Term Rehabilitation Research Articles

Service evaluation project: the effects of healthy weight commissioning for quality and innovation (CQUIN) interventions on metabolic parametrs of service users in a medium secure forensic ward

AimsService users of secure forensic units can be prone to weight gain due to various reasons including medications, physical illnesses, sedentary habits and mental health difficulties. They in turn are at greater risk of obesity related health problems like Diabetes, Hypercholesterolaemia, Ischaemic Heart Disease, Depression among others.Our project was aligned with government's plan to improve prevention and screening for the obesity and metabolic syndrome among the patients of medium secure facilities by 2020.Our primary objective was to gather and analyse the data on current metabolic parameters such as weight, body mass index (BMI), blood pressure (BP) and biochemistry markers of the service users on a 18 bedded Male medium secure long term rehabilitation ward.Our secondary objective was to suggest healthy weight interventions that would help patients to loose weight and to explore the effects of these interventions on biochemistry markers and vital signs parameters.MethodWe collected cross sectional data in given period of time (mid-March 2020). Seventeen service users were included in the final sample. Following initial data collection, we suggested various healthy weight interventions for the patients and repeated data collection after four months (July 2020).Interventions offered:Healthy eating group1:1 sessions with doctors and pharmacistsGym referralsDietician referralsRelaxation groupResultBaselineFourteen patients on the ward (n = 14) were found to be either overweight or obese. Two patients (n = 2) had high BP, twelve patients (n = 12) had deranged lipid profile, six (n = 6) had high blood glucose (existing Diabetes).Following interventionFourteen patients (n = 14) remained either overweight or obese. Nine patients (n = 9) lost weight following the intervention. Eight patients (n = 8) gained weight over 4 months. In both of the patients (n = 2) with raised BP the readings came back to normal after the intervention. One (n = 1) patient with normal BP at the baseline had high blood pressure following intervention.ConclusionOur service evaluation projects revealed that majority of the patients on the ward had deranged metabolic parameters such as increased BMI, abnormal blood tests and high BP.Following our intervention more than a half of the patients lost weight whilst other half gained weight during the period of observation, which we suspect is associated with significant physical activity restrictions during the coronavirus pandemic. In both patients with high BP at the baseline it has improved following the intervention.We would continue implementing healthy weight interventions on the ward and across the unit.

Study on the level of daily living function and its influencing factors in elderly patients after hip fracture surgery

To analyze the short-term prognosis of elderly patients with hip fracture after operation, and to explore the main factors affecting the recovery of daily life function. From November 2015 to November 2016, 130 elderly patients with hip fracture were analyzed, including 43 males and 87 females, aged from 60 to 95 (77.54±8.49) years. The death, fall and complications were recorded 3 months after operation. The daily life function of the patients was followed up 3 months after operation with the functional recovery of daily life scale (FRS). T-test, analysis of variance and single factor linear regression analysis were used to analyze the general clinical data. The factors with P<0.05 were analyzed by multi factor linear regression method, and the influencing factors of postoperative ADL were obtained. Among 130 patients, 7 died (5.4%), 4 fell (3.1%), 103 (79.2%) had postoperative complications, and the FRS score of 123 patients was 65.92±22.79. The results showed that gender, age, fracture site, pre fracture Basel rating, frailty index, postoperative hospital stay and total number of postoperative complications had significant differences in the recovery of daily life function (P<0.05);multiple linear regression analysis showed that pre fracture Basel rating (t=-2.727, P=0.007), frailty index (t=-2.573, P=0.011) and postoperative hospital stay had significant differences. The days of hospital stay (t=-3.391, P=0.001) and the total number of postoperative complications (t=-3.281, P=0.001) were the independent risk factors for postoperative ADL in elderly patients with hip fracture (R2=0.411). The short term rehabilitation level of elderly patients with hip fracture after operation is poor. Basel rating before fracture, frailty index, postoperative hospital stay and total number of postoperative complications may be related risk factors affecting the recovery of daily life function of patients after operation.

