Abstract
Background: The prevalence of polytrauma is increasing globally and in South Africa, contributing to the reported rates of disability. Early physiotherapy intervention in the acute care setting reduces the risk of complications and facilitates functional recovery of patients who sustained polytrauma injuries. There is minimal evidence exploring patients’ perceptions of their recovery of physical function following polytrauma injury in an acute setting and after hospital discharge.
Objectives: To explore patients’ perceptions of their recovery of physical function after polytrauma.
Method: A qualitative single-case study was carried out at a private trauma facility in Johannesburg, drawing on eight semi-structured interviews gathered through purposive sampling. The interview transcripts were examined using an inductive analytical approach, with MAXQDA assisting in generating the codes and themes.
Results: Six central themes emerged, capturing patients’ views on the factors that hindered or supported their recovery of physical function following polytrauma. These broad themes included satisfaction with the care received, experiences with rehabilitation after discharge, mental health and resilience, degree of disability, pain and physical functioning, and the influence of support systems.
Conclusion: Multiple factors shape how patients perceive their physical recovery after experiencing polytrauma. Notably, the quality of interpersonal interactions played a prominent role in shaping their views of the care they received.
Clinical implications: Our study may inform practice in the clinical setting in the management of patients recovering from polytrauma injuries to address barriers and promote facilitators identified.
Keywords: physiotherapy; polytrauma injury; patient’s perceptions; rehabilitation; South Africa; patient satisfaction; physical recovery.
Introduction
Polytrauma is a life-threatening condition in patients who have sustained multiple injuries to various parts of the body because of physical trauma, resulting in orthopaedic and systemic injuries (Rau et al. 2017). Patients who survive traumatic events often do not receive the quality of care required to optimise their recovery (Van Breugel et al. 2020). Common causes of polytrauma locally include road traffic accidents (61%), falls from height (25%) and falling heavy objects (7%) (Arumugam et al. 2015). South Africa, an upper-middle-income country, experiences a high burden of traumatic injury, with approximately 50 000 trauma-related deaths annually (Hardcastle et al. 2016). Globally, the World Health Organization reports 5 million annual injury-related deaths, nearly one-fifth occurring in Africa (Mathers 2008). Trauma survivors in South Africa outnumber deaths by 10–50 times, with approximately 50% living with permanent disability (Matzopoulos et al. 2015).
In KwaZulu-Natal, for example, 10 644 trauma patients presented to hospital services in 1 year, with 35% as a result of motor vehicle accidents, 35% to assaults, 26% to stabbings and 5% to gunshot wounds (Moodley, Aldous & Clarke 2014). Trauma accounts for up to 25% of the public hospital workload, with 90% of cases occurring in low-income communities (Hardcastle et al. 2016). High-income countries generally have more structured trauma systems with established referral pathways and rehabilitation programmes, which reduce long-term disability (Van Breugel et al. 2020).
Polytrauma injuries, often sustained through high-energy mechanisms, frequently require hospitalisation and intensive care unit (ICU) admission for specialised management (Amato et al. 2021). Long-term immobility because of prolonged bed rest can lead to neuromuscular weakness, persistent physical impairments, loss of function and reduced quality of life (Aitken et al. 2016).
Studies have shown that up to 85% of polytrauma patients experience ongoing pain 5 years post-injury, with the severity of pain correlating to the severity of the initial trauma (Gross & Amsler 2011). Prolonged bed rest contributes to patient deconditioning, depression, lethargy and neuromuscular instability (Padovani et al. 2016). Early physiotherapy improves outcomes by reducing hospital length of stay and enhancing physical function (Frandsen et al. 2024). As survival rates increase, the resulting disabilities post-ICU admission have increased, including reduced mobility and limitations in activities of daily living (Iddagoda et al. 2024; Pape et al. 2010).
Recovery after polytrauma is influenced by several factors. Patients report taking ownership of their recovery when provided with guidance and support in hospital and post-discharge (Claydon, Robinson & Aldridge 2017).
Family support is also critical in shaping recovery perceptions (Boyle et al. 2018). Despite these supports, only a minority of patients return to work 1 year post-injury; Neubert et al. (2025) found a return-to-work rate of 32%, highlighting long-term functional and socio-economic consequences. Pain is a major barrier to recovery, influenced by physical, psychological and social factors (Ahmadi et al. 2025).
While research exists on quality of life post-polytrauma, few studies have specifically explored patients’ perceptions of care and recovery. For example, Bouman et al. (2017) conducted a study in the Netherlands and reported that patients valued personalised rehabilitation and clear communication with healthcare providers, but often experienced gaps in support post-discharge. Similar findings in high-income countries indicate that inadequate guidance and limited follow-up can negatively affect recovery and patient satisfaction (Neubert et al. 2025). However, there is limited evidence from low- and middle-income countries, including South Africa, where trauma systems are less structured, rehabilitation services are often constrained, and access to care varies substantially between public and private healthcare settings.
