Bio-psycho-social aspects of severe multiple trauma

Subjects with severe multiple trauma present great challenges in rehabilitation, and investigations with a holistic bio-psycho-social point of view have been scarce. In the main part of this investigation all 146 patients with severe multiple trauma (ISS 16) admitted to a regional hospital in 1990. were target. Ten years survival probability for those discharged alive from the Department of Surgery (fl: 91) was 82%. Mortality rates were significantly higher than those of the general population, particularly during the first year after discharge, during which the main cause of death was traumatic brain injury. Later, overuse of alcohol and drugs, were the main causes of death. A principal aim was to analyse the relations between impairments/ functions. disabilities/ abilities and psychological and social well-being. In a three year follow-up investigation of 69 subjects (84% of those available), 80% had one or more residual impairments: 74% had physical and 32°/g cognitive impairment. Very few subjects (n=4) were ADL-dependent. Vocational disability was present in 19% and leisure disability in 76%. Vocational disability was associated with higher age, blue collar work and cognitive impairment. Leisure disability was most prevalent in those with severe physical impairments and residual pain. Cognitive performance was significantly related both to the severity of traumatic brain injury and to degree of psychological distress. A consecutive series of subjects with severe multiple trauma without brain injury (n:26), were investigated at admission to the rehabilitation hospital, at discharge and at follow-up 1- 3.5 year following trauma. Both retrospectively and prospectively, the subjects experienced significant decreases in satisfaction with life as a whole from before to after trauma. Furthermore, compared to before trauma, significantly fewer subjects reported to be satisfied (5-6) with life as a whole, and with the domains: Sexual life. ADL, contact with friends, leisure, vocational situation and financial situation. Among the life satisfaction domains, the most important contributors for global life satisfaction after trauma. were satisfaction with leisure, family life and vocation. In multiple regression analyses, having a sufficient social network, and also a strong sense of coherence, could buffer the negative influence of disabilities on life satisfaction following trauma. Though level of sense of coherence was closely related to simultaneously measured social well-being, the SOC was not stable over time, and the hypothesis about a strong sense of coherence as protective against future distress and reduced satisfaction after stressful life events could not be confirmed, at least not the first years after multiple trauma

Healthcare Professionals' Experiences with Rehabilitation Practices for Patients with Cognitive Impairment after Stroke in North Norway: A Qualitative Study

Background and Aim. Cognitive impairment is a common consequence following stroke. Previous research shows differences in rehabilitation services supporting physical, cognitive, and psychosocial needs. The aim of the current study was to explore health professionals’ experiences with service provision for patients with mild and moderate cognitive impairment after stroke in a North Norwegian context. Methods. A focus group interview with clinicians, coordinators, and leaders involved in stroke survivors’ rehabilitation trajectories was conducted. The group consisted of a strategic selection of participants with diverse professional backgrounds from specialist and primary healthcare services. The transcribed material was analyzed thematically using systematic text condensation based on an inductive, interpretive approach. Results. We found that patients with mild and moderate cognitive impairment after stroke were characterized as a neglected group in rehabilitation services and that neglect was related to both structural and professional issues. First, neglect seemed partly related to the availability of existing healthcare services, which mainly followed up on physical challenges after stroke. Second, cognitive rehabilitation seemed to be less prioritized than other health services, and the established interdisciplinary municipality teams did not seem prepared to follow-up on cognitive issues. Finally, at a professional level, the study reveals the need for building competence in cognitive rehabilitation and having services available in the long run. Conclusion. The study demonstrates the need to increase knowledge concerning cognitive rehabilitation and how rehabilitation trajectories and services should be organized to fulfil stroke survivors’ and carers’ long-term needs

Use of health and dental care services in adults with intellectual disability in relation to age and intellectual disability levels

