Engen G, Lu J. Organization of rehabilitation services in randomized controlled trials - which factors influence functional outcome? A systematic review. Arch Rehabil Res Clin Transl 2022; 4:100197. [PMID: 35756983 PMCID: PMC9214333 DOI: 10.1016/j.arrct.2022.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To identify factors related to the organization of rehabilitation services that may influence patients’ functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions. Data Sources A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019. Study Selection In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0. Data Synthesis In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results. Conclusions Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.
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Affiliation(s)
- Cecilie Røe
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Corresponding author Cecilie Røe, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway, P.O. Box 1089, Blidern, 0319 Oslo, Norway.
| | - Erik Bautz-Holter
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Helene Lundgaard Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Boya Nugraha
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | | | - Andrea Boekel
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | - Marit Kirkevold
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet University, Oslo, Norway
| | - Grace Engen
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia
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11
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Ritschel M, Kuske S, Gnass I, Andrich S, Moschinski K, Borgmann SO, Herrmann-Frank A, Metzendorf MI, Wittgens C, Flohé S, Sturm J, Windolf J, Icks A. Assessment of patient-reported outcomes after polytrauma - instruments and methods: a systematic review. BMJ Open 2021; 11:e050168. [PMID: 34916311 PMCID: PMC8679059 DOI: 10.1136/bmjopen-2021-050168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We (1) collected instruments that assess health-related quality of life (HRQoL), activities of daily living (ADL) and social participation during follow-up after polytrauma, (2) described their use and (3) investigated other relevant patient-reported outcomes (PROs) assessed in the studies. DESIGN Systematic Review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, as well as the trials registers ClinicalTrials.gov and WHO ICTRP were searched from January 2005 to April 2018. ELIGIBILITY CRITERIA All original empirical research published in English or German including PROs of patients aged 18-75 years with an Injury Severity Score≥16 and/or an Abbreviated Injury Scale≥3. Studies with defined injuries or diseases (e.g. low-energy injuries) and some text types (e.g. grey literature and books) were excluded. Systematic reviews and meta-analyses were excluded, but references screened for appropriate studies. DATA EXTRACTION AND SYNTHESIS Data extraction, narrative content analysis and a critical appraisal (e.g. UK National Institute for Health and Care Excellence) were performed by two reviewers independently. RESULTS The search yielded 3496 hits; 54 publications were included. Predominantly, HRQoL was assessed, with Short Form-36 Health Survey applied most frequently. ADL and (social) participation were rarely assessed. The methods most used were postal surveys and single assessments of PROs, with a follow-up period of one to one and a half years. Other relevant PRO areas reported were function, mental disorders and pain. CONCLUSIONS There is a large variation in the assessment of PROs after polytrauma, impairing comparability of outcomes. First efforts to standardise the collection of PROs have been initiated, but require further harmonisation between central players. Additional knowledge on rarely reported PRO areas (e.g. (social) participation, social networks) may lead to their consideration in health services provision. PROSPERO REGISTRATION NUMBER CRD42017060825.
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Affiliation(s)
- Michaela Ritschel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Silke Kuske
- Fliedner Fachhochschule Düsseldorf, University of Applied Sciences, Düsseldorf, Germany
| | - Irmela Gnass
- Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Kai Moschinski
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sandra Olivia Borgmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Annegret Herrmann-Frank
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Charlotte Wittgens
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sascha Flohé
- Department of Trauma, Orthopaedics and Hand Surgery, Städt. Klinikum Solingen, Solingen, Germany
- Department of Orthopaedics and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Joachim Windolf
- Department of Orthopaedics and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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12
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Martin MP, Rojas D, Dean CS, Lockwood W, Nadeau J, Maertens A, Parry J, Maher M, Funk A, Stacey S, Burlew CC, Mauffrey C. Psychological outcomes affect functional outcomes in patients with severe pelvic ring fractures. Injury 2021; 52:2750-2753. [PMID: 32151428 DOI: 10.1016/j.injury.2020.02.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the correlation between post-traumatic functional and psychological outcomes in patients with severe pelvic ring injuries. METHODS Forty-four patients who sustained a completely unstable pelvic ring injury (Tile C, AO/OTA 61C) treated in our institution from 2012 to 2017 were included. A telephone interview was performed in 16 of 44 patients to evaluate pelvic functionality, using the Majeed pelvic score, and psychological evaluation, using Hamilton anxiety and depression rating scales. RESULTS The mean Injury Severity Score (ISS) was 27 ± 12, and mean GCS at presentation was 13 ± 4. Average time from trauma to interview was 3 years (range, 1-5 years). Mean Majeed pelvic score was 67 ± 22. Majeed sub-scores were pain 19 ± 9, work 10 ± 7, sitting 8 ± 2, sexual intercourse 3 ± 2, walking aids 11 ± 2, gait unaided 9 ± 2, walking distance 8 ± 3. Mean depression and anxiety scores were 16 ± 12 and 17 ± 14, respectively. Significant correlations were observed between functional and psychological outcomes (P < 0.005). Majeed score was negatively correlated with depressive symptoms (r = -0.721, P = 0.002) and anxiety symptoms (r = -0.756, P = 0.001). Depression and anxiety scores were positively correlated (r = 0.945, P < 0.001). CONCLUSION Lower functional outcomes in patients with Tile C pelvic injuries were correlated with more severe symptoms of depression and anxiety. We recommend that providers consider and treat patients' mental health condition during posttraumatic recovery.
