Wiedererlangung der Arbeitsfähigkeit nach Trauma – ist der Zeitpunkt der Rehabilitation entscheidend?

PURPOSE: The aim of this study was to investigate outcome of trauma rehabilitation and whether the time of starting rehabilitation after trauma has an influence on outcome. As “indicator-injuries” we choose fractures of thoracic and lumbar spine, fractures of lower extremity without joint involvement and calcanear fractures, injuries that are known as major causes for long-term absence from work, disability and premature retirement. MATERIALS AND METHODS: In a prospective randomized multicenter study starting January 2004 up to January 2006 without changing the initial surgical treatment patients were treated in two level-one trauma centers and three rehabilitation units. Following randomisation rehabilitation took place either at once following acute trauma care (“early” group) or about six weeks after discharge from trauma center (“late” group). The primary outcome criterion was return to work within 180 days after trauma. Additional criteria were the generic questionnaire SF-36 and the VAS-Wirbelsaulenscore of the Deutsche Gesellschaft fur Unfallchirurgie (VAS spinal score of the German Trauma Society). RESULTS: 55 patients were recruited to the study, 35 in the “early”, 20 in the “late” group. In both groups spinal injury was leading. In the early group only 23% were able to return to work within 180 days, whereas in the late group 72% of the patients could restart their work. There difference was statistically significant (χ 2 , p<0,0012). The were no relevant differences in SF-36 and VAS-Scores. CONCLUSIONS: Significantly more patients are able to return to work within 180 days when rehabilitation starts six weeks after primary care, compared to immediate rehabilitation.