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Health Series: Research Spotlight

Focusing on injury recovery from trauma patient’s point of view

Study is vital to understanding how trauma patients define successful outcomes which are key to enhanced patient care and research

by George Wigmore (Senior Communications Officer)

A first-of-its-kind study by Professor Leanne Aitken and colleagues has focused on the trauma patient’s point of view when it comes to injury recovery.

In one of the first studies to examine priorities in recovery identified by trauma patients, family members and clinicians over time, the research – which is published in the journal Injury - is vital to understanding how trauma patients define successful outcomes which are key to enhanced patient care and research.

Patient and nurseThe research idea was devised by Professor Aitken at the University of Pennsylvania while was on a Fulbright Senior Scholarship. Conducted in partnership with Penn Nursing’s Therese S. Richmond, the Andrea B. Laporte Professor of Nursing and Associate Dean for Research & Innovation, the research also involved Griffith University School of Nursing & Midwifery in Australia along with other institutions in Australia and the UK.

Professor Aitken, lead author of the study and Professor of Nursing at City, University of London, said:

“It is expected that by understanding what matters to patients and family members will help us empower patients to be active participants in the healthcare process and will underpin development of patient-reported outcomes that should be used in practice and research in trauma care. This information will also inform future trauma outcome research to ensure these priority areas are appropriate for a broader range of participants.”

The study focused on two areas: learning what patients, family members and clinicians considered to be the indicators of successful recovery from an acute hospitalisation after traumatic injury; and understanding if these indicators differed between these groups of stakeholders or changed over time, from during hospitalization to three months after discharge. Thirty-three trauma patients, 22 family members and 40 clinicians were recruited from trauma departments in two Australian teaching hospitals.

Stakeholders in the study identified five specific Indicators of recovery, including returning to work, resuming family roles, achieving independence, recapturing normality and achieving comfort. Trauma patients articulated the most detail in these indicators, compared to the responses from the study’s other stakeholders.

Perceptions of indicators of injury recovery changed for some participants over the three months after they were discharged. These changes fell into three broad groups: increasing recognition that activities of daily living were important; increasing realisation of the impact of the injury; and unfolding appreciation that life could not be taken for granted.

While in the hospital, trauma patients in the study often noted the desire to be able to care for themselves. The practical implications of their physical limitations, however, did not fully reveal themselves until after discharge. Instead, the ripple effects of limitations in their abilities to undertake basic self-care activities or have full range of movement of their limbs became increasingly apparent within the first month of being at home.

Professor Richmond, Andrea B. Laporte Professor of Nursing and Associate Dean for Research & Innovation at the University of Pennsylvania, said:

“Changes in expectations and priorities over time have implications for how we provide education and support that should be tailored to different phases in the recovery trajectory. As patients and family members change their expectations over time, appropriate care needs to be provided across the care continuum.”

The study’s findings indicate a further need to explore recovery priorities using quantitative techniques to determine relevance to a broad cross-section of trauma patients and to develop an appropriate set of outcome measures that patients consider to be important. Although some differences between stakeholder groups were identified, similarities and differences should be tested further in larger groups.

A recent study by Professor Aitken in the Journal of Critical Care has also looked at whether distress post-intensive care influences patients' and relatives' choice as to whether they would like to receive a diary and what information delivery method is preferred.

Diaries summarising intensive care are routine practice in some countries, although evidence to support diary use is limited. As a result the study interviewed 22 patients and 22 relatives, finding that psychological distress was evident in 47% patients and 23% relatives. Participants' psychological health was similar for those who perceived diaries as beneficial, and those who did not. As a result, the study concludes that patient and relative preferences of receiving a diary are not related to psychological distress and that diverse opinions around common themes suggest the need for a range of interventions to aid psychological recovery.

“Indicators of Injury Recovery Identified by Patients, Family Members and Clinicians,” was recently published in the journal Injury and is available here in digital format.

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