The British Society of Physical & Rehabilitation Medicine (BSPRM) represents about 300 members. On 3-5 July 2023, the BSPRM organised its annual scientific meeting in cooperation with the British Association of Spinal Cord Injury Specialists (BASCIS) in Sheffield, UK. This was the first time that these two societies were having a combined meeting. Abstracts for oral and poster presentations were peer-reviewed before selection. Eighteen abstracts were selected for publication in this supplement. The selection was done by a panel comprising members of the abstract adjudication committee and the scientific committee of the meeting.
Contact person within the BSPRM: Jackie Campbell. Email: admin@bsprm.org.uk
Utility of Sensate Pedicled Medial Thigh Perforator Flaps in Treating Recurrent Ischial Ulcers in Individuals with Cauda Equina Lesions and Spinal Dysraphisms
Prashanth H Chalageri1, Henry Prakash Magimairaj1
1Christian Medical College Vellore, Vellore, India
Background: A small proportion of Persons with Spinal Cord Injury (PwSCI) with lesions in cauda equina secondary to trauma or spinal dysraphisms have recurrent ischial ulcers. Providing a reliable, well vascularized and sensate soft tissue cover over the ischial area is necessary to prevent their recurrence.
Objective: To study utility and complication rates following Pedicled Medial Thigh Perforator (P-MTP) Flap procedure for recurrent ischial ulcers and perineal lesions.
Methodology and Setting: A retrospective study was done at a tertiary care centre in South India after approval from the institutional ethics review board.
Results: 13 sensate P-MTP sensate flaps aimed at providing sensation to the ischial region. A comparison of age, sex and sensory level matched PwSCI cohort in individuals who underwent other methods of surgical corrections was made. Recurrence in P-MTP flaps was none at 6 month follow-up when compared to 4 in the control group. None of the P-MTP flaps needed revision due to major complications. 3 minor complications in the form of partial wound dehiscence were seen in the immediate postoperative period. 1 case of late recurrence at the same site was seen after 2 years. Sensation in the P-MTP Flap transposed over the ischial region was intact in all 13 patients at 12 months follow-up.
Conclusion: A sensate P-MTP flap is an easy and reliable treatment strategy for ischial pressure ulcers
The Effect of Early Compared to Late Mobilisation Following Spinal Cord Injury on Function, Complications and Wellbeing - A Systematic Review
Natalie Gray1,2, John Gladman1, Alison Cowley1,2, Pip Logan1, Vicky L Goosey-Tolfrey3, Nasir Quraishi2, Vicky Booth1,2
1University of Nottingham, UK
2Nottingham University Hospitals NHS Trust, UK
3University of Loughborough, UK
Introduction: The optimum time to mobilise following spinal cord injury (SCI) is unknown but may have implications for patient outcomes. Objective: to evaluate the effect of early compared to later initiation of mobilisation on function, the incidence of complications and well-being, in patients with SCI.
Methods: A systematic review was undertaken using a literature search of six databases (CINAHL (ESBCO), MEDLINE (Ovid), Embase (Ovid), The Cochrane Library, Web of Science, EThOS). Studies were included of any research method giving numerical results comparing one or more outcomes of interest between adult in-patients mobilised <6 weeks and >6 weeks following traumatic or acquired SCI. All forms of mobilisation were considered, including sitting, standing and walking. The certainty of findings was reported using the GRADE approach.
Results: Of 1473 identified studies, only two met the inclusion criteria, involving 492 patients. In meta-analysis, earlier mobilisation compared to later mobilisation, was associated with greater improvement in Barthel (0-100) score of 16.3 points (CI:8.9, 23.7). One study reported a lower incidence of complications in the group treated <6 weeks following SCI (37% vs 61%). Measures of well-being were not reported. Both studies were at high risk of bias and indirectness (difficulty isolating the effect of mobilisation from rehabilitation).
