A qualitative approach to recovery after open tibial fracture: The road to a novel, patient-derived recovery scale

Trickett, Ryan W; Mudge, Elizabeth Joan; Price, Patricia Elaine; Pallister, Ian

doi:10.1016/j.injury.2012.01.027

Cited by 46 publications

(62 citation statements)

References 35 publications

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“…The results of this study identify that patients experience strong emotions, immobility, dependency, anxiety, pain and disruption to their body image during hospitalisation. Later on during recovery, similar concerns and a lack of return to their pre injury state have been noted 4 . Studies with more diverse samples of lower limb injury 7,9 and general traumatic injury 10 suggest patients require increased support for pain control and psychological distress; which can be present 5-10 years post injury 11 .…”

Section: Discussionmentioning

confidence: 68%

A qualitative study of patient experience of an open fracture of the lower limb during acute care

Tutton

Achten

Lamb

et al. 2018

The Bone & Joint Journal

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Section: Discussionmentioning

confidence: 68%

A qualitative study of patient experience of an open fracture of the lower limb during acute care

Tutton

Achten

Lamb

et al. 2018

The Bone & Joint Journal

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“…Members of the Trauma Patient and Public Involvement Group also reviewed the progress of the WOLLF study at the annual NIHR Trauma Trials Meetings. 32 interviewed nine participants 1.2-2.8 years post injury. They identified the serious impact of injury on participants' daily life as they struggled to recover in terms of a range of different types of pain including stiffness and discomfort, reduced mobility and flexibility, the impact of temperature on their body, frustration and fear, anxiety around their appearance, concerns about getting back to work, a fear of falling, reduced finances and the impact of injury on family and friends.…”

Section: Patient and Public Involvementmentioning

confidence: 99%

“…Other studies of lower limb injury identify pain as a key problem. 32,34,35 Studies specifically including open fracture of the lower limb 34 identify getting through the pain and seeking control as two key experiences. Pain management was an overriding concern, and patients struggled to live with the pain and manage the side effects of medication.…”

Section: Being In Painmentioning

confidence: 99%

Negative-pressure wound therapy versus standard dressings for adults with an open lower limb fracture: the WOLLF RCT

Costa

Achten

Bruce

et al. 2018

Health Technol Assess

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Background Open fractures of the lower limb occur when a broken bone penetrates the skin and is exposed to the outside environment. These are life-changing injuries. The risk of deep infection may be as high as 27%. The type of dressing applied after surgical debridement could potentially reduce the risk of infection in the open-fracture wound. Objectives To assess the disability, rate of deep infection, quality of life and resource use in patients with severe open fracture of the lower limb treated with negative-pressure wound therapy (NPWT) versus standard wound management after the first surgical debridement of the wound. Design A pragmatic, multicentre randomised controlled trial. Setting Twenty-four specialist trauma hospitals in the UK Major Trauma Network. Participants A total of 460 patients aged ≥ 16 years with a severe open fracture of the lower limb were recruited from July 2012 through to December 2015. Patients were excluded if they presented more than 72 hours after their injury or were unable to complete questionnaires. Interventions Negative-pressure wound therapy (n = 226) where an ‘open-cell’ solid foam or gauze was placed over the surface of the wound and connected to a suction pump which created a partial vacuum over the dressing versus standard dressings not involving negative pressure (n = 234). Main outcome measures Disability Rating Index (DRI) – a score of 0 (no disability) to 100 (completely disabled) at 12 months was the primary outcome measure, with a minimal clinically important difference of 8 points. The secondary outcomes were deep infection, quality of life and resource use collected at 3, 6, 9 and 12 months post randomisaton. Results There was no evidence of a difference in the patients’ DRI at 12 months. The mean DRI in the NPWT group was 45.5 points [standard deviation (SD) 28.0 points] versus 42.4 points (SD 24.2 points) in the standard dressing group, giving a difference of –3.9 points (95% confidence interval –8.9 to 1.2 points) in favour of standard dressings (p = 0.132). There was no difference in HRQoL and no difference in the number of surgical site infections or other complications at any point in the 12 months after surgery. NPWT did not reduce the cost of treatment and it was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the interventions, we anticipated that some patients who were randomised into the trial would subsequently be unable or unwilling to take part. Such post-randomisation withdrawal of patients could have posed a risk to the external validity of the trial. However, the great majority of these patients (85%) were found to be ineligible after randomisation. Therefore, we can be confident that the patients who took part were representative of the population with severe open fractures of the lower limb. Conclusions Contrary to the existing literature and current clinical guidelines, NPWT dressings do not provide a clinical or an economic benefit for patients with an open fracture of the lower limb. Future work Future work should investigate alternative strategies to reduce the incidence of infection and improve outcomes for patients with an open fracture of the lower limb. Two specific areas of potentially great benefit are (1) the use of topical antibiotic preparations in the open-fracture wound and (2) the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. Trial registration Current Controlled Trials ISRCTN33756652 and UKCRN Portfolio ID 11783. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 73. See the NIHR Journals Library website for further project information.

