Effects of an Integrated 'Fast Track' Rehabilitation Service for Multi-Trauma Patients: A Non-Randomized Clinical Trial in the Netherlands

PLoS One. 2017 Jan 11;12(1):e0170047. doi: 10.1371/journal.pone.0170047. eCollection 2017.

Abstract

Objectives: The effects on health related outcomes of a newly-developed rehabilitation program, called 'supported Fast Track multi-trauma rehabilitation service' (Fast Track), were evaluated in comparison with conventional trauma rehabilitation service (Care as Usual).

Methods: Prospective, multi-center, non-randomized controlled study. Between 2009 and 2012, 132 adult multi-trauma patients were included: 65 Fast Track and 67 Care as Usual patients with an Injury Severity Score ≥16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures. The Fast Track program involved: integrated coordination between trauma surgeon and rehabilitation physician, shorter stay in hospital with faster transfer to a specialized trauma rehabilitation unit, earlier start of multidisciplinary treatment and 'non-weight bearing' mobilization. Primary outcomes were functional status (FIM) and quality of life (SF-36) measured through questionnaires at baseline, 3, 6, 9 and 12 months post-trauma. Outcomes were analyzed using a linear mixed-effects regression model.

Results: The FIM scores significantly increased between 0 and 3 months (p<0.001) for both groups showing that they had improved overall, and continued to improve between 3 and 6 months for Fast Track (p = 0.04) and between 3 and 9 months for Care as Usual (p = 0.03). SF-36 scores significantly improved in both groups between 3 and 6 months (Fast Track, p<0.001; Care as Usual, p = 0.01). At 12 months, SF-36 scores were still below (self-reported) baseline measurements of patient health prior to the accident. However, the FIM and SF-36 scores differed little between the groups at any of the measured time points.

Conclusion: Both Fast Track and Care as Usual rehabilitation programs were effective in that multi-trauma patients improved their functional status and quality of life. A faster (maximum) recovery in functional status was observed for Fast Track at 6 months compared to 9 months for Care as Usual. At twelve months follow-up no differential effects between treatment conditions were found.

Trial registration: ISRCTN68246661.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Critical Pathways* / organization & administration
  • Critical Pathways* / standards
  • Female
  • Humans
  • Injury Severity Score
  • Length of Stay*
  • Male
  • Middle Aged
  • Multiple Trauma / rehabilitation*
  • Netherlands
  • Patient Care Team / organization & administration
  • Patient Care Team / standards
  • Recovery of Function
  • Standard of Care / organization & administration
  • Time Factors
  • Trauma Centers / organization & administration*
  • Young Adult

Grants and funding

This manuscript is part of a study funded by ZonMw, the Netherlands Organization for Health Research and Development, The Hague, the Netherlands (http://www.zonmw.nl/en/). The Grant number was 170882704. The funding was received by BH, PB and HS. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.