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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

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 Thumbnail


Authors

STEPHEN TIMMONS stephen.timmons@nottingham.ac.uk
Professor of Health Services Management

Kay Bridger

DENISE KENDRICK DENISE.KENDRICK@NOTTINGHAM.AC.UK
Professor of Primary Care Research

Blerina Kellezi

JAIN HOLMES JAIN.HOLMES@NOTTINGHAM.AC.UK
Senior Research Fellow

Priya Patel



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