Conclusion: Earlier vs later mobilisation in SCI may produce a large effect on functional gains, but this finding is of low certainty because of the risk of bias and indirectness. There is insufficient evidence to examine whether earlier vs later mobilisation is associated with a difference in complications or well-being.
Highly Commended Oral Presentation: Developing a Rehabilitation Medicine National Teaching Programme (RM-NTP)
Ahmad Saif1, Annie Price2, Anas Hassan3
1Oxford, Thames Valley Deanery, United Kingdom
2Cardiff, Wales Deanery, United Kingdom
3Newcastle, North East Deanery, United Kingdom
Objective: Rehabilitation Medicine (RM) is a small, but expanding, medical speciality in the UK. Teaching is organised within deaneries, with some regions joining together. Two major changes led to the proposal for an RM National Teaching Programme (RM-NTP); the COVID-19 pandemic, with increased virtual teaching sessions, and the introduction of the new RM curriculum and syllabus. The RM-NTP aims to ensure all UK trainees have access to a structured teaching programme covering the broad areas of the curriculum.
Programme set-up: The development of the NTP involved support from the Specialty Advisory Committee (SAC) and BSPRM. Regional trainee representatives were involved through the formation of a national trainee forum, allowing for discussion and exchange of ideas. Deaneries take turns to deliver allocated topics, bi-monthly, and recordings are made available on the BSPRM website for later viewing.
Data: Data collected included trainee attendance and feedback on the session. A descriptive analysis was then carried out.
Results: Two national teaching days have been carried out with 56 and 50 attendees respectively. Feedback was received from 43 attendees in the first session and 41 in the second, with more than 95% agreeing that all talks were relevant, improved their knowledge and were delivered effectively. 100% agreed that the sessions were well organised and most had no issues being released from clinical duties. Further developments based on feedback include adding post-teaching networking and creating hybrid sessions with topics that require more hands-on training.
Conclusions: To our knowledge, this is the first teaching programme of its kind for RM successfully initiated in the UK and provides a framework for other specialities.
Setting up a Robotic RehabHub with Fourier Intelligence Solutions: An Evaluation of the Clinicians’ Experience
Amy Hartley1, Kerrie Bingham2
1Research and Development Therapist, STEPS Rehabilitation
2Apprentice Occupational Therapy Student, STEPS Rehabilitation and Sheffield Hallam University
Background: In April 2021 a Fourier Intelligence Robotic RehabHub was set up at STEPS Neurological and Trauma Rehabilitation Centre. It aimed to provide safe, high repetition and intensive treatment options for upper and lower limb rehabilitation. Alongside using the equipment with patients, clinicians have been in the unusual position of being part of the ongoing development of these robotics with Fourier Intelligence.
Aim: To understand the clinicians' experiences of using robotics and their role in the robotic development process, in turn, inform future involvement in similar projects.
Methods: Semi-structured interviews were carried out with three Physiotherapists and one Occupational Therapist, who were all clinically using the technology with patients and involved in the technology development process. An inductive thematic analysis of data was completed to provide themes around the clinicians’ experiences.
Results: Six themes emerged. “Specialist clinical knowledge” was a central theme that facilitated three further themes: “Feedback processes”, “Protocol development” and “The wider picture”. All four of these themes were influenced both beneficially and as a barrier by the themes “Time” and “Adaptability”.
Conclusions: All emerging themes were relevant to both the clinical use and development side of the clinicians’ roles. The clinicians’ specialist clinical knowledge emerged as being essential for the roles and directly influenced the other themes identified. The development of protocols for the clinical application of the technology was highlighted as a key outcome of combining clinical use and development. A local need was identified for future work on formalising the processes involved in technological development.
