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Rehabilitation outcomes based on service provision and geographical location for patients with multiple trauma: a mixed-method systematic review

Published:January 21, 2023DOI:https://doi.org/10.1016/j.injury.2023.01.034

      Highlights

      • Annually major trauma costs the NHS up to £0.4billion with resultant economic loss of £3.7billion which fails to account for rehabilitation.
      • Nationally, trauma network success is measured and benchmarked on mortality rates but whilst there is a lack of specialist rehabilitation, acute care efforts appear futile.
      • Geographical access to specialist rehabilitation appears synonymous with trauma care. A lack of exposure to complex patient cases results in dilution of expertise.
      • Early access with strong communication, coordination and continuity of rehabilitation within and between trauma networks is recommended.
      • Geographical rehabilitation disparity showed lack of rural services, often with long travel distances. Higher quality rehabilitation was experienced where a major trauma centre was present.

      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.

      Keywords

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