Private healthcare patients were selected for our study because they represent a distinct context within the South African health system, where patients generally have access to well-resourced trauma facilities and rehabilitation services, yet little is known about their lived experiences of recovery post-polytrauma. Investigating perceptions within this population allows the study to examine whether the availability of resources translates into improved patient experiences and recovery outcomes. Moreover, insights from private healthcare patients can identify gaps that may not be apparent in public healthcare settings, thereby informing strategies to optimise rehabilitation and support services across different healthcare contexts.
Prolonged hospitalisation and delayed rehabilitation increase financial burden on patients, families, society and the healthcare system (Carpenè et al. 2010; Seneff et al. 2000).
To address this gap, the present study explored patients’ perceptions of their recovery of physical function following polytrauma, focusing on in-hospital care, rehabilitation services, secondary complications, pain and support structures. Understanding patient experiences in a private healthcare setting can guide improvements in rehabilitation services, enhance outcomes and reduce the long-term socio-economic impact of trauma.
Research methods and design
This qualitative study utilised a constructivist paradigm, underpinned by an ontological perspective that reality is socially constructed and understood through individuals’ experiences. In this context, our study explored patients’ perceptions of their recovery of physical function following polytrauma, focusing on how in-hospital care, rehabilitation services, pain management, secondary complications and support structures influenced their recovery. Semi-structured interviews were employed to allow participants to share detailed, personal accounts of their recovery journeys, providing rich insight into the factors they perceived as most important in regaining physical function.
Our study focused on patients’ perceptions of their health and rehabilitation care, which was crucial for the author in understanding the phenomenon of recovery of physical function following polytrauma. By exploring these perceptions, our study sought to uncover how patients experienced and interpreted the care they received, the challenges they faced, and the factors they considered most influential in their rehabilitation, thereby revealing the reality and presence of the phenomenon under investigation. Additionally, our study incorporated an epistemological perspective, enabling the author to articulate this population’s unique experiences of care.
Purposive sampling was employed to identify potential participants from the physiotherapy practice’s patient database. The inclusion criteria were clearly defined to ensure that only appropriate participants were recruited. Eligible participants were adults aged 18 years or older, of any gender, who had sustained multiple orthopaedic injuries to the upper and/or lower limbs, with or without additional trunk injuries, and who required admission to the ICU for treatment. This inclusion criterion was designed to focus on patients who experienced significant polytrauma, as these individuals are more likely to face complex recovery trajectories, including prolonged hospitalisation, intensive rehabilitation needs and potential secondary complications. Including only adults ensures that participants can provide informed consent and reliably report their perceptions and experiences of care and recovery. Intensive care unit admission was specifically included to capture patients with severe injuries requiring high-level care, as their recovery experiences are likely to be distinct from those with less severe trauma, making their perspectives particularly valuable for understanding the challenges of rehabilitation, physical function recovery, and the support structures needed in a private healthcare setting. Participants were required to have been discharged from the hospital for 6 months to 1 year to ensure sufficient time for typical healing processes to occur.
Individuals with isolated head injuries, spinal cord injuries, amputations or pre-existing cognitive impairments were excluded to ensure a more homogeneous sample and to maintain the integrity of the study’s focus on physical recovery following polytrauma. These conditions each involve distinct recovery trajectories, rehabilitation needs, and functional limitations that differ substantially from those associated with multiple orthopaedic injuries. Including such patients could have introduced significant variability, making it difficult to attribute perceptions of physical recovery specifically to polytrauma-related orthopaedic injuries. Additionally, cognitive impairments may affect a participant’s ability to provide reliable accounts of their experiences, thereby influencing the validity and consistency of the qualitative data. Physiotherapy clinicians initially screened their database to identify patients who met the inclusion criteria, drawing on their knowledge of each patient’s clinical background. Only after patients provided verbal permission for their contact information to be released were they approached by the principal investigator for recruitment and formal consent. This ensured that the selection process was based on clinical eligibility rather than patient availability or convenience, in line with the purposive sampling strategy.
The semi-structured interview schedule was developed based on a thorough review of existing literature on patient recovery and the factors influencing perceptions of care in polytrauma cases. Questions were designed to elicit in-depth responses regarding patients’ experiences, focusing on aspects such as satisfaction with care, rehabilitation processes and mental health.
During the interview procedure, participants were engaged in a conversational manner, allowing for follow-up questions and clarifications to deepen the exploration of their perceptions, which facilitated a richer understanding of their recovery journey. The interviews were audio-recorded and transcribed verbatim by a transcription service, after which the data were reviewed and cleaned up by the author.
An inductive thematic analysis was conducted using MAXQDA (version 2018.2) (VERBI GmbH, Berlin, Germany). The process began with the author thoroughly reading and becoming familiar with each interview transcript. From this immersion, initial broad codes were generated and subsequently organised into overarching themes, following the steps outlined by Braun and Clarke (2019). Codes and themes were developed after each interview to help determine when no new insights were arising, signalling data saturation. To enhance the trustworthiness of the analysis, an external reviewer independently co-coded the transcripts.
