Major trauma involving multiple injuries is a leading contributor to the global burden of disease. Many severely injured patients will experience prolonged periods in critical care which often leads to additional non-injury related morbidity.

The accurate and comprehensive assessment of health outcomes, which includes physical, psychological and social wellbeing, as well as the impact on family and society is fundamental to improve lives after injury. However, existing generic health outcome measures used by clinicians are diverse and often assess only a small proportion of the overall burden experienced by trauma patients. There has been no agreed international standard for categorising what are the multi-dimensional health and functioning problems that survivors of multiple traumatic injuries most commonly face. Yet, this is essential before clinicians and researchers can decide what rehabilitation interventions to use and then measure and compare their impact on patients, across countries and across time.

Developing an ICF Core set

The International Classification of Functioning, Disability and Health (ICF) is a comprehensive and international framework that considers human functioning as a whole. It covers body structures, participation in daily life activities, and the impact of environmental factors. It is a WHO endorsed tool to enable internationally standardised patient outcome measures.

C4TS has undertaken research to develop the world's first ICF Core set for traumatic injury rehabilitation. ICF Core Sets are endorsed by the WHO to promote the use of a standardised ICF language amongst rehabilitation professionals to enable international comparison of health and disability in similar patient populations.  


The diagram below shows the phases undertaken from the start of the study period in 2013:


The core work from Phase 1 involved collecting information about intermediate and long-term outcomes from a group of trauma patients (sample size 45) from the Royal London Hospital Major Trauma Centre. These patients were followed up 12 months after discharge, and the information gathered through structured interviews included quality of life, employment, post-traumatic stress, and return to previous activities.  Health Care Practitioners (HCPs) drawn from across the UK were also surveyed to collect their views regarding trauma patients' rehabilitation needs.

The responses enabled the distillation of the 1454 available ICF categories into 109 that are most relevant to mutiple trauma patients and could form the basis of a minimum data set. Click here to download an article which describes this study in detail.

Phase 2 involved organising an international consensus conference, drawing together clinicians from a variety of trauma related disciplines from across the globe to agree on a core set of categories. This was essential to secure WHO endorsement and compliance with the Core Set development protocol. 

The consensus conference took place at Gatwick, UK in October 2016, and was attended by 30 delegates, including 3 patient representatives. The conference agreed a Comprehensive Core Set of 95 categories, and a Brief Core Set of 19.

Next steps

After an article about the Core Sets is published in a peer reviewed journal, they will then be available for download from the ICF Core Sets site and subject to further validation via implementation with patients.

It is hoped that the Core Sets will provide a standard, global framework for the assessment of recovering trauma patient needs, and a structure for effective rehabilitation interventions. Over time, the Core Sets will enable clinicians and researchers to compare the rehabilitation needs and outcomes of trauma patients nationally and internationally. 


Project lead: Dr Karen Hoffman


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