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NICE invites responses to draft guideline on rehabilitation after traumatic injury

Consultation launched on proposed NICE guideline on rehabilitation after traumatic injury

Published on 22nd August 2018

The Department of Health and NHS England have asked NICE to develop a guideline about rehabilitation after traumatic injury.

In England, 45,000 people are affected by very severe or major trauma every year. Half a million people experience less severe trauma, and a proportion of those will require hospital admission because of pre-existing conditions, disability or frailty.

"Trauma is a significant cause of early death and morbidity – particularly in the working population. Major trauma is the biggest cause of death in children and adults under the age of 40," said The National Institute for Health and Care Excellence in its guideline scope for rehabilitation after traumatic injury which will be used to develop NICE quality standards.

After a traumatic injury, people require rehabilitation assessment and interventions that take account of any pre-existing conditions and focus on helping them regain optimum function and independence as quickly as possible.

Trauma negatively affects quality of life both physically and mentally and can lead to problems with mobility, pain, breathing, eating, drinking, toileting, and sensory problems, and can lead to psychological difficulties. The impact of these problems may be influenced by pre-existing conditions.

The guideline will focus on people with complex rehabilitation needs following traumatic injury. The scoping guideline outlines the areas that the guideline will and will not cover.

It states that complex needs will cover multiple needs, and will always involve coordinated multidisciplinary input from two or more allied health professional disciplines, and could also include:

- Vocational or educational social support for the person to return to their previous functional level, including return to work, school or college.

- Equipment or adaptations.

- Ongoing recovery from injury that may change the person's rehabilitation needs (for example, restrictions of weight bearing, cast immobilisation in fracture clinic).

NICE outlines that currently, patients have a rehabilitation assessment and prescription carried out during the hospital admission. Further assessments are performed over time to capture changing needs. There are limitations in access to the appropriate rehabilitation services for people following trauma, which may be related to geography and age. There is significant variation in practice, with no national network of services.

"Early, intense rehabilitation can improve function, pain, quality of life and mental health outcomes. It can also improve outcomes for carers of those affected by traumatic injury," said the guideline.

NICE will look at evidence concerning complex rehabilitation needs following traumatic injury, including physical, psychological and psychosocial interventions, in the areas below when developing the guideline, but it may not be possible to make recommendations in all the areas.

- Identification and assessment of rehabilitation needs following traumatic injury.

- Rehabilitation packages and programmes for people with complex rehabilitation needs after traumatic injury (for example, exercise-based therapies, manual therapies, gait training, vocational support, talking therapies and adjuncts to therapy such as blood flow occlusion therapy).

- Specific packages and programmes for limb loss, nerve injury and chest injury.

- Coordination of rehabilitation services.

- Principles of care.

The draft scope asks a number of questions for people wanting to contribute to the consultation including:

- What should be included in rehabilitation needs assessment for people following traumatic injury, including consideration of the interface with social care?

- How should ongoing assessments be managed beyond the first asessment (not including long-term care needs)?

- What rehabilitation programmes and packages are effective and acceptable for people with complex rehabilitation needs after traumatic injury?

- For people with complex rehabilitation needs after traumatic injury that involves nerve injury, what specific rehabilitation programmes and packages are effective and acceptable?

Rehabilitation after Traumatic injury: Draft scope consultation

You can now comment on this draft scope. The consultation closes on 12 September 2018 at 5pm.

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