Several strategies were applied to ensure rigour in this qualitative study. Credibility was supported by maintaining consistent interview procedures and using the same approach to questions across all interviews. Transferability and dependability were strengthened through comprehensive documentation of the study’s methods. The author also kept a reflective journal to capture observations of non-verbal cues.
Ethical considerations
Ethical considerations, or axiology, played a vital role in ensuring that our study refrained from making judgments about patients’ perceptions. The principal investigator subsequently contacted the patients to arrange interview times, after which electronic written informed consent was secured for both participation and audio recording. Ethical clearance to conduct our study was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand (clearance number: R14/49; Protocol no. M200951). Participants were informed that their information would remain confidential, with all data stored on a password-protected computer accessible only to the authors. These procedures were carried out between September 2020 and February 2021.
Results
Thirteen individuals were invited to take part in our study, and eight agreed to participate. All eight semi-structured interviews; conducted in English, was the participants’ home language in our study; and were held via video platforms such as WhatsApp, Skype or Zoom, depending on each participant’s preference. Each interview lasted approximately 30 min. While virtual interviews inherently limit the authors’ ability to observe full body language, facial cues and expressions were still noted.
Participants ranged in age from 21 years to 59 years. One quarter of the sample consisted of women, while the remaining 75% were men. Most participants had been discharged for between 6 months and 9 months at the time of their interview. Hospital stays varied widely, from under 1 month to as long as 6 months, with male participants generally experiencing longer admissions. All participants had sustained their injuries as a result of motor vehicle accidents (see Table 1).
Through inductive thematic analysis, six themes were identified and later organised under each objective of the current study during the write-up. The overarching themes include: level of satisfaction with care, post discharge rehabilitation, mental health status and mental resilience, level of disability, pain and physical function and support structures. These themes are illustrated in Figure 1, followed by a detailed discussion of each theme.
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FIGURE 1: Overview of the current study’s findings, highlighting the key themes. |
|
Level of satisfaction with care
The overarching theme from participants’ experiences of in-hospital care was that their satisfaction with the care received influenced their recovery after injury. Subthemes included the quality of care, communication and emotional support. Most participants felt that care was of a high standard, the hospital environment was clean and staff were professional, although some reported that night-shift staff were loud and unprofessional, disturbing their sleep. Poor communication with hospital staff was frequently noted, with some participants feeling that physiotherapy was overly demanding and not tailored to their needs. Participants also reported a lack of emotional support and a strong desire to return to a familiar environment. This is presented in Table 2:
| TABLE 2: Participant responses relating to satisfaction with level of care received during their hospital stay. Overarching theme: Level of satisfaction with care influencing physical function recovery. |
Post discharge care influencing physical function recovery
The overarching theme that arose from participants’ experiences of post discharge care is the influence rehabilitation service provision, or lack thereof, had on physical function recovery. The corresponding sub-themes which arose include the following: care at rehabilitation centres was noted to have greatly assisted with recovery of physical function (Participant 2).
In this context, ‘care’ refers to the structured therapeutic interventions provided by the rehabilitation healthcare providers, including physiotherapy and occupational therapy. The effectiveness of this care was influenced both by the type of care delivered, such as hands-on physiotherapy, mobility training and patient education, and by the frequency of attendance, with regular sessions contributing to more noticeable improvements in physical function.
Participants highlighted that regular engagement with therapy supported the gradual recovery of strength, mobility and independence in daily activities. A key limitation to post-discharge care, both at home and in rehabilitation centres, was financial constraints (Participants 1 and 3). High costs and job loss were also reported as barriers (Participants 1 and 7). As a result, participants often received only partial rehabilitation, leaving them motivated to continue therapy after noticing improvements in physical function and understanding their potential for further recovery (Participant 3). This information is summarised in Table 3.
| TABLE 3: Participant responses relating to rehabilitation services after discharge encompassing financial constraints and the rehabilitation facility. Overarching theme: Post discharge rehabilitation influencing physical function recovery. |
| TABLE 4: Participant responses relating to their perceived level of disability. Overarching theme: Level of disability and its influence on physical function recovery. |
Level of disability
The overarching theme from participants’ perceptions of their recovery was the impact of disability on regaining physical function. Subthemes that emerged included negative body image, physical limitations and emotional health. While some participants felt they had achieved a normal and full recovery (Participants 1 and 4), others felt they had overcome shortcomings in the medical care they received (Participants 2, 5, and 6).
Participants’ emotional state played a significant role in recovery, with personal drive helping some to overcome physical challenges (Participant 4). Challenges reported included coping with repeated surgeries (Participant 3), poor nursing care triggering previous depression (Participant 3) and the need for professional psychological support to aid recovery (Participant 7). The trauma of the accident itself was also reported to affect rehabilitation (Participants 6 and 7). In cases of incomplete recovery (Participant 5), participants experienced job loss, inability to perform certain physical activities (Participant 3), or the need to adapt how they carried out tasks (Participant 2). Personal body image was negatively affected in one participant (Participant 8).
