Systematic review of multidisciplinary rehabilitation in patients with multiple trauma

Abstract

Background: Multiple trauma is a cause of significant disability in adults of working age. Despite the implementation of trauma systems for improved coordination and organization of care, rehabilitation services are not yet routinely considered integral to trauma care processes. Results: No randomized and/or controlled clinical trials were identified. Fifteen observational studies involving 2386 participants with injuries were included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach assessed methodological quality as 'poor' in all studies, with selection and observer bias. Although patients with low functional scores showed improvement after rehabilitation, they were unable to resume their pretrauma level of activity. Their functional ability was significantly associated with motor independence on admission and early acute rehabilitation, which contributed to a shorter hospital stay. Injury location, age, co-morbidity and education predicted long-term functional consequences. Trauma care systems were associated with reduced mortality. The gaps in evidence include: rehabilitation settings, components, intensity, duration and types of therapy, and long-term outcomes for survivors of multiple trauma. Conclusion:Rehabilitation is an expensive resource and the evidence to support its justification is needed urgently. The issues in study design and research methodology in rehabilitation are challenging. Opportunities to prioritize trauma rehabilitation, disability management and social reintegration of multiple injury survivors are discussed.

The Impact of Trauma Care Systems in Low- and Middle-Income Countries

“…Disability after injury is 20-50 times more common than death; much of the resultant morbidity can be alleviated by early and appropriate rehabilitation services that increase functioning, prevent secondary complications (e.g., pressure sores, contractures), and promote independence (55). Rehabilitation is critical to maximizing the effectiveness of emergency and surgical care services for injury and should be an area of priority inquiry and planning.…”

A benchmarking project of physiotherapy in Australian and New Zealand adult major trauma services

“…However, it could be argued that even this referral process is not as effective as a blanket physiotherapy referral given only 55% of all trauma patients in that study received any physiotherapy and not until a median time point of 1.5 days into their hospital stay (Curtis et al 2006). Given early and more intensive physiotherapy has been shown to improve functional independence (Calthorpe et al 2014, Khan et al 2012 and reduce length of stay (Kimmel et al 2012, Pendleton et al 2007, a more consistent approach to referrals and staffing may improve patient and organisational outcomes.…”

Trauma system development

“…Rehabilitation services in local and specialised facilities should be integrated into the trauma system, with agreed protocols in place to facilitate transfer once treatment at the MTC is completed [61]. Good data on the benefits of rehabilitation after major trauma is scarce [78], but early, intensive rehabilitation may improve outcome [3,79,80]. A robust quality improvement and clinical governance programme, using key performance indicators, should monitor the standard of care provided by the trauma system, implement new strategies and submit data to national trauma registries such as TARN [46,67].…”