目的:重大创伤“康复处方”旨在促进护理的连续性,并描述从英国重大创伤中心(MTC)出院后的患者需求,然而,研究表明康复处方没有按预期实施。我们旨在使用行为变化轮(BCW)和理论域框架(TDF)确定影响完成和使用康复处方的因素。
方法:由TDF和BCW提供的在线调查。
方法:英国创伤康复途径。
方法: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)。
方法:计算TDF行为域的平均分数,确定促进者(得分≥5)和障碍(≤3.5)康复处方的实施。由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者和障碍,加上潜在的行为改变策略。
结果:大多数受访者在英国MTC工作(n=63),并且是物理治疗师(n=34),创伤康复协调员(n=16)或职业治疗师(n=15)。\'社会/职业角色和身份\',“知识”和“情感”(得分最高的TDF领域)是实施康复处方的促进者。定性数据确定了康复处方完成的障碍,包括“被视为勾号练习”,\'不是优先级\',缺乏资源(IT和劳动力),服务间通信不良,有限的知识/培训。主持人包括治疗师买入,标准化培训,轻松的服务间康复处方转移,分享患者需求的有用性。
结论:虽然康复处方受到一些服务提供者的重视,他们的有效性受到消极态度的阻碍,知识有限,沟通不畅。康复处方是否达到目标存在不确定性,特别是在记录患者需求方面,让病人参与康复,并通知MTC出院后的转诊。改善IT系统,赋予患者权力,重定向资金,提供培训可能会提高他们的使用率。进一步的研究应该探索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。
OBJECTIVE: 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).
METHODS: Online survey informed by the TDF and BCW.
METHODS: UK trauma rehabilitation pathway.
METHODS: Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78).
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.