Pain and physical function recovery
Participants reported that both acute and chronic pain impacted physical functioning as seen in Table 3. In the acute phase after injury, a participant reported that pain had hindered physical functioning in the hospital bed (Participant 8). In severe cases of high pain levels, physical functioning was limited because of fear of pain (Participant 2). In the chronic phase after injury, the effects of pain hindered physical function from intimacy with one’s partner to activities of daily living (Participants 6, 7, 8 and 9). One participant reported no pain (Participant 5), which aided the recovery process, while another used the presence of pain as a motivator to do their ward exercise programme to improve recovery (Participant 4).
Medication was used to support the recovery of physical function; however, withdrawal symptoms following cessation were reported to hinder progress (Participants 1, 2 and 7). Persistent pain was also linked to disrupted sleep patterns, which in turn negatively affected functional outcomes. This is summarised in Table 5.
| TABLE 5: Participant responses relating to pain and physical function recovery. |
The role of support structures in recovery of physical function
Participants consistently expressed gratitude to family, friends and neighbours (Participants 1–8) for their care and support both in-hospital and after discharge, highlighting their role in aiding the recovery of physical function. Rehabilitation centres were also described as very supportive (Participant 9) as seen in Table 6. Conversely, depression was reported to reduce motivation to work on physical recovery (Participant 3). A lack of support, particularly in-hospital, led to significant frustration (Participants 3, 6, 7 and 8). In some instances, this frustration stemmed from a perceived lack of medical support during hospitalisation (Participant 8), with participants believing that better support could have resulted in improved physical outcomes (Participants 7 and 8).
| TABLE 6: Participant responses relating to the role of their support structures during recovery of physical function. |
An example of this is a patient who mentioned the delay in the referral process between the physiotherapist and occupational therapist to assist with upper limb function and rehabilitation to facilitate hand function (Participant 6).
Mental health status and mental health resilience
Table 4 shows how participants described posttraumatic stress disorder symptoms, feelings of terror, hallucinations, disorientation, nightmares (Participants 4, 7 and 8), Additionally, the inability to allow others physical contact with the injury sight (Participant 7), residual pain and feelings of body disfigurement (Participant 3) were reported. The need to seek medical intervention for such symptoms (Participant 7) as seen in Table 7. Although pain was a limiting factor and recovery took noticeably long (Participants 2 and 7), limited work reintegration (Participants 2 and 6) or even inability to return to work (Participants 5, 7 and 8) was preceded by fear of ability to return to work (Participant 7). Participants reported difficulty reintegrating into the community because of both physical injuries and poor mental health (Participants 3 and 8).
| TABLE 7: Participant responses relating to their experience of the impact of mental health of physical function recovery. |
Discussion
The demographics reflected in the participants’ profiles align with those reported in other studies, with a predominance of male adults under the age of 59 (Zaidi et al. 2019; Dhaffala et al. 2013). In our study, as well as in research conducted by Seedat et al. (2009) and David (2022), male participants who experienced polytrauma had longer hospital stays than female participants, likely as a result of more severe injuries, including injuries to the lower extremities. While all participants in our study sustained injuries through motor vehicle accidents, Milton, Engelbrecht and Geyser (2021) reported varied mechanisms of injury, including falls and pedestrian accidents. Our study focused specifically on adults with multiple orthopaedic injuries who had been discharged from the hospital for 6 months to 1 year to allow for sufficient healing prior to assessment. Most participants reported difficulty reintegrating into work and the need to adapt their functionality in the workplace following the injury. This aligns with Khan, Amatya and Hoffman (2012), who similarly found a high demand for work adaptation post-injury. Moreover, our study observed that older patients experienced longer in-hospital stays, consistent with findings by Hedinger et al. (2016) and Zaidi et al. (2019).
Our study also revealed a notable link between participants’ perceptions of care and their perceived recovery post-injury. Higher satisfaction with the care received was associated with a greater sense of physical recovery, in agreement with Calydon, Robinson and Alridge (2017) and Kimmel et al. (2016), who reported a strong association between patient satisfaction and recovery outcomes. Furthermore, a patient-centred approach appeared to enhance participants’ perceptions of recovery, as participants reported feeling empowered when included in decision-making regarding rehabilitation interventions. This is supported by Kimmel et al. (2016) and Boulding et al. (2011), who observed improved compliance and encouragement when patients were actively involved in care decisions. Environmental factors, including the hospital’s appearance and noise levels, also influenced perceived recovery. Gustavson et al. (2021) similarly demonstrated that a pleasant and comfortable hospital environment positively affected functional recovery outcomes, while Tronstad et al. (2021) highlighted that non-personalised environments often contributed to negative patient perceptions.
Focusing on a private trauma rehabilitation setting in Johannesburg is relevant for several reasons. Private hospitals in this context often serve patients who have access to extended rehabilitation resources and a structured continuum of care, which allows for a detailed exploration of patient perceptions of recovery and care. Although perceptions from private healthcare patients may differ from those in public settings, they remain generalisable to the study’s aims, which focus on understanding patient-reported experiences and functional reintegration post-trauma. Insights from this setting provide valuable information on rehabilitation outcomes, patient empowerment, and environmental influences on recovery, which are critical for guiding interventions in both private and potentially public contexts.
