Impact of interventions on work outcomes after musculoskeletal road traffic injuries: a systematic review

Dr Charlotte Brakenridge1, Dr Elise Gane1, Dr Esther Smits1, Dr Nicole Andrews1,2, Associate Professor Venerina Johnston1

1Recover Injury Research Centre, The University Of Queensland, Brisbane, Australia, 2Occupational Therapy Department and The Professor Tess Cramond Multidisciplinary Pain Centre, The Royal Brisbane and Women’s Hospital, Brisbane, Australia

Background: Musculoskeletal injuries are the most common non-fatal injuries that result from road traffic crashes. Even though these injuries are often ‘mild’ in severity, they can still affect one’s work capacity or ability to return to work post-crash. This review explored whether there are effective interventions that can improve work-related outcomes after musculoskeletal road traffic injuries.

Methods: A systematic search of seven databases was conducted in August 2018. Studies were included if they involved adults with a musculoskeletal injury from a road traffic crash, evaluated an intervention, and reported on a work-related outcome (e.g., time to return to work, sick leave).

Results: The review identified 25 studies from 24 papers. Studies were predominantly conducted in Europe (n=19), with the remaining studies conducted in Australia (n=4) or Canada (n=2). Individuals with whiplash injuries or whiplash-associated disorders were the most targeted group (n=19); the remaining studies included participants with a range of musculoskeletal injuries (n=3), fracture (n=1), soft tissue neck injury (n=1), or neck sprain injury only (n=1). Many interventions were delivered by physiotherapists only (n=11) or by a team of clinicians including physiotherapists (n=4). Only seven out of 25 studies (28%) reported a statistically significant intervention effect for at least one work-related outcome (most commonly days to return to work, 3 studies). These studies were heterogeneous in intervention delivery (physiotherapist, occupational therapist, rehabilitation physician, emergency department clinician, pharmacist), in the target of the intervention (pain, disability, return to work), and length of follow up (14 weeks to 1 year).

Conclusions: The evidence to date indicates that many interventions in individuals with musculoskeletal road traffic injuries do not improve work outcomes. Future research should evaluate more targeted return-to-work interventions, in a range of musculoskeletal injuries from a road traffic crash, with longer-term follow-up and cost-effectiveness outcomes.


Biography:

Dr Brakenridge has a background in health psychology and public health, and completed her PhD in workplace health promotion in 2018. She is currently a postdoctoral research fellow at the RECOVER Injury Research Centre, evaluating return to work and function for people who have sustained a road traffic injury.

Back in action: Establishing a chronic low back pain exercise and education group in the community

Vanessa Sandi1, Shaun Archer1, Jacqui Barker1, Renai De Marco1, Dominic Furphy1, Juliana Symonds1

1ACT Health, Canberra, Australia

Introduction
In ACT Health (Canberra, Australia), 15% of Community Care Program Physiotherapy referrals are for chronic low back pain; patients often wait 10 weeks for assessment. Referral numbers have increased, resulting in longer wait times. Research suggests outcomes and psychosocial benefits of group versus individual therapy are similar. The project aims to reduce wait times and increase therapy time for patients with chronic back pain, by establishing group therapy sessions instead of the current model of individualised intervention.

Methods
A literature search and benchmarking across private and public health services in Australia identified there were no similar groups established. A four-week exercise and education group was designed. Quality of life and fear of movement were measured using the Revised Oswestry Disability Scale (ODS) and Tampa Scale of Kinesiophobia (TSK) questionnaires. A qualitative survey was also completed by attendees.

Results

  • Chronic low back pain assessment wait times were reduced to 4 weeks.
  • Patients received an additional 1.5 hours of therapy time compared to individual appointments.
  • Survey data from 25 patients attending the group:
  • Aged 18-64: improved by 7% in TSK and 5.8% in ODS.
  • Aged 65-79: improved by 0.5% in TSK and 3.1% in ODS.
  • 96% reported the education was helpful and would recommend the group to others.

