Case Study 3

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Case study 3 -  Mr B

Mr B is a 51-year-old High Court judge who suffered severe injuries following a cycling accident in April 2017 when he was hit from behind by a car and dragged under the vehicle. He was evacuated from the scene to St George’s Hospital where he spent 8 weeks on ITU and on the orthopaedic ward. His injuries were extensive and serious, including over 20 fractures, peripheral nerve injury, joint dislocations and soft tissue injuries, as well as serious cardio-respiratory complications (see chart below).

 

 

 

 

Mr B was discharged home in June 2017 with a pelvic external fixator in-situ and able to fully weight bear through his left lower limb and partial weight bear through his right lower limb. On discharge home, Mr B was confined to a micro-environment downstairs, as he was unable to negotiate the staircase to his bedroom. He was then admitted to The Clavadel for a short programme of residential rehabilitation, after which his rehabilitation continued with community-based physiotherapy and occupational therapy input from the Remedy Healthcare team at his home and outpatient hydrotherapy at The Clavadel.

 

In October 2017, Mr B attended the 2-week High Intensity, Residential Rehabilitation course. The Consultant-led, interdisciplinary programme delivered 5 hours of input each day over 10 days and included physiotherapy, occupational therapy, hydrotherapy, rehabilitation exercise instruction (addressing deficits in strength, balance, joint stability, posture, endurance, cardio-respiratory fitness, etc), yoga instruction and psychology.

 

Prior to attending the residential course, Mr B identified his personal short and long-term goals. These included:

  • To consolidate progress made since the accident;

  • To return to full time work, including commuting via bicycle and train;

  • To return to leisure activities and sport, including road cycling, golf, swimming, badminton, tennis and occasional running;

  • To complete a family holiday to Canada that had been planned for Sep 2017 but then cancelled as a result of his accident.

 

During the Residential Rehabilitation course Mr B made significant gains. His functional performance improved across a range of parameters, as did his understanding of the principles and benefits of therapeutic exercise. His confidence in making further gains towards his long-term goals also grew throughout the course.

 

Following the Residential Rehabilitation course – and only 6 months after his accident - Mr B returned to work, including cycling daily to his local train station. He continued his rehabilitation journey into 2018 with ongoing physiotherapy input and underwent further surgical intervention in early 2018. He was able to enjoy a family holiday to Canada in September 2018 (see photo below), thus achieving his personal long term objective.

Formal Outcome measures

Mr B made significant gains, particularly during the first 6 months of his recovery. Of note was his return to independence with his ADL’s following just over 2 months of residential & community-based rehabilitation and his return to work 6 months following injury. His formal outcome measures from the 2-week residential rehabilitation course showed that his performance and satisfaction (COPM scores) greatly improved during the 2 weeks, demonstrating a significant change in both areas. Improvement was also seen in Mr B’s Re-integration into Normal Living Index (RNLI), with specific gains seen in the areas of reintegration into work and recreation and social interaction. Mr B remained highly motivated throughout his rehabilitation pathway and succeeded in achieving his personal goals over a remarkably short period of time.

 

Mr B’s case illustrates several important aspects of effective specialist MSK rehabilitation:

  1. Integrated clinical care pathways (‘joined up rehabilitation’) are critical to success. Mr B has stated that “I believe very strongly that the seamless transition from in-patient to (effectively) full-time, properly supported, rehabilitation was a key element of getting to hit my recovery milestones.”

  2. Close collaboration between legal, case management & specialist rehabilitation providers is key to delivering effective, timely intervention.

  3. The combination of motivation & opportunity can deliver extraordinary outcomes – Mr B was highly motivated to achieve his personal goals and was given access to the expertise & support he needed to reach these, including his return to work within 7 months of injury.

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