Configuration of accident trajectories after a rehabilitation programme: on the sharp edge between reintegration and socio-professional exclusion

To analyse the factors influencing the configuration of accident trajectories from de perspective of patients and assess the role of rehabilitation in managing pain and functional limitations autonomously. Using a qualitative, longitudinal, interdisciplinary approach, we conducted two comprehensive interviews (one year apart) with patients experiencing chronic pain and functional limitations following orthopaedic trauma. Thematic analysis was conducted utilising MaxQDA^® software to systematically analyse the data. Twenty-four patients participated (4 ♀; 20 ♂; 44.9 ± 10.6, min. 19; max. 63.5 yo; 1.0 ± 4.0 years duration; pain 4.6 (1.8) severity subscale (0-10) [mean (SD)]). Through reconstruction their experiences we identified three types of accident trajectories: socio-professional reintegration, ongoing reintegration, and exclusion. Factors influencing these trajectories included physical and psychological health status, occupational status, private and social context, and insurance and therapeutic aspects. Patients’ perceptions and socio-demographic characteristics also contributed to trajectories specificities. Understanding the factors that influence accident trajectories links individual and social dimensions, offering an overall comprehension of patients’ situations and structural constraints. This understanding enables the factors influencing trajectories to be considered during rehabilitation, thereby promoting the patient’s socio-professional reintegration through targeted interventions. A holistic approach is required to identify and address specifically factors jeopardising socio-professional reintegration.Rehabilitation practitioners should be conscious of the role of structural barriers such as occupational challenges, lack of social support, or inadequate insurance, which can hinder patients’ societal reintegration.The practitioner and the patient should discuss the patient’s point of view on his or her trajectory and on the health and social systems, to help the patient make use of existing resources and be aware of their limitations.Advocacy through collective action by professional associations at the political level should be considered to address systemic issues impacting rehabilitation outcomes. A holistic approach is required to identify and address specifically factors jeopardising socio-professional reintegration. Rehabilitation practitioners should be conscious of the role of structural barriers such as occupational challenges, lack of social support, or inadequate insurance, which can hinder patients’ societal reintegration. The practitioner and the patient should discuss the patient’s point of view on his or her trajectory and on the health and social systems, to help the patient make use of existing resources and be aware of their limitations. Advocacy through collective action by professional associations at the political level should be considered to address systemic issues impacting rehabilitation outcomes.

本研究旨在从患者视角分析影响事故轨迹配置的相关因素，并评估康复在自主管理疼痛与功能受限方面的作用。本研究采用定性、纵向、跨学科研究方法，对骨科创伤后罹患慢性疼痛与功能受限的患者开展了两次间隔一年的全面访谈。主题分析采用MaxQDA®软件对研究数据进行系统化处理。本研究共纳入24名受试者（女性4名，男性20名；年龄44.9±10.6岁，年龄范围19~63.5岁；病程1.0±4.0年；疼痛严重程度评分采用0~10分量表，均值±标准差为4.6(1.8)）。通过重构患者的患病经历，本研究识别出三类事故轨迹：社会职业再融入型、持续再融入型与社会排斥型。影响此类轨迹的因素包括身心健康状况、职业状态、私人与社会背景、保险与治疗相关维度，此外患者的认知水平与社会人口学特征也会对轨迹特征产生影响。对事故轨迹影响因素的解析连接了个体与社会维度，可全面理解患者的处境与结构性限制。此类认知能够帮助在康复过程中考量轨迹影响因素，进而通过针对性干预措施促进患者的社会职业再融入。需采用整体化研究方法，识别并针对性解决阻碍社会职业再融入的相关因素。康复从业者应意识到结构性障碍的作用，例如职业挑战、社会支持不足或保险保障不足等，此类障碍会阻碍患者的社会再融入。从业者应与患者共同探讨其对自身轨迹以及健康与社会系统的看法，以帮助患者充分利用现有资源，并认清自身局限。可考虑通过专业协会在政治层面开展集体行动进行政策倡导，以解决影响康复结局的系统性问题。需采用整体化研究方法，识别并针对性解决阻碍社会职业再融入的相关因素。康复从业者应意识到结构性障碍的作用，例如职业挑战、社会支持不足或保险保障不足等，此类障碍会阻碍患者的社会再融入。从业者应与患者共同探讨其对自身轨迹以及健康与社会系统的看法，以帮助患者充分利用现有资源，并认清自身局限。可考虑通过专业协会在政治层面开展集体行动进行政策倡导，以解决影响康复结局的系统性问题。