Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized Controlled Trial

• Published in: Clinical orthopaedics and related research 2020-04, Vol.478 (4), p.792-804
• Main Authors: Zdziarski-Horodyski, Laura, Vasilopoulos, Terrie, Horodyski, MaryBeth, Hagen, Jennifer E., Sadasivan, Kalia S., Sharififar, Sharareh, Patrick, Matthew, Guenther, Robert, Vincent, Heather K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Clinical Research; Delivery of Health Care, Integrated - methods; Disability Evaluation; Elbow; Fear; Female; Florida; Hand Strength; Humans; Intervention; Male; Middle Aged; Musculoskeletal System - injuries; Orthopedic Procedures - methods; Orthopedics; Patient Reported Outcome Measures; Patients; Range of Motion, Articular; Recovery (Medical); Recovery of Function; Single-Blind Method; Trauma; Trauma centers; Traumatic brain injury; Wounds and Injuries - surgery
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1097/CORR.0000000000001140

Orthopaedic trauma patients frequently experience mobility impairment, fear-related issues, self-care difficulties, and work-related disability []. Recovery from trauma-related injuries is dependent upon injury severity as well as psychosocial factors []. However, traditional treatments do not integrate psychosocial and early mobilization to promote improved function, and they fail to provide a satisfying patient experience. We sought to determine (1) whether an early psychosocial intervention (integrative care with movement) among patients with orthopaedic trauma improved objective physical function outcomes during recovery compared with usual care, and (2) whether an integrative care approach with orthopaedic trauma patients improved patient-reported physical function outcomes during recovery compared with usual care. Between November 2015 and February 2017, 1133 patients were admitted to one hospital as orthopaedic trauma alerts to the care of the three orthopaedic trauma surgeons involved in the study. Patients with severe or multiple orthopaedic trauma requiring one or more surgical procedures were identified by our orthopaedic trauma surgeons and approached by study staff for enrollment in the study. Patients were between 18 years and 85 years of age. We excluded individuals outside of the age range; those with diagnosis of a traumatic brain injury []; those who were unable to communicate effectively (for example, at a level where self-report measures could not be answered completely); patients currently using psychotropic medications; or those who had psychotic, suicidal, or homicidal ideations at time of study enrollment. A total of 112 orthopaedic trauma patients were randomized to treatment groups (integrative and usual care), with 13 withdrawn (n = 99; 58% men; mean age 44 years ± 17 years). Data was collected at the following time points: baseline (acute hospitalization), 6 weeks, 3 months, 6 months, and at 1 year. By 1-year follow-up, we had a 75% loss to follow-up. Because our data showed no difference in the trajectories of these outcomes during the first few months of recovery, it is highly unlikely that any differences would appear months after 6 months. Therefore, analyses are presented for the 6-month follow-up time window. Integrative care consisted of usual trauma care plus additional resources, connections to services, as well as psychosocial and movement strategies to help patients recover. Physical function was measured objectively