Improving recovery - Learning from patients’ experiences after injury:A qualitative study

Objectives: To explore experiences of patients after injury and identify implications for clinical care and support within the hospital setting and primary care. Design: Semi-structured telephone administered qualitative interviews with purposive sampling and thematic qualitative analysis. Participants: Patients who have experienced an unintentional injury and attended hospital. Setting: Bristol, Surrey and Swansea. Results: Key issues that emerged were: most patients reported mixed experiences of hospital care but some described the delivery of care as depersonalising; the need for clinicians to provide adequate, timely and realistic information to patients about their injury and treatment to inform their expectations of recovery; the impact of pain at the time of the injury and for an extended period afterwards; the experience of injury on patients' emotional state with possible implications for longer term mental health issues; the pivotal role of physiotherapy care in providing practical and individualised strategies for recovery; and the importance of social support for recovery. Conclusions: Trauma patients' recovery needs to be supported by information protocols. The social circumstances of patients need to be considered at the point of discharge and during recovery. There is a need to identify people who may be experiencing mental health issues for timely referral to assessment services and appropriate care. Signposting to support groups may also be helpful for those with life changing injuries. Improved pain management would help alleviate discomfort and stress. Physiotherapy has a key role to play in supporting patients in recovery. © 2013 Elsevier Ltd. All rights reserved

Psychological morbidity and return to work after injury: multicentre cohort study

Background: The benefits of work for physical, psychological and financial wellbeing are well documented. Return to work (RTW) after unintentional injury is often delayed, and psychological morbidity may contribute to this delay. The impact of psychological morbidity on RTW after a wide range of unintentional injuries in the UK has not been adequately quantified. Aims: To quantify the role of psychological factors including anxiety, depression and post-traumatic distress on RTW following unintentional injuries. Design and Setting: Longitudinal multi-centre prospective study in Nottingham, Bristol, Leicester and Guildford, UK Method: Participants (n=273) were 16-69 year olds admitted to hospital following unintentional injury and, in paid employment prior to injury. They were surveyed at baseline, 1, 2, 4 and 12 months following injury on demographic and injury characteristics, psychological morbidity and RTW status. Associations between demographic, injury and psychological factors and RTW status were quantified using random effects logistic regression. Results: The odds of RTW reduced as depression scores one month post-injury increased (OR 0.87, 95%CI 0.79, 0.95) and as length of hospital stay increased (OR 0.91, 95%CI 0.86, 0.96). Those experiencing threatening life events following injury (OR 0.27, 95%CI 0.10, 0.72) and with higher scores on the crisis social support scale (OR 0.93, 95%CI 0.88, 0.99) had a lower odds of RTW. Multiple imputation analysis found similar results except crisis social support did not remain significant. Conclusion: Primary care professionals can identify patients at risk of delayed RTW who may benefit from management of psychological morbidity and support to RTW

The UK Burden of Injury Study – a protocol. [National Research Register number: M0044160889]

<p>Abstract</p> <p>Background</p> <p>Globally and nationally large numbers of people are injured each year, yet there is little information on the impact of these injuries on people's lives, on society and on health and social care services. Measurement of the burden of injuries is needed at a global, national and regional level to be able to inform injured people of the likely duration of impairment; to guide policy makers in investing in preventative measures; to facilitate the evaluation and cost effectiveness of interventions and to contribute to international efforts to more accurately assess the global burden of injuries.</p> <p>Methods/Design</p> <p>A prospective, longitudinal multi-centre study of 1333 injured individuals, atttending Emergency Departments or admitted to hospital in four UK areas: Swansea, Surrey, Bristol and Nottingham. Specified quotas of patients with defined injuries covering the whole spectrum will be recruited. Participants (or a proxy) will complete a baseline questionnaire regarding their injury and pre-injury quality of life. Follow up occurs at 1, 4, and 12 months post injury or until return to normal function within 12 months, with measures of health service utilisation, impairment, disability, and health related quality of life. National estimates of the burden of injuries will be calculated by extrapolation from the sample population to national and regional computerised hospital in-patient, emergency department and mortality data.</p> <p>Discussion</p> <p>This study will provide more detailed data on the national burden of injuries than has previously been available in any country and will contribute to international collaborative efforts to more accurately assess the global burden of injuries. The results will be used to advise policy makers on prioritisation of preventive measures, support the evaluation of interventions, and provide guidance on the likely impact and degree of impairment and disability following specific injuries.</p