Successful Experience of Fecal Transplantation in a Patient with Severe Pseudomembranous Colitis

Introduction . At the present time there is increase the number of patients diagnosed with pseudomembranous colitis due to Clostridiodes difficile, respectively it significantly increases the frequency of hospitalizations, the length of hospital stay and the cost of treatment. Approved drug methods for correcting a pathological condition are not always able to lead to recovery after the first use, repeated and prolonged courses of therapy are often required, especially with recurrent Clostridiodes difficile. An alternative way of treatment is fecal microbiota transplantation from a donor. Nowadays, fecal microbiota transplantation is included in national clinical guidelines in several countries in Europe, the USA and Australia. In Russia this method has not been registered, however, there are some publications about its successful application in gastrointestinal diseases, oncohematology, and some autoimmune diseases. Aim . To show the result of successful treatment of severe pseudomembranous colitis after a single fecal microbiota transplantation. Material and methods . Outpatient treatment of an acute respiratory infection with a broad-spectrum antibacterial drug caused the development of severe pseudomembranous colitis in a young patient. Standard courses of metronidazole and vancomycin were unsuccessful. Transplantation of fecal microbiota from a donor was performed via ileocolonoscopy. Results. A single fecal microbiota transplantation contributed to the patient’s complete recovery, short term rehabilitation and the absence of recurrence of Clostridiodes difficile within two years. Conclusions. Evidence-based medicine has shown the high efficiency of fecal microbiota transplantation. In Russia a legislative basis is needed for including fecal microbiota transplantation in clinical guidelines for the treatment of severe Clostridiodes difficile resistant to standard therapy .

Nursing Stroke Patients

Stroke worldwide is the second most common cause of death and one of the most important causes of severe adult disability. While there have been major advances in the development of acute treatments such as endovascular thrombectomy, many patients will not make a rapid recovery and will need rehabilitation and often prolonged care. Nurses are vital members of the acute admitting team and have a central role on the stroke unit and in the delivery of longer term rehabilitation and support. In many countries these roles are not fully realized. This article highlights some of the evidence supporting the need for stroke specialist nurses and identifies the key skills required.

COVID-19 Rehab Fright Management.

Being diagnosed as positive for SARS-2 CoV RNA on PCR generates anxiety and stress as well as depression due to the prospects of being isolated. With genetically varied forms of virus on the rise the widely adopted manner to protect oneself is social distancing. This is frightening for rehabilitation professionals who at times are exposed at close quarters to the patients as rehabilitation is essential. Data in this backdrop is lacking, as this is a recent and ongoing pandemic. As such the current study was conducted with an attempt to review and highlight the causes of fright among rehabilitation professionals and possible management options in the wake of current pandemic of COVID-19 in the perspective of Pakistan. For this purpose literature was searched from major electronic databases including PubMed, Google, Google Scholar and Web-of-science, with keywords “Covid-19, mental health, telehealth, telemedicine, tele-rehabilitation and combination of words”. Eighty English, full text articles were studied out of which 36 were used for the literature review. With this literature review we conclude that COVID-19 has resulted in fear of contracting and transmitting this disease among health professionals and can be reduced and managed by provision of tele-rehabilitation and telehealth facilities. Patients emerging from prolonged mechanical ventilations require extensive rehabilitation to restore routine body functions. The role of the otolaryngologist and speech language pathologist (SLP) is formal and direct to ensure appropriate and timely long term intervention and rehabilitation to ensure that these individuals re-enter mainstream activities.

A clinical case study and medical nutritional therapy in pediatric meningioencephalitis

Meningoencephalitis is an inflammation of the brain and its surrounding protective membranes. Meningitis is a life-threatening disease and can lead to significant sequelae. We were presented with a 6 year 5 months old female child on ventilation, retrieved by referral hospital on examination revealed human herpesvirus 6 through cerebrospinal fluid analysis and diagnosed with meningoencephalitis on Magnetic Resonance Imaging(MRI) with three repeated failed extubation and hence planned tracheostomy. Child presented no movements with suspected motor or sensory (vision, hearing) disability, generalized tonic-clonic seizure (GTCS), altered sensorium requiring a long term rehabilitation and nutrition support. On close monitoring, a continuous effort of three months and with a multidisciplinary clinical approach from different disciplines including neurologist, intensivist, clinical dietitian and physiotherapy, the child successfully completed the long term rehabilitation treatment with remarkable improvement observed within 12 weeks both neurologically and nutritionally with a better clinical outcome.

Long-term Results of a Combined Procedure of Cataract Surgery and Descemet Membrane Endothelial Keratoplasty With Stromal Rim.

