Improving Long-Term Outcomes of Patients with Severe Traumatic Injuries

In severe musculoskeletal trauma, studies suggest that patients may have better long-term outcomes when interventions in the early recovery period support psychosocial health needs. A new report in JBJS continues to explore this topic. 

The 12-Month Effects of the Trauma Collaborative Care Intervention. A Nonrandomized Controlled Trial 

Study Highlights 

• This study was conducted by the Major Extremity Trauma Research Consortium (METRC) and included patients with high-energy orthopaedic injuries treated surgically. 
• This was a cluster-controlled trial conducted at 12 U.S. Level-I trauma centers. Six of the centers implemented the Trauma Collaborative Care (TCC) program (378 patients enrolled), and 6 centers provided standard care (344 patients enrolled).  
• The main components of the patient-focused TCC program, and the study design, were previously described¹. As noted in the current report, “The TCC expands the programs and services provided by the Trauma Survivors Network (TSN), which includes evidence-based interventions: peer visitation, patient education, a self-management program, and peer support².” 
• A composite primary outcome measure—including the Short Musculoskeletal Function Assessment (SMFA) Dysfunction Index, Patient Health Questionnaire-9 (PHQ-9), and Posttraumatic Stress Disorder Checklist (PCL)—was assessed. The investigators employed a 2-stage Bayesian hierarchical statistical procedure to characterize treatment effects. 

Findings 

The authors found substantial variability in patient use of the intervention components across sites, with just 29% of the patients in the intervention group receiving all 5 of the core program components (TSN handbook education, peer visits, recovery assessment, and calls before and after recovery assessment). 

Although prior research showed early positive effects, the TCC program as delivered did not have a meaningful impact on patient outcomes at 1 year. The authors had hypothesized that access to the program would result in lower rates of poor function, depression, and PTSD. 

In discussing their findings, the authors note that it is surprising that evidence-based strategies that have individually shown efficacy “were not efficacious when offered as a set of optional services.” They further note that their results along with the low use of the program suggest that “we still do not fully understand the impact of the program on patients with orthopaedic trauma.”  

Whether programs that improve compliance or are aimed at specific subgroups would better meet the psychosocial needs of trauma survivors is not known, they say. And they conclude that “Given the resource intensity of this comprehensive intervention, alternative models need to be explored to address the psychosocial challenges of individuals following orthopaedic trauma.” 

Access the full JBJS report: The 12-Month Effects of the Trauma Collaborative Care Intervention. A Nonrandomized Controlled Trial 

References 

1. Wegener ST, Pollak AN, Frey KP, Hymes RA, Archer KR, Jones CB, Seymour RB, OʼToole RV, Castillo RC, Huang Y, Scharfstein DO, MacKenzie EJ; METRC. The Trauma Collaborative Care Study (TCCS). J Orthop Trauma. 2017 Apr;31(Suppl 1):S78-87. 
2. Bradford AN, Castillo RC, Carlini AR, Wegener ST, Teter H Jr, Mackenzie EJ. The trauma survivors network: Survive. Connect. Rebuild. J Trauma. 2011 Jun;70(6): 1557-60.