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Affiliation(s)
- Murphy P Martin
- Department of Orthopaedics, Tulane University, 1430 Tulane Avenue New Orleans, LA 70112, USA
| | - David Rojas
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Chase S Dean
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Winthrop Lockwood
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Jason Nadeau
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Andrew Maertens
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Joshua Parry
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Michael Maher
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - August Funk
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Stephen Stacey
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Clay Cothren Burlew
- Department of Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, Colorado 80204, USA.
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Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers: A Systematic Review. Ann Surg 2021; 273:e239-e246. [PMID: 30985368 DOI: 10.1097/sla.0000000000003313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To appraise the quality of reporting on guideline, protocol, and algorithm implementations in adult trauma settings according to the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0). BACKGROUND At present we do not know if published reports of guideline implementations in trauma settings are of sufficient quality to facilitate replication by other centers wishing to implement the same or similar guidelines. METHODS A systematic review of the literature was conducted. Articles were identified through electronic databases and hand searching relevant trauma journals. Studies meeting inclusion criteria focused on a guideline, protocol, or algorithm that targeted adult trauma patients ≥18 years and/or trauma patient care providers, and evaluated the effectiveness of guideline, protocol, or algorithm implementation in terms of change in clinical practice or patient outcomes. Each included study was assessed in duplicate for adherence to the 18-item SQUIRE 2.0 criteria. The primary endpoint was the proportion of studies meeting at least 80% (score ≥15) of SQUIRE 2.0. RESULTS Of 7368 screened studies, 74 met inclusion criteria. Thirty-nine percent of studies scored ≥80% on SQUIRE 2.0. Criteria that were met most frequently were abstract (93%), problem description (93%), and specific aims (89%). The lowest scores appeared in the funding (28%), context (47%), and results (54%) criteria. No study indicated using SQUIRE 2.0 as a guideline to writing the report. CONCLUSIONS Significant opportunity exists to improve the utility of guideline implementation reports in adult trauma settings, particularly in the domains of study context and the implications of context for study outcomes.
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14
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Shiner CT, Vratsistas-Curto A, Bramah V, McDonell K, Mahoney AEJ, Sweeney S, Faux SG. Assessing unmet rehabilitation needs and the feasibility of a telehealth rehabilitation consultation service for road trauma survivors recently discharged from hospital. Disabil Rehabil 2021; 44:3795-3804. [PMID: 33605180 DOI: 10.1080/09638288.2021.1887377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Persistent activity limitations are common among road trauma survivors, yet access to rehabilitation in hospital and in the community remains variable. This study aimed to identify unmet rehabilitation needs following road trauma and assess the feasibility of a novel rehabilitation consultation service delivered via telehealth following hospitalization. METHODS A pilot cohort study was conducted with survivors of road trauma who were hospitalized but did not receive formal inpatient rehabilitation. All participants received a multidisciplinary rehabilitation consultation via telehealth 1-3 weeks post-discharge, to assess rehabilitation needs and initiate treatment referrals as required. Functional and qualitative outcomes were assessed at baseline (1-7 days); one month and three months post-discharge. RESULTS 38 participants were enrolled. All (100%) reported functional limitations at baseline; 86.5% were found to have unmet rehabilitation needs, and 75.7% were recommended rehabilitation interventions. Functional ability improved over time, but more than half the cohort continued to report activity limitations (67.6%), pain (64.7%) and/or altered mood (41.2%) for up to three months. Participants found the telehealth service to be acceptable, convenient, and helpful for recovery. CONCLUSIONS A high proportion of mild-moderate trauma survivors report unmet rehabilitation needs following hospital discharge. Telehealth appears to be a feasible, convenient and acceptable mode of assessing these needs.Implications for rehabilitationSurvivors of road-related injuries often experience ongoing impairments and activity limitations.Among those who don't receive rehabilitation in hospital, we found a high proportion (86.5%) had unmet rehabilitation needs after discharge.A telehealth rehabilitation service was feasible to deliver and could successfully identify unmet rehabilitation needs.The piloted telehealth intervention was viewed as acceptable, convenient and beneficial by patients.