Change in Coma Recovery Score (CRS) with the use of Amantadine in Prolonged Disorder of Consciousness (PDOC) in Acquired Brain Injury patients
Sagarika Muradia1, Subha Vandabona1, Sachithra Adhikari1, Rama Prasad1
1University Hospital Leicester, Leicester, United Kingdom
Background: Patients with impaired consciousness for four weeks post-Acquired Brain Injury are deemed as Prolonged Disorder of Consciousness (PDOC). As per RCP National Clinical Guidelines 2020, for PDOC post-Acquired Brain Injury-there is Level 1 evidence for the use of amantadine for faster recovery in PDOC patients.
Objective: This audit was done to assess the efficacy of amantadine in improving awareness and alertness in PDOC patients and to monitor any significant side effects with the use of this drug in our cohort of patients.
Method: A Retrospective analysis was done in PDOC patients admitted to our Level 1 Neuro Rehabilitation Unit who were put on amantadine between June 2021 to December 2022. The level of awareness and responsiveness was assessed using weekly JFK Coma Recovery Scale-Revised (CRS-R) or Wessex Head Injury Matrix (WHIM) pre and post-use of amantadine (100-200mg BD for 8-12 weeks). A total of 10 patients were treated with amantadine within 4-8 weeks of injury.
Results: 50% (5/10) of patients emerged from PDOC after starting amantadine. All the patients who showed functional object use or functional communication were deemed as emerged from PDOC State. 30% (3/10) of patients developed vomiting after starting amantadine and 10% of patients developed focal seizure in the left upper limb.
Action plan: Vomiting was the most common side effect noted with the use of amantadine in these patients, hence we plan to start antiemetics along with amantadine for patients in future and then reassess PDOC outcomes post implementation of the above action plan in one year.
Reference: Prolonged Disorders of Consciousness following sudden onset brain injury, published March 2020, National Clinical Guidelines, Royal College of Physicians, United Kingdom
Spinal Infection Causing Spinal Cord Injury: A Review of the Current Medico-Legal Position
Lisa Grandidge1, Naomi Assame2, Pradeep Thumbikat1
1Consultant in Spinal Cord Injuries, Princess Royal Spinal Injuries Centre, Sheffield, UK
2Safety and Learning Lead, NHS Resolution
Introduction: This is a retrospective analysis of clinical negligence claims related to spinal infection in England. This is the first time a detailed analysis has been undertaken of spinal infection claims in the UK.
Methods: Clinical Negligence claims related to spinal infection from 01/01/2009 to 31/12/2019 were identified using the NHS Resolution Claims Management System (n=232) and the overall cost of clinical negligence claims was identified. Letters of claim for the 85 claims settled with damages paid were reviewed to identify presenting symptoms, risk factors, neurological outcomes and causes of diagnostic delays.
Results: The total predicted cost to the NHS over the period analysed was £278,763,701. This equates to 21 claims per year with a potential annual cost of £25.3 million. The total for legal costs and damages for the closed claims was £112,396,538. Delayed diagnoses were caused by failure to consider spinal infection as a diagnosis (65%), failure to consider red flag symptoms (58%) and delayed imaging (58%). 27 (32%) suffered spinal cord injuries or “nerve damage”.
Conclusion: Spinal infection and delays in its diagnosis have resulted in a substantial cost to the NHS through the pursuit of clinical negligence claims. The majority of claims were successful. Costly mistakes occurred at many stages along patient pathways. We recommend a greater index of suspicion when considering the differential diagnosis of spinal pain and better access to out-of-hours MRI. A recent invasive procedure, recent infection and up-trending C-reactive protein should be considered as additional warning signs for new onset spinal/chest pain.
Best Oral Presentation 1st Prize: Randomised Evaluation of Early v Late Cranioplasty
Harry Mee, A. Kolias, A. Helmy, I. Timofeev, Fahim Anwar, G. Whiting, Peter Hutchinson
Cambridge University Hospitals NHS Trust
Background: Patients with significant brain swelling and/or raised intracranial pressure after TBI or stroke can undergo a decompressive craniectomy (DC) to help in management. Those who survive often require a second operation, known as cranioplasty. This aims to restore the integrity of the skull and gives a degree of mechanical protection to the brain but there is a growing body of evidence showing improvements in neurological outcome. There is some limited evidence that earlier cranioplasty can enhance this effect.
