Priority 2 from the Complex Fractures PSP

UNCERTAINTY: What is the optimal outpatient rehabilitation strategy for patients with complex fractures? (JLA PSP Priority 2)
Overall ranking	2
JLA question ID	0105/2
Explanatory note	Patients with complex fractures may spend significant amounts of time completing rehabilitation over months or years. This may be very challenging and involve many trips to the rehabilitation facility.
Evidence	NG37 and NG39 – discuss patient rehabilitation in the context of providing adequate information. They state that this is very important to patients citing the qualitative study listed here. No other relevant trial evidence Cochrane/PUBMED since 2015. Improving recovery-Learning from patients' experiences after injury: a qualitative study NICE Guideline 37 Fractures (complex): assessment and management NICE Guideline 39 Major trauma: assessment and initial management
Health Research Classification System category	Injuries and accidents

Extra information provided by this PSP
Original uncertainty examples	what is the optimum regimen of physio for various injuries ~ Was the level of inpatient physiotherapy satisfactory?? ~ I wanted to do a lot of physiotherapy to maximise my recovery but was concerned about avoiding making things worse. This wasn’t always clear. ~ does enough rehab exist / happen ? ~ What is the best approach for regaining ankle rangle of movement once immobilisation is ceased? i.e. hydrotherapy, heat, intensive exercise. Often significant delay from fracture clinic follow up to out-patient MSK services.
Submitted by	8 x Surgeon/Doctor, 1 x Carer for patient, 6 x Physio, 7 x Patient, Healthcare Professional (unspecified) x 3, 1 x Knows a patient

Extra information provided by this PSP

Original uncertainty examples

what is the optimum regimen of physio for various injuries ~ Was the level of inpatient physiotherapy satisfactory?? ~ I wanted to do a lot of physiotherapy to maximise my recovery but was concerned about avoiding making things worse. This wasn’t always clear. ~ does enough rehab exist / happen ? ~ What is the best approach for regaining ankle rangle of movement once immobilisation is ceased? i.e. hydrotherapy, heat, intensive exercise. Often significant delay from fracture clinic follow up to out-patient MSK services.

Submitted by

8 x Surgeon/Doctor, 1 x Carer for patient, 6 x Physio, 7 x Patient, Healthcare Professional (unspecified) x 3, 1 x Knows a patient

PSP information
PSP unique ID	0105
PSP name	Complex Fractures
Total number of uncertainties identified by this PSP.	58 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	8th June 2021