Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan

Abstract

Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan. Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score > 9. Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥ 2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma. LAY ABSTRACT Three recommendations for acute rehabilitation in the Norwegian trauma plan were evaluated in 538 adults with moderate to severe injuries. Recommendation one: Examination by a rehabilitation physician within 72 h after hospital admission. This was documented in 18% of the patients. Recommendation two: Start of early rehabilitation in the intensive care unit. This was given to 72% of those with severe trauma. Early rehabilitation was more frequent in patients with spinal cord injury, and with long intensive care stays. Recommendation three: Patients are directly transferred from acute care in the trauma centre to specialized rehabilitation. This was followed for 22% of the patients. This happened more often in patients with severe injuries, spinal cord injury and brain injury. Being in work and longer intensive care stays increased the probability for direct transfer. Conclusion: Overall compliance with the guidelines is poor, except for early therapist rehabilitation in the intensive care unit.

Keywords

• guideline adherence
• continuity of patient care
• health service research
• multiple trauma
• rehabilitation
• trauma centres