Determinants of functional outcomes after trauma in humanitarian settings

What did this study set out to achieve?

The Activity Independence Measure – Trauma (AIM-T) was developed as a practical tool allowing healthcare professionals to evaluate independence of a patient after injury, in key daily life activities. It was developed by Médecins Sans Frontières (MSF) and Humanity & Inclusion (HI) in 2011 in Afghanistan and used in other countries without formal testing. This research set out to confirm the validity and reliability of the AIM-T before further use, and assess recovery of functioning among patients with traumatic injury.

This research project was implemented in two phases:

• Phase 1: to revise and evaluate a measure of independence in activities, the Activity Independence Measure-Trauma (AIM-T)
• Phase 2: to conduct a longitudinal study to assess recovery of functioning among patients after acute orthopedic, visceral and/or skin injury, and its associated factors, including early rehabilitation.

What were the key findings?

From the initial AIM-T composed of 20 activities, the AIM-T was revised to 12 activities considering:

• Brevity and focus: 9 activities were removed due to redundancy
• Cultural appropriateness and relevance: 10 activities were revised, and one added.

This research provided evidence that the AIM-T is:

• Valid: The AIM-T can discriminate between different types of patients, is consistent with other measures, reflects independence in activities, and is best structured in three subscales.
• Reliable: There was a good-to-excellent agreement between raters.

The longitudinal study found:

• Patients gradually recovered functioning over the first six months after injury.
• Age, type and location of injury, baseline independence and trauma care interventions were associated with recovery of independence at one or several timepoints.
• Patients receiving early physiotherapy (i.e., within 48 hours of admission) were more likely to be independent at hospital discharge and after three months.

What does this mean for policymakers and practitioners?

Having a valid and appropriate tool to gather data on the patients’ outcomes in terms of disability may contribute to the improvement of the quality of trauma care in humanitarian settings through:

• At health professionals’ level, by improving practice: contributing to a comprehensive assessment, promoting a patient-centered approach, encouraging early mobilisation, supporting clinical reasoning and trauma team decision-making (e.g. discharge planning).
• At service level, by monitoring and improving the quality of trauma care: using the AIM-T as quality of trauma care indicator – beyond mortality and morbidity, benchmarking the recovery of functioning after injury in humanitarian settings, and promoting the early integration of rehabilitation and its provision along the continuum of care.
• At a global level, by informing advocacy: producing reliable figures on the burden of injury beyond mortality and morbidity in different humanitarian settings.

For an adequate use of the AIM-T, healthcare professionals must be trained on its use and practical applications, using the training materials developed and available open access (E-learning and guidelines).