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Affiliation(s)
- Christine T Shiner
- St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | | | | | | | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | - Steven G Faux
- St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
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15
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Jukema GN, Farokhzad F, Volbracht J, Steigmiller K, Held U, Bretscher B, Jucker F, Pape HC. [Care Management for Polytrauma Patients in a Level-1 Trauma Centre]. PRAXIS 2020; 109:1039-1049. [PMID: 32787532 DOI: 10.1024/1661-8157/a003532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Care Management for Polytrauma Patients in a Level-1 Trauma Centre Abstract. In our level-1 trauma institution, polytrauma patients with an Injury Severity Score of 16 or higher are facing waiting times for transfer to a rehabilitation facility, causing a negative financial outcome for our institution. The purpose of this study is to stimulate rapid transfer to a rehabilitation facility. In a single-centre case study, care management for (poly)trauma patients was started to ensure time-directed treatment for trauma patients related to Diagnosis-Related Groups (DRG). In the period of 2013-2018 there was an increase in trauma admissions up to 14 % (n = 16 157) with a mean length of hospital stay of 6.4 days, together with a reduction in the number of trauma bed capacity from 50 to 42. In relation to the DRGs, regular trauma patients who were not in need of a stationary rehabilitation facility stayed in line with the expected time of hospital stay. But (poly)trauma patients (n = 1831) with the need of a stationary stay in a rehabilitation centre were faced with waiting times before they could be transferred. The average excess waiting time in relation to DRG for polytrauma patients was 5.1 days. Trauma patients for a rehabilitation centre have a higher Case Mix Index (CMI) compared to those who do not require inpatient rehabilitation (4.22 versus 1.04, p <0.0001). With about 280 trauma patients annually waiting an extra 5.1 days for transfer to a rehabilitation facility, the financial burden for our department amounts to Swiss francs 885,360 without reimbursement. Since no extra bed capacities in rehabilitation facilities are available in our area, it may be advised to set up an early in-hospital trauma rehabilitation program in a level-1 trauma centre in order to reduce financial loss.
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Affiliation(s)
| | | | - Jörk Volbracht
- Medizin Controlling, Ärztliche Direktion, Universitätsspital Zürich
| | - Klaus Steigmiller
- Institut für Epidemiologie, Biostatistik und Prävention, Departement Biostatistik, Universität Zürich
| | - Ulrike Held
- Institut für Epidemiologie, Biostatistik und Prävention, Departement Biostatistik, Universität Zürich
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Naess HL, Vikane E, Wehling EI, Skouen JS, Bell RF, Johnsen LG. Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100070. [PMID: 33543097 PMCID: PMC7853396 DOI: 10.1016/j.arrct.2020.100070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective To perform a systematic review to assess the current scientific evidence concerning the effect of EIR for trauma patients with or without an associated traumatic brain injury. Data Source We performed a systematic search of several electronic (Ovid MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and SveMed+) and 2 clinical trial registers (clinicaltrials.gov and International Clinical Trials Registry Platform). In addition, we handsearched reference lists from relevant studies. Data Extraction Two review authors independently identified studies that were eligible for inclusion. The primary outcome measures were functional-related outcomes and return to work. The secondary outcome measures were length of stay in hospital, number of days on respirator, complication rate, physical and mental health measures, quality of life, and socioeconomic costs. Data Synthesis Four studies with a total number of 409 subjects, all with traumatic brain–associated injuries, were included in this review. The included trials varied considerably in study design, inclusion and exclusion criteria, and had small numbers of participants. All studies were judged to have at least 1 high risk of bias. We found the quality of evidence, for both our primary and secondary outcomes, low. Conclusions No studies that matched our inclusion criteria for EIR for trauma patients without traumatic brain injuries could be found. For traumatic brain injuries, there are a limited number of studies demonstrating that EIR has a positive effect on functional outcomes and socioeconomic costs. This review highlights the need for further research in trauma care regarding early phase interdisciplinary rehabilitation.
