Clinical PRM care pathways "patients after lower limb bone joint injury".

OBJECTIVE: To describe a clinical care pathway for patients who underwent lower limb bone joint injury, taking into account patients' needs, PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes.

MATERIAL/PATIENTS AND METHODS: This clinical care pathway is designed upon the expertise of the Sofmer-Fedmer signatory group, after analysis of literature, French rules and recommendations. It is ratified by the Sofmer scientific council. It focuses on patients with lower limb bone joint injury, excluding pelvis trauma, burns, amputations, isolated knee and ankle ligaments injuries, and fractures treated by arthroplasty.

RESULTS: Patients are classified in - 4 care sequences: stage 1 post-trauma/pre-op; stage 2 form acute care to 6(th) week post-trauma/post-op: rehabilitation to daily life; stage 3 from 7(th) week to third month (bone consolidation period); stage 4 from 4(th) month post-op (bone healing acquired) until 5(th) month (indicative) - and 3 clinical categories: category 1 only one impairment, category 2 several impairments without previous neurological disability, category 3 neurological disability before injury. Each category is declined according to the International Classification of Functioning (ICF) while taking into account the various personal or environmental parameters that could influence the outcomes of an "optimum" clinical care pathway: impairments without any added difficulty, need to adapt the environment (equipment related only), inadequate or insufficient medical network, social difficulties, professional plan, associated medical conditions with functional impact, previous psychiatric illness. It follows a clinical care pathway algorithm.

DISCUSSION - CONCLUSION: This PRM care pathway written by a Sofmer-Fedmer group aims to promote a proper understanding of the patients' needs and the right care to be implemented, as well as being a guide for organizing and pricing care activities.