Is more better? Does a more intensive physiotherapy programme result in a more accelerated recovery for patients following trauma.

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The Alfred Hospital Trauma Service admits over 5000 patients per year with 1 in 5 deemed to have suffered major trauma (Trauma Registry, The Alfred, Trauma Audit 2010). Acute hospital care must be as efficient and effective as possible, given the high demand and the current pressure on inpatient beds. The doctors stabilise the patient medically and surgically as soon as possible, while the allied health team prepares the patient physically, psychologically and socially for timely discharge. For the trauma physiotherapists this involves treating patients in the emergency department, the intensive care unit and the ward. Despite dedicated clinical resources, trauma patient care may be impacted on by other acute care priorities and this can result in sub-optimal patient recovery and delayed discharge. A recent audit (2010) undertaken in the trauma service at The Alfred revealed only 33% of patients who could sit out of bed for meals, actually did so. We hypothesize that inadequate resources and low patient self confidence results in an unacceptable achievement of simple daily tasks after trauma. The optimal intensity / frequency of physiotherapy intervention for trauma patients in the acute care is unclear. Studies have shown early and intensive physiotherapy to be safe following stroke (Bernhardt et al 2008) and within the intensive care context (Schweickert et al 2008, Hopkins et al 2009). It also assists with functional independence and discharge destination gains following acquired brain injury (Turner-Stokes et al 2005), femoral fracture (Oldmeadow et al 2006, Pendleton et al 2007) and ankle fracture (Kimmel et al 2010). The goal of the physiotherapy intervention in the acute hospital is to prepare the patient physically for discharge to the community, commonly detailed as independence in transfers and ambulation (with or without a gait aid) and the ability to safely negotiate steps. These criteria are achieved through a regime of strengthening exercises and gait retraining. It seems reasonable to hypothesise that success may be enhanced by increasing the patients opportunity to practice these skills and may result in improved functional ability, a shorter hospital length of stay and more discharges directly home. Information regarding the optimal intensity / frequency of physiotherapy input will inform appropriate resource allocation to ensure maximum benefit for the patient, their families and the health care system.

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