Abstract
Objective
To perform a systematic review to assess the current scientific evidence concerning the effect of EIR for trauma patients with or without an associated traumatic brain injury.
Data Source
We performed a systematic search of several electronic (Ovid MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and SveMed+) and 2 clinical trial registers (clinicaltrials.gov and International Clinical Trials Registry Platform). In addition, we handsearched reference lists from relevant studies.
Data Extraction
Two review authors independently identified studies that were eligible for inclusion. The primary outcome measures were functional-related outcomes and return to work. The secondary outcome measures were length of stay in hospital, number of days on respirator, complication rate, physical and mental health measures, quality of life, and socioeconomic costs.
Data Synthesis
Four studies with a total number of 409 subjects, all with traumatic brain–associated injuries, were included in this review. The included trials varied considerably in study design, inclusion and exclusion criteria, and had small numbers of participants. All studies were judged to have at least 1 high risk of bias. We found the quality of evidence, for both our primary and secondary outcomes, low.
Conclusions
No studies that matched our inclusion criteria for EIR for trauma patients without traumatic brain injuries could be found. For traumatic brain injuries, there are a limited number of studies demonstrating that EIR has a positive effect on functional outcomes and socioeconomic costs. This review highlights the need for further research in trauma care regarding early phase interdisciplinary rehabilitation.
Studies on rehabilitation in cerebral stroke and spinal cord injuries show that early interdisciplinary rehabilitation (EIR) and a continued chain of rehabilitation accelerate the rate of recovery and improve functional outcomes.1,2 Furthermore, a continuous chain of rehabilitation is cost-effective.2, 3, 4, 5 A systematic review6 on multidisciplinary rehabilitation intervention in trauma survivors published in 2011 found a lack of high-quality studies and was unable to conclude whether multidisciplinary rehabilitation for this population is effective or not.
The primary model for collaboration in most hospitals is one where the different professionals work in parallel, in accordance with each one’s profession-specific goal and treatment plan, with the aim of accomplishing discipline-specific goals. In an interdisciplinary model the team members work together, both in treatment and goal setting.7,8 In EIR, the early onset of rehabilitation interventions is essential to prevent complications and promote recovery. Interdisciplinary rehabilitation comprises team-based interventions using the International Classification of Functioning, Disability, and Health model alongside curative, supportive, preventive, and palliative strategies.9
EIR is poorly defined in the literature. In studies concerning severe traumatic brain injury (TBI), “early” means within hours or few days, with the intervention started in the intensive care unit. A patient with TBI admitted to a trauma hospital without a specific EIR program will typically, in addition to medical care, get conventional physical therapy, occupational therapy, speech therapy, and help from a social worker concerning psychosocial issues. There seems to be consensus on early rehabilitation interventions for this specific trauma population, although the approach is not always interdisciplinary. Even though EIR is the preferred approach within rehabilitation medicine for all severely injured patients, with the exception of conventional physical therapy, early interventions for trauma patients without associated head injury seem to be lacking.
Major trauma refers to physical injury or a combination of injuries where there is a strong possibility of death or disability and is commonly defined using an Injury Severity Score10 threshold of 15.
During the past decades acute trauma care has improved because of the development of highly specialized trauma centers and teams. As a result, the mortality rate for severely injured patients has decreased.11 However, motor vehicle crashes alone are responsible for 1.35 million deaths per year worldwide and is the leading cause of death for children and young adults.12 Exact numbers of cases of disability due to trauma injuries are lacking. The European Commission estimates that about 135,000 persons experience serious injury due to traffic accidents each year.13 Because trauma patients are often young, the traumatic event may result in lifelong physical, cognitive, and emotional limitations that compromise an independent, self-determined life. Trauma patients report reduced quality of life, pain problems, and anxiety or depression several years after the traumatic event.14 Trauma is also associated with considerable socioeconomic costs related to return to work and use of disability benefits.15
This review examines the effect of EIR for trauma patients. To our knowledge, no previous systematic review has addressed this topic.