Another finding was the discrepancies reported between day and night shift healthcare staff service delivery. Four participants expressed noise and sleep disturbances because of staff causing loud noises and providing poor nursing care, which was also seen by Palese et al. (2017), who conducted a secondary analysis of 12 Italian nursing units and also found that patients were not satisfied with nursing care as a result of noise disturbances. The majority of participants reported that physiotherapy played a major role in their functional recovery, which has been shown by Silvester, Trompeter and Hing (2021) as well. Despite this positive perception of physiotherapy, some participants felt that the high turnover of physiotherapy staff often limited progress because of a lack of continuity of care. Participants also reported that they perceived better recovery outcomes when they received positive reinforcement and efficient communication. This is in concordance with findings by Jensen (2026), who found that patient’s reported better recovery outcomes when there was good communication between the patient and healthcare practitioners.
The socioeconomic relationship with access to rehabilitative care cannot go unnoticed. Participants reported reduced affordability of rehabilitation services upon discharge, which resulted in their perceptions of poorer functional outcomes. This issue is further compounded by the fact that medical aid funders often do not adequately cover rehabilitative care, frequently resulting in substantial out-of-pocket expenses to the patients themselves. Allen et al. (2022) highlighted that affordability remains a significant barrier to recovery. Because of the high levels of out-of-pocket expenditure on rehabilitation, compounded with the high levels of job losses after injury, return to work becomes that much harder for patients. This aligns with findings by Wyse et al. (2020) who reported that there is a reduced rate of return to work in patients who sustained injuries from motor vehicle accidents because of poor recovery outcomes associated with the lack of affordability of rehabilitation services.
A factor often overlooked in physical recovery is the role that mental health plays in perceptions of recovery, where participants express that depression and lack of motivation hinder progress. Participants reported that there was inadequate mental health support provided to them in the trauma unit during their hospital stay, which they felt impacted their functional outcomes. Similarly, Wiseman, Foster and Curtis (2013) reported a lack of mental health referral and follow up for their patients who sustained polytrauma injury and its negative impact on their recovery outcomes. Participants in the current study reported experiencing physical limitations such as pain, restricted mobility, and poor quality of life after polytrauma, which Schneiderman, Van Aswegen and Becker (2013) also observed in their study of trauma survivors when assessed for quality of life at 6 months after hospital discharge.
A relevant finding of our study is that pain in the acute phase of recovery limited participants’ functional recovery because of the fear of pain and movement. Nummela et al. (2022) and Shafeeq et al. (2022) reported a high correlation between pain and recovery, with pain often being a barrier to movement. An unexpected finding was the impact of pain during intimacy, which negatively affected some participants’ quality of life and underscored the need for a holistic approach to rehabilitation. Effective pain management and interprofessional collaboration are essential for recovery following polytrauma. Another finding of the current study highlighted delays in referral between physiotherapy and occupational therapy for upper limb rehabilitation, which prolonged pain and hindered functional recovery. These challenges align with literature emphasising the importance of interprofessional rehabilitation in optimising service delivery and patient outcomes (Keller 2024). Strengthening collaboration frameworks can improve access to timely interventions, enhancing both pain management and hand function rehabilitation.
Family support was reported to be a major facilitator of functional recovery, consistent with findings by Critchfield et al. (2019) and De Beer and Brysiewicz (2017). These authors highlighted the importance of strong support networks in improving functional outcomes for patients who sustained polytrauma injuries. Additionally, the patient-practitioner relationship affected recovery by improved outcomes associated with positive relationships, echoing the research of Khan et al. (2012), who conducted a prospective cross-sectional study in patients with polytrauma and traumatic brain injury, and found that the relationship with the healthcare provider was a predictor of recovery outcomes.
Strengths and limitations
The strength of our study lies in its qualitative approach, addressing the gap in understanding what patients experience and perceive in their recovery of function following polytrauma injury. These qualitative insights highlighted barriers and facilitators to recovery, offering valuable clinical implications. Our study also has limitations, such as a small sample size from one facility in Gauteng and the high potential for recall bias. Additionally, the reflexivity and positionality of the principal author, a rehabilitation professional, may have influenced how data was perceived. Also, potential bias from purposive sampling and self-reported data, limited exploration of mental health factors, and a narrow temporal scope may restrict the generalisability and depth of the findings.
Conclusion
Our study revealed six key themes which affect the recovery of physical function of adults following polytrauma injury in the Gauteng region of South Africa. Positive mental health and strong relationships with healthcare providers were associated with improved perceived outcomes, while physical limitations, pain, financial constraints and poor quality of care received hindered perceptions of recovery. Our study findings may inform rehabilitation clinical practice as well as clinical guidelines to advocate for improved affordability of rehabilitation services to improved functional recovery outcomes. This research should be repeated on a broader and more inclusive scale, beginning with an assessment of whether public health patients have similar perceptions. Further research is required to map referral pathways to mental health practitioners from patient admission to hospital discharge to post-discharge follow up. In addition, patients’ recovery outcomes need to be monitored to identify issues in recovery as they arise.