To evaluate the long-term results of combining cataract surgery, intraocular lens (IOL) implantation, and Descemet membrane endothelial keratoplasty with peripheral stromal support (DMEK-S). The outcomes of 107 eyes of 37 patients who had undergone a combination of cataract surgery, IOL implantation, and DMEK-S between October 2007 and February 2015 were retrospectively evaluated. The average follow-up duration was 18.2 ± 18.3 months (range, 6-84 months). Changes in uncorrected and corrected distance visual acuity, spherical equivalent, and corneal endothelial cell density were analyzed. Intraoperative and postoperative complications were also recorded. The mean logMAR uncorrected distance visual acuity improved from 0.92 ± 0.60 preoperatively to 0.33 ± 0.33, 0.28 ± 0.25, 0.24 ± 0.20, and 0.27 ± 0.27 at 6, 12, 24, and 36 months postoperatively (P < 0.001), respectively. The mean logMAR corrected distance visual acuity improved from 0.62 ± 0.65 preoperatively to 0.17 ± 0.29, 0.13 ± 0.21, 0.07 ± 0.16, and 0.11 ± 0.23 at 6, 12, 24, and 36 months postoperatively (P < 0.001), respectively. The mean endothelial cell density decreases were 50.7% ± 21.1%, 50.8% ± 19.8%, 60.7% ± 16.6%, 62.2% ± 11.8%, and 61.8% ± 20.0% at 6, 12, 24, 36, and 48 months after surgery, respectively. Similar trends, although with slightly better visual outcomes, were found in the subgroup of patients without other eye diseases. The mean final deviation from intended spherical equivalent was 0.77 ± 1.19 D, representing a hyperopic shift. A combined procedure of cataract surgery, IOL implantation, and DMEK-S is an effective method of treatment in patients with combined corneal disease and cataract, maintaining visual rehabilitation in the long term. Future developments should be performed to minimize the incidence of complications.

Cognitive Improvement After Cochlear Implantation in Older Adults With Severe or Profound Hearing Impairment: A Prospective, Longitudinal, Controlled, Multicenter Study.

Objective:To compare the cognitive evolution of older adults with severe or profound hearing impairment after cochlear implantation with that of a matched group of older adults with severe hearing impairment who do not receive a cochlear implant (CI).Design:In this prospective, longitudinal, controlled, and multicenter study, 24 older CI users were included in the intervention group and 24 adults without a CI in the control group. The control group matched the intervention group in terms of gender, age, formal education, cognitive functioning, and residual hearing. Assessments were made at baseline and 14 months later. Primary outcome measurements included the change in the total score on the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals score and on its subdomain score to assess cognitive evolution in both groups. Secondary outcome measurements included self-reported changes in sound quality (Hearing Implant Sound Quality Index), self-perceived hearing disability (Speech, Spatial, and Qualities of Hearing Scale), states of anxiety and depression (Hospital Anxiety and Depression Scale), and level of negative affectivity and social inhibition (Type D questionnaire).Results:Improvements of the overall cognitive functioning (p = 0.05) and the subdomain “Attention” (p = 0.02) were observed after cochlear implantation in the intervention group; their scores were compared to the corresponding scores in the control group. Significant positive effects of cochlear implantation on sound quality and self-perceived hearing outcomes were found in the intervention group. Notably, 20% fewer traits of Type D personalities were measured in the intervention group after cochlear implantation. In the control group, traits of Type D personalities increased by 13%.Conclusion:Intervention with a CI improved cognitive functioning (domain Attention in particular) in older adults with severe hearing impairment compared to that of the matched controls with hearing impairment without a CI. However, older CI users did not, in terms of cognition, bridge the performance gap with adults with normal hearing after 1 year of CI use. The fact that experienced, older CI users still present subnormal cognitive functioning may highlight the need for additional cognitive rehabilitation in the long term after implantation.