Objective: To undertake a single centre, pilot randomised study comparing two distinct time intervals for cranioplasty: early (within 3 months after DC) vs standard of care (more than 6 months after DC) on functional outcomes at 6- and 12 months following DC.
Population: Adult patients (>16) who have undergone a DC for either TBI or stroke and who were clinically assessed for cranioplasty.
Data: Functional outcome and functional independence measured using GOSE and FIM. Time points taken from the date of DC – baseline at 2 months.
Results: 14 patients were randomised. Mean FIM total change from baseline to 12 months (post-DC) of 27.7 (SD 26.94) (FIM motor 21.9, FIM cognitive 5.8) in the early arm compared to 33.92 (SD 33.54) (FIM motor 26.42, FIM cognitive 7.5) in the late arm. FIM efficiency was 0.21 in the early group compared to 0.13 in the late group.
Conclusions: Although no definitive findings can be drawn, there is an increase in the rate of functional independence following cranioplasty independent of timing. A further substantial study is required to evaluate any potential effect of timing on functional outcomes.
United Kingdom Cranial Reconstruction Registry (UKCRR): Where we are and Next Steps
Harry Mee, G. Whiting, M. Martin, Fahim Anwar, Peter Hutchinson
Cambridge University Hospitals NHS Trust
Background: Decompressive craniectomy (DC) is an operation where a large section of the skull is removed to accommodate brain swelling. Patients who survive usually require subsequent reconstruction known as cranioplasty. A better understanding of the effects of cranioplasty and the relationship between timing and complications would enable more focused patient-tailored rehabilitation programs, which may maximise recovery potential, possibly resulting in improved functional and cognitive gains, enhancement of quality of life and potentially reducing longer-term care needs.
Objective: Collect core procedural data regarding cranioplasty procedures enabling monitoring of contemporary practice patterns, and revisions of cranioplasty.
Population: All patients undergoing cranial reconstruction in the UK.
Data: A prospective, observational registry hosted by the ORION platform. It captures core procedural data with 30 day follow-up.
Design: Prospective registry, observational.
Results: To date 841 procedures from 25 neurosurgical centres - 513 male, 328 female (mean age 45 (1-88)). 684 (81%) new insertions - indications include acute subdural haematomas 187 (27%) and cerebral infarcts 117 (17%). 157 (19%) removals/revisions with 78 (50%) due to infection. Material includes 661 (79%) synthetic plates and 49 (6%) autologous.
Conclusions: The data provide a useful resource to improve patient care and outcomes. The next step is to include patients from craniectomy, with a 5-year follow-up, allowing for a better understanding of long-term neurological outcomes and quality of life post-DC.
Identifying the Wider Healthcare Needs of a Marginalised Population at Increased Risk from Brain Injury: A Mixed Methodology Study
Edwin Eshun1, Orla Burke2, Florence Do2, Aashik J Mohamed Jemseed2, Angus Maciver2, Anushka Mathur2, Cassie Mayne2, Levente Novak2, Anna Siddique2, Eve Smith2, David Tapia Stocker2, Andy Johnston3, Alistair Stewart3, Alasdair FitzGerald 1
1Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, EH9 2HL
2University of Edinburgh Medical School, Edinburgh, EH16 4SB
3NHS Lothian, eHealth Programmes & Development, Edinburgh, EH10 4SG
Objectives: Estimate the prevalence of acquired brain injury in a population of people experiencing homelessness/at risk of experiencing homelessness. Explore the association between brain injury and other conditions with a high prevalence within this population. Explore the barriers and facilitators to healthcare provision for people experiencing homelessness.
Data collection: Electronic healthcare record searches of people registered to a specialist homeless Access GP practice (n=2762). 10 semi-structured interviews were conducted with primary care; mental health; infectious disease; sexual health and brain injury specialists.
Data Analysis: Numbers within this cohort who had presented with acquired brain injury; mental illness; substance abuse; drug overdose; or infectious disease within the previous 5 years. Sub-cohort analysis of brain injured vs non-brain injured was also performed. Interviews were analysed using a thematic analysis with an inductive approach, to generate themes.
Findings: High prevalence of acquired brain injury, 17.7% (488/2762) within this cohort. High dependence between brain injury and other conditions in this population with a significantly higher prevalence of substance misuse, drug overdose and infectious disease in the brain-injured subcohort. Themes identified from interviews included: lack of resources, stigmatisation, and under-recognised multimorbidity as barriers. Trauma-informed, person-centred adaptable, & integrated models of care were seen as facilitators.
Conclusions: This study suggests a potential role for the integration of brain injury rehabilitation services into models of inclusion medicine, for this marginalised population, as a means of mitigating multimorbidity in this client group.
A Feasibility Study of Virtual Reality Relaxation for Treating Pain and Other Hidden Symptoms in People with Progressive Multiple Sclerosis
Laura Edwards1,2, Adam Gordon1,2, Kim Fletcher1,3, Fiona Marshall1,4, Roshan das Nair1,5, Lauren Milbourne6
1University of Nottingham
2University Hospitals of Derby and Burton NHS Foundation Trust
3Ministry of Defence
4Derbyshire County Council
5SINTEF
6Coventry and Warwickshire Partnership NHS Trust
Introduction: Common and disabling symptoms of progressive subtypes of multiple sclerosis (MS) include pain, fatigue, and depression, which can be challenging to treat. There is a need for engaging, enjoyable and effective therapies that can be delivered flexibly.
Virtual reality (VR) provides an immersive experience in new environments and activities. Education, mindfulness and behaviour modification can be delivered at home through such technologies, which have been effective in other forms of chronic pain.
Methods: Participants with progressive MS were randomized 1:1 to intervention (VR) or control (mindfulness and meditation audio-tracks) arms for 8 weeks. Endpoints included the feasibility of recruitment, retention and data collection, and outcomes around pain, fatigue, mood and quality of life.
Results: 10 participants were recruited and randomized. Recruitment took longer than anticipated. Participants had a high baseline level of disability. Three participants discontinued the study early.
Data: Data collection was limited, primarily due to participant fatigue. No statistically significant differences were seen in outcome measures.
Findings: Qualitative findings showed themes around distraction and enjoyment but challenges around using the equipment mainly due to dexterity and mobility. Reliance on others to help set up the devices was a barrier to using the technology independently.
Conclusion: Both VR and audio interventions were enjoyable. Conducting a study in a population with high levels of disability and symptom burden is challenging. Information from this study will enable us to redesign and re-run a trial to improve recruitment, engagement, and outcome collection.
Best Poster Presentation: Hospital Soundscapes, Acquired Brain Injury and Noise – A Mixed Methods Study Exploring the Sound Environment of 5 Secondary Care Units in a Large Teaching Hospital in the UK
Laura Edwards1,2, Peter Rutherford1, Olivia Smith, Hannah Elliott1, David Baguley1, Fiona Marshall1,3
1University of Nottingham
2University Hospitals of Derby and Burton NHS Foundation Trust
3Derbyshire County Council
Introduction: Hospitals are noisy places. High sound levels and unpleasant sounds can affect the health and well-being of patients, visitors and staff. Patients with acquired brain injury (ABI) may be particularly sensitive to sound and at a higher risk of sleep disturbance.
Methods: We assessed the soundscape in 5 departments where people with ABI are commonly cared for – the Emergency Department, Medical Admissions Unit, Acute Stroke Unit, Intensive Care Unit, and Neurological Rehabilitation Unit.
We measured sound levels over 7-day periods and recruited staff and patients to explore their experiences and opinions through questionnaires and interviews.
Results: Sound levels in all departments exceeded World Health Organization recommendations. The Resuscitation area in the Emergency Department was the loudest; the rehabilitation unit was quieter in the evenings and overnight. 23 staff members and 31 patients provided feedback. In general, staff were more adversely affected by noise.
In interviews, staff considered sounds as important to their own and their patient's well-being, as well as a symbol of their professionalism. Many patients reported positive "people" sounds in addition to the more disruptive and distressing sounds associated with suffering and distress. Notably, patients with ABI reported using sounds for environmental orientation.
Discussion: Hospital soundscapes are complex but there seems to be considerable room for improvement. All respondents provided at least 1 suggestion for improvement to the soundscape. Our next project will be in implementing some of these and assessing the effects on sound levels, as well as staff and patient wellbeing.
Retrospective Quality Improvement Initiative of the Use of Parental Nutrition in Patients with Spinal Cord Injury
A. Khine1, S.S. Swarna1, S. P. Hirani2, A. Daulatzai3, V. Blackwell4, C. Hillier1, M. Woodley1, A. Forbes5, S. Wong1,2
1National Spinal Injuries Centre, Stoke Mandeville Hospital
2Centre for Health Service Research, City, University of London
3Department of Pharmacy, Stoke Mandeville Hospital, UK
4Department of Gastroenterology, Stoke Mandeville Hospital, UK
5University of Tartu, Estonia and Norwich Medical School, University of East Anglia, UK
Introduction: Patients with spinal cord injury (PWSCI) will require additional protein for pressure ulcer healing and/or pre and post-operatively.1 Enteral tube feeding is sometimes insufficient or unavailable and supplementary PN is therefore indicated.2 The study aimed to establish the trend of PN use and to report the occurrence of metabolic and catheter-related bloodstream infections (CRBSI).
Methods: A retrospective study was conducted from January 2019 to December 2022. We defined CRBSI as the presence of bacteraemia (positive culture report) originating from an intravenous catheter.
Results: 1,298 adults with SCI were admitted during the study period. Twenty-one (1.6%) (median age: 65 years) with SCI (23.8% tetraplegia) received PN support. PN was used for a median of 18 days (IQ range: 147.5; range: 5-440 days). PN use increased significantly overtime (2019: n=3, 0.8%; 2020: n=4, 1.65%; 2021: n=2, 0.6%; 2022: n=12, 3.5%, p<0.001). Metabolic complications occurred in 95.2% of PWSCI on PN. The top complications were hyponatremia(61.9%), hypomagnesaemia (61.9%) and abnormal liver function tests (57.1%). Of 1,774 days of PN, 5 confirmed CRBSIs (n=1 in 2021, 2.87 per 1,000 PN days; and n=4 in 2022, 4.67 per 1,000 PN days; overall: 2.82 per 1,000 PN days).
Conclusion: This study suggests a true increase in the use of PN in PWSCI over time. The CRBSI rate is higher than the reference UK national audit data.2 A follow-up study is underway to establish risk factors for CRBSIs.
References
1. Consortium for Spinal Cord Medicine (2014) Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury.
2. National Institute for Health and Clinical Excellence (NICE): Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition.
Feasibility of Self-Directed Arm-Crank Exercise Training in Patients with a Recent Spinal Cord Injury
Humain Choudhury1, Kimberley Deighton2, Jan Lee3, Wunna Aung2, Ram Hariharan3, Shin-Yi Chloe Chiou1
1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham
2The Golden Jubilee Spinal Injuries Centre, James Cook University Hospital
3Princess Royal Spinal Cord Injuries Centre, Sheffield Teaching Hospital
Objective: To examine the acceptability of self-directed arm-crank exercise training (ACET) to patients with a recent spinal cord injury (SCI).
