A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK

Kettlewell, Jade; Timmons, Stephen; Bridger, Kay; Kendrick, Denise; Kellezi, Blerina; Holmes, Jain; Patel, Priya; Radford, Kate

Abstract

Objective: To identify where and how trauma survivors’ rehabilitation needs are met after trauma, to map rehabilitation across five UK major trauma networks, and to compare with recommended pathways. Design: Qualitative study (interviews, focus groups, workshops) using soft-systems methodology to map usual care across trauma networks and explore service gaps. Publicly available documents were consulted. CATWOE (Customers, Actors, Transformation, Worldview, Owners, Environment) was used as an analytic framework to explore the relationship between stakeholders in the pathway. Setting: Five major trauma networks across the UK. Subjects: 106 key rehabilitation stakeholders (service providers, trauma survivors) were recruited to interviews (n = 46), focus groups (n = 4 groups, 17 participants) and workshops (n = 5 workshops, 43 participants). Interventions: None. Results: Mapping of rehabilitation pathways identified several issues: (1) lack of vocational/psychological support particularly for musculoskeletal injuries; (2) inconsistent service provision in areas located further from major trauma centres; (3) lack of communication between acute and community care; (4) long waiting lists (up to 12 months) for community rehabilitation; (5) most well-established pathways were neurologically focused. Conclusions: The trauma rehabilitation pathway is complex and varies across the UK with few, if any patients following the recommended pathway. Services have developed piecemeal to address specific issues, but rarely meet the needs of individuals with multiple impairments post-trauma, with a lack of vocational rehabilitation and psychological support for this population.

Citation

Kettlewell, J., Timmons, S., Bridger, K., Kendrick, D., Kellezi, B., Holmes, J., …Radford, K. (2021). A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK. Clinical Rehabilitation, 35(5), 750-764. https://doi.org/10.1177/0269215520971777

• Journal Article Type: Article
• Acceptance Date: Oct 15, 2020
• Online Publication Date: Nov 23, 2020
• Publication Date: May 1, 2021
• Deposit Date: Oct 27, 2020
• Publicly Available Date: Nov 23, 2020
• Journal: Clinical Rehabilitation
• Print ISSN: 0269-2155
• Electronic ISSN: 1477-0873
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Issue: 5
• Pages: 750-764
• DOI: https://doi.org/10.1177/0269215520971777
• Keywords: Physical Therapy, Sports Therapy and Rehabilitation; Rehabilitation
• Public URL: https://nottingham-repository.worktribe.com/output/4993669
• Publisher URL: https://journals.sagepub.com/doi/10.1177/0269215520971777