Современные тенденции в оперативном лечении больных с повреждениями таза и вертлужной впадины (обзор литературы)

Introduction There is evidence in the literature over the past 5 years that pelvic and acetabular fractures are increasing in prevalence with the rise of injuries sustained in road traffic accidents, the growing number and severity of trauma, significant complication rate and unsatisfactory outcomes due to untimely surgical treatment. Objective Review current trends in the selection of surgical approaches and fixation of the pelvis and acetabulum, the postoperative rehabilitation strategies and identify factors for poor outcomes of surgical treatment. Material and methods We performed searches using HAC peer-reviewed and SCOPUS indexed journals, EMBASE, MEDLINE, Сochrane library, еLibrary.ru, Wiley Online Library with search criteria of pelvic fractures, displaced acetabular fractures, open reduction of the pelvis and acetabulum, osteosynthesis, minimally invasive osteosynthesis and primary total hip arthroplasty, approaches and complications of acetabular fracture surgery. Results Indications to surgical treatment of patients with concomitant, multiple and isolated fractures of the pelvis and acetabulum were identified with the use of current strategy and principles of damage control surgery and damage control orthopaedics. Surgical approaches for two-column acetabular fractures have been shown to be extensile and traumatic. Discussion Most authors report use of the active surgical strategy for displaced fractures of the pelvis and acetabulum. Open reduction internal fixation is the standard of care for pelvic and acetabular fractures. Conclusion Postoperative complications and long term rehabilitation of patients with pelvic and acetabular fractures support further research and development of new more effective approaches to address the solution of the challenging issue.

The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients.

Hip fractures are common orthopaedic injuries in the elderly. Opioids can provide peri-operative pain relief in hip fracture patients, but may have side effects. Peripheral nerve blocks such as the fascia iliaca compartment block (FICB) have become an established part of the multimodal analgesic regime administered peri-operatively to hip fracture patients. We compare the efficacy of the continuous infusion FICB (CFICB) on peri-operative pain relief, opioid usage, its associated complications and the short as well as long term rehabilitation status in geriatric hip fractures patients. In this retrospective matched case control study, 40 geriatric patients with hip fractures who had received the CFICB from Nov 2014 to April 2016 were matched in a 1:3 ratio with similar patients whom had not received the CFICB from our institution's hip fracture database of 913 patients. A total of 157 patients in both the CFICB group (N = 40) and the control group (N = 117) were studied. The post-operative pain scores and the total opioid consumption during the first 3days in the CFICB group were significantly less than the control group (p < 0.0001, respectively). The systemic complications in the CFICB group were comparable with the control group. The CFICB group had slower rehabilitation at up to 2weeks but there was no significant difference at 1year post surgery in terms of function and mobility between the two groups. In both groups, better pre-fracture function was associated with faster short term rehab outcomes in post-operative patients. The CFICB provides safe and effective post-operative pain relief in geriatric hip fracture patients. Post-operative opioid usage is decreased in older hip fracture patients treated with CFICB. Rehabilitation milestones are slower in the short term, but have no significant difference at 1-year post surgery.

Older Adults With Cognitive and/or Physical Impairments Can Benefit From Immersive Virtual Reality Experiences: A Feasibility Study.

Background: Older adults living in long term care, rehabilitation hospitals, and seniors' residences often experience reduced mobility, sometimes resulting in confinement indoors and isolation, which can introduce or aggravate symptoms of depression, anxiety, loneliness, and apathy. As Virtual Reality (VR) technologies become increasingly accessible and affordable, there is a unique opportunity to enable older adults to escape their restricted physical realities and be transported to both stimulating and calming places which may improve their general well-being. To date no robust evaluations of the use of immersive VR therapy [experienced through a head-mounted-display (HMD)] for older adults within these settings have been reported. VR-therapy may prove to be a safe, inexpensive, non-pharmacological means of managing depressive symptoms and providing engagement and enjoyment to this rapidly growing demographic.Objectives: Establish whether it is feasible to use immersive VR technology as therapy for older adults who have reduced sensory, mobility and/or impaired cognition. This includes evaluation of tolerability, comfort, and ease of use of the HMD, and of the potential for immersive VR to provide enjoyment/relaxation and reduce anxiety and depressive symptoms.Methods: Sixty-six older adults (mean age 80.5, SD = 10.5) with varying cognitive abilities (normal = 28, mild impairment = 17, moderate impairment = 12, severe impairment = 3, unknown cognitive score = 6), and/or physical impairments, entered a multi-site non-randomized interventional study in Toronto, Canada. Participants experienced 3 to 20 min of 360°-video footage of nature scenes displayed on Samsung GearVR HMD. Data was collected through pre/post-intervention surveys, standardized observations during intervention, and post-intervention semi-structured interviews addressing the VR experience.Results: All participants completed the study with no negative side-effects reported (e.g., No dizziness, disorientation, interference with hearing aids); the average time spent in VR was 8 min and 76% of participants viewed the entire experience at least once. Participants tolerated the HMD very well; most had positive feedback, feeling more relaxed and adventurous; 76% wanted to try VR again. Better image quality and increased narrative video content were suggested to improve the experience.Conclusion: It is feasible and safe to expose older adults with various levels of cognitive and physical impairments to immersive VR within these settings. Further research should evaluate the potential benefits of VR in different settings (e.g., home/community based) and explore better customization/optimization of the VR content and equipment for the targeted populations.

