Key components of rehabilitation programmes for adults with complex fractures following traumatic injury: A scoping review

Abstract

Introduction: Complex fractures are severe injuries that cause considerable disability, particularly in the working population. Effective rehabilitation is essential to achieve good outcomes, however, it is unclear what the best rehabilitation strategy is for adults with complex fractures, after their discharge from hospital. The aim of this scoping review was to identify and map the breadth of evidence available on this topic.

Methods: A systematic search was completed on 24th July 2023 using a combination of subject and specialist databases. In addition, a secondary search assessed unpublished literature from trial registries. A citation search was completed on the selected studies. The template for intervention description and replication (TIDieR) checklist was used to extract consistent data on the interventions reported in the studies. The Joanna Briggs Institute methodology for scoping reviews was followed.

Results: 19,253 studies were identified from the search strategy of which 25 studies met the eligibility criteria. Most interventions were exercise-based and delivered by physiotherapists. Some studies compared manual therapy treatments to other forms of physiotherapy or a placebo, whilst others investigated psychosocial interventions, such as cognitive behavioural therapy, in comparison to usual care. Two studies took a multidisciplinary team approach, incorporating components such as exercise, functional activities and self-management strategies.

Discussion: The studies included were heterogenous in terms of population (fracture type, location and complexity), intervention content and therapeutic aims. However, commonalities were found with most interventions or comparators including range of movement, strengthening and task specific exercises; functional tasks; gait and balance training; and advice on return to activities as components. Value was attributed to components such as, a coordinated team approach, person-centred rehabilitation, supervised exercise and psychosocial support.

Conclusion: There is a broad and varied approach to the rehabilitation of complex fractures. The studies differed in population and approach, with a wide range of injuries, interventions and modes of delivery reported. Fidelity was poorly described, with only a third of studies reporting adherence or acceptability. There was inconclusive evidence to inform clinical practice and further research is advised. Qualitative, expert consensus, and coproduction approaches are recommended methods to develop complex interventions and best practice guidance.

Keywords: Complex fracture; Evidence review; Rehabilitation; Trauma.