Psychological Distress After Orthopedic Trauma: Prevalence in Patients and Implications for Rehabilitation

Abstract

Orthopedic trauma is an unforeseen life-changing event. Serious injuries include multiple fractures and amputation. Physical rehabilitation has traditionally focused on addressing functional deficits after traumatic injury, but important psychological factors also can dramatically affect acute and long-term recovery. This review presents the effects of orthopedic trauma on psychological distress, potential interventions for distress reduction after trauma, and implications for participation in rehabilitation. Survivors commonly experience post-traumatic stress syndrome, depression, and anxiety, all of which interfere with functional gains and quality of life. More than 50% of survivors have psychological distress that can last decades after the physical injury has been treated. Early identification of patients with distress can help care teams provide the resources and support to offset the distress. Several options that help trauma patients navigate their short-term recovery include holistic approaches, pastoral care, coping skills, mindfulness, peer visitation, and educational resources. The long-term physical and mental health of the trauma survivor can be enhanced by strategies that connect the survivor to a network of people with similar experiences or injuries, facilitate support groups, and social support networking (The Trauma Survivors Network). Rehabilitation specialists can help optimize patient outcomes and quality of life by participating in and advocating these strategies.

Nosocomial infections in a Pediatric Intensive Care Unit in Albania

“…The incidence of NI in PICU during the study period proved to be 22.8%, similar to reports from other studies done in PICUs ranging from 22.2% -29.7% [20][21][22]. The data are also similar to other studies done in adult ICUs as reported in the study EPIC of 20.6% [23], but higher than data reported by NNIS of 6.1% or 14.1 / 1000 patient-days or other studies in Europe, where the incidence varies from 6.1-10.2% [24,25]. According to WHO NI incidence in countries with limited sources or low and medium income, it varies from 4.4% -88.9% [26].…”

Passive Hydrotherapy WATSU® for Rehabilitation of an Accident Survivor: A Prospective Case Report

“…Over the course of the reported weeks, her condition improved continuously (Online Supplemental Tables 1 and 3, Online Supplemental Material; www.karger.com/?DOI=487768 ). Considering her traumatic history and the distress she presented with at the beginning of her outpatient rehabilitation, the patient was originally at risk of an unfavorable rehabilitation course [37,38,39]. Given the multimodal setting and the singularity of this case, it remains unclear whether some of this success can be attributed to WATSU.…”

“…She was also alert towards signs of inflammation and competent to advise the patient on how to proceed when they augmented. Due to the generous time frame of a WATSU setting and the extensive training of its providers, traumatic emotional contents - which regularly occur in the aftermath of severe physical trauma [37] - can be processed in a constructive spirit, as was exemplified in this case. Technically, aquatic exercise could have been part of this patient's regular physiotherapy during rehabilitation [40]; however, the lack of a hydrotherapy pool, open wounds that cannot be covered, or - as in this case - elevated inflammation markers can easily impede this.…”

Distortion of Body Image Following Lower Limb Amputation: Implications for Comprehensive Rehabilitation

“…In fact the person suffered of a severe trauma involving his/her safety; Often during the clinical interview the patients report bad and intrusive memories about the trauma and the amputation event; It can also be noted an introverted behavior respect to the relationship with others in order to avoid situation that are related to the traumatic event. The PTSD in amputees is described in many studies regarding veterans [22] and people who suffered of an orthopedic trauma [23], but it has never been considered inside the rehabilitation program.…”