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“…Qualitative research has thrown light on patients' experiences and perceptions of the impact of open lower limb fractures, which extend far beyond the obvious physical consequences (3,13,25). Nevertheless, functional recovery is the key determinant in patients being able to return to work and provide for themselves and their family or resume independent living for older patients.…”

Section: Discussionmentioning

confidence: 99%

“…open lower limb fracture patients attending the Morriston Hospital Ortho-Plastic Trauma Research Clinic (OPRC) and these ndings were correlated with the passage of time from injury and the Disability Rating Index (DRI) (5,(11)(12)(13).…”

Section: An Observational Study Was Conducted Of the Objective Functimentioning

confidence: 99%

Objective Measures of Functional Outcome in Recovery from Open Lower Limb Fractures – A Report from an Ortho-Plastic Research Clinic

Pallister

Handley

Maggs

et al. 2020

Preprint

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BACKGROUNDOpen lower limb fractures are serious, potentially life-changing injuriesrequiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery.Our hypothesis was that objective measures combining strength, agility and balance would better reflect recovery than isolated parameters (e.g. range of motion) and would compare well to patients’ perceived recovery.METHODSAdultopen lower limb fracture patients were followed-up at 6 and 12 weeks, 6, 9 and 12 months post-injury. The mechanism,injurypattern, age, gender and treatment were recorded. Isolated parameter objective functional outcome measures (OFOMs)(range of movement and MRC strength grade) were compared to combined OFOMs(timed up and go (TUAG), comfortable and fast gait speed (CGS and FGS), Edgren Side Step Test(ESST) and Single Leg balance. Patient reported outcomes were recorded (Global Perceived Effect (GPE) scoreand Disability Rating Index (DRI)). RESULTS68 patients (54 male) with a medianage of 45 years (range 20-75). Neither range of movement,strength nor Single Leg balance consistently improved with time. TUAG, ESST, CGS, FGS and GPE scoresshowed consistent improvement, with TUAG and FGS showing highest proportion of improving results at each time-point. Patients’ estimation of recovery paralleled these measures with all but 2 patients achieving the minimum clinical important difference in DRI by 12 months compared to baseline. However, the GPE score compared favourably withthe DRI having a higher proportion of improving responses at each time-point. DISCUSSIONFunctional recovery is a key determinant in patients returning to work, providing for themselves and their family or resuming independent living for older patients. This study has demonstrated time-related improvements in combined OFOMs measuringmobility, strength, agility and balance paralleling patients’ perception of recovery in the 12 months after open lower limb fractures. Over the same time-frame, the simple GPE score compared favourably with the DRI. Such parameters could become part of a defined core outcomes set. Focussing rehabilitation towards these combined OFOMs may help hasten recovery.Trial registrationSouth West Wales REC 06/WMW02/10)

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A qualitative approach to recovery after open tibial fracture: The road to a novel, patient-derived recovery scale

Cited by 46 publications

References 35 publications

A qualitative study of patient experience of an open fracture of the lower limb during acute care

A qualitative study of patient experience of an open fracture of the lower limb during acute care

Negative-pressure wound therapy versus standard dressings for adults with an open lower limb fracture: the WOLLF RCT

Objective Measures of Functional Outcome in Recovery from Open Lower Limb Fractures – A Report from an Ortho-Plastic Research Clinic

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