The Transmural Trauma Care Model (TTCM) for the rehabilitation of trauma patients is effective in improving patient related outcome measures: a non-randomized controlled trial

Suzanne H Wiertsema,Vincent De Groot,Johanna M Van Dongen,Edwin Geleijn,Raymond W J G Ostelo,Heleen Beckerman,Frank W Bloemers

doi:10.1186/s12913-019-4547-6

Abstract

BackgroundThe Transmural Trauma Care Model (TTCM) is a refined post-clinical rehabilitation approach, in which a multidisciplinary hospital-based team guides a network of primary care physical therapists in the treatment of trauma patients. The objective of this study was to assess the effectiveness of the TTCM compared to regular care.MethodsA controlled-before-and-after study was performed in a level 1 trauma center. The TTCM includes four elements: 1) a multidisciplinary team at the outpatient clinic, 2) coordination and individual goal setting for each patient by this team, 3) a network of primary care physical therapists, 4) E-health support for transmural communication. Intervention group patients were prospectively followed (3, 6 and 9 months). The control group consisted of 4 clusters of patients who either had their first consultation at the outpatient clinic 0, 3, 6 or 9 months ago. Outcomes included generic- and disease-specific health-related quality of life (HR-QOL), pain, functional status, patient satisfaction, and perceived recovery. Between-group comparisons were made using linear regression analyses. The recovery pattern of intervention group patients was identified using longitudinal data analysis methods.ResultsA total of 83 participants were included in the intervention group. In the control group, 202 participants were included (68 in the baseline cluster, 26 in the 3-month cluster, 51 in the 6-month cluster, 57 in the 9-month cluster). Between-group differences were statistically significant in favor of the intervention group for disease-specific HR-QOL at 9 months, pain at 6 and 9 months, functional status at 6 and 9 months, patient satisfaction at 3, 6 and 9 months, and perceived recovery at 6 months. No significant differences were found between groups for generic HR-QOL at any time point. Generic HR-QOL, disease-specific HR-QOL, pain, and functional status significantly improved in a linear fashion among intervention group patients during the nine-month follow-up period.ConclusionsThis study provides preliminary evidence that the TTCM is effective in improving patient related outcome measures, such as disease-specific HR-QOL, pain and functional status. A multicenter, and ideally randomized controlled trial, is required to confirm these results.Trial registrationThe trial is registered at the Dutch Trial Register (NTR5474). Registered 12 October 2015. Retrospectively registered.

Highlights

The Transmural Trauma Care Model (TTCM) is a refined post-clinical rehabilitation approach, in which a multidisciplinary hospital-based team guides a network of primary care physical therapists in the treatment of trauma patients
We developed a new Transmural Trauma Care Model (TTCM) for trauma patients
Study participants A total of 655 trauma patients were identified as being potentially eligible for participation in the control group

Summary

Introduction

The Transmural Trauma Care Model (TTCM) is a refined post-clinical rehabilitation approach, in which a multidisciplinary hospital-based team guides a network of primary care physical therapists in the treatment of trauma patients. Traumatic injury-related mortality accounts for almost 10% of the global annual mortality. Major trauma accounts for the highest mortality rate among people under 40 years of age, compared to any other disease [1, 2]. Traumatic injury is responsible for the highest loss of Disability-Adjusted Life Years (DALYs) worldwide. A significant decrease in mortality has been achieved among severe trauma patients through the optimization of pre-hospital and in-hospital trauma care [9,10,11,12]. As further reductions in mortality rates are expected to be trivial, the focus of trauma care has shifted from aiming to reduce mortality rates to aiming to improve trauma patients’ HR-QOL and outcome [9,10,11,12]. HR-QOL has become one of the most important outcome measures in studies among severely injured trauma patients [13, 14], whereas relatively few studies have focused on measuring HR-QOL amongst mildly to moderately injured patients [15, 16]

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