A comparison of the predictions made by orthopaedic surgeons, nurses and physiotherapists about the rehabilitation problems of fracture patients.

Health service staff sometimes are not aware of the psychological and social aspects of patients' rehabilitation problems. This paper compares the accuracy of predictions made by orthopaedic surgeons, nurses and physiotherapists about the rehabilitation problems of a series of fracture patients. Predictions were obtained in the acute orthopaedic trauma wards of one hospital, from members of all three professions, about 26 patients selected as likely to have rehabilitation problems. Follow-up data were obtained from interviews with the patients during the six months after their injury and from the orthopaedic case notes. The orthopaedic surgeons accurately predicted 48 per cent of the problems that occurred, the nurses 26 per cent and the physiotherapists 20 per cent. In their predictions the surgeons discriminated more accurately than the nurses or physiotherapists between the occasions on which problems did and did not occur in the follow-up period. The surgeons were better predictors than the other professions about medical and orthopaedic, work and personal and social problems. Fifty-five per cent of the problems that occurred were predicted by members of one or more professions. If it is desired to base early decisions about treatment or referral in rehabilitation on predictions about patients' likely problems, there is a need to increase the proportion of problems that are accurately predicted, and to increase the ability of predictors to discriminate between the occasions on which problems are and are not likely to occur.