Negotiating post injury life Patients’ experiences of recovering from injury

Research on recovering from unintended injury is dominated by the medical and psychological literature focussing on issues they deem important; return to work, functional recovery and psychological impacts of injury. My research explores from a sociological perspective, patients’ understanding and experiences of recovery after unintended injury.Employing an interpretative approach, 45 participants were qualitatively interviewed; 21 participants were men and 24 were women. The average age was 53 years and ranged from 18-70. Participants had experienced an injury requiring at least one night in hospital and were interviewed once between 1-14 months post injury.For participants, recovery meant ‘getting back to normal’ and recovering certain ‘key goals’. Participants were split into a heuristic typology according to their ‘key goals’ of recovery; these were recovering a ‘specific recreational activity’, recovering ‘independence’ and ‘recovering a whole life’. The social context of participants’ lives including gender, age, ageing, employment, living arrangements and their current life circumstances, shaped recovering the key goals.Before participants could achieve their ‘key goal’ of recovery, they had to attain three prerequisites for recovery; specifically to restore limb function sufficiently to participate in certain key activities; to overcome the perceived fear/risk of reinjury/further injury, to recover the confidence to participate in certain activities; and to overcome a lack of trust in their injured limb to allow the performance of prior key activities. This took time to accomplish, and some participants were unable to achieve these prerequisites, thus they were unable to recover their key goal.Bury’s (1982) concept of ‘biographical disruption’ was limited in its explanatory capacity but three further biographical impacts were identified; ‘biographical interruption’, biographical threat’ and ‘biographical redirection’. ‘Biographical interruption’ and ‘biographical threat’ were temporary, transitional states and ‘biographical redirection’ (an acceptable new normal) and ‘biographical disruption’ (an unacceptable new normal) were final outcome states

After ICU : the longer-term experiences of patients following discharge

Hilary Thomas, Sarah Earthy, Judith Sleney, ‘After ICU: the longer-term experiences of patients following discharge’, poster presented at the State of the Art Intensive Care Society, London, UK, 7-9 December, 2015.Peer reviewe

Patients’ Perceptions of a Changing Body: Coming to Terms with Heart Attack

Judith Sleney, Sarah Earthy, Hilary Thomas, ‘Patients’ Perceptions of a Changing Body: Coming to Terms with Heart Attack’, poster presented at Physiotherapy UK, Birmingham, UK, 10-11 October, 2014.Peer reviewe

The advocacy in action study: A cluster randomized controlled trial to reduce pedestrian injuries in deprived communities

BACKGROUND: Road traffic-related injury is a major global public health problem. In most countries, pedestrian injuries occur predominantly to the poorest in society. A number of evaluated interventions are effective in reducing these injuries. Very little research has been carried out into the distribution and determinants of the uptake of these interventions. Previous research has shown an association between local political influence and the distribution of traffic calming after adjustment for historical crash patterns. This led to the hypothesis that advocacy could be used to increase local politicians knowledge of pedestrian injury risk and effective interventions, ultimately resulting in improved pedestrian safety. OBJECTIVE: To design an intervention to improve the uptake of pedestrian safety measures in deprived communities. SETTING: Electoral wards in deprived areas of England and Wales with a poor record of pedestrian safety for children and older adults. METHODS: Design mixedmethods study, incorporating a cluster randomized controlled trial. Data mixture of Geographical Information Systems data collision locations, road safety interventions, telephone interviews, and questionnaires. Randomization 239 electoral wards clustered within 57 local authorities. Participants 615 politicians representing intervention and control wards. Intervention a package of tailored information including maps of pedestrian injuries was designed for intervention politicians, and a general information pack for controls. OUTCOME MEASURES: Primary outcome number of road safety interventions 25 months after randomization. Secondary outcomes politicians interest and involvement in injury prevention cost of interventions. Process evaluation use of advocacy pack, facilitators and barriers to involvement, and success

The Advocacy for Pedestrian Safety Study : Cluster Randomised Trial Evaluating a Political Advocacy Approach to Reduce Pedestrian Injuries in Deprived Communities

Objective: To determine whether advocacy targeted at local politicians leads to action to reduce the risk of pedestrian injury in deprived areas. Setting: 239 electoral wards in 57 local authorities in England and Wales. Participants: 617 elected local politicians. Main outcome measures: 25–30 months post intervention, primary outcomes included: electoral ward level: percentage of road traffic calmed; proportion with new interventions; school level: percentage with 20 mph zones, Safe Routes to School, pedestrian training or Road injury education; politician level: percentage lobbying for safety measures. Secondary outcomes included politicians’ interest and involvement in injury prevention, and facilitators and barriers to implementation. Results: Primary outcomes did not significantly differ. Intervention group politicians reported greater interest in child injury prevention (RR 1.09, 95%CI 1.03 to 1.16), belief in potential to help prevent injuries (RR 1.36, 95%CI 1.16 to 1.61), particularly pedestrian safety (RR 1.55, 95%CI 1.19 to 2.03). 63% of intervention politicians reported supporting new pedestrian safety schemes. Conclusions: This study demonstrates the feasibility of an innovative approach to translational public health by targeting local politicians in a randomised controlled trial. The intervention package was positively viewed and raised interest but changes in interventions were not statistically significance. Longer term supported advocacy may be needed.Medicine, Faculty ofOther UBCNon UBCPediatrics, Department ofPopulation and Public Health (SPPH), School ofReviewedFacult