Acknowledgements
This article includes content that overlaps with research originally conducted as part of Mughammad A. Reis’s master’s thesis titled ‘Patient’s perceptions on their recovery of physical function after polytrauma’, submitted to the Department of Physiotherapy, Faculty of Health sciences, University of the Witwatersrand in 2023. The thesis was supervised by Monique Keller and Heleen van Aswegen. Portions of the data, analysis and discussion have been revised, updated and adapted for publication as a journal article. The original thesis is publicly available at: https://hdl.handle.net/10539/37806. The author affirms that this article complies with ethical standards for secondary publication, and appropriate acknowledgement has been made of the original work.
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. The author, Heleen van Aswegen, serve as an editorial board member of this journal. The peer review process for this submission was handled independently, and the author had no involvement in the editorial decision-making process for this article. The author has no other competing interests to declare.
CRediT authorship contribution
Mughammad A. Reis: Conceptualisation, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Visualisation, Writing – original draft, Writing – review & editing. Monique M. Keller: Data curation, Methodology, Supervision, Visualisation, Writing – review & editing. Heleen van Aswegen: Conceptualisation, Formal analysis, Supervision, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication, and take responsibility for the integrity of its findings.
Funding information
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data availability
Data is available upon request from the corresponding author, Mughammad A. Reis. The dataset contains potentially identifiable information.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.
References
Ahmadi, M., Mohammadi-Shahboulaghi, F., Hosseini, M. & Fallahi-Khoshknab, M., 2025, ‘Nurses’ experiences of barriers and facilitators to family participation in the care for hospitalized older adult patients: A qualitative study’, Journal of Education and Health Promotion 14(1), 347. https://doi.org/10.4103/jehp.jehp_845_24
Aitken, L.M., Macfarlane, B., Chaboyer, W., Schuetz, M., Joyce, C. & Barnett, A.G., 2016, ‘Physical function and mental health in trauma intensive care patients: A 2-year cohort study’, Critical Care Medicine 44(4), 734–746. https://doi.org/10.1097/CCM.0000000000001481
Allen, A.P., Bolton, W.S., Jalloh, M.B., Halpin, S.J., Jayne, D.G. & Scott, J.D., 2022, ‘Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone – A multidisciplinary patient and service provider perspective’, Disability and Rehabilitation 44(11), 2392–2399. https://doi.org/10.1080/09638288.2020.1836043
Amato, S., Bonnell, L., Mohan, M., Roy, N. & Malhotra, A., 2021, ‘Comparing trauma mortality of injured patients in India and the USA: A risk-adjusted analysis’, Trauma Surgery & Acute Care Open 6(1), e000719. https://doi.org/10.1136/tsaco-2021-000719
Arumugam, S., Al-Hassani, A., El-Menyar, A., Abdelrahman, H., Parchani, A., Peralta, R. et al., 2015, ‘Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis’, Journal of Emergencies, Trauma, and Shock 8(4), 193–198. https://doi.org/10.4103/0974-2700.166590
Boulding, W., Glickman, S.W., Manary, M.P., Schulman, K.A. & Staelin, R., 2011, ‘Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days’, The American Journal of Managed Care 17(1), 41–48.
Bouman, A.I., Hemmen, B., Evers, S.M., Van De Meent, H., Ambergen, T., Vos, P.E. et al., 2017, ‘Effects of an integrated “fast track” rehabilitation service for multi-trauma patients: A non-randomized clinical trial in the Netherlands’, PLoS One 12(1), e0170047. https://doi.org/10.1371/journal.pone.0170047
Boyle, J., Vukicevic, M., Koklanis, K., Itsiopoulos, C. & Rees, G., 2018, ‘Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration’, Psychology, Health & Medicine 23(2), 127–140. https://doi.org/10.1080/13548506.2016.1274040
Braun, V. & Clarke, V., 2019, ‘Reflecting on reflexive thematic analysis’, Qualitative Research in Sport, Exercise and Health 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806
Carpenè, N., Vagheggini, G., Panait, E., Gabbrielli, L. & Ambrosino, N., 2010, ‘A proposal of a new model for long-term weaning: Respiratory intensive care unit and weaning center’, Respiratory Medicine 104(10), 1505–1511. https://doi.org/10.1016/j.rmed.2010.05.012
Chan, B., Goldman, L.E., Sarkar, U., Guzman, D., Critchfield, J., Saha, S. et al., 2019, ‘High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population’, BMC Health Services Research 19(1), 334.
Claydon, J.H., Robinson, L. & Aldridge, S.E., 2017, ‘Patients’ perceptions of repair, rehabilitation and recovery after major orthopaedic trauma: A qualitative study’, Physiotherapy 103(3), 322–329. https://doi.org/10.1016/j.physio.2015.11.002
David, S., 2022, Beyond the hospital bed: Studies of post discharge socioeconomic and quality of life outcomes in trauma patients in Urban India, Karolinska Institutet, Solna.
