Supported fast track multi-trauma rehabilitation service

INTERVENTION: Supported fast track multi‐trauma rehabilitation service: SFTRS involves the following: 1. The rehabilitation physician from the rehabilitation centre is routinely involved at a very early stage post‐trauma. This allows an early start for multidisciplinary rehabilitation treatment. 2. Early transfer (within five days after having been added to the waiting list from the rehabilitation centre) to a centralised, specialised trauma rehabilitation unit equipped with facilities for early training programs 3. Early individual rehabilitation goal setting 4. Close co‐operation and exchange of views and experiences between the trauma surgeon and the rehabilitation team by, for example, monthly clinical sessions and individual patient visits by the trauma surgeon in the first weeks after discharge 5. Well‐documented treatment protocols for multi‐trauma patients for both the hospital and rehabilitation centre phases Three phases can be identified in the treatment of multi‐trauma patients: 1. Early rehabilitation phase 2. Stage II rehabilitation phase 3. Discharge or post‐discharge phase Phase 1: Early rehabilitation phase In the early rehabilitation phase, the patient is not allowed to mobilise weight bearing. Consequently, the physiotherapist is concerned with maintaining joint mobility, muscle strength, sitting balance, condition and training transfers as well as treatments with non‐weight‐bearing conditions such as hydrotherapy and non‐weight‐bearing gait training. There are 10 sessions per week of 30 minutes each. In addition, fitness, gymnastics, table tennis, swimming, bowling, hand bike, wheelchair training, and archery are given. There are 2 ‐ 3 sessions per week for each treatment modality of 60 minutes each. The occupational therapist advises on bed posture, mattress types, aids for independent daily self‐care, wheelchair‐dependency training and meaningful activities that can be performed while bedridden. In addition, the wheelchair accessibility and wheelchair frie CONDITION: Multi‐trauma rehabilitation ; Injury, Occupational Diseases, Poisoning ; Unspecified multiple injuries PRIMARY OUTCOME: 1. Generic quality of life: 36‐item Short Form Health Survey (SF‐36); 2. Functional health status: Functional Independence Measure (FIM); ; Outcome measures are collected at baseline (i.e. as soon as possible after trauma), 3, 6, 9 and 12 months post‐trauma, i.e. T0, T1, T2, T3 and T4. SECONDARY OUTCOME: 1. Extent to which individual ADL treatment goals are met: Canadian Occupational Performance Measure (COPM); 2. Anxiety and depression: Hospital Anxiety and Depression Scale (HADS); 3. Cognitive functioning: Mini‐Mental State Examination (MMSE); ; Next to that costs will be assessed using the PRODISQ, a cost questionnaire and data from the hospital databases. Outcome measures are collected at baseline (i.e. as soon as possible after trauma), 3, 6, 9 and 12 months post‐trauma, i.e. T0, T1, T2, T3 and T4.; ; In studies comparing the effectiveness of different treatment regimes, differences in treatment credibility and expectancy may influence the outcome. In the proposed study the credibility/expectancy questionnaire (CEQ) will be administered directly following the explanation of the study?s rationale to patients, i.e. after informed consent has been obtained. INCLUSION CRITERIA: Multi‐trauma patients admitted to one of the Accident and Emergency Departments (A&E) of the participating hospitals are included. Multi‐trauma is defined as having at least two or more injuries of which at least one is life‐threatening, including: 1. Trauma with an Injury Severity Scale score (ISS) greater than or equal to 16 2. Complex multiple injuries on both lower extremities 3. A combination of one upper and one lower extremity injury, the latter of which can not be used in load‐bearing, or 4. Complex pelvis/acetabulum fractures Inclusion criteria are: 1. Aged 18 years or over, either sex 2. Multi‐trauma (as defined above) 3. Hospitalisation after A&E admission 4. Rehabilitation indication, i.e. lasting impairments or handicaps are expected 5. Adequate Dutch language skills