Advances in the rescue chain and first aid of polytrauma patients, which have consequently increased their chance of survival, have led to an increase in demands for rehabilitation. However, there is still a large hole in the continuity of rehabilitation between acute patient care and in-patient rehabilitation, the so-called "rehab-hole". The consequences are untapped rehabilitation potential, loss of strength, endurance and motivation as well as impairment of function of the patient.Based on the phase model of neurological/neurosurgical rehabilitation, we propose a step model for the rehabilitation of polytrauma patients that ensures an uninterrupted chain of rehabilitation. After acute patient care (phase a) and a potentially required early patient rehabilitation (phase b), trauma rehabilitation should seamlessly continue on to phase c. The implementation of phase c after acute patient rehabilitation requires changes in the structure of "orthopaedic" rehabilitation clinics and financial support due the large consumption of resources by more complexly injured patients in this phase. The subsequent rehabilitation in phase d is well established and complies with current rehabilitation measures (AHB, BGSW). Further rehabilitation measures may be essential for social and occupational reintegration of the patient (phase e), depending on the complexity of their injuries after the accident. For patients with long-lasting results after an accident, it is crucial to implement continuous follow-ups (phase f) to ensure a better long-term outcome.In order to implement this phase model it is necessary to establish specialized facilities that meet the particular requirements needed for phase c. This tri-phased treatment model in trauma centres can therefore be used in trauma rehabilitation. In addition to the already established local and regional rehabilitation centres, nationwide trauma rehabilitation centres have adopted phase c rehabilitation.
ZusammenfassungDie aktuelle Versorgungskette von Traumapatienten in Deutschland weist noch erhebliche Defizite, sogenannte „Reha-Löcher“, in den Bereichen Früh- und Postakutreha, aber auch in der langfristigen Nachsorge ehemals Schwerverletzter, auf. Die Einführung eines 6-stufigen Phasenmodells der Traumarehabilitation, in Anlehnung an das über Jahre gut etablierte und erfolgreiche Phasenmodell Neurorehabilitation der BAR, könnte, aus Sicht der Autoren, die Schwerverletztenversorgung komplettieren. Die erfolgreiche Umsetzung des neuen Phasenmodells ist abhängig von der Einbindung eines Trauma-Rehanetzwerkes mit geeigneten und entsprechend ausgestatten Reha-Einrichtungen in das Traumanetzwerk DGU®. Die enge Kooperation zwischen Akutbehandlung und Rehabilitation soll zu einer lückenlosen Behandlung Schwerverletzter und dadurch zu einem verbesserten langfristigen Outcome führen. Die Zu- und Einordnung der Trauma-Rehabilitationszentren sollte analog des 3-stufigen Modells des Traumanetzwerkes durch Reha-Einrichtungen unterschiedlicher Versorgungsstufen realisiert werden. Wesentliche Charakteristika zur Einordnung dieser Reha-Einrichtungen in die bestehenden Traumanetzwerke von DGU und DGUV, einschließlich der in den jeweiligen Versorgungsstufen zugeordneten Heilverfahren, werden vom Autorenteam vorgeschlagen und zur Diskussion gestellt.
The self-reported quality of life after multiple trauma no longer permanently achieves the original level despite extensive rehabilitation measures. Post-traumatic factors have a greater impact on the long-term quality of life than the injury severity. A long-term care and specialized rehabilitation services are needed to improve outcome further.
Zusammenfassung Fragestellung Schwerverletzte Patienten benötigen nach Ende der Akutbehandlung eine qualifizierte und lückenlose Rehabilitation. Diese postakute Rehabilitation (Phase C) stellt hohe Anforderungen an die Rehabilitationseinrichtung bezüglich personeller, sachlicher, organisatorischer und räumlicher Voraussetzungen. Aufgrund der Verletzungsschwere und den komplexen Anforderungen an eine postakute, multimodale Rehabilitation besteht ein hoher ärztlicher, pflegerischer, therapeutischer und ggf. psychologischer Einsatz. Methoden Der Arbeitskreis Traumarehabilitation der Sektion Rehabilitation der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) hat in mehreren Expertenrunden Anforderungen an die postakute Rehabilitation der Phase C bei Schwerverletzten konsentiert. Ergebnisse Die Arbeit führt die Anforderungen der postakuten Rehabilitation gemäß Expertenkonsens auf. Diskussion und Zusammenfassung Über eine hohe Qualifikation und entsprechende Infrastruktur überregionaler Traumarehabilitationszentren wird ein lückenloser Übergang in die Nach- und Weiterbehandlung von Schwerverletzten im TraumaNetzwerk DGU® sichergestellt.
Many polytrauma patients report significant long-term impairments to their physical and mental health, resulting in a reduction of their quality of life. In addition to the obvious physical accident sequences, psychological influences and the individual context factors pose special challenges to the rehabilitation team and the infrastructure of the facility. Professional reintegration and chronic pain are particularly common problems in the trauma rehabilitation. The central task of rehabilitation after accidents is the restoration or substantial improvement of the functional health and thus the reintegration into the social and professional environment. The overall rehabilitation goal is based on the biopsychosocial ICF model: the patient should achieve the best possible quality of life despite his functional impairments, and the workability and functional capability are to be restored as well as possible. This goal can only be reached after a lengthy process, in the course of which differentiated measures must be coordinated. This is the task of experienced doctors, therapists and rehabilitation managers, who accompany the patient permanently. The rehabilitation after serious accidents is to be distinguished from the "normal" orthopedic rehabilitation after elective interventions. The challenges of traumatic rehabilitation require special processes, infrastructures, as well as interrelated and coordinated rehabilitation phases. The three-phase model described in the "Weißbuch Schwerverletztenversorgung der DGU" has to be differentiated. Between the discharge from the acute care clinic and the beginning of the post-acute rehabilitation, a "rehabilitation hole" frequently occurs. The early rehabilitation, by definition, a part of the acute treatment, cannot adequately close this hole. A 6-phase model is proposed. Phase C of post-acute rehabilitation places particular demands on the rehabilitation facility. The further rehabilitation (phase E) provides specific measures, such as pain rehabilitation or activity-oriented procedures. A long-term follow-up of formerly seriously injured patients is necessary (phase F). An integration of trauma rehabilitation centers into the existing trauma network remains the long-term goal to improve the outcome after polytrauma.
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