Die Rehabilitation nach schweren Unfällen ist von der „normalen“ orthopädischen Rehabilitation nach elektiven Eingriffen abzugrenzen. Die Herausforderungen dabei erfordern spezielle Prozesse, Infrastrukturen sowie ineinander übergehende und aufeinander abgestimmte Rehabilitationsphasen. Zwischen der Entlassung aus der Akutklinik und dem Beginn der postakuten Rehabilitation klafft häufig ein „Reha-Loch“, das es zu schließen gilt.
Abstract
Many polytrauma patients report significant long-term impairments to their physical and mental health, resulting in a reduction of their quality of life. In addition to the obvious physical accident sequences, psychological influences and the individual context factors pose special challenges to the rehabilitation team and the infrastructure of the facility. Professional reintegration and chronic pain are particularly common problems in the trauma rehabilitation. The central task of rehabilitation after accidents is the restoration or substantial improvement of the functional health and thus the reintegration into the social and professional environment. The overall rehabilitation goal is based on the biopsychosocial ICF model: the patient should achieve the best possible quality of life despite his functional impairments, and the workability and functional capability are to be restored as well as possible. This goal can only be reached after a lengthy process, in the course of which differentiated measures must be coordinated. This is the task of experienced doctors, therapists and rehabilitation managers, who accompany the patient permanently. The rehabilitation after serious accidents is to be distinguished from the “normal” orthopedic rehabilitation after elective interventions. The challenges of traumatic rehabilitation require special processes, infrastructures, as well as interrelated and coordinated rehabilitation phases. The three-phase model described in the “Weißbuch Schwerverletztenversorgung der DGU” has to be differentiated. Between the discharge from the acute care clinic and the beginning of the post-acute rehabilitation, a “rehabilitation hole” frequently occurs. The early rehabilitation, by definition, a part of the acute treatment, cannot adequately close this hole. A 6-phase model is proposed. Phase C of post-acute rehabilitation places particular demands on the rehabilitation facility. The further rehabilitation (phase E) provides specific measures, such as pain rehabilitation or activity-oriented procedures. A long-term follow-up of formerly seriously injured patients is necessary (phase F). An integration of trauma rehabilitation centers into the existing trauma network remains the long-term goal to improve the outcome after polytrauma.
2
Debus F,
Moosdorf L,
Lopez CL.
et al. Rehabilitation von Schwerverletzten in Deutschland – Klinikstandorte, Struktur- und Ausstattungsmerkmale. Unfallchirurg 2016; 119: 209-216
10
Airey CM,
Chell SM,
Rigby AS.
et al. The epidemiology of disability and occupation handicap resulting from major traumatic injury. Disability and Rehabilitation 2001; 23: 509-515
13
Livingston DH,
Tripp T,
Biggs C.
et al. A Fate Worse Than Death? Long-Term Outcome of Trauma Patients Admitted to the Surgical Intensive Care Unit. J Trauma 2009; 67: 341-349
16
Van Delft-Schreurs CCHM,
van Bergen JJM,
de Jongh MAC.
et al. Quality of life in severely injured patients depends on psychosocial factors rather than on severity or type of injury. Injury 2014; 45: 320-326
17
Simmel S,
Drisch S,
Haag S.
et al. Langzeitergebnisse nach Polytrauma mit ISS ≥ 25. Outcome und Prädiktoren der Lebensqualität. Chirurg 2013; 84: 771-779
18
Larsen P,
Goethgen CB,
Rasmussen S.
et al. One-year development of QOL following orthopaedic polytrauma: a prospective observational cohort study of 53 patients. Arch Orthop Trauma Surg 2016; 136: 1539-1546
19
Kaske S,
Lefering R,
Trentzsch H.
et al. Quality of life two years after severe trauma: A single centre evaluation. Injury 2014; 45 (Suppl. 03) 100-105
20
Soberg HL,
Bautz-Holter E,
Roise O.
et al. Long-Term Multidimensional Functional Consequences of Severe Multiple Injuries Two Years After Trauma: A Prospective Longitudinal Cohort Study. J Trauma 2007; 62: 461-470
21
Holbrook TL,
Hoyt DB.
The impact of major trauma: quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity. J Trauma 2004; 56: 284-290
22
Ommen O,
Janßen C,
Neugebauer E.
et al. Patienten- und krankenhausspezifische Einflussfaktoren auf die Zufriedenheit mit dem Krankenhausaufenthalt schwerverletzter Patienten. Unfallchirurg 2006; 109: 628-639
23
Petersen C,
Ullrich A,
Wahls F.
et al. Psychosoziale Belastungen und Ressourcen von Patienten nach Polytrauma. Phys Med Rehab Kuror 2008; 18: 313-317
27
Beyer J,
Berliner M,
Glaesener JJ.
et al. Positionspapier zur Fachübergreifenden Frührehabilitation. 2. Aufl. Phys Med Rehab Kuror 2015; 25: 260-280
28
Elmer N,
Reißhauer A,
Schröder I.
et al. Fachübergreifende Frührehabilitation nach Polytrauma – Eine deskriptive Analyse. Phys Med Rehab Kuror 2016; 26: 245-252
29
Debus F,
Mierswa D,
Ruchholtz S.
et al. Rehabilitation von schwerverletzten Patienten im Akutkrankenhaus: wer macht was? Eine bundesweite Umfrage im TraumaNetzwerk DGU. Rehabilitation 2014; 53: 25-30
32
Simmel S,
Glaesener JJ,
Jürgens C.
et al. Schmerzrehabilitation im Heilverfahren der gesetzlichen Unfallversicherung. Trauma Berufskrankh 2014; 16: 197-203
34
Simmel S,
Müller WD,
Reimertz C.
et al. Phasenmodell der Traumarehabilitation – Wie können wir das „Rehaloch“ vermeiden?. Unfallchirurg 2017; 120: 804-812
35
Simmel S,
Müller WD,
Bork H.
et al. Anforderungen an Einrichtungen der Phase C der Traumarehabilitation – Überregionale Traumarehabilitationszentren in der postakuten Rehabilitation. Phys Med Rehab Kuror 2018; 28: 282-286
36
Müller WD,
Simmel S,
Köhler S.
et al. Einbindung von Rehabilitationseinrichtungen in die Traumanetzwerke – Praktische Umsetzung des Phasenmodells der Traumarehabilitation. Phys Med Rehab Kuror 2018; 28: 163-170
