Effects of an Integrated ‘Fast Track’ Rehabilitation Service for Multi-Trauma Patients: A Non-Randomized Clinical Trial in the Netherlands

by Ans I. E. Bouman, Bea Hemmen, Silvia M. A. A. Evers, Henk van de Meent, Ton Ambergen, Pieter E. Vos, Peter R. G. Brink, Henk A. M. Seelen

Objectives

The effects on health related outcomes of a newly-developed rehabilitation program, called ‘supported Fast Track multi-trauma rehabilitation service’ (Fast Track), were evaluated in comparison with conventional trauma rehabilitation service (Care as Usual).

Methods

Prospective, multi-center, non-randomized controlled study. Between 2009 and 2012, 132 adult multi-trauma patients were included: 65 Fast Track and 67 Care as Usual patients with an Injury Severity Score ≥16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures. The Fast Track program involved: integrated coordination between trauma surgeon and rehabilitation physician, shorter stay in hospital with faster transfer to a specialized trauma rehabilitation unit, earlier start of multidisciplinary treatment and ‘non-weight bearing’ mobilization. Primary outcomes were functional status (FIM) and quality of life (SF-36) measured through questionnaires at baseline, 3, 6, 9 and 12 months post-trauma. Outcomes were analyzed using a linear mixed-effects regression model.

Results

The FIM scores significantly increased between 0 and 3 months (p Conclusion

Both Fast Track and Care as Usual rehabilitation programs were effective in that multi-trauma patients improved their functional status and quality of life. A faster (maximum) recovery in functional status was observed for Fast Track at 6 months compared to 9 months for Care as Usual. At twelve months follow-up no differential effects between treatment conditions were found.

Trial Registration

ISRCTN68246661

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