Conclusion
Group therapy for chronic low back pain reduced the wait time for assessment, enabled more therapy time for patients, and achieved high patient satisfaction. Patients achieved a reduction in pain with activities of daily living and had reduced Kinesiophobia after completing the class.


Biography:

Vanessa is a senior physiotherapist working in the public health system in Canberra. Her passion is the treatment of musculoskeletal conditions and empowering people to self-manage and maximise independence.  Her current role is community based and provides contact with a diverse range of musculoskeletal conditions. Vanessa has completed a post graduate certificate in musculoskeletal physiotherapy. This has enhanced her clinical knowledge and she is able to utilise these skills in her daily practice and also to identify and influence new models of care in the service. Outside of work she keeps herself busy by participating in Mexican folkloric dancing.

A referral pathway for patients attending the Emergency Department with an acute high risk foot pathology.

Ms Annie  Walsh1,3,4, Professor Hugh Dickson1,2,3,4, Doctor Serena Ayers5, Doctor Matthew  Malone1,3,4

1High Risk Foot Service, Liverpool Hospital, South West Sydney Local Health District , Sydney, Australia, 2Ambulatory Care Department, Liverpool Hospital, South Western Sydney Local Health District, Sydney , Australia , 3South West Sydney Limb Preservation and Wound Research Unit, Sydney , Australia , 4Liverpool Diabetes Research Collaborative Unit, Sydney , Australia , 5Liverpool Emergency Department, Liverpool Hospital, South Western Sydney Local Health District, Sydney , Australia

Aim
The aim of study was to develop a referral pathway for treatment and management of patients attending Liverpool hospital emergency department (ED) with an acute high risk foot pathology.

Objectives

– Aid in the delivery of “the right care, in the right place, at the right time”

– Reduce the “time to assessment” in line with Emergency Department National Emergency Access Targets (NEAT).

– Reduce the number of avoidable admission

– Facilitate the transfer of “fast track” patients out of the ED for treatment in at the High Risk Foot Service (HRFS)

Methods
The Liverpool Hospital High Risk Foot Service Emergency Department Pathway was designed in conjunction with the ED staff to offer both clinical and after hours “on call” service.  The ED High Risk Foot Team developed included Podiatrists, Physicians, Vascular Surgeons, Continuum of Care Nurses and Hospital in the Home (HITH). ED staff attended education sessions about the pathway and how to access the service.

Results
Over the 22-month period 154 patients were referred to the pathway, the main reason for referral was infection. Of the 154 patients, 86 were transferred to the HRFS with non-emergency symptoms not requiring admission. Twenty four were commenced on oral antibiotics. Twenty patients were avoidable admissions requiring IV antibiotics, HITH was initiated via the HRFS OPAT program.  Thirty three were inappropriate ED presentations and were provided with outpatient follow-ups. The mean time to assessment was 7minutes and the mean time from assessment to HRFS transfer was 10minutes. The remaining forty four were admitted under Vascular, all requiring immediate interventions. Of the 154 patients referred only 89 were previously known to the HRFS.

Conclusions
The ED high risk foot team aided with timely admissions when required while also facilitating ‘avoidable admissions’ and transfers out of the ED. Following its success the pathway will continue to operate and support the ED staff.


Biography:

Annie is a Senior Podiatrist at the Liverpool Hospital High Risk Foot Service, specialising in the treatment and management of diabetic foot pathology. Annie is an associate researcher for the Liverpool Diabetes Research Collaborative Unit based at Ingham Institute of Applied Medical Research. Annie’s research interests include diabetic foot infection, Charcot neuropathic osteoarthropathy and the use of advance technology in the measurement of diabetic foot wounds, she is currently involved in three clinical trails at the Institute. Annie has completed her Masters in Wound Care from Monash University, Melbourne and she currently works as a unit advisor for the course. In 2017 Annie was elected as a Board Member of Wounds Australia, the peak body for wound care and management in Australia.

