Karen Hoffman

Systematic review of multidisciplinary rehabilitation in patients with multiple trauma.

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.

Health Outcome after Major Trauma: What Are We Measuring?

Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.

Improving outcomes in the early phases after major trauma.

Purpose of reviewThe scope of this review is to describe what is known about injury outcomes and the principles by which they can be improved by acute phase interventions. Assessing which outcomes matter to trauma patients is important both for the evaluation of existing and novel acute interventions and to assess the delivery of care within trauma systems’ performance improvement frameworks. Recent findingsTrauma care is moving away from the straightforward assessment of simple endpoints such as mortality or amputation. These have limited applicability and may not truly demonstrate the effectiveness of some acute interventions. Other intermediate or long-term measures are more patient-centred but are harder to measure, collect and interpret. Acute interventions improve outcomes through a combination of early definitive care concurrent with techniques to maintain homeostasis and preserve cells and tissues. These interventions need to be delivered within a regional systems framework. Trauma systems improve outcomes by reducing randomness and error from trauma care pathways. SummaryImproving outcomes in the acute phase of trauma care requires the timely delivery of complex interventions with an organized trauma system. Research is needed both in developing novel interventions and in developing and validating patient-centred and surrogate outcome tools.

NICE on rehabilitation. New guidelines on rehabilitation likely to restrict practices and stifle innovation.

We are pleased that the National Institute for Health and Care Excellence thought it important to develop guidelines for the management of patients with stroke.1 We are also reassured by the position taken by the Guideline Development Group (GDG)—that the evidence pointed to intervention improving function and mobility, but that there was little evidence to support one type of intervention over another.2 However, despite the GDG’s intentions to facilitate innovations in practice,3 there is a serious risk that …

NICE on rehabilitation

We are pleased that the National Institute for Health and Care Excellence thought it important to develop guidelines for the management of patients with stroke.1 We are also reassured by the position taken by the Guideline Development Group (GDG)—that the evidence pointed to intervention improving function and mobility, but that there was little evidence to support one type of intervention over another.2 However, despite the GDG’s intentions to facilitate innovations in practice,3 there is a serious risk that …

Acute rehabilitation after resuscitative endovascular balloon occlusion of the aorta (REBOA) in major trauma

We report a 23-year-old woman admitted post cyclist versus heavy goods vehicle accident in December 2014. This was the second case the life-saving procedure, that is, resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed on at the roadside. This advanced procedure was performed due to the extensive haemorrhage from this patient’s complex pelvic fracture . As a result of REBOA, the patient consequently lost her left lower limb and underwent a variety of complex pelvic and lower limb surgeries. The patient was admitted to the acute critical care unit and underwent repeated operations and was not ready to start active rehabilitation until 12 days into her admission. Prior to this she was on movement restrictions and received physiotherapy for limb care and dietetics in order to meet her nutritional requirements. The patient was stepped down to a ward setting and started on an extensive physiotherapy programme and was then transferred to the rehabilitation unit for amputees at Roehampton.

Patient perception of recovery following severe trauma: experience from a trauma follow-up clinic

Methods A prospective cohort study was conducted on trauma patients admitted to a Major Trauma Centre for more than 72 hours. A proportion of these patients were seen in a trauma follow-up clinic approximately two months post injury. Semi structured interviews were conducted during clinic appointments. The World Health Organisation International Classification of Function Disability and Health (WHO ICF) was used as a framework to structure questions relating to recovery. Descriptive data analysis was completed.