Background - This study investigates the use of health and dental care services in adults with intellectual disability in the last 12 months according to Norwegian recommendations and in relation to age and intellectual disability levels. Method - A cross-sectional community-based survey including 214 participants (56% men). POMONA health indicators were used for data collection. Results - Health checks and contact with general practitioners in the last year increased with age but were less frequent in those with more severe intellectual disability. Hospital admissions were age independent. Less than one-fifth of women had undergone cancer screening, with small variations according to intellectual disability severity levels. Few had an individual plan. More than one-third experienced poor dental health despite frequent controls. Conclusions - The use of health checks was lower than recommended, especially in individuals with more severe intellectual disability. Service access and individual plan use need to be enhanced, and dental care services should be improved

Barriers to physical activity participation for adults with intellectual disability: A cross-sectional study

Background - Identifying barriers that can be modified to promote physical activity is important for informing health interventions for adults with intellectual disabilities. Objectives - Exploring participation in physical activity considering age, sex, living conditions, and health conditions. Further, identifying barriers significantly associated with sedentary activity after adjustment for physical activity correlates. Methods - A cross-sectional study including physical activity and barrier questions from the POMONA-15 health indicators. Multivariate logistic regression analysis with sedentary activity level as dependent variable. Results - Among 213 participants with intellectual disabilities, 36% reported predominately sedentary activities, 53% light and 11% moderate/vigorous physical activity. Barriers related to sedentary activity after adjustment were transportation, health conditions, mobility impairment, and lack of activities at the day activity centre. Conclusions - The findings highlight the need to enhance physical activity opportunities at day activity centres, tailor programmes for wheelchair users, and improve access to physical activity facilities for adults with intellectual disabilities

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

Background - Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries. Methods - A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Results - In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age  Conclusions - Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination

Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries

This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population

Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan.

Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan. Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score >9. Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma

Amoxicillin did not Reduce Modic Change Oedema in Patients with Chronic Low Back pain - subgroup Analyses of a Randomised Trial (the AIM study)

Study Design. Exploratory subgroup analyses of a randomised trial [Antibiotics in Modic changes (AIM) study]. Objective. The aim was to assess the effect of amoxicillin versus placebo in reducing Modic change (MC) edema in patients with chronic low back pain. Summary of Background Data. The AIM study showed a small, clinically insignificant effect of amoxicillin on pain-related disability in patients with chronic low back pain and MC type 1 (edema type) on magnetic resonance imaging (MRI). Materials and Methods. A total of 180 patients were randomised to receive 100 days of amoxicillin or placebo. MC edema was assessed on MRI at baseline and one-year follow-up. Per-protocol analyses were conducted in subgroups with MC edema on short tau inversion recovery (STIR) or T1/T2-weighted MRI at baseline. MC edema reductions (yes/no) in STIR and T1/T2 series were analyzed separately. The effect of amoxicillin in reducing MC edema was analyzed using logistic regression adjusted for prior disk surgery. To assess the effect of amoxicillin versus placebo within the group with the most abundant MC edema on STIR at baseline (“STIR3” group), we added age, STIR3 (yes/no), and STIR3×treatment group (interaction term) as independent variables and compared the marginal means (probabilities of edema reduction). Results. Compared to placebo, amoxicillin did not reduce MC edema on STIR (volume/intensity) in the total sample with edema on STIR at baseline (odds ratio 1.0, 95% CI: 0.5, 2.0; n=141) or within the STIR3 group (probability of edema reduction 0.69, 95% CI: 0.47, 0.92 with amoxicillin and 0.61, 95% CI: 0.43, 0.80 with placebo; n=41). Compared with placebo, amoxicillin did not reduce MC edema in T1/T2 series (volume of the type 1 part of MCs) (odds ratio: 1.0, 95% CI: 0.5, 2.3, n=104). Edema declined in >50% of patients in both treatment groups. Conclusions. From baseline to one-year follow-up, amoxicillin did not reduce MC edema compared with placebo.publishedVersio

Amoxicillin did not Reduce Modic Change Oedema in Patients with Chronic Low Back pain - subgroup Analyses of a Randomised Trial (the AIM study)

