Van Aswegen H1, Reeve J2, Beach L3, Fagevik Olsen M4, Parker R5
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2Auckland University of Technology, Physiotherapy, Auckland, New Zealand, 3The Royal Melbourne Hospital, Physiotherapy, Melbourne, Australia, 4Sahlgrenska University Hospital, Department of Physical Therapy, Göteborg, Sweden, 5University of Cape Town, Department of Health and Rehabilitation Sciences, Cape Town, South Africa
- To evaluate current research evidence and efficacy of physiotherapy interventions for patients who sustained chest wall injury and/or lung parenchyma damage.
- To provide insight into the limitations in physical activity and lung function that patients experience after sustaining chest wall injury.
- To propose a theoretical framework for the management of chronic pain in this patient population.
The incidence of trauma and rate of hospital admissions of patients who suffered life threatening injury have escalated world-wide over the last decade. Motor vehicle or pedestrian vehicle accidents and violence towards others or oneself are associated with blunt or penetrating injury to the chest wall. Such injuries lead to internal bleeding, destabilization of the rib cage, pain, abnormal breathing patterns, impairments in ventilation and oxygenation and an increased risk of mortality. Most patients are managed conservatively through pain control and non-invasive or invasive ventilator support but those with flail injuries may undergo surgical fixation of the flail segments to restore stability of the chest wall. Physiotherapists are involved in the inpatient management of such patients to optimize secretion clearance and prevent the onset of respiratory infections, to restore lung volumes and pulmonary function and improve physical function and activity. Research evidence to support physiotherapy interventions in the management of patients with chest wall injury and/or lung parenchyma damage, is limited and influences the variety of clinical management strategies observed for this patient population. This symposium will summarise the available evidence and describe the current best physiotherapy practice for patients who sustained chest wall trauma and lung parenchyma injury.
Patients recovering from chest trauma are rarely referred to physiotherapy after discharge from an acute care facility for continued rehabilitation. One reason for this lack of post discharge service delivery is that information on long-term outcomes of patients recovering from chest wall injury and/or parenchyma damage is scarce. Little information is available regarding the degree of disability experienced by these patients and to what extent their injuries impact on their rate of recovery; hence the appropriateness of physiotherapy intervention for this patient population after discharge from hospital is unclear. This symposium will present information on the post discharge rate of recovery of patients with chest wall injury in relation to physical ability and pulmonary function for those who were managed conservatively and those who underwent surgical fixation of the rib cage. Rehabilitation needs to address persistent elements of disability/dysfunction will be highlighted.
Patients who sustained rib fractures suffer from a significant amount of chronic pain for months after the time of injury. Chronic pain in this population may be the result of delayed soft tissue healing following intercostal drain placement, thoracotomy incisions, movement at rib fracture sites with deep breathing and coughing and impaired shoulder and thoracic range of motion resulting in poor posture or be neural in origin with chronic pain changes in the peripheral and central nervous systems. Physiotherapy management strategies for chronic pain have been successful in patient populations who have not suffered chest wall injury. This symposium will propose a theoretical framework for the management of chronic pain in patients recovering from chest wall trauma.
Implications / Conclusions
Few opportunities have been available for physiotherapists to discuss their input in the management of patients who sustained traumatic injury, especially in the field of chest trauma. Physiotherapists attending this symposium will receive information relating to physiotherapy practice to enable delivery of high quality care based on the current best available evidence. Aspects of physiotherapy management that require further research will be highlighted.
- Chest wall injury
- Physiotherapy in trauma
Relevance to physical therapy globally
Physiotherapists are increasingly more involved in and responsible for the management of patients who sustained chest wall trauma as the worldwide incidence of trauma continues to escalate. This symposium provides physiotherapists with the opportunity to engage with research evidence supporting best practice and to engage with specialists who work in the field of trauma to share ideas regarding provision of high quality care for this patient population in acute care and community health settings.
Physiotherapy clinicians working in trauma; physiotherapy researchers and educators.
Programme subject to change