In England, 45,000 people are affected by very severe or major trauma every year. Half a million people experience less severe trauma, and a proportion of those will require hospital admission because of pre-existing conditions, disability, frailty, or because the functional impact of injuries and environmental factors means that they will not be able to manage in their own home.
Trauma affects all age groups, and every patient will have different rehabilitation needs that reflect different functional expectations and priorities. Trauma can negatively affect quality of life, both physically and mentally. Patients can suffer in the short term with physical injuries but long term have to manage issues with mobility, pain management and the psychological effects following trauma.
Following serious injury rehabilitation can be a long and complex process. All aspects of a patient’s life can be affected including breathing, swallowing, eating, drinking, toileting, cognitive function, speech and communication. Some patients suffer from several issues, these are sometimes referred to as having ‘complex needs’ . The impact of these problems may be influenced by pre-existing conditions.
A coordinated, multidisciplinary response is often required following serious injury, and this assessment of rehabilitation needs begins in the hospital setting.
Major Trauma Centres (MTCs) are resourced to provide rehabilitation to seriously injured patients and may include:
– Physical therapy and assistance (including Occupational Therapy, Speech and Language Therapy, Physiotherapy and therapy exercises to work on specific needs)
– Psychological, psychosocial and emotional support
– Equipment or adaptations necessary to carry out the activities of daily living (ADLs)
Following the introduction of major trauma networks in 2012, improved survival rates has led to an increased need for rehabilitation.
Early, intensive rehabilitation can improve function, pain, quality of life and mental health outcomes. It can also improve outcomes for carers of those affected by traumatic injury. Costs to treat trauma patients are high in the acute phase, and there are also long-term care costs to the NHS through ongoing treatment. Social care costs may be high for people who need ongoing care and support in the community.
There are wider costs to the community if people are unable to return to work or education. Rehabilitation may be able to reduce these costs through improving overall function. Interventions may improve outcomes at a number of stages, and every person is individually assessed and a programme of care developed.
Patients who sustain major trauma injuries will have their rehabilitation needs discussed with them, with their nominated key worker or a Rehab Coordinator and a ‘Rehabilitation Prescription’ will be formulated. Copies are given to the patient and sent to the patient’s GP service. The prescription outlines therapy needs and aims to maximise recovery and benefit to the patient and are unique to each patient. Further assessments are performed over time to capture changing needs. There is significant variation in practice across areas and provision varies greatly in Greater Manchester. Currently all Level 1 and Level 2 neuro-rehabilitation for patients following head injuries is provided by Salford Royal Foundation Trust. All other hospital sites carry out rehabilitation to both inpatients and outpatients.
The National Institute for Health and Care Excellence (NICE) produce guidelines around the transition between hospital and home, from children’s to adults’ services, and about home care services.
You can find more information about rehabilitation in Greater Manchester on the following websites: