Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1118, 1081 HZ, Amsterdam, Netherlands.
Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, Netherlands.
BMC Health Serv Res. 2019 Nov 8;19(1):819. doi: 10.1186/s12913-019-4547-6.
The Transmural Trauma Care Model (TTCM) is a refined post-clinical rehabilitation approach, in which a multidisciplinary hospital-based team guides a network of primary care physical therapists in the treatment of trauma patients. The objective of this study was to assess the effectiveness of the TTCM compared to regular care.
A controlled-before-and-after study was performed in a level 1 trauma center. The TTCM includes four elements: 1) a multidisciplinary team at the outpatient clinic, 2) coordination and individual goal setting for each patient by this team, 3) a network of primary care physical therapists, 4) E-health support for transmural communication. Intervention group patients were prospectively followed (3, 6 and 9 months). The control group consisted of 4 clusters of patients who either had their first consultation at the outpatient clinic 0, 3, 6 or 9 months ago. Outcomes included generic- and disease-specific health-related quality of life (HR-QOL), pain, functional status, patient satisfaction, and perceived recovery. Between-group comparisons were made using linear regression analyses. The recovery pattern of intervention group patients was identified using longitudinal data analysis methods.
A total of 83 participants were included in the intervention group. In the control group, 202 participants were included (68 in the baseline cluster, 26 in the 3-month cluster, 51 in the 6-month cluster, 57 in the 9-month cluster). Between-group differences were statistically significant in favor of the intervention group for disease-specific HR-QOL at 9 months, pain at 6 and 9 months, functional status at 6 and 9 months, patient satisfaction at 3, 6 and 9 months, and perceived recovery at 6 months. No significant differences were found between groups for generic HR-QOL at any time point. Generic HR-QOL, disease-specific HR-QOL, pain, and functional status significantly improved in a linear fashion among intervention group patients during the nine-month follow-up period.
This study provides preliminary evidence that the TTCM is effective in improving patient related outcome measures, such as disease-specific HR-QOL, pain and functional status. A multicenter, and ideally randomized controlled trial, is required to confirm these results.
The trial is registered at the Dutch Trial Register (NTR5474). Registered 12 October 2015. Retrospectively registered.
经壁创伤护理模式（TTCM）是一种精细化的临床后康复方法，多学科医院团队指导初级保健物理治疗师网络治疗创伤患者。本研究的目的是评估 TTCM 与常规护理相比的有效性。
在 1 级创伤中心进行了一项对照前后研究。TTCM 包括四个要素：1）门诊的多学科团队，2）该团队为每位患者进行协调和个体化目标设定，3）初级保健物理治疗师网络，4）经壁通信的电子健康支持。干预组患者前瞻性随访（3、6 和 9 个月）。对照组由 4 组患者组成，他们要么在门诊就诊 0、3、6 或 9 个月前首次就诊。结果包括通用和疾病特异性健康相关生活质量（HR-QOL）、疼痛、功能状态、患者满意度和感知恢复。使用线性回归分析进行组间比较。使用纵向数据分析方法确定干预组患者的恢复模式。
共纳入 83 名干预组患者。对照组纳入 202 名患者（基线组 68 例，3 个月组 26 例，6 个月组 51 例，9 个月组 57 例）。干预组在 9 个月时疾病特异性 HR-QOL、6 个月和 9 个月时疼痛、6 个月和 9 个月时功能状态、3 个月、6 个月和 9 个月时患者满意度以及 6 个月时感知恢复方面均优于对照组，差异有统计学意义。在任何时间点，两组间通用 HR-QOL 均无显著差异。在 9 个月的随访期间，干预组患者的通用 HR-QOL、疾病特异性 HR-QOL、疼痛和功能状态呈线性显著改善。需要多中心、理想的随机对照试验来证实这些结果。
该试验在荷兰试验注册处（NTR5474）注册。2015 年 10 月 12 日注册。回顾性注册。
