Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK.
Centre for Rehabilitation & Ageing Research, School of Medicine, University of Nottingham, UK.
Injury. 2024 Sep;55(9):111722. doi: 10.1016/j.injury.2024.111722. Epub 2024 Jul 14.
Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF).
Online survey informed by the TDF and BCW.
UK trauma rehabilitation pathway.
Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78).
Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies.
Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). 'Social/professional role and identity', 'knowledge' and 'emotion' (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including 'seen as tick-box exercise','not a priority', lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs.
Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.
主要创伤“康复处方”旨在促进护理连续性，并描述患者从英国主要创伤中心（MTC）出院后的需求，然而研究表明，康复处方并未按预期实施。我们旨在使用行为改变轮（BCW）和理论领域框架（TDF）确定影响康复处方完成和使用的因素。
在线调查，由 TDF 和 BCW 提供信息。
英国创伤康复途径。
参与完成和/或使用康复处方的康复和创伤服务提供者（n=78）。
计算 TDF 行为领域的平均分数，确定康复处方实施的促进因素（得分≥5）和障碍（≤3.5）。BCW/TDF 提供的自由文本数据的主题分析确定了进一步的促进因素和障碍，以及潜在的行为改变策略。
大多数受访者在英国 MTC 工作（n=63），是物理治疗师（n=34）、创伤康复协调员（n=16）或职业治疗师（n=15）。“社会/专业角色和身份”、“知识”和“情感”（得分最高的 TDF 领域）是实施康复处方的促进因素。定性数据确定了康复处方完成的障碍，包括“被视为勾选练习”、“不是优先事项”、缺乏资源（IT 和劳动力）、服务间沟通不畅、知识/培训有限。促进因素包括治疗师的认同、标准化培训、轻松的服务间康复处方转移、对分享患者需求的有用性。
尽管一些服务提供者重视康复处方，但由于负面态度、知识有限和沟通不畅，其效果受到阻碍。关于康复处方是否达到其目标存在不确定性，特别是在记录患者需求、让患者参与康复以及为 MTC 出院后的转介提供信息方面。改善 IT 系统、赋予患者权力、重新分配资金以及提供培训可能会提高其使用率。进一步的研究应该探讨服务提供者和患者的观点，以及对康复处方建议结果的前瞻性长期随访。
