Barth C.1, Rau B.2, Veen H.3
1International Committee of the Red Cross (ICRC), Health (Hospital Services Programme), Bukavu, Congo (Democratic Republic), 2International Committee of the Red Cross (ICRC), Health (Physical Rehabilitation Programme), Geneva, Switzerland, 3International Committee of the Red Cross (ICRC), Health (Hospital Services Programme), Geneva, Switzerland
Background: The International Committee of the Red Cross supports hospitals in conflict zones which includes capacity building of staff often lacking professional training. In such a setup femur fractures are mostly conservatively managed by skeletal traction for which no guidelines exist to ensure effective rehabilitation. A simple and evidence-based protocol was needed for the crucial phase of rehabilitation during several weeks of bedrest under traction and after traction removal.
Purpose: The protocol to be developed should meet the following criteria:
- Based on the highest level of evidence possible;
- Easy to understand also by non-professionals;
- Easy to perform without specific material.
The protocol is targeted at:
- Clinical supervisors, trainers and technical consultants;
- Members of a physical rehabilitation team: team leaders, physiotherapists and rehabilitation assistants, especially untrained staff in a physiotherapy assistant role;
- Members of the multidisciplinary medical team, especially surgeons and nurses in postoperative care;
- Patients, family members, caretakers.
The purpose of the protocol is to:
- Promote evidence-based practice in challenging contexts;
- Serve as a basis for future clinical research;
- Provide standards for teaching and capacity building purposes;
- Apply standardized treatment for all patients in ICRC supported hospitals.
- Based on the highest level of evidence possible;
- Easy to understand also by non-professionals;
- Easy to perform without specific material.
The protocol is targeted at:
- Clinical supervisors, trainers and technical consultants;
- Members of a physical rehabilitation team: team leaders, physiotherapists and rehabilitation assistants, especially untrained staff in a physiotherapy assistant role;
- Members of the multidisciplinary medical team, especially surgeons and nurses in postoperative care;
- Patients, family members, caretakers.
The purpose of the protocol is to:
- Promote evidence-based practice in challenging contexts;
- Serve as a basis for future clinical research;
- Provide standards for teaching and capacity building purposes;
- Apply standardized treatment for all patients in ICRC supported hospitals.
Methods: The modus operandi for development of the protocol was as follows:
1. Literature search;
2. Compilation of exercises from the literature;
3. Assessment and selection of exercises that can be utilised in the protocol aimed at a predominantly weapon wounded population with an elevated risk of complications;
4. Protocol development including adapted exercises plus exercises derived from professional experience;
5. Application of protocol pilot and further refinement of documentation with a team of rehabilitation personnel in ICRC supported hospital HPGRB Bukavu, DRC;
6. Validation of the document by the ICRC health department, Geneva headquarters.
Results: The protocol proved easy to use after introduction and under supervision by an expatriate physiotherapist. The recommended material can be locally organised at very low cost. The exercises can be performed by the majority of adolescent and adult patients. The medical staff appreciated the standardization of care which ensured quality services.
Conclusion(s): This is the first evidence-based protocol for this population. Written in simple, yet precise terms this guideline can be used by all members of the rehabilitation team, including untrained staff or patients themselves. In the future pilot studies in different hospital settings are required in order to investigate practicability and effectivity of this intervention.
Implications: The protocol will help promote best practice in challenging contexts. It allows more standardized rehabilitation in ICRC supported hospitals. It will be used for training purposes of rehabilitation staff including team members without formal qualification.
Funding acknowledgements: n/a
Topic: Disaster management
Ethics approval: n/a
All authors, affiliations and abstracts have been published as submitted.