De Beer, J. & Brysiewicz, P., 2017, ‘The conceptualization of family care during critical illness in KwaZulu-Natal, South Africa’, Health SA Gesondheid 22(1), 20–27. https://doi.org/10.1016/j.hsag.2016.01.006
Dhaffala, A., Longo-Mbenza, B., Kingu, J.H., Peden, M., Kafuko-Bwoye, A., Clarke, M. et al., 2013, ‘Demographic profile and epidemiology of injury in Mthatha, South Africa’, African Health Sciences 13(4), 1144–1148. https://doi.org/10.4314/ahs.v13i4.40
Ferreira, D.C., Vieira, I., Pedro, M.I., Caldas, P. & Varela, M., 2023, ‘Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis’, Healthcare (Basel, Switzerland), 11(5), 639. https://doi.org/10.3390/healthcare11050639
Frandsen, C.F., Mechlenburg, I., Birch, S., Lundager, L., Bæk-Hansen, T. & Stilling, M., 2024, ‘Improved physical function following a three-month, home-based resistance training program for fragile patients with poor recovery years after femoral neck fracture – A prospective cohort study’, Applied Sciences 14(2), 552. https://doi.org/10.3390/app14020552
Gross, T. & Amsler, F., 2011, ‘Prevalence and incidence of longer term pain in survivors of polytrauma’, Surgery 150(5), 985–995. https://doi.org/10.1016/j.surg.2011.04.003
Gustavson, A.M., LeDoux, C.V., Stutzbach, J.A., Miller, M.J., Seidler, K.J. & Stevens-Lapsley, J.E., 2021, ‘Mixed-methods approach to understanding determinants of practice change in skilled nursing facility rehabilitation: Adapting to and sustaining value with postacute reform’, Journal of Geriatric Physical Therapy 44(2), 108–118. https://doi.org/10.1519/JPT.0000000000000288
Hardcastle, T.C., Oosthuizen, G., Clarke, D. & Lutge, E., 2016, ‘Trauma, a preventable burden of disease in South Africa: Review of the evidence, with a focus on KwaZulu-Natal’, South African Health Review 2016(1), 179–189.
Hedinger, D., Braun, J., Kaplan, V., Bopp, M. & Swiss National Cohort Study Group, 2016, ‘Determinants of aggregate length of hospital stay in the last year of life in Switzerland’, BMC Health Services Research 16(1), 463. https://doi.org/10.1186/s12913-016-1725-7
Iddagoda, M.T., Trevenen, M., Meaton, C., Etherton-Beer, C. & Flicker, L., 2024, ‘Identifying factors predicting outcomes after major trauma in older patients: Prognostic systematic review and meta-analysis’, Journal of Trauma and Acute Care Surgery 97(3), 478–487. https://doi.org/10.1097/TA.0000000000004320
Jensen, J.F., Boehm, P.W., Hjorhöy, L.G. & Jensen, C.F., 2026, ‘Communication Between Patients and Healthcare Professionals in Neurological Hospitalisation: A Qualitative Photo-Voice Study’, Journal of clinical nursing 35(4), 1752–1765. https://doi.org/10.1111/jocn.70122
Keller, M.M., Barnes, R. & Brandt, C., 2024, ‘Development of a clinical hand rehabilitation guideline for second to fifth metacarpal fracture rehabilitation: A Delphi method’, The British Journal of Occupational Therapy 87(7), 414–423. https://doi.org/10.1177/03080226241241990
Khan, F., Amatya, B. & Hoffman, K., 2012, ‘Systematic review of multidisciplinary rehabilitation in patients with multiple trauma’, British Journal of Surgery 99(suppl. 1), 88–96. https://doi.org/10.1002/bjs.7776
Kimmel, L.A., Holland, A.E., Hart, M.J., Edwards, E.R., Page, R.S., Hau, R. et al., 2016, ‘Discharge from the acute hospital: Trauma patients’ perceptions of care’, Australian Health Review 40(6), 625–632. https://doi.org/10.1071/AH15148
Mathers, C., 2008, Global burden of disease: 2004 update, World Health Organization, Geneva.
Matzopoulos, R., Prinsloo, M., Pillay-Van Wyk, V., Gwebushe, N., Mathews, S., Martin, L.J. et al., 2015, ‘Injury-related mortality in South Africa: A retrospective descriptive study of postmortem investigations’, Bulletin of the World Health Organization 93(5), 303–313. https://doi.org/10.2471/BLT.14.145771
Milton, M., Engelbrecht, A. & Geyser, M., 2021, ‘Predicting mortality in trauma patients – A retrospective comparison of the performance of six scoring systems applied to polytrauma patients from the emergency centre of a South African central hospital’, African Journal of Emergency Medicine 11(4), 453–458. https://doi.org/10.1016/j.afjem.2021.09.001
Moodley, N.B., Aldous, C. & Clarke, D.L., 2014, ‘An audit of trauma-related mortality in a provincial capital in South Africa’, South African Journal of Surgery 52(4), 101–104. https://doi.org/10.7196/sajs.1995
Neubert, A., Hempe, S., Bieler, D., Schulz, D., Jaekel, C., Bernhard, M. et al., 2025, ‘Return to work after major trauma: A systematic review’, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 33(1), 44. https://doi.org/10.1186/s13049-025-01351-0
Nummela, M.T., Pyhältö, T.T., Bensch, F.V., Heinänen, M.T. & Koskinen, S.K., 2022, ‘Costal cartilage fractures in blunt polytrauma patients – A prospective clinical and radiological follow-up study’, Emergency Radiology 35(3), 1–10.
