Early physical and functional rehabilitation of trauma patients in the Médecins Sans Frontières trauma centre in Kunduz, Afghanistan: luxury or necessity?

Abstract

Background: In Afghanistan, Médecins Sans Frontières provided specialised trauma care in Kunduz Trauma Centre (KTC), including physiotherapy. In this study, we describe the development of an adapted functional score for patient outcome monitoring, and document the rehabilitation care provided and patient outcomes in relation to this functional score.

Methods: A descriptive cohort study was done, including all patients admitted in the KTC inpatient department (IPD) between January and June 2015. The adapted functional score was collected at four points in time: admission and discharge from both IPD and outpatient department (OPD).

Results: Out of the 1528 admitted patients, 92.3% (n = 1410) received at least one physiotherapy session. A total of 1022 patients sustained either lower limb fracture, upper limb fracture, traumatic brain injury or multiple injury. Among them, 966 patients received physiotherapy in IPD, of whom 596 (61.7%) received IPD sessions within 2 days of admission; 696 patients received physiotherapy in OPD. Functional independence increased over time; among patients having a functional score taken at admission and discharge from IPD, 32.2% (172/535) were independent at discharge, and among patients having a functional score at OPD admission and discharge, 79% (75/95) were independent at discharge.

Conclusions: The provision of physiotherapy was feasible in this humanitarian setting, and the tailored functional score appeared to be relevant.

Keywords: Function; MSF; Operational Research; Outcome measure; Rehabilitation; Trauma.

Figure 1.

Scoring system of the adapted functional score, adapted from the scoring system used in the Functional Independence Measure (FIM).

Figure 2.

Functional independence of four subgroups of trauma patients admitted to MSF Kunduz Trauma Centre between January and June 2015, at admission and discharge from IPD and OPD physiotherapy, using the adapted functional score. n is the number of patients with both admission and discharge functional scores. IPD: Inpatient Department; IPD1: admission to IPD physiotherapy; IPD2: discharge from IPD physiotherapy; LLF: lower limb fracture; MI: multiple injury; OPD: Outpatient Department; OPD1: admission to OPD physiotherapy; OPD2: discharge from OPD physiotherapy; TBI: traumatic brain injury; ULF: upper limb fracture.

Figure 3.

Pain score of trauma patients admitted to MSF Kunduz Trauma Centre between January and June 2015, at admission and discharge from IPD and OPD physiotherapy, using adapted functional pain score. IPD: Inpatient Department; IPD1: admission to IPD physiotherapy; IPD2: discharge from IPD physiotherapy; OPD: Outpatient Department; OPD1: admission to OPD physiotherapy; OPD2: discharge from OPD physiotherapy. Pain score 0: none; 1: occasional and slight; 2: present during heavy activities; 3: present during light activities; 4: present always but bearable; 5: present always, unbearable.