Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized...

Area of Science:

• Orthopaedic surgery
• Rehabilitation medicine
• Psychosocial health

Background:

• Orthopaedic trauma patients often face mobility issues, fear, and self-care challenges, impacting recovery.
• Traditional treatments lack integration of psychosocial support and early mobilization, leading to suboptimal patient experiences.
• Recovery is influenced by injury severity and psychosocial factors, highlighting the need for holistic approaches.

Purpose of the Study:

• To evaluate if an early psychosocial intervention (integrative care with movement) improves objective physical function in orthopaedic trauma patients.
• To assess if an integrative care approach enhances patient-reported physical function outcomes during recovery compared to usual care.

Main Methods:

• A randomized controlled trial involving 112 orthopaedic trauma patients (n=99 analyzed at 6 months) comparing integrative care with usual care.
• Data collected at baseline, 6 weeks, 3, 6 months, and 1 year, with analyses focused on the 6-month follow-up due to early recovery trajectories.
• Objective measures included handgrip strength, range of motion (ROM), and Lower Extremity Gain Scale; subjective measures included Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS®-PF) and Tampa Scale of Kinesiophobia.

Main Results:

• No significant differences were found between groups in handgrip strength or Lower Extremity Gain Scale scores at 6 months.
• The integrative care group showed a trend towards improved elbow flexion ROM (p=0.05), but no other significant differences in ROM were observed.
• Both groups demonstrated similar trajectories in fear of movement (Tampa Scale of Kinesiophobia).

Conclusions:

• The early psychosocial intervention did not alter the physical function recovery trajectory in orthopaedic trauma patients compared to usual care.
• Despite the lack of significant difference, interventions targeting psychosocial barriers and early functional gains remain crucial.
• Further research is necessary to refine strategies that capitalize on early recovery phases to enhance functional outcomes and address patient-reported barriers.