title: Effects of an Integrated 'Fast Track' Rehabilitation Service for Multi-Trauma Patients: A Non-Randomized Clinical Trial in the Netherlands.
abstract: OBJECTIVE
  The effects on health related outcomes of a newly-developed rehabilitation program, called 'supported Fast Track multi-trauma rehabilitation service' (Fast Track), were evaluated in comparison with conventional trauma rehabilitation service (Care as Usual).
  
  
  METHODS
  Prospective, multi-center, non-randomized controlled study. Between 2009 and 2012, 132 adult multi-trauma patients were included: 65 Fast Track and 67 Care as Usual patients with an Injury Severity Score ≥16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures. The Fast Track program involved: integrated coordination between trauma surgeon and rehabilitation physician, shorter stay in hospital with faster transfer to a specialized trauma rehabilitation unit, earlier start of multidisciplinary treatment and 'non-weight bearing' mobilization. Primary outcomes were functional status (FIM) and quality of life (SF-36) measured through questionnaires at baseline, 3, 6, 9 and 12 months post-trauma. Outcomes were analyzed using a linear mixed-effects regression model.
  
  
  RESULTS
  The FIM scores significantly increased between 0 and 3 months (p<0.001) for both groups showing that they had improved overall, and continued to improve between 3 and 6 months for Fast Track (p = 0.04) and between 3 and 9 months for Care as Usual (p = 0.03). SF-36 scores significantly improved in both groups between 3 and 6 months (Fast Track, p<0.001; Care as Usual, p = 0.01). At 12 months, SF-36 scores were still below (self-reported) baseline measurements of patient health prior to the accident. However, the FIM and SF-36 scores differed little between the groups at any of the measured time points.
  
  
  CONCLUSIONS
  Both Fast Track and Care as Usual rehabilitation programs were effective in that multi-trauma patients improved their functional status and quality of life. A faster (maximum) recovery in functional status was observed for Fast Track at 6 months compared to 9 months for Care as Usual. At twelve months follow-up no differential effects between treatment conditions were found.
  
  
  BACKGROUND
  ISRCTN68246661.
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Caphri, School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Ans I E
authors.initials: AI
authors.lastname: Bouman
authors.affiliation: Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands.|Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, Caphri, School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.|Department of Rehabilitation Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Bea
authors.initials: B
authors.lastname: Hemmen
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Caphri, School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: van de Meent
authors.affiliation: Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, Caphri, School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: Ambergen
authors.affiliation: Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands.
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Vos
authors.affiliation: Netwerk Acute Zorg Limburg, Maastricht University Medical Center, the Netherlands.
authors.forename: Peter R G
authors.initials: PR
authors.lastname: Brink
authors.affiliation: Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands.|Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, Caphri, School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Henk A M
authors.initials: HA
authors.lastname: Seelen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019091:Critical Pathways / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000534:rehabilitation*; D009426:Netherlands; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D020127:Recovery of Function; D059039:Standard of Care / Q000458:organization & administration; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*; D055815:Young Adult