The enhanced rehabilitation programme for significant musculoskeletal injuries from the manchester arena bombing - A process evaluation study investigating patients' and physiotherapists' experiences.

The 2017 Manchester Arena bombing exposed major gaps in the UK's civilian trauma rehabilitation services. In response, the Enhanced Rehabilitation after Major Trauma Programme (ERP), a structured, multidisciplinary rehabilitation approach, was developed by the NHS, in collaboration with the Universities of Manchester and Salford, and the Manchester Institute of Health and Performance (MIHP). This study employed the Normalisation Process Theory (NPT) framework to evaluate the integration and impact of ERP from the perspectives of physiotherapists and patients. Thirteen patients and four physiotherapists participated in semi-structured interviews and a focus group. Data were analysed using reflexive thematic analysis (RTA) and then deductively with NPT constructs. Both groups regarded ERP as a valuable alternative to standard NHS rehabilitation. Its structured, multidisciplinary design supported physical and psychological recovery, improved motivation, and enhanced physiotherapist expertise. However, concerns were raised about sustaining progress after ERP, difficulties transitioning back to NHS care, and the absence of long-term rehabilitation pathways. Despite its positive outcomes, the wider adoption of ERP in the NHS faces barriers, including limited resources and systemic constraints. This study demonstrates the potential of structured rehabilitation models for trauma survivors. Future research should explore cost-effective ways to sustain and expand enhanced trauma rehabilitation.