A patient on crutches with a knee brace undergoing rehabilitation from major trauma injuries with the help of a rehabilitation specialist

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Rehabilitation challenges in complex musculoskeletal injuries

Claire Roantree looks at the challenges of rehabilitation provision after complex musculoskeletal injuries for major trauma patients.

Since the NHS rollout of Major Trauma Centres across England in 2012 and advances in pre-hospital emergency medicine, survival rates for major trauma victims have improved, but so too have the number and complexity of care and rehabilitation needs of survivors.  

Major trauma victims receive highly skilled lifesaving treatment in major trauma centres during the acute phase of their recovery and are then discharged to major trauma units or district hospitals for ongoing recovery.  Since the start of the pandemic, many patients have been discharged much earlier than normal due to the need for beds.

Major trauma patients are given a Rehabilitation Prescription outlining their health and care needs post-discharge.  Provision of community-based rehabilitation services is costly and often a postcode lottery and dependent on the type of injury suffered.  Survivors of traumatic brain injury, spinal cord injury or amputation can usually expect to be discharged to specialist rehabilitation units for multi-disciplinary treatment and care designed to meet their specific needs. 

What about patients who suffer multiple fractures, nerve, and soft tissue damage? 

Defined as “complex MSK” (musculoskeletal), these types of injuries can have a life-changing impact resulting in reduced mobility or independence, significant pain, or psychological injury.  There are few specialist NHS multi-disciplinary rehabilitation services available for these patients who often have numerous complex injuries involving upper and/or lower limb injuries, spinal injuries, injuries to internal organs, psychological injury, and pain. 

Complex MSK patients often require coordinated physiotherapy, occupational therapy, pain management and psychological treatment, and ongoing input from multiple medical disciplines. However, with limited resources and staff available, we see many situations where hospitals struggle to deliver multi-disciplinary treatment, both in hospital and post discharge. 

The long-term outcome for these patients is not as good as it could or should be.

On 18 January 2022, the NHS published NICE guidelines for “Rehabilitation after traumatic injury” which provides detailed guidance on the delivery of rehabilitation for patients with complex injuries. 

A patient on crutches with a knee brace undergoing rehabilitation from major trauma injuries with the help of a rehabilitation specialist
A patient undergoing physiotherapy

There are huge challenges for our already overstretched NHS in trying to coordinate and deliver multi-disciplinary holistic treatment for these patients.  In the wake of the pandemic, where hospitals are now under added pressure to deliver rehabilitation services for survivors with long Covid, the NHS is even more limited in what they are able to provide for the long term rehabilitation of patients post-discharge. 

Many major trauma victims suffer physically and mentally from the trauma of their accident with nightmares, flashbacks, medically induced hallucinations, fear, and anxiety about what the future holds.  Not being able to see family whilst in hospital due to Covid-19 has exacerbated their psychological response due to isolation and lack of support.  Many experience considerable post-trauma pain after operations or nerve damage.  There are numerous factors that can impact recovery, making it a very long, slow and frightening road. 

How Major Trauma Group improve patient outcomes

Our Major Trauma Group lawyers offer a unique service as they have an in-depth knowledge of the health and social care pathways therefore ensuring a rehabilitation focus, extending beyond compensation for injuries and loss. Our lawyers are specialists in using the Rehabilitation Code as part of the personal injury claims process.  The Code provides assessment in respect of physical, psychological, social and vocational needs and subsequent funding for treatment and support.  Interim payments can also be obtained to alleviate financial hardship. 

Major Trauma Group understand the complexity of these types of injuries and the need for carefully coordinated multidisciplinary rehabilitation. 

Where people are injured due to the negligence of another and there is insurance in place in relation to that negligence, the Major Trauma Group strongly believe that it is vital to utilise insurance payments to supplement NHS rehabilitation provision to:

  • improve clinical outcomes
  • improve the client experience along the treatment and care pathways
  • relieve pressure on the NHS
  • free up NHS funds and resource
  • enable the NHS to reallocate vital funding into rehabilitation where patients do not have a claim against an insurer.

Sadly, we see the challenges the NHS face in delivering ongoing rehabilitation to patients in hospitals, which impacts the frequency and intensity of rehabilitative treatment, often prolonging recovery and discharge home.

Focussing on improving rehabilitation outcomes and quality of life is fundamentally important to the lawyers within the Major Trauma Group.

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