Provider perspectives on rehabilitation of patients with polytrauma.
OBJECTIVE
To describe, from the perspective of U.S. Department of Veterans Affairs (VA) polytrauma rehabilitation providers, (1) patients with combat-related polytrauma and their rehabilitation, (2) polytrauma patient family member involvement in rehabilitation, and (3) the impact on providers of providing polytrauma rehabilitation.


METHODS
Qualitative study based on rapid assessment process methodology, which included semistructured interviews, observation, and use of a field liaison.


METHODS
The 4 VA polytrauma rehabilitation centers (PRCs).


METHODS
Fifty-six purposefully selected PRC providers and providers from consulting services.


METHODS
Not applicable.


METHODS
Provider self-report of polytrauma patient characteristics, polytrauma patient family member involvement in rehabilitation, and the impact of polytrauma rehabilitation on providers themselves.


RESULTS
According to PRC providers, polytrauma patients are younger than VA rehabilitation patients. Strong military identities affect rehabilitation needs and reactions to severe injury. The public and the media have particular interest in war-injured patients. Patients with blast-related polytrauma have unique constellations of visible (including amputations, craniectomies, and burns) and invisible (including traumatic brain injury, pain, and posttraumatic stress disorder) injuries. Providers have adjusted treatment strategies and involved services outside of rehabilitation because of this clinical complexity. Family members are intensely involved in rehabilitation and have service needs that may surpass those of families of rehabilitation patients without polytrauma. Sources of provider stress include new responsibilities, media attention, increased oversight, and emotional costs associated with treating severely injured young patients and their families. Providers also described the work as deeply rewarding.


CONCLUSIONS
The VA should prioritize the identification or development and implementation of strategies to address family member needs and to monitor and ensure that PRC providers have access to appropriate resources. Future research should determine whether findings generalize to patients injured in other wars and to people who sustain polytraumatic injuries outside of a war zone, including victims of terrorist attacks.
Friedemann-Sánchez
Greta
G
Center for Chronic Disease Outcomes Research VA Medical Center, Minneapolis, MN, USA. frie0013@umn.edu
Sayer
Nina A
NA
Pickett
Treven
T
D017677:Age Distribution; D001291:Attitude of Health Personnel; D001753:Blast Injuries / Q000534:rehabilitation; D003695:Delivery of Health Care / Q000458:organization & administration; D005190:Family / Q000523:psychology*; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D054542:Iraq War, 2003-2011; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel; D009104:Multiple Trauma / Q000534:rehabilitation*; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D012047:Rehabilitation Centers / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans