Conceptualizing the key components of rehabilitation following major musculoskeletal trauma: A mixed methods service evaluation

Abstract

Rationale, Aims, and Objectives: The reorganization of acute major trauma pathways in England has increased survival following traumatic injury, resulting in an increased patient population with diverse and complex needs requiring specialist rehabilitation. However, national audit data indicate that only 5% of patients with traumatic injuries have access to specialist rehabilitation, and there are limited guidelines or standards to inform the delivery of rehabilitation interventions for individuals following major trauma. This group concept mapping project aimed to identify the clinical service needs of individuals accessing our major trauma rehabilitation service, prioritize these needs, determine whether each of these needs is currently being met, and plan targeted service enhancements. Methods: Participants contributed towards a statement generation exercise to identify the key components of rehabilitation following major trauma, and individually sorted these statements into themes. Each statement was rated based on importance and current success. Multi-dimensional scaling and hierarchical cluster analysis were applied to the sorted data to produce themed clusters of ideas within concept maps. Priority values were applied to these maps to identify key areas for targeted service enhancement. Results: Fifty-eight patients and health care professionals participated in the ideas generation activity, 34 in the sorting, and 49 in the rating activity. A 7-item cluster map was agreed upon, containing the following named clusters: Communication and Coordination; Emotional and psychological wellbeing; Rehabilitation environment; Early rehabilitation; Structured therapy input; Planning for home; and Long-term support. Areas for targeted service enhancement included access to timely and adequate information provision, collaborative goal setting, and specialist pain management across the rehabilitation pathway. Conclusion: The conceptual framework presented in this article illustrates the importance of a continuum of rehabilitation provision across the injury trajectory, and provides a platform to track future service changes and facilitate the codesign of new rehabilitation interventions for individuals following major trauma.

Embedded rehabilitation in major trauma: Retrospective pre-post observational study of service and patient outcomes

“…Previous analyses of extremity injuries in major trauma have found a similar pattern 23 . At a local level, these likely reflect the complex inpatient rehabilitation requirements of this patient group in relation to mobility, function and safety currently provided within our MTC as part of the dedicated multidisciplinary trauma pathway 24 .…”

Identifying and prioritising the key components of a Quality Improvement Network for allied health professionals and psychological therapists: a group concept mapping project

“…These concept maps provide accessible, visual representations of how participants conceptualise the relationships between ideas they generate on a particular topic 14. GCM has been used in a variety of settings by members of this project team and other authors to plan, evaluate and make improvements to existing healthcare interventions and services 15–19. However, to the best of our knowledge, this is the first time GCM has been used to investigate and prioritise the perceived QI support needs of National Health Service (NHS) staff in an applied healthcare setting.…”

A group concept mapping and ethnographic study of intensive care rehabilitation culture

“…22 It has previously been used within health care research to evaluate existing services and to provide co-authored solutions to concepts or phenomena in health care that have previously been difficult to describe or define. 23,24 Unlike other participatory methods, such as a Delphi study, where the aim is to reach consensus and negate outlying responses, GCM recognizes the views and perspectives of all stakeholder participants as valid and reflects these in the resultant concept map. Stakeholder participants are key throughout the GCM process, providing their perspectives in the generation of ideas, the cataloguing of the data and the interpretation of the results.…”