Integrated Musculoskeletal Rehabilitation Care at a Comprehensive Combat and Complex Casualty Care Program

Goldberg, Capt Kathy F.; Green, Bart N.; Moore, Jacqueline L; Wyatt, Marilynn; Boulanger, Lynn; Belnap, Brian; Harsch, Peter; Donaldson, David S.

doi:10.1016/j.jmpt.2009.10.010

Cited by 25 publications

(22 citation statements)

References 14 publications

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“…Overall, one must bear in mind that recovery from trauma is a multifaceted process, positive patient evolution cannot be entirely attributed to physiotherapy, 25 even though it has been proven to influence the outcomes. 26 Based on the adapted tool, most of the patients’ function improved over the course of treatment.…”

Section: Discussionmentioning

confidence: 99%

Early physical and functional rehabilitation of trauma patients in the Médecins Sans Frontières trauma centre in Kunduz, Afghanistan: luxury or necessity?

Gohy¹,

Ali

Bergh

et al. 2016

Int. Health

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BackgroundIn Afghanistan, Médecins Sans Frontières provided specialised trauma care in Kunduz Trauma Centre (KTC), including physiotherapy. In this study, we describe the development of an adapted functional score for patient outcome monitoring, and document the rehabilitation care provided and patient outcomes in relation to this functional score.MethodsA descriptive cohort study was done, including all patients admitted in the KTC inpatient department (IPD) between January and June 2015. The adapted functional score was collected at four points in time: admission and discharge from both IPD and outpatient department (OPD).ResultsOut of the 1528 admitted patients, 92.3% (n = 1410) received at least one physiotherapy session. A total of 1022 patients sustained either lower limb fracture, upper limb fracture, traumatic brain injury or multiple injury. Among them, 966 patients received physiotherapy in IPD, of whom 596 (61.7%) received IPD sessions within 2 days of admission; 696 patients received physiotherapy in OPD. Functional independence increased over time; among patients having a functional score taken at admission and discharge from IPD, 32.2% (172/535) were independent at discharge, and among patients having a functional score at OPD admission and discharge, 79% (75/95) were independent at discharge.ConclusionsThe provision of physiotherapy was feasible in this humanitarian setting, and the tailored functional score appeared to be relevant.

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Section: Discussionmentioning

confidence: 99%

Early physical and functional rehabilitation of trauma patients in the Médecins Sans Frontières trauma centre in Kunduz, Afghanistan: luxury or necessity?

Gohy¹,

Ali

Bergh

et al. 2016

Int. Health

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“…The members within that team and its working practices, however, required constant review and development to ensure the complex needs of service patients were met. There are benefits of a well-trained MDT,3 especially within critical care4 and with patients with complex trauma 5. The main adaptations to working practices instigated at RCDM and QEHB are detailed in Table 1.…”

Section: Multidisciplinary Team and Working Practicesmentioning

confidence: 99%

“…Finally, staff experienced significant and chronic stressors by exposure to complex trauma 5. In order to mitigate against this, stress management sessions were instigated by the RCDM therapy team to recognise and facilitate active peer support.…”

Section: Multidisciplinary Team and Working Practicesmentioning

confidence: 99%

Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine

Pope

Vickerstaff

Wareham³

2016

J R Army Med Corps

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During the recent conflicts in Iraq and Afghanistan, substantial numbers of service personnel survived devastating injuries, presenting significant challenges for early rehabilitation at Queen Elizabeth Hospital Birmingham. Royal Centre for Defence Medicine personnel augmented NHS therapy provision, gaining significant experience in rehabilitating complex trauma. Multidisciplinary working was key to delivering this service, with a unique rehabilitation coordinating officer position established to manage the rehabilitation pathway. A military exercise rehabilitation instructor provided daily gym-based rehabilitation, developing exercise tolerance. Emphasis was placed on early independence, reducing pain, eliminating complications and optimising function. Innovative solutions and non-standard combinations of rehabilitation were required, with therapy working practices redesigned that, we believe, exceed provision elsewhere, including novel applications such as unique patient transfers, specialist seating, additional equipment, problem-solving teaching and early upper limb prosthetic provision. Active pain management allowed engagement in rehabilitation. With limited evidence available, therapeutic modalities attempting to alleviate phantom limb pain centred on patients' ability to engage in treatment. Finally, the requirement to measure change in early trauma rehabilitation was identified, leading to the development of the preprosthetic functional outcome measure. This article aims to document advances made, lessons learned, encourage debate and identify priorities for future research for military complex trauma rehabilitation.

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“…26 Electronic Health Care Records have been described as one method used to coordinate and facilitate integrated care in these environments. 27 In these settings, the chiropractic provider enters all care notes into the HER and all other providers have access to these files. Patients can be more quickly directed to appropriate care, such as a patient with simple mechanical low back pain can be scheduled for a chiropractic visit instead of burdening the appointment waitlist for orthopedic surgery.…”

Section: Electronic Health Care Recordsmentioning

confidence: 99%

Comparative Effectiveness Research and the Chiropractic Profession

Johnson

2010

Journal of Manipulative and Physiological Therapeutics

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Integrated Musculoskeletal Rehabilitation Care at a Comprehensive Combat and Complex Casualty Care Program

Cited by 25 publications

References 14 publications

Early physical and functional rehabilitation of trauma patients in the Médecins Sans Frontières trauma centre in Kunduz, Afghanistan: luxury or necessity?

Early physical and functional rehabilitation of trauma patients in the Médecins Sans Frontières trauma centre in Kunduz, Afghanistan: luxury or necessity?

Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine

Comparative Effectiveness Research and the Chiropractic Profession

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