DOI: 10.6084/m9.figshare.27247933
title: Configuration of accident trajectories after a rehabilitation programme: on the sharp edge between reintegration and socio-professional exclusion

description: To analyse the factors influencing the configuration of accident trajectories from de perspective of patients and assess the role of rehabilitation in managing pain and functional limitations autonomously. Using a qualitative, longitudinal, interdisciplinary approach, we conducted two comprehensive interviews (one year apart) with patients experiencing chronic pain and functional limitations following orthopaedic trauma. Thematic analysis was conducted utilising MaxQDA<sup>®</sup> software to systematically analyse the data. Twenty-four patients participated (4 ♀; 20 ♂; 44.9 ± 10.6, min. 19; max. 63.5 yo; 1.0 ± 4.0 years duration; pain 4.6 (1.8) severity subscale (0-10) [mean (SD)]). Through reconstruction their experiences we identified three types of accident trajectories: socio-professional reintegration, ongoing reintegration, and exclusion. Factors influencing these trajectories included physical and psychological health status, occupational status, private and social context, and insurance and therapeutic aspects. Patients’ perceptions and socio-demographic characteristics also contributed to trajectories specificities. Understanding the factors that influence accident trajectories links individual and social dimensions, offering an overall comprehension of patients’ situations and structural constraints. This understanding enables the factors influencing trajectories to be considered during rehabilitation, thereby promoting the patient’s socio-professional reintegration through targeted interventions. A holistic approach is required to identify and address specifically factors jeopardising socio-professional reintegration.Rehabilitation practitioners should be conscious of the role of structural barriers such as occupational challenges, lack of social support, or inadequate insurance, which can hinder patients’ societal reintegration.The practitioner and the patient should discuss the patient’s point of view on his or her trajectory and on the health and social systems, to help the patient make use of existing resources and be aware of their limitations.Advocacy through collective action by professional associations at the political level should be considered to address systemic issues impacting rehabilitation outcomes. A holistic approach is required to identify and address specifically factors jeopardising socio-professional reintegration. Rehabilitation practitioners should be conscious of the role of structural barriers such as occupational challenges, lack of social support, or inadequate insurance, which can hinder patients’ societal reintegration. The practitioner and the patient should discuss the patient’s point of view on his or her trajectory and on the health and social systems, to help the patient make use of existing resources and be aware of their limitations. Advocacy through collective action by professional associations at the political level should be considered to address systemic issues impacting rehabilitation outcomes.