Predicting the rehabilitation outcome after trauma based on the ICF - icfPROreha

Status:

completed 10/2021

Aims:

Aim of the research project "ICF-based prediction of outcome in rehabilitation after trauma" (icfPROreha) was to identify factors (aspects of functioning as well as contextual factors) that allow prediction of work ability and quality of life of persons with severe musculoskeletal injuries after inpatient trauma surgery-orthopedic rehabilitation.

Activities/Methods:

Methodologically, the project was implemented in four phases with the participation of the Ludwig-Maximilians-University (LMU) Munich, the BG Unfallklinik Murnau, the nine cooperating clinics or rehabilitation departments, and the project group ICF-based trauma rehabilitation. The identification of potential predictors (phase 1) and the determination of assessment instruments to collect the potential predictors (phase 2) were followed in phase 3 by building up a database for the development of predictive models, the results of which led to recommendations for measures that were written up in a strategy paper (phase 4).

Building up a data basis for the development of prediction models was carried out by means of a multicenter longitudinal study conducted at ten participating clinics or rehabilitation departments in Germany. Aspects of functioning and contextual factors as well as injury-specific data and the patients quality of life were collected with standardized procedures and assessment instruments upon admission to inpatient rehabilitation and recorded in extracts upon discharge from inpatient rehabilitation as well as – by means of telephone surveys – at the time points 12, 26, 52 and 78 weeks after discharge from inpatient rehabilitation.

Patients with

1. severe musculoskeletal injuries according to the injury type list of the German Social Accident Insurance (DGUV) and SVLFG who were admitted for
2. initial inpatient rehabilitation in one of the cooperating hospitals were included. Additional study inclusion criteria were
3. age ≥ 18 years and
4. admission to inpatient trauma surgery-orthopedic rehabilitation occurred within 16 weeks of the date of the accident or injury.

Patients with injuries of the major nerves including spinal injuries with neurological symptoms (item 3 VAV) as well as patients with open or covered moderate and severe craniocerebral injuries (from SHT grade II) (item 4 VAV) were excluded, as well as persons with insufficient knowledge of the spoken and written German language. Descriptive, bivariate, and multivariate analyses were performed.

Finally, 775 patients (mean age 47.2 years, 73.9% male) were included who were admitted to the first inpatient rehabilitation an average of 37.2 days after discharge from the acute hospital and which lasted an average of 6.2 weeks (median: 4.7 weeks). Severe injuries of large joints were the most common injuries present (52.9%), followed by complex fractures of the large long bones (31.1%). In total, 646 (83.4%) regained work ability within 78 weeks after discharge from inpatient rehabilitation (median time to work ability: 111.5 days).

Results:

The final model for predicting work ability status 78 weeks after discharge from inpatient rehabilitation contains 12 predictors, seven of which are attributable to contextual factors (e.g., assets, life attitudes). The final model for predicting the duration of work incapacity in the period up to 78 weeks after discharge from inpatient rehabilitation contains 16 predictors, 11 of which are attributable to contextual factors (e.g., type of treatment before inpatient rehabilitation, coping). Based on this, the "icfPROreha prediction scores" was developed. With these scores, the social accident insurance institutions and treatment providers have a control tool at their disposal with which the risk of a long period of sick leave or continued sick leave can already be estimated at the time of admission to inpatient rehabilitation or to the rehabilitation management of the social accident insurance institutions.

Based on the results of both prediction models, the members of the ICF-based trauma rehabilitation project group also developed recommendations for the care and treatment of patients with severe musculoskeletal injuries for the total of 22 identified predictors, which were summarized in a strategy paper. In this way, the professional groups and institutions involved in the care of patients in all sectors of care are provided with information on how to optimize the treatment of these patients in order to sustainably shorten the duration of work incapacity and ensure a return to work.

Last Update:

12 May 2022