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Affiliation(s)
- Hanne Langseth Naess
- Regional Trauma Center, Haukeland University Hospital, Bergen, Norway.,Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Eirik Vikane
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Eike Ines Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medicine Psychology, University of Bergen, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rae Frances Bell
- Regional Centre of Excellence in Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, University of Trondheim, Trondheim, Norway.,Norwegian National Advisory Unit on Trauma, Oslo, Norway
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Farr B, Olver J, Fedele B, McKenzie D. Co-Located or Freestanding Multi-Trauma Orthopedic Rehabilitation. PM R 2020; 13:153-158. [PMID: 32306518 DOI: 10.1002/pmrj.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Multi-trauma rehabilitation is delivered in a variety of hospital settings. However, it is unclear whether the proximity of rehabilitation to acute services has an effect on rehabilitation outcomes. OBJECTIVE To evaluate whether the primary outcomes of an inpatient multi-trauma rehabilitation program (functional outcome and length of rehabilitation stay) are impacted when rehabilitation is delivered in a unit co-located in an acute hospital compared with a unit located in a freestanding hospital. To also compare these outcomes at a national level using data provided by the Australasian Rehabilitation Outcomes Centre (AROC). DESIGN Observational, retrospective audit study. SETTING An inpatient, orthopedic, multi-trauma rehabilitation unit that re-located from an acute co-located facility to a freestanding facility. PATIENTS Patients following multi-trauma injury admitted to the co-located rehabilitation unit (n = 216) or after its relocation to the freestanding rehabilitation unit (n = 186). METHODS Data were audited from the patients' hospital medical records including demographics, injury characteristics, and rehabilitation outcome measures (Functional Independence Measure [FIM] and length of rehabilitation stay). OUTCOME MEASURES The primary outcome variables were motor FIM change (change in function between admission and discharge), FIM efficiency (functional gain per inpatient day), and length of rehabilitation stay. RESULTS There were no statistically significant differences between the two settings in terms of motor FIM change (adjusted for admission motor FIM score) and motor FIM efficiency. In general, there was no statistically significant difference in length of rehabilitation stay between settings (median: 26 vs 27 days). At a national level, the majority of facilities offering inpatient multi-trauma rehabilitation are co-located. Nationally, freestanding units resulted in a slightly greater motor FIM change (difference between median changes adjusted for baseline = -.5, 95% confidence interval [CI] = -2.5, -0.6, P = .0012). CONCLUSIONS There were no differences observed in outcomes between multidisciplinary rehabilitation programs in either setting. Optimizing the individual components of a rehabilitation program and improving staff skill sets should be a focus going forward.
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Affiliation(s)
- Babak Farr
- Epworth HealthCare, Melbourne, Australia.,Chronic Pain Service, Austin Health, Melbourne, Australia.,Department of Anaestheisa and Pain management, Western Health, Melbourne, Australia
| | - John Olver
- Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Bianca Fedele
- Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Dean McKenzie
- Epworth HealthCare, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Cost-Effectiveness of the Transmural Trauma Care Model (TTCM) for the Rehabilitation of Trauma Patients. Int J Technol Assess Health Care 2019; 35:307-316. [PMID: 31337454 DOI: 10.1017/s0266462319000436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the societal cost-effectiveness of the Transmural Trauma Care Model (TTCM), a multidisciplinary transmural rehabilitation model for trauma patients, compared with regular care. METHODS The economic evaluation was performed alongside a before-and-after study, with a convenience control group measured only afterward, and a 9-month follow-up. Control group patients received regular care and were measured before implementation of the TTCM. Intervention group patients received the TTCM and were measured after its implementation. The primary outcome was generic health-related quality of life (HR-QOL). Secondary outcomes included disease-specific HR-QOL, pain, functional status, and perceived recovery. RESULTS Eighty-three trauma patients were included in the intervention group and fifty-seven in the control group. Total societal costs were lower in the intervention group than in the control group, but not statistically significantly so (EUR-267; 95 percent confidence interval [CI], EUR-4,175-3011). At 9 months, there was no statistically significant between-group differences in generic HR-QOL (0.05;95 percent CI, -0.02-0.12) and perceived recovery (0.09;95 percent CI, -0.09-0.28). However, mean between-group differences were statistically significantly in favor of the intervention group for disease-specific HR-QOL (-8.2;95 percent CI, -15.0--1.4), pain (-0.84;95CI, -1.42--0.26), and functional status (-20.1;95 percent CI, -29.6--10.7). Cost-effectiveness acceptability curves indicated that if decision makers are not willing to pay anything per unit of effect gained, the TTCM has a 0.54-0.58 probability of being cost-effective compared with regular care. For all outcomes, this probability increased with increasing values of willingness-to-pay. CONCLUSIONS The TTCM may be cost-effective compared with regular care, depending on the decision-makers willingness to pay and the probability of cost-effectiveness that they perceive as acceptable.
