The value of inpatient rehabilitation on patient function and quality of life after multiple trauma

Following multiple trauma, individuals experience significant disability and poor functioning across several health domains. Rehabilitation is a component of trauma care management, however, there is limited evidence on patient outcomes after multiple trauma and the effectiveness of rehabilitation. This study was based on a Value-Based HealthCare (VBHC) framework and aimed to evaluate the impact of multiple trauma on patients' function and quality of life, and the relationship between these outcomes and the cost of inpatient rehabilitation. It also aimed to obtain the patient perspective regarding health areas to address for future trauma research.

This prospective, cohort study recruited 62 adult participants from a specialist inpatient rehabilitation unit following multiple trauma orthopaedic injuries. Patients health-related quality of life was measured using the 12-Item Short Form Health Survey (Version 2) (SF-12v2). The SF-12v2 was completed during inpatient rehabilitation (to capture patient recalled pre-injury quality of life) and via a telephone interview at two weeks after rehabilitation discharge. Patients also self-reported their satisfaction with the SF-12v2 and identified important health areas to address after multiple trauma. Routine inpatient rehabilitation data was collected including: the Functional Independence Measure (FIM) (assesses patients' functional independence on rehabilitation admission and discharge) and demographics.

The sample's mean age was 51.6 years (standard deviation: 17.8) and the majority were male (69.4 %). Between rehabilitation admission to discharge, patients' demonstrated a statistically significant increase in function (FIM scores). However, quality of life (SF-12v2 scores) significantly decreased between pre-injury to after hospital discharge. At both timepoints, an increased proportion of patients had quality of life scores that were below the population norms. Increased rehabilitation costs (i.e., longer inpatient stays) were positively and significantly associated with increased functional independence, albeit, not quality of life scores. Patients identified important health areas that related to individual outcomes (e.g., mental health, limitations, goals) and familial impacts.

This study reported that an individually tailored rehabilitation program was cost effective and led to significant improvements in patient function. Patients experienced significant impacts to quality of life after multiple trauma, which suggests the need for a long-term and integrated care plan including psychological medical input.