Jacqueline Claydon February 2014 Clinical Research Associate awarded by CLRN 2013

To use the rehabilitation prescription to improve patient care  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

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

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

Clinical database, n=692  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%) ISS does not reflect functional limitations

Inpatient Rehabilitation Needs n=143Initial Mobility97% IADL79% Wound management73% Pain95% Environment50% Vocation/Education21% Urinary incontinence14% Nutrition7% Ventilator / Pulm rehab2% Mood4% Other Upper limb function6% Falls/balance1% Sports / hobbies1% ◦ Physiotherapy ◦ OT ◦ Nurse ◦ Orthopaedics ◦ Pain team Rehabilitation Prescription They were so good everybody, right through, the doctors as well

 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

Rehabilitation Reality  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 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

“…. 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

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

Increase at reviewRehabilitation needs change with time InitialReview Mobility97%60% IADL79%30% Wound management73%6% Pain95%27% Environment50%4% Vocation/Education21%26% Urinary incontinence14%2% Nutrition7%3% Ventilator / Pulm rehab2%8% Mood4%22% Other Upper limb function6%16% Falls/ balance1%6% Driving021% Financial difficulties05% Sports / hobbies1%4% Rehabilitation prescription review  Outpatient and community teams ◦ Orthopaedics ◦ Physiotherapy ◦ Access to  Pain team  Health psychology  OT

Identified unmet rehabilitation needs  Referrals made ◦ Physiotherapy36 ◦ Health psychology 18 ◦ Orthopaedics8 ◦ Other 21  Falls, exercise prescription, pulmonary rehab, pain management

Rehabilitation needs change with time  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 I felt like I was being treated as a person No-one had set any goals, think it will help me move forward I was surprised I’d not been seen

 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