Population: Adults with a cervical or upper thoracic incomplete SCI (time since injury < 3 months) who were in-patients at the SCI units were recruited.
Design/Data Analysis: Participants were randomly allocated into an ACET group or a control group. Both groups received standard SCI care. Participants in the ACET group additionally undertook weekly 5 x 30 minutes of ACET for 8 weeks, in the hospital or at home, if they were discharged during the intervention. Adherence was recorded via a Fitbit tracker. Acceptability was evaluated via the recruitment and retention rates, and exercise adherence.
Results: Twenty-two out of 24 patients meeting the inclusion criteria between October 2022 and May 2023 consented to take part in the study (recruitment rate: 92%). Of 22, 10 participants withdrew (retention rate: 55%); 7 of them withdrew before the group randomisation, and 3 discontinued the ACET. The main reasons for withdrawal were poor mental health, feeling overwhelmed, and having to deal with ongoing bowel issues. Of those who completed the ACET, the Adherence rate was 82%, although some participants expressed difficulty in recording adherence with the Fitbit.
Conclusion: Our results suggest that patients with SCI were willing to undertake the self-led ACET during their stay in a spinal unit and their exercise adherence was acceptable.
Clinical Impact Statement: Self-directed ACET may be a feasible exercise for rehabilitation after SCI.
Best Oral Presentation 2nd Prize: Non-Randomised Mixed-Methods Feasibility Study Assessing the Delivery of a Remote Vocational Rehabilitation Intervention (ROWTATE) for Patients with Traumatic Injuries
Jade Kettlewell1, Kate Radford1, Blerina Kellezi1,2, Isabel Andrews1, Lauren Blackburn3, Kay Bridger2, Adam Brooks3, Roshan das Nair1,4, Stephen Fallon1, Amanda Farrin5, Karen Hoffman6, Jain Holmes1, Trevor Jones1, Rebecca Lindley1, Richard Morriss1, Priya Patel1, Stephen Timmons1, Hereward Tresidder1, Denise Kendrick1
1University of Nottingham, UK
2Nottingham Trent University, UK
3Nottingham University Hospitals NHS Trust, UK
4SINTEF, Norway
5University of Leeds, UK
6Queen Mary University of London, UK
Objective: To assess the feasibility of delivering a remote vocational rehabilitation intervention (ROWTATE) to enhance the return to work for people with traumatic injuries.
Population: Patients with traumatic injuries (n=10) recruited from two UK major trauma centres, aged 16-69, injury severity score >8, in work (paid/voluntary) or full-time education, recruited ⩽12 weeks post-injury. Treating occupational therapists (OTs) and clinical psychologists (CPs) trained to deliver ROWTATE (n=6).
Methods: Mixed-methods study: i) single-arm feasibility study delivering ROWTATE post-traumatic injury; ii) therapists' competency assessment (n=6), iii) review of telerehabilitation literature, iv) remote adaptation of intervention and training, v) interviews with patients (n=4) and therapists pre- (n=7) and post-intervention (n=6), vi) surveys with therapists pre- (n=7) and post-training (n=4) measuring training usefulness, attitudes towards, and confidence in evidence-based practice.
Results: Intervention and training successfully adapted for remote delivery. Therapists found the training useful and reported positive attitudes and high levels of confidence in delivering evidence-based practice and intervention. High levels of fidelity (intervention components delivered: OTs=84.5%, CPs=92.9%) and session attendance rates (median: OT=97%/CP=100%). Nearly all sessions were delivered remotely. The intervention was acceptable to patients and therapists, but face-face delivery was considered important for some situations.
Conclusions: Findings informed the design of a definitive randomised controlled trial. ROWTATE is acceptable to patients and therapists and can be delivered with high fidelity. Changes for the trial included modifying therapist training and competency assessment, monitoring/addressing intervention components with lower fidelity, and face-to-face delivery where necessary.