Padovani, C., Da Silva, J.M., Rotta, B.P., Neto, R.D.C.P., Fu, C. & Tanaka, C., 2016, ‘Recovery of functional capacity in severe trauma victims at one year after injury: Association with trauma-related and hospital stay aspects’, Journal of Physical Therapy Science 28(5), 1432–1437. https://doi.org/10.1589/jpts.28.1432
Palese, A., Gonella, S., Fontanive, A., Guarnier, A., Barelli, P., Zambiasi, P. et al., 2017, ‘The degree of satisfaction of in-hospital medical patients with nursing care and predictors of dissatisfaction: Findings from a secondary analysis’, Scandinavian Journal of Caring Sciences 31(4), 768–778. https://doi.org/10.1111/scs.12396
Pape, H.C., Probst, C., Lohse, R., Zelle, B.A., Panzica, M., Stalp, M. et al., 2010, ‘Predictors of late clinical outcome following orthopedic injuries after multiple trauma’, Journal of Trauma and Acute Care Surgery 69(5), 1243–1251. https://doi.org/10.1097/TA.0b013e3181ce1fa1
Rau, C.S., Wu, S.C., Kuo, P.J., Chen, Y.C., Chien, P.C., Hsieh, H.Y. et al., 2017, ‘Polytrauma defined by the new Berlin definition: A validation test based on propensity-score matching approach’, International Journal of Environmental Research and Public Health 14(9), 1045. https://doi.org/10.3390/ijerph14091045
Saggie, J., 2013, ‘Trauma: South Africa’s other epidemic’, South African Medical Journal 103(9), 589–590. https://doi.org/10.7196/SAMJ.7387
Schneiderman, J., Van Aswegen, H. & Becker, P., 2013, ‘Health related quality of life of survivors of trauma six months after discharge’, South African Journal of Physiotherapy 69(1), 10–14. https://doi.org/10.4102/sajp.v69i1.366
Seedat, M., Van Niekerk, A., Jewkes, R., Suffla, S. & Ratele, K., 2009, ‘Violence and injuries in South Africa: Prioritising an agenda for prevention’, The Lancet 374(9694), 1011–1022. https://doi.org/10.1016/S0140-6736(09)60948-X
Seneff, M.G., Zimmerman, J.E., Knaus, W.A., Wagner, D.P. & Draper, E.A., 2000, ‘Predicting the duration of intensive care unit stay for patients with acute trauma’, Critical Care Medicine 28(4), 1349–1355. https://doi.org/10.1097/00003246-200004000-00023
Shafeeq, H., DiGiacomo, J.C., Sookraj, K.A., Gerber, N., Bahr, A., Talreja, O.N. et al., 2022, ‘Perioperative multimodal pain management approach in older adults with polytrauma’, Journal of Surgical Research 275, 96–102. https://doi.org/10.1016/j.jss.2021.12.028
Silvester, L.A., Trompeter, A.J. & Hing, C.B., 2021, ‘Patient experiences of rehabilitation following traumatic complex musculoskeletal injury – A mixed methods pilot study’, Trauma 24(3), 218–225. https://doi.org/10.1177/1460408620988123
Tronstad, O., Flaws, D., Fraser, J.F. & Patterson, S., 2021, ‘Doing time in an Australian ICU; the experience and environment from the perspective of patients and family members’, Australian Critical Care 34(3), 254–262. https://doi.org/10.1016/j.aucc.2020.06.006
Van Breugel, J.M., Niemeyer, M.J., Houwert, R.M., Groenwold, R.H., Leenen, L.P. & Van Wessem, K.J., 2020, ‘Global changes in mortality rates in polytrauma patients admitted to the ICU – A systematic review’, World Journal of Emergency Surgery 15, 1–13. https://doi.org/10.1186/s13017-020-00330-3
Wiseman, T., Foster, K. & Curtis, K., 2013, ‘Mental health following traumatic physical injury: An integrative literature review’, Injury 44(11), 1383–1390. https://doi.org/10.1016/j.injury.2012.02.015
Wyse, J.J., Pogoda, T.K., Mastarone, G.L., Gilbert, T. & Carlson, K.F., 2020, ‘Employment and vocational rehabilitation experiences among veterans with polytrauma/traumatic brain injury history’, Psychological Services 17(1), 65. https://doi.org/10.1037/ser0000283
Zaidi, A.A., Dixon, J., Lupez, K., De Vries, S., Wallis, L.A., Ginde, A. et al., 2019, ‘The burden of trauma at a district hospital in the Western Cape Province of South Africa’, African Journal of Emergency Medicine 9, S14–S20. https://doi.org/10.1016/j.afjem.2019.01.007
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