Clinical and cost effectiveness of an early exercise programme on chronic pain and health-related quality of life following blunt chest wall trauma: A parallel, randomised controlled trial (ELECT2 trial)

End of project summary:

What we did and why

We know from previous research that chronic pain (pain persisting over 3 months after an injury) and poor health-related quality of life is reported by over one third of adult patients with a rib injury. Despite this, there is no evidence supporting the physiotherapy treatment given to these patients in hospital. We tested whether an exercise programme consisting of simple trunk and shoulder movements, could reduce the rate of chronic pain and improve health-related quality of life in these patients. In six hospitals, 360 patients with rib injuries were split into two groups; one that completed the exercise programme and one that didn’t. Both groups still received other routine physiotherapy treatment. All patients filled out questionnaires on admission to hospital and again three months later, to tell us about their pain and health related quality of life. We also looked at whether the programme was cost effective, and if patients and physiotherapists liked it or not.

Main messages:

• 71% patients told us how much of the exercise programme they had completed. Only 23% of these patients completed the entire programme.
• By three months, the levels of chronic pain and poor quality of life reported by patients was very low. This suggest that most patients made a full recovery.
• We found that for some patients, the exercise programme may not have helped their recovery. Chronic pain was reported by 28.3% of those patients completing the exercise programme, and 16.9% of those not completing it.
• The exercise programme was safe. There were no reported differences in the rate of problems (related to the trial) between the two groups. 
• Patients felt the exercise programme was helpful and easy to follow, although was possibly started too early after their injury.
• The physiotherapists reported that the programme was straightforward. They also felt that for some patients, it was started too early after their injury. 
• The exercise programme is not cost-effective for patients with blunt chest wall trauma.