Exploring the Implementation of Rehabilitation Prescriptions for Individuals Admitted to Major Trauma Centres: An Ongoing Mixed-Methods Study
Jade Kettlewell1, Kate Radford2, Stephen Timmons3, Trevor Jones1, Stephen Fallon1, Susan White1, Denise Kendrick1
1Centre for Academic Primary Care, University of Nottingham, UK
2Centre for Rehabilitation & Ageing Research, University of Nottingham, UK
3Nottingham University Business School, UK
Background: Survival rates have increased since UK Major Trauma Centres (MTCs) opened in 2012, however, more people are living with the long-term effects of injury. Many survivors require long-term rehabilitation, placing a significant burden on healthcare resources. 'Rehabilitation Prescriptions' (RPs) were designed to describe patient needs and improve continuity of care across the pathway. However, RPs are not being implemented as intended. There is a timely need to understand the context for RP completion/use.
Objective: To explore the implementation of RPs for trauma survivors.
Methods: Mixed-methods study commenced in April 2022, split into five stages: 1) ethnographic observations in four MTCs to understand context for RP completion; 2) online survey targeting service providers to identify behavioural factors (Theoretical Domains Framework) influencing RP implementation; 3) patient case studies (n⩽9) to map the ‘journey’ of their RP; 4) service provider interviews (n⩽20) to explore factors affecting RP completion; 5) three workshops across MTCs to co-design potential solutions to improve RP implementation.
Results: Stage 1: ethnographic observations completed in three MTCs; four clinical meetings and 13 service providers observed to date. Stage 2: 78 service providers completed the online survey, identifying 'knowledge', 'professional role' and 'emotion' as key facilitators to RP completion. Stage 3: case studies ongoing, three patients and one service provider recruited. Stage 4: recruitment ongoing, seven service providers interviewed. Next steps: analyse qualitative data and co-design workshops.
Conclusions: Findings from the study will inform the development of a solution or recommendations to improve RP implementation across trauma rehabilitation pathways.
Highly Commended Oral Presentation: A Digital Patient Reported Outcome Measures platform for Long Covid (DPROM-LC): user-centred development
Manoj Sivan1,2, Roman Rocha Lawrence1,3, Paul O’Brien3
1Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
2Leeds Teaching Hospitals NHS Trust & Leeds Community Healthcare NHS Trust, Leeds, UK
3ELAROS Digital Company, Sheffield, UK
Background: There are 2 million people with Long Covid (pwLC) in the UK alone needing assessment, diagnosis, monitoring, and specialist rehabilitation from a multidisciplinary team of healthcare professionals (HCPs).
Objective: To develop and implement a novel digital PROMs platform for a) users to monitor symptoms longitudinally and assess response to treatment; b) secure collection of PROMs and linking to electronic health records; and d) facilitate research in LC.
Methods: We undertook a) requirement analysis with pwLC, HCPs and researchers to identify user needs and desired platform functionalities; b) designed and developed the platform and c) determined the PROMs that LC services prefer to use
Results: The interactive DPROM-LC comprises a clinically useful web portal for HCPs and a mobile application for patients, with a web-based alternative to provide alternative means for data collection and limit the risk of digital exclusion. The platform captures LC symptom profile, condition severity, functional disability, and quality of life, based on the C19-YRS (Yorkshire Rehabilitation Scale)1 [Ref] and 35 other PROMs. Individual-level medical information and details on the COVID-19 illness are captured systematically. DPROM-LC is currently used in >30 NHS trusts and by > 20,000 pwLC. The data collected is being used for user self-management, individual service evaluation, NHS England national evaluation and NIHR research studies (such as LOCOMOTION).
Conclusion: A multifunctional DPROM-LC has been developed and used by pwLC, HCPs, LC services, NHS England and in research.
Reference
1. Sivan M, et al. The modified COVID-19 Yorkshire Rehabilitation Scale (C19-
YRSm). J Med Virol. 2022; 94(9):4253-4264.
