Rehabilitation needs change with time after orthopaedic major trauma

Abstract

Background: To comply with the Best Practice Tariff for Major Trauma, rehabilitation prescriptions are completed for patients with an Injury Severity Score above 8, which covers a broader, previously-undefined population. This project uses the rehabilitation prescription to define the characteristics and rehabilitation needs of the orthopaedic major trauma population. Methods: A total of 336 patients with orthopaedic major trauma had an initial rehabilitation prescription completed in 1 year. Over a 7-month period, 143 of these patients were clinically assessed by a trauma rehabilitation specialist physiotherapist. Demographic data and rehabilitation needs identified from initial and follow-up rehabilitation prescriptions were recorded and analysed. Results: Orthopaedic injuries affect the largest number of major trauma patients (n=336/692). Falls (30%) and road accidents (29%) are the most common mechanisms of trauma for patients of all ages (mean 55.6 years). At initial assessment, mobility (97%), pain (95%), and independence with activities of daily living (IADL) (79%) were the most prevalent rehabilitation needs identified. Five months after injury, patients had a reduced rehabilitation need for mobility (60%), IADL (30%), and pain (27%). The need for psychological support increased from 2% to 22%, while vocational needs remained stable (initial 29%, review 26%). Difficulties with mood were first identified at the review stage in 94% of cases. Of patients who were reassessed, 48% had unmet rehabilitation needs requiring referral to physiotherapy (25%), health psychology (13%), and orthopaedic review (6%). Conclusions: Rehabilitation from orthopaedic major trauma continues beyond the acute hospital admission. Mobility, pain and IADL are most affected by injury, and mobility problems can persist for many months after injury. Rehabilitation needs can change, with difficulties managing emotions developing over time. Physiotherapists play a lead role in addressing the most frequent rehabilitation needs, but patients need multidisciplinary support, including health psychology and pain specialists, to meet their ongoing rehabilitation needs. Implications: Orthopaedic major trauma patients require access to specialist multidisciplinary rehabilitation throughout their recovery journey. Reassessment of the rehabilitation prescription is necessary to evaluate an individual's changing rehabilitation needs and improve access to appropriate professionals.