Domestic Violence Initial Assessment Form: A brief structured psychosocial assessment and intervention tool

Ms. Alexandra Miller1, Ms Julie  Greathouse1

1St Vincent’s Hospital Sydney, Darlinghurst, Australia

Routine screening for domestic violence of women attending health services has been established as a key strategy for early identification and response to domestic violence. St Vincent’s Hospital Sydney recently participated in a multi- site pilot introducing routine screening for domestic violence in the Emergency Department. Where studies have reported on the benefits or not of the screening process, they have historically focussed heavily on the process of identification, ignoring the significance of the intervention that follows and the influence that that next stage of intervention has on outcomes. This paper will report on the implementation of a structured intervention for women who identified they were experiencing DV.  We developed a Domestic Violence Initial Assessment Form (DVIAF), along with an extensive education package, to ensure consistency in the content of initial brief psychosocial assessment and intervention with patients identified through a screening program. The DVIAF was informed by the NSW Health Policy and Procedures for Responding to Domestic Violence, the WHO’s Clinical and policy guidelines for responding to intimate partner violence and sexual violence against women , as well as studies reviewing the evidence about screening and psychosocial interventions. Intervention protocols reviewed in the development of this tool included an assessment of danger; helping to develop safety plans, provision of emotional support, and facilitation of referrals to local advocacy programs.

This paper reports on a survey that found social workers using the (DVIAF) felt the quality of their interventions and assessments were improved and all felt the quality of their documentation improved. All surveyed stated that they would like to continue use of the tool and suggested only minor structural adjustments. For the future we intend to review records of psychosocial interventions prior to the introduction of the DVIAF which will provide objective comparison to records where the DVIAF has been utilized.


Biography:

Alex Miller is the Manager of Domestic Violence and Community Social Work at a large urban hospital and has qualifications Social Work and Child Welfare. She is responsible for strategic leadership in the area of domestic violence, development of policy and protocols, program implementation and staff management at St Vincent’s Hospital. Alex Miller has worked in the field of domestic and family violence in health care and community child protection for 16 years.

Domestic Violence Initial Assessment Form: A brief structured psychosocial assessment and intervention tool

Ms. Alexandra Miller1, Ms Julie Greathouse1

1St Vincent’s Hospital Sydney, Darlinghurst, Australia

Routine screening for domestic violence of women attending health services has been established as a key strategy for early identification and response to domestic violence. St Vincent’s Hospital Sydney recently participated in a multi- site pilot introducing routine screening for domestic violence in the Emergency Department. Where studies have reported on the benefits or not of the screening process, they have historically focussed heavily on the process of identification, ignoring the significance of the intervention that follows and the influence that that next stage of intervention has on outcomes. This paper will report on the implementation of a structured intervention for women who identified they were experiencing DV.  We developed a Domestic Violence Initial Assessment Form (DVIAF), along with an extensive education package, to ensure consistency in the content of initial brief psychosocial assessment and intervention with patients identified through a screening program. The DVIAF was informed by the NSW Health Policy and Procedures for Responding to Domestic Violence, the WHO’s Clinical and policy guidelines for responding to intimate partner violence and sexual violence against women , as well as studies reviewing the evidence about screening and psychosocial interventions. Intervention protocols reviewed in the development of this tool included an assessment of danger; helping to develop safety plans, provision of emotional support, and facilitation of referrals to local advocacy programs.

This paper reports on a survey that found social workers using the (DVIAF) felt the quality of their interventions and assessments were improved and all felt the quality of their documentation improved. All surveyed stated that they would like to continue use of the tool and suggested only minor structural adjustments. For the future we intend to review records of psychosocial interventions prior to the introduction of the DVIAF which will provide objective comparison to records where the DVIAF has been utilized.


Biography:

Alex Miller is the Manager of Domestic Violence and Community Social Work at a large urban hospital and has

qualifications Social Work and Child Welfare. She is responsible for strategic leadership in the area of

domestic violence, development of policy and protocols, program implementation and staff management at St Vincent’s Hospital. Alex Miller has worked in the field of domestic and family violence in health care and community child protection for 16 years.

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