Apport des patients ressources accompagnateurs dans le suivi des patients ayant bénéficié de réimplantation micro-chirurgicale d'urgence du membre supérieur : un essai pragmatique randomisé

 

Marie-Pascal Annie Pomey

Centre hospitalier de l'Université de Montréal [CHUM]

 

Domaine : appareil locomoteur et arthrite

Programme Consortium pour le développement de la recherche en traumatologie - Volet 1

Concours 2018-2019

Introduction : The Center of Expertise in Reimplantation or Emergency Microsurgical Revascularization (CEVARMU) is the only center of the reimplantation of the upper limb in Quebec. Its mandate is to provide specialized care to victims of traumatic amputation of upper limb requiring an emergency microsurgery reimplantation.  A Patient Advisor (PA) is a patient of CEVARMU who have completed their rehabilitation process and who accompanies and supports patients in their own care process. The objective of the proposed project is to evaluate the effectiveness of the Patient Advisor (PA)  Program for the  traumatic upper limb amputation victims treated at CEVARMU.

Methodology : A pragmatic randomized trial is proposed. It is called pragmatic because we will test the efficiency in a real context and randomization will be stratified according to the presence or absence of the insurance disability for the period post reimplantation care to 116 traumatic amputation victims over two and a half years. Knowing that 40% of patients are covered by this type of insurance, we will have 46 covered and 70 non-covered patients. The half of each group will benefit from Patient Advisor meetings and also from the regular care, and the other half will benefit from regular care only. Meetings with the PA will take place during hospitalization, at 8 weeks and then at 6 months following the reimplantation surgery. Our main measure will be focused on the perception of disability assessed by the Disabilities Arm Shoulder Hand (DASH) Questionnaire to which we will associate functional measures, pain, depression, anxiety and also the quality of life and a cost-utility study. These measures will be taken at the same three moments.

Expected results : By integrating the experiential knowledge of former patients, it is expected that the Patient Advisor Program will significantly improve the living conditions of traumatic amputation victims in Quebec.