Transcript Rehabilitation Prescription Review

Jacqueline Claydon February 2014
Clinical Research Associate awarded by CLRN 2013

Pilot: May – November 2013

Physiotherapy-led consultation

Refer to clinical and rehabilitation services

Qualitative Research
◦ n=143, mean 5.0 months
◦ Subjective and clinical assessment of all injuries
◦ Reassess Rehabilitation Prescription
◦ Set Rehabilitation Goals
◦ Patient perception of recovery and rehabilitation after orthopaedic major trauma,
n=15
To use the rehabilitation prescription to
improve patient care
Age distribution, %
Percentage, %
40
30
20
10
20
18
9
10
11
9
11
10
11
10
17
11
17
13
13
10
0
16 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 +
Age, years



Male, 63, working
Fall from a height
Major Trauma bypass
Non-ortho
Ortho
Work Status
% (Ortho)
28
Background
55
Want to go back
to work, I’ve
worked all my life
Retired
Not work pre
18
Working
Road accident: 15%
Motorbikes: 14%
Assault: 1%
Industrial: 1%
Bike: 4%
Fall from height:
22%
Slips, trips and falls:
30%
Pedestrian: 8%
Sports: 6%

Rehabilitation Prescriptions
Orthopaedic:
Ortho
◦ Pilon fracture ankle
General
 Spanning ex-fix; ORIF
 Non weight-bearing 3 months
◦ T12 wedge fracture: conservative
Burns
Neuro
Other
Max Fax

ISS 13
◦ Level 1 All 42% (Ortho 26%)
◦ Level 2 All 34% (Ortho 11%)
Plastics
Resp
Spines
17% Ortho
48%
Neuro
26%
SCI
Spines
ISS does not reflect functional
limitations
Clinical database, n=692
n=143
Initial
Mobility
97%
IADL
79%
Wound management
73%
Pain
95%
Environment
50%
Vocation/Education
21%
Urinary incontinence
14%
Nutrition
7%
Ventilator / Pulm rehab
2%
Mood
4%
Other
Upper limb function
6%
Falls/balance
1%
Sports / hobbies
1%
Rehabilitation Prescription
They were so
good everybody,
right through,
the doctors as
well
◦
◦
◦
◦
◦
Physiotherapy
OT
Nurse
Orthopaedics
Pain team
Inpatient Rehabilitation Needs

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
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

Environmental issues
◦ Not able to manage in own home
 Partner’s bungalow
◦ Stuck in the house
 Wheelchair from the red cross
Rehabilitation Reality
day and stepped in, I
◦ Osteopenia:
still mightn’t be
 Referred
for urgent
physio to
getting
physio
commence weightbearing


If you
hadn’t rung that
Fracture
complications
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
“…. 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
Geographic distribution
Northumberland: 19%
Cumbria: 5%
NUTH: 47%
Gateshead: 5%
South Tyneside: 4%
County Durham
and Darlington: 11%
Sunderland: 5%
Initial
Review
Mobility
97%
60%
IADL
79%
30%
Wound management
73%
6%
Pain
95%
27%
Environment
50%
4%
Vocation/Education
21%
26%
Urinary incontinence
14%
2%
Nutrition
7%
3%
Ventilator / Pulm rehab
2%
8%
Mood
4%
22%
Upper limb function
6%
16%
Falls/ balance
1%
6%
Driving
0
21%
Financial difficulties
0
5%
Sports / hobbies
1%
4%
Other
Increase at review
Rehabilitation prescription review

Outpatient and community
teams
◦ Orthopaedics
◦ Physiotherapy
◦ Access to
 Pain team
 Health psychology
 OT
Rehabilitation needs change with time
Identified unmet rehabilitation needs

Current
22%
None
23%
Not yet
6%
Unmet
49%
Referrals made
◦
◦
◦
◦
Physiotherapy
Health psychology
Orthopaedics
Other
36
18
8
21
 Falls, exercise prescription, pulmonary
rehab, pain management

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
Rehabilitation needs change with time
I felt like I
was
being
treated as
a person
I was surprised
I’d not been
seen
No-one had set
any goals, think it
will help me move
forward

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

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

“Changed me outlook on life.
Live for tomorrow, ‘cause you
never know what’s going to
happen”
Harry,
2013
Rehabilitation Prescription