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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

Rehabilitation after orthopaedic major trauma

Jacqueline Claydon February 2014

Clinical Research Associate awarded by CLRN 2013

orthopaedic trauma rehab clinic
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

harry s story
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

mechanism
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%

harry s injuries
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

slide6

Rehabilitation Prescription

They were so good everybody, right through, the doctors as well

  • Physiotherapy
  • OT
  • Nurse
  • Orthopaedics
  • Pain team

Inpatient Rehabilitation Needs

discharge planning
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
slide8

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

slide9

“…. 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

slide10

Geographic distribution

Northumberland: 19%

NUTH: 47%

Cumbria: 5%

Sunderland: 5%

South Tyneside: 4%

Gateshead: 5%

County Durham and Darlington: 11%

slide11

Rehabilitation prescription review

  • Outpatient and community teams
    • Orthopaedics
    • Physiotherapy
    • Access to
      • Painteam
      • Healthpsychology
      • OT

Increase at review

Rehabilitation needs change with time

trauma rehab clinic
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

trauma rehab clinic1
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

what s next
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
slide15

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

slide16

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

major trauma rehabilitation
Major Trauma Rehabilitation

Rehabilitation Prescription