Study Design. Exploratory subgroup analyses of a randomised trial (Antibiotics In Modic changes (AIM) study). Objective. To assess the effect of amoxicillin versus placebo in reducing Modic change (MC) oedema in patients with chronic low back pain (LBP). Summary of Background Data. The AIM study showed a small, clinically insignificant effect of amoxicillin on pain-related disability in patients with chronic LBP and MC type 1 (oedema type) on magnetic resonance imaging (MRI). Methods. A total of 180 patients were randomised to receive 100 days of amoxicillin or placebo. MC oedema was assessed on MRI at baseline and one-year follow-up. Per-protocol analyses were conducted in subgroups with MC oedema on short tau inversion recovery (STIR) or T1/T2-weighted MRI at baseline. MC oedema reductions (yes/no) in STIR and T1/T2-series were analysed separately. The effect of amoxicillin in reducing MC oedema was analysed using logistic regression adjusted for prior disc surgery. To assess the effect of amoxicillin versus placebo within the group with the most abundant MC oedema on STIR at baseline (‘STIR3’ group), we added age, STIR3 (yes/no), and STIR3×treatment group (interaction term) as independent variables and compared the marginal means (probabilities of oedema reduction). Results. Compared to placebo, amoxicillin did not reduce MC oedema on STIR (volume/intensity) in the total sample with oedema on STIR at baseline (odds ratio 1.0, 95% confidence interval (95%CI) [0.5, 2.0]; n=141) or within the STIR3 group (probability of oedema reduction 0.69, 95%CI [0.47, 0.92] with amoxicillin and 0.61, 95%CI [0.43, 0.80] with placebo; n=41). Compared with placebo, amoxicillin did not reduce MC oedema in T1/T2-series (volume of the type 1 part of MCs) (odds ratio 1.0, 95%CI [0.5, 2.3], n=104). Oedema declined in >50% of patients in both treatment groups. Conclusions. From baseline to one-year follow-up, amoxicillin did not reduce MC oedema compared with placebo. Level of Evidence. Level 2

Bio-psycho-social aspects of severe multiple trauma

Subjects with severe multiple trauma present great challenges in rehabilitation, and investigations with a holistic bio-psycho-social point of view have been scarce. In the main part of this investigation all 146 patients with severe multiple trauma (ISS 16) admitted to a regional hospital in 1990. were target. Ten years survival probability for those discharged alive from the Department of Surgery (fl: 91) was 82%. Mortality rates were significantly higher than those of the general population, particularly during the first year after discharge, during which the main cause of death was traumatic brain injury. Later, overuse of alcohol and drugs, were the main causes of death. A principal aim was to analyse the relations between impairments/ functions. disabilities/ abilities and psychological and social well-being. In a three year follow-up investigation of 69 subjects (84% of those available), 80% had one or more residual impairments: 74% had physical and 32°/g cognitive impairment. Very few subjects (n=4) were ADL-dependent. Vocational disability was present in 19% and leisure disability in 76%. Vocational disability was associated with higher age, blue collar work and cognitive impairment. Leisure disability was most prevalent in those with severe physical impairments and residual pain. Cognitive performance was significantly related both to the severity of traumatic brain injury and to degree of psychological distress. A consecutive series of subjects with severe multiple trauma without brain injury (n:26), were investigated at admission to the rehabilitation hospital, at discharge and at follow-up 1- 3.5 year following trauma. Both retrospectively and prospectively, the subjects experienced significant decreases in satisfaction with life as a whole from before to after trauma. Furthermore, compared to before trauma, significantly fewer subjects reported to be satisfied (5-6) with life as a whole, and with the domains: Sexual life. ADL, contact with friends, leisure, vocational situation and financial situation. Among the life satisfaction domains, the most important contributors for global life satisfaction after trauma. were satisfaction with leisure, family life and vocation. In multiple regression analyses, having a sufficient social network, and also a strong sense of coherence, could buffer the negative influence of disabilities on life satisfaction following trauma. Though level of sense of coherence was closely related to simultaneously measured social well-being, the SOC was not stable over time, and the hypothesis about a strong sense of coherence as protective against future distress and reduced satisfaction after stressful life events could not be confirmed, at least not the first years after multiple trauma