EVALUATION OF REHABILITATION OUTCOME AFTER SEVERE TRAUMA
More than a billion people worldwide live with disabilities, a significant proportion caused by injuries due to road accidents, burns, falls and acts of violence (WHO 2007).
Many disabled people are unable to fully participate in society due to lack of access to medical care, rehabilitation, employment and education. Rehabilitation outcomes are an important measurement of trauma system effectiveness and new interventions have the potential to enhance recovery following trauma (Schweickert et al. 2009, Khan, Amatya and Hoffman 2012b). However, currently there is no clinically applicable trauma rehabilitation score available (Kreder 2003, Cameron, Gabbe and McNeil 2006, Horwitz and Schuerer 2008, Grill et al. 2010).
The World Health Organisation International Classification of Function, Disability and Health (WHO ICF) has been recommended as an international framework and classification system to evaluate all aspects of rehabilitation.The ICF is a classification system consisting of approximately 1400 categories related to health and environmental factors. To aid the application and uptake of the ICF in rehabilitation, smaller core sets have been developed for conditions such as stroke, multiple sclerosis and spinal injuries. This has significantly improved the comparison of health outcomes between different patient groups, via the standardization of language and thereby understanding. However, no previous studies have examined to what extent the ICF can be applied to trauma outcome evaluation. The EROS project was conceived to specifically evaluate to what extent the ICF can be used as a framework to capture and evaluate health and rehabilitation outcome of patients following traumatic injuries.
Methodology
The project's complimentary work packages were designed to identify rehabilitation needs and priorities from both the patients’ and the health care professional perspective:
1. EVIDENCE. Systematic review of the literature has explored how well outcomes terms used frequently in trauma, to capture health aspects, are identified by the ICF.
2. PATIENTS. Rehabilitation complexity and rehabilitation needs were measured quantitatively using the Rehabilitation Complexity Scale (RCS) to establish the rehabilitation needs of trauma patients in relation to their injury severity. In addition, qualitative patient interviews explored patient perspectives of rehabilitation priorities. Transcribed interviews were then analysed using ‘meaning condensation’ (i.e. the grouping of keywords and phrases) and the patient data coded to the ICF using established methods.
3. HEALTH CARE PROFESSIONALS. By conducting an international online survey, using the acute and post-acute ICF core set, we explored the health care professional (HCP) perspective of priority health and rehabilitation needs after trauma.
Findings
- Traditional outcome tools only capture 6 percent of concepts contained in the WHOICF.
- The Rehabilitation Complexity Scale (RCS) is able to measure and predict rehabilitation needs of trauma patients better than existing dependency and injury severity tools.
- Thirty two patients identified 146 ICF concepts important to their recovery and rehabilitation.
- Three hundred and twenty nine experts working in trauma participated in the online survey and identified 90 ICF concepts that are important to consider when treating trauma patients.
- Patient data and expert data were combined to propose 109 ICF concepts relevant for rehabilitation and recovery of trauma patients as a Trauma ICF core set.
Next Steps
The proposed Trauma ICF core set shall be presented, optimised and approved at an international consensus conference.
Once approved, a multi-centre validation study will be developed to measure the practicality and effectiveness of the Trauma Core set for health and rehabilitation outcome assessment of severely injured patients.
