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Rehabilitation after orthopaedic major trauma

Rehabilitation after orthopaedic major trauma. Jacqueline Claydon February 2014 Clinical Research Associate awarded by CLRN 2013. Orthopaedic Trauma Rehab Clinic. Pilot: May – November 2013 n=143, mean 5.0 months Physiotherapy-led consultation

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Rehabilitation after orthopaedic major trauma

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  1. Rehabilitation after orthopaedic major trauma Jacqueline Claydon February 2014 Clinical Research Associate awarded by CLRN 2013

  2. Orthopaedic Trauma Rehab Clinic • Pilot: May – November 2013 • n=143, mean 5.0 months • Physiotherapy-led consultation • Subjective and clinical assessment of all injuries • Reassess Rehabilitation Prescription • Set Rehabilitation Goals • Refer to clinical and rehabilitation services • Qualitative Research • Patient perception of recovery and rehabilitation after orthopaedic major trauma, n=15 To use the rehabilitation prescription to improve patient care

  3. Harry’s story Age distribution, % • Male, 63, working • Fall from a height • Major Trauma bypass Want to go back to work, I’ve worked all my life Work Status % (Ortho) Background

  4. Mechanism Road accident: 15% Motorbikes: 14% Assault: 1% Industrial: 1% Bike: 4% Fall from height: 22% Slips, trips and falls: 30% Pedestrian: 8% Sports: 6%

  5. Harry’s injuries • Orthopaedic: • Pilon fracture ankle • Spanning ex-fix; ORIF • Non weight-bearing 3 months • T12 wedge fracture: conservative • ISS 13 • Level 1 All 42% (Ortho 26%) • Level 2 All 34% (Ortho 11%) Clinical database, n=692 ISS does not reflect functional limitations

  6. Rehabilitation Prescription They were so good everybody, right through, the doctors as well • Physiotherapy • OT • Nurse • Orthopaedics • Pain team Inpatient Rehabilitation Needs

  7. Discharge planning • Discharge home with equipment and carer support • 7 days after injury • Minimal mobility • Non weightbearing, zimmer frame • Fracture clinic follow up • Physio referral when weightbearing status changes • Trauma Rehab clinic

  8. we rang the Red Cross, and uh, they said yes, and that’s the best, it was twenty pound to hire it, and that’s the best twenty pound I ever, ever spent If you hadn’t rung that day and stepped in, I still mightn’t be getting physio • Environmental issues • Not able to manage in own home • Partner’s bungalow • Stuck in the house • Wheelchair from the red cross • Fracture complications • Osteopenia: • Referred for urgent physio to commence weightbearing • Accessing physiotherapy • Geographic issues • Not accept referral from MTC • Different health authority than usual residence (although he pays his Council Tax there) • No capacity for urgent referrals Rehabilitation Reality

  9. “…. It got us really down, you know. Got us really down. I know I need physio, why can’t I have it? …..and I felt is it because I’ve got a Hospital C consultant and Hospital O won’t look after us ….” I just thought, why can’t everybody get together

  10. Geographic distribution Northumberland: 19% NUTH: 47% Cumbria: 5% Sunderland: 5% South Tyneside: 4% Gateshead: 5% County Durham and Darlington: 11%

  11. Rehabilitation prescription review • Outpatient and community teams • Orthopaedics • Physiotherapy • Access to • Painteam • Healthpsychology • OT Increase at review Rehabilitation needs change with time

  12. Trauma Rehab clinic • Referrals made • Physiotherapy 36 • Health psychology 18 • Orthopaedics 8 • Other 21 • Falls, exercise prescription, pulmonary rehab, pain management Identified unmet rehabilitation needs

  13. Trauma Rehab Clinic I was surprised I’d not been seen I felt like I was being treated as a person • Rehabilitation needs change with time • Trauma rehab clinic effectively identifies current multidisciplinary needs • Improved co-ordination and communication between existing services • Virtual team • Raised awareness: inequalities of rehabilitation provision No-one had set any goals, think it will help me move forward Rehabilitation needs change with time

  14. What’s next… • Newcastle Clinical AHP group • Improving co-ordination and communication between local teams • Regional AHP clinical conference • Clinical skills • Start to build regional network • Research: patient perceptions of recovery and rehabilitation after orthopaedic major trauma • Data analysis completion May 2014

  15. I’ve got to be honest. I didn’t think it would take as long. You think you’re like, I’ll be back in work in four or five weeks. It’s hard to grasp

  16. “Changed me outlook on life. Live for tomorrow, ‘cause you never know what’s going to happen” Harry, 2013

  17. Major Trauma Rehabilitation Rehabilitation Prescription

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