We, the rehabilitation world including especially managers and commissioners, love to talk about pathways which patients will follow. The reality is more like water flowing down hill. The patient goes where the flow takes him, and often there is no flow, no road to travel.

This lovely piece of research from Jade Kettlewell and colleagues in Nottingham was presented first at the BSRM and SRR annual conference in October 2019. It shows the contrast between the ideal pathways envisioned and even, possibly, aimed for and the practical reality. The two colour figures are a stark illustration of the complexity faced by patients, and by rehabilitation professionals when trying to receive or organise rehabilitation.

Next time you start talking about pathways, just remember this paper.

Kettlewell J, Timmons S, Bridger K, et al.
A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK.
Clinical Rehabilitation. November 2020. doi:10.1177/0269215520971777