Long term complications and rehabilitation of COVID-19 patients.

With the ongoing pandemic of COVID-19 having caught the world almost unaware millions of people across the globe are presently grappling to deal with its acute effects . Our previous experience with members of the same corona virus family (SARS and MERS) which have caused two major epidemics in the past albeit of much lower magnitude , has taught us that the harmful effect of such outbreaks are not limited to acute complications alone .Long term cardiopulmonary, glucometabolic and neuropsychiatric complications have been documented following these infections .In the given circumstance it is therefore imperative to keep in mind the possible complications that may occur after the acute phase of the disease subsides and to prepare the healthcare system for such challenges.

АКТУАЛЬНІ ПИТАННЯ, МЕТА І ЗАВДАННЯ КОРЕКЦІЙНОРЕАБІЛІТАЦІЙНИХ СЛУЖБ УКРАЇНИ ДЛЯ ДІТЕЙ З ІНВАЛІДНІСТЮ ТА/АБО З ОСОБЛИВИМИ ОСВІТНІМИ ПОТРЕБАМИ

The article reveals status, goals and objectives of correctional and rehabilitation services for children with special educational needs and/or children with disabilities at the present stage of development of Ukraine. The author provided scientific and pedagogical definition of term correctional and rehabilitation services as structured system of facilities, divisions and positions that implements correctional and rehabilitation activities support for the different social institution (medicine, social protection, education). The attention is focused on on multidimensional concept of correctional and rehabilitation services that could be considered as a social institution, process, team of specialists, result. A number of issues that actual for practical work of correctional and rehabilitation services are given in the article. There have been analyzed main international documents and legislative base of Ukraine about ensuring constitutional rights to receive correctional and rehabilitation services for children with special educational needs and/or children with disabilities. The accent was done that state takes actions for effective functionality of system of correctional and rehabilitation services. But absence of unified mechanism for coordination activities of correctional and rehabilitation services of different social institution leads to non effective functionality of services and have an impact to the provided quality of correctional and rehabilitation assistance. Prospects for further research are in studying structure, meaning and activities efficiency new type of correctional and rehabilitation services. Key words: correctional and rehabilitation services, children with special educational needs, children with disabilities, legislative base.

Effect of Rehabilitation Interventions on Sensation, Function, and Pain of the Patients With Carpal Tunnel Release

Objectives: Carpal Tunnel Syndrome (CTS) is now the most common type of nerve compression neuropathies constituting about (90) of the neuropathic disorders. To attain the optimal recovery following the operation, a rehabilitation intervention is urgent. This study aims at investigating the efficacy of short and long term rehabilitation interventions following Carpal Tunnel Release (CTR) on motor functions, sensory, and pain. Methods: Thirty patients were randomly assigned to two groups after CTR. The intervention group received rehabilitation exercises within a week after the operation, and the control group received a progressive home exercise program. The patients were assessed in terms of pain, sensation, function (measured by Boston Questionnaire), pinch, and grip (measured by dynamometer) in three periods of time, before operation, 6 weeks, and 12 weeks after operation by Visual Analogue Scale (VAS), Semmes Weinstein Test of Monofilaments, Boston questionnaire test, and dynamometer. Results: No significant differences in function were seen between the two groups (P=0.28). The average score of pain decreased. In spite of the increase in sensory score in the intervention group, no significant difference was found (P=0.19). A considerable difference was found in pain, grip, and pinch between the two groups during the first 6 weeks after the operation. Discussion: The rehabilitation interventions, even in short term, affect the pain and power (pinch and grip). Also, they facilitate returning to work. In the long term, however, there were no considerable diversities. In other words, improvements gained in two groups are the same in the long-term. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

A child in shock: carotid blowout syndrome

Paediatricians commonly encounter neck lumps during their routine clinical practice; vascular abnormalities, such as (pseudo)aneurysms, are a rare cause of these. Pseudoaneurysms of the carotid artery in children are usually...

