What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel

Kettlewell, Jade; Radford, Kate; Timmons, Stephen; Jones, Trevor; Fallon, Stephen; Westley, Ryan; White, Susan; Kendrick, Denise

Abstract

Objective: Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). Design: Online survey informed by the TDF and BCW. Setting: UK trauma rehabilitation pathway. Population: Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). Analysis: Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. Results: Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). ‘Social/professional role and identity’, 'knowledge’ and ‘emotion’ (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including ‘seen as tick-box exercise’,‘not a priority’, lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. Conclusions: Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.

Citation

Kettlewell, J., Radford, K., Timmons, S., Jones, T., Fallon, S., Westley, R., White, S., & Kendrick, D. (2024). What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel. Injury, Article 111722. https://doi.org/10.1016/j.injury.2024.111722

• Journal Article Type: Article
• Acceptance Date: Jul 5, 2024
• Online Publication Date: Jul 13, 2024
• Publication Date: Jul 13, 2024
• Deposit Date: Jul 25, 2024
• Publicly Available Date: Jul 25, 2024
• Journal: Injury
• Print ISSN: 0020-1383
• Electronic ISSN: 1879-0267
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Article Number: 111722
• DOI: https://doi.org/10.1016/j.injury.2024.111722
• Public URL: https://nottingham-repository.worktribe.com/output/37319982
• Publisher URL: https://www.injuryjournal.com/article/S0020-1383(24)00428-5/fulltext
• Additional Information: This article is maintained by: Elsevier; Article Title: What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel; Journal Title: Injury; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.injury.2024.111722; Content Type: article; Copyright: © 2024 The Author(s). Published by Elsevier Ltd.