Improving Trauma Rehabilitation and Upscaling the Transmural Trauma Care Model: Clinical Effects, Challenges, and Opportunities

Traumatic injuries, defined as injuries resulting from a traumatic event such as a motor vehicle accident, fall, or violence, represent a significant global health burden. Traumatic injuries encompass a wide range of severities, ranging from minor wounds to life-threatening incidents, and can have profound consequences for the affected individuals and society.They not only result in immediate physical pain and disability but also have long-term consequences that can significantly impact the quality of life for survivors. On top of that, the economic burden of trauma is high, and traumatic injuries rank among the five most costly medical conditions worldwide. Also, these costs are expected to increase during the upcoming decades due to the aging population. The effectiveness of trauma care systems has been extensively researched over the past years. Due to decreased trauma-related mortality, the focus has shifted towards improving trauma survivors’ quality of life and long-term functional outcomes. Amongst others, this is done by aiming to improve the organization of trauma rehabilitation and streamlining care between primary and secondary care. The Transmural Trauma Care Model (TTCM) was developed at Amsterdam UMC, the Netherlands, to bridge this gap between these two care sectors. The TTCM is a multidisciplinary and patient‐centered transmural rehabilitation care model, consisting of 1) joint consultations by a multidisciplinary team at the outpatient clinic for trauma patients; 2) coordination and individual goal setting; 3) a network of specialized network physiotherapists (NPs) and 4) secured email traffic between hospital‐based physiotherapists and NPs. The primary aim of this thesis was to assess the (cost-)effectiveness of the TTCM compared with usual care. Secondary aims included the investigation of the barriers and facilitators of the upscaling and financing of the TTCM, exploring the association of fracture- and treatmentrelated factors and disease-specific HR-QOL, functional outcome, and societal costs in trauma patients, and assessing the measurement properties of the Lower Extremity Functional Scale (i.e., a functional outcome scale, used for patients with lower extremity fractures).