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Nikbakht-Nasrabadi A, Mohammadi N, Yazdanshenas M, Shabany M. Toward overcoming physical disability in spinal cord injury: a qualitative inquiry of the experiences of injured individuals and their families. BMC Neurol 2019; 19:171. [PMID: 31324152 PMCID: PMC6642509 DOI: 10.1186/s12883-019-1391-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background Spinal cord injury (SCI) is a life-changing experience for the individuals with SCI and their families. This study aimed to investigate physical strategies used for overcoming physical disability in individuals with SCI. Methods In this qualitative study, 17 SCI persons and 13 family caregivers were selected by a purposeful sampling. Settings of the study were Brain and SCI research (BASIR) center of Tehran University of Medical Sciences and Southern Social Welfare Center of Tehran and SCI Association of Tehran, Iran. Data were collected by face-to-face semi-structured interviews, which were continued until data saturation. The gathered data were concurrently analyzed by the content analysis method. Results The data analysis revealed one main theme (towards overcoming physical disability) and three sub-themes: 1) physical rehabilitation by various methods; 2) tendency towards the use of alternative medical methods; and 3) making effort for self-reliance. Conclusion The participants used physiotherapy and occupational therapy as an effective and essential approach offered by the healthcare team. Some individuals with SCI with help of their family had invented simple rehabilitation equipment for help to their physical rehabilitation. However, most participants had referred to different complimentary medicine specialists based on advice friends and relatives and they often had spent a lot of time and money ineffectively. Therefore, they need training and support of the healthcare team as well as social support to achieve physical independence and physical recovery. Further research is suggested to investigate the barriers to achieving physical empowerment in people with SCI in Iran.
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Affiliation(s)
- Alireza Nikbakht-Nasrabadi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Surgical Nursing and Head of the Faculty, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
| | - Manijeh Yazdanshenas
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shabany
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients: A non-randomized clinical trial in the Netherlands. PLoS One 2019; 14:e0213980. [PMID: 30901353 PMCID: PMC6430380 DOI: 10.1371/journal.pone.0213980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 03/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Multidisciplinary rehabilitation has been recommended for multi-trauma patients, but there is only low-quality evidence to support its use with these patients. This study examined whether a Supported Fast track multi-Trauma Rehabilitation Service (Fast Track) was cost-effective compared to conventional trauma rehabilitation service (Care As Usual) in patients with multi-trauma from a societal perspective with a one-year follow-up. Methods An economic evaluation alongside a prospective, multi-center, non-randomized, controlled clinical study, was conducted in the Netherlands. The primary outcome measure was the Functional Independence Measure (FIM). Generic Quality of Life and Quality Adjusted Life Years (QALYs) of the patients were derived using the Short-form 36 Health Status Questionnaire. Incremental Cost-Effectiveness Ratios (ICERs) were stated in terms of costs per unit of FIM improvement and costs per QALY. To investigate the uncertainty around the ICERs, non-parametric bootstrapping was used. Results In total, 132 patients participated, 65 Fast Track patients and 67 Care As Usual patients. Mean total costs per person were €18,918 higher in the Fast Track group than in the Care As Usual group. Average incremental effects on the FIM were 3.7 points (in favor of the Fast Track group) and the incremental (extra) bootstrapped costs were €19,033, resulting in an ICER for cost per FIM improvement of €5,177. Care As Usual dominated Fast Track in cost per QALY as it gave both higher QALYs and lower costs. All sensitivity analyses attested to the robustness of our results. Conclusions This study demonstrated that a multidisciplinary rehabilitation program for multi-trauma patients according to the supported fast track principle is promising but cost-effectiveness evidence remains inconclusive. In terms of functional outcome, Fast Track was more expensive but yielded also more effects compared to the Care As Usual group. Looking at the costs per QALYs, unfavorable ICERs were found. Given the lack of a willingness-to-pay threshold for functional recovery and the relatively short time horizon, it is not possible to draw firm conclusions about the first. Trial registration (Current Controlled Trials register: ISRCTN68246661).
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