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      Physiotherapy management of patients with trunk trauma: A state-of-the-art review

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          Abstract

          Background

          Trauma injury remains a significant health risk for all on a global level. Patients with trunk trauma suffer blood loss, inflammation and hypoxia and are at risk of developing respiratory and musculoskeletal complications during their recovery. Physiotherapists are an integral part of the interprofessional team that manages patients who sustain trunk trauma.

          Objectives

          To describe the physiotherapy management of adult patients with trunk trauma, their quality of life, post-discharge rehabilitation service provision, and outcome measures used in the physiotherapy management.

          Method

          A non-systematic narrative review of published literature was performed.

          Results

          Mobilisation, functional exercises, deep breathing exercises and active coughing are used to optimise patients’ respiratory and musculoskeletal functioning. Some physiotherapists educate patients on the use of pain management strategies to reduce discomfort from rib fractures, surgical sites and intercostal drainage bottle tubing. Survivors of trunk trauma experience limitations in physical function up to two years. Little is known about post-discharge rehabilitation service provision to these patients after discharge. Few physiotherapists use outcome measures as part of their daily clinical practice.

          Conclusion

          Physiotherapy management of patients with blunt or penetrating trunk trauma during hospitalisation and after discharge is a field of clinical practice that is rich for high-quality research related to service provision, cost analysis and interventions used.

          Clinical implications

          Physiotherapy clinicians and researchers can use the findings of this review as a guide to their management of adult patients recovering from trunk trauma.

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          Most cited references40

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          Writing narrative literature reviews for peer-reviewed journals: secrets of the trade.

          To describe and discuss the process used to write a narrative review of the literature for publication in a peer-reviewed journal. Publication of narrative overviews of the literature should be standardized to increase their objectivity. In the past decade numerous changes in research methodology pertaining to reviews of the literature have occurred. These changes necessitate authors of review articles to be familiar with current standards in the publication process. Narrative overview of the literature synthesizing the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative texts. An overview of the use of three types of reviews of the literature is presented. Step by step instructions for how to conduct and write a narrative overview utilizing a 'best-evidence synthesis' approach are discussed, starting with appropriate preparatory work and ending with how to create proper illustrations. Several resources for creating reviews of the literature are presented and a narrative overview critical appraisal worksheet is included. A bibliography of other useful reading is presented in an appendix. Narrative overviews can be a valuable contribution to the literature if prepared properly. New and experienced authors wishing to write a narrative overview should find this article useful in constructing such a paper and carrying out the research process. It is hoped that this article will stimulate scholarly dialog amongst colleagues about this research design and other complex literature review methods.
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            Rib Fractures in the Elderly

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              Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis.

              The risk factors for mortality following blunt chest wall trauma have neither been well established or summarised. To summarise the risk factors for mortality in blunt chest wall trauma patients based on available evidence in the literature. A systematic review of English and non-English articles using MEDLINE, EMBASE and the Cochrane Library from their introduction until May 2010. Additional studies were identified by hand-searching bibliographies and contacting relevant clinical experts. Grey literature was sought by searching abstracts from all Emergency Medicine conferences. Broad search terms and inclusion criteria were used to reduce the number of missed studies. A two step study selection process was used. All published and unpublished observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. A two step data extraction process using pre-defined data fields, including study quality indicators. Each study was appraised using a previously designed quality assessment tool and the STROBE checklist. Where sufficient data were available, odds ratios with 95% confidence intervals were calculated using Mantel-Haenszel method for the risk factors investigated. The I(2) statistic was calculated for combined studies in order to assess heterogeneity. Age, number of rib fractures, presence of pre-existing disease and pneumonia were found to be related to mortality in 29 identified studies. Combined odds ratio of 1.98 (1.86-2.11, 95% CI), 2.02 (1.89-2.15, 95% CI), 2.43 (1.03-5.72, 95% CI) and 5.24 (3.51-7.82) for mortality were calculated for blunt chest wall trauma patients aged 65 years or more, with three or more rib fractures, pre-existing conditions and pneumonia respectively. The risk factors for mortality in patients sustaining blunt chest wall trauma were a patient age of 65 years or more, three or more rib fractures and the presence of pre-existing disease especially cardiopulmonary disease. The development of pneumonia post injury was also a significant risk factor for mortality. As a result of the variable quality in the studies, the results of the selected studies should be interpreted with caution. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                S Afr J Physiother
                S Afr J Physiother
                SAJP
                The South African Journal of Physiotherapy
                AOSIS
                0379-6175
                2410-8219
                11 June 2020
                2020
                : 76
                : 1
                : 1406
                Affiliations
                [1 ]Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
                Author notes
                Corresponding author: Helena van Aswegen, helena.vanaswegen@ 123456wits.ac.za
                Author information
                https://orcid.org/0000-0002-2973-904X
                Article
                SAJP-76-1406
                10.4102/sajp.v76i1.1406
                7343940
                32671276
                b3a15ade-b90f-4dc2-9b0b-b9a9d626efea
                © 2020. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 16 October 2019
                : 27 March 2020
                Categories
                State of the Art

                chest trauma,abdominal trauma,physiotherapy,quality of life,rehabilitation,outcome measures

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