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Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine
  1. Sue Pope1,
  2. A L Vickerstaff2 and
  3. A P Wareham3
  1. 1Directorate of Defence Rehabilitation, DMRC Headley Court, Epsom, UK
  2. 2Defence Primary Healthcare, Wales and West Midlands, Donnington, UK
  3. 3PCRF Leuchars, Leuchars Station Medical Centre, St Andrews, Fife, UK
  1. Correspondence to Maj A P Wareham, PCRF Leuchars, Leuchars Station Medical Centre, St Andrews, Fife KY16 0JX, UK; Andy.Wareham247{at}


During the recent conflicts in Iraq and Afghanistan, substantial numbers of service personnel survived devastating injuries, presenting significant challenges for early rehabilitation at Queen Elizabeth Hospital Birmingham. Royal Centre for Defence Medicine personnel augmented NHS therapy provision, gaining significant experience in rehabilitating complex trauma. Multidisciplinary working was key to delivering this service, with a unique rehabilitation coordinating officer position established to manage the rehabilitation pathway. A military exercise rehabilitation instructor provided daily gym-based rehabilitation, developing exercise tolerance. Emphasis was placed on early independence, reducing pain, eliminating complications and optimising function. Innovative solutions and non-standard combinations of rehabilitation were required, with therapy working practices redesigned that, we believe, exceed provision elsewhere, including novel applications such as unique patient transfers, specialist seating, additional equipment, problem-solving teaching and early upper limb prosthetic provision. Active pain management allowed engagement in rehabilitation. With limited evidence available, therapeutic modalities attempting to alleviate phantom limb pain centred on patients' ability to engage in treatment. Finally, the requirement to measure change in early trauma rehabilitation was identified, leading to the development of the preprosthetic functional outcome measure. This article aims to document advances made, lessons learned, encourage debate and identify priorities for future research for military complex trauma rehabilitation.

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