STRESSORS FOR PARENTS OF CHILDREN WITH COCHLEAR IMPLANT IN PAKISTAN

STRESSORS FOR PARENTS OF CHILDREN WITH COCHLEAR IMPLANT IN PAKISTAN

Proprioception following the Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Tendon Allograft.

After the anterior cruciate ligament (ACL) reconstruction, a loss of proprioception is observed and it can continue years after the operation. The aim of this study is to evaluate proprioception in standing position at different knee flexion angles in patients who underwent ACL reconstruction with tibialis anterior tendon allograft. The study included 34 patients who underwent ACL reconstruction with tibialis anterior tendon allograft and 34 healthy individuals. Proprioception was evaluated in standing position at 15°, 30°, 60° flexion angles with the active joint position sense (AJPS) method using digital inclinometer. Proprioception deviation angle was found to be higher in the operated leg at 30° and 60° flexion angles in the patient group compared with the other leg (p < 0.05), the biggest proprioception difference was between the 15° and 60° flexion angles in both the patient and the control group (p < 0.05) that the difference between 15° and 30° flexion angles is lowest (p < 0.05), and that these differences are higher in the operated leg of the patient group compared with the other leg of the patient group and to the dominant leg of the control group (p < 0.05). As approximately 4 years after ACL reconstruction with tibialis anterior tendon allograft, loss of proprioception at 60° knee flexion continued, ACL injury related to loss of proprioception may occur at angles higher than 30° flexion. Thus, patients may be provided with proprioception-enhancing rehabilitation in the long term, particularly, at flexion angles above medium levels.

Using economic asset valuation to meet rehabilitation priority needs in the water sector

ABSTRACTThe current study aims at economic asset valuation of water and wastewater infrastructures to prioritize rehabilitation interventions using the infrastructure value index (IVI) as a key performance indicator. The proposed methodology follows a three-step procedure: (1) identification, characterization and site inspection of existing assets; (2) estimation of the current replacement cost and the current value; and (3) establishment of the priority needs. Data from a utility in the Algarve region of Portugal are used as a case study. The specific objectives are to illustrate the methodology and highlight the inherent challenges and complexities associated with economic asset valuation. Results include the IVI calculation for different assets using scenarios of service lives. Different strategic interventions of rehabilitation in the long term were studied, allowing to assess the evolution of IVI, rehabilitation cost and increased risk assets. Asset valuation is important to establish short-term rehabilitation priorities and to analyse long-term strategies of rehabilitation.

420 Improved Outpatient Follow Up Compliance of Patients Discharged to Long Term Care and Rehabilitation Facilities Achieved by Initiating Multidisciplinary Caregiver Communication upon Discharge

420 Improved Outpatient Follow Up Compliance of Patients Discharged to Long Term Care and Rehabilitation Facilities Achieved by Initiating Multidisciplinary Caregiver Communication upon Discharge

Introduction of a novel questionnaire to assess the quality of postdischarge outpatient care and socioeconomic state after severe multiple injury.

Trauma registries provide knowledge about the pathophysiological events that follow severe injuries but only little is known about outpatient care and socioeconomic consequences at later stages in case of survival. We introduce a novel questionnaire to specifically assess the quality of postdischarge outpatient care and socioeconomic burden up to two years after severe multiple injury. Observational Study. Postdischarge outpatient treatment and socioeconomic burden within two years after severe trauma. Severely injured adult trauma patients (Injury Severity Score 9 and ICU admission). A new questionnaire was introduced in context of a two-year follow-up mail survey. The response rate was 57% (150/264 patients; 73% male, mean 45 years, mean ISS 17/New ISS 22; 99% blunt trauma). Rehabilitation measures were conducted in 70% of patients while 87% underwent outpatient treatment after discharge from the acute care facility. Further in-hospital stays were observed in 63% of patients and 19% reported the need for ongoing permanent care. Pain medication was taken by 74% of patients after discharge while 32% were still on pain medication at two years. 35% had been on sick leave >1 year while 18% had entirely lost their job. Every second patient reported financial disadvantages. The questionnaire yielded detailed information about the quality of outpatient care after discharge and confirmed the high socioeconomic burden among patients at two years after severe multiple injury. Long- term impairments after severe trauma are described frequently. Evaluation of ambulant treatment is the first step to optimize long- term rehabilitation and re-integration.