Similar return to work for early intervention programs after motor vehicle collision

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Dr. Steven Faux discusses the road accident acute rehabilitation initiative.
184 patients were randomized to receive either an Early Rehabilitation Intervention (ERI) or a Brief Educational Intervention (BEI) for road traffic injuries. The goal of this study was to determine the best return to work or usual activities for patients of varying risk levels for mental health disorders. The results of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Motor Accidents Authority of New South Wales
Conflicts: Other
Why was this study needed now?
Mental health disorders have been found to occur at very high rates among motor vehicle collision victims. Due to the poor health infrastructure and funding restrictions in New South Wales, Australia, targeted early intervention is needed for those most at risk. Patients with general trauma are often discharged without proper treatment and insufficient follow-up. This study was needed to develop a targeted rehabilitation treatment program for those patients that were of the highest risk of persistent pain, activity limitation, and psychological symptoms following a motor vehicle collision.
What was the principal research question?
How effective was a targeted rehabilitation program for an improvement in return to work or usual activities for patients following a road traffic injury, as measured up to 24 weeks after rehabilitation?
Population: Patients over the age of 18 that had sustained road traffic injuries on public roads were included in this study. Participants had to have been admitted to an emergency department as a result of a motor vehicle collision. Participants were classified by Injury Severity Score (ISS) as minor, moderate, or serious/major. (n=184, 161 complete; minor/moderate injury: 177; major injury: 7)
Intervention: ERI: Patients were enrolled in an Early Rehabilitation Intervention (ERI) program, and received treatment appropriate to their level of risk. A rehabilitation physician used guidelines formed by evidence based medicine to manage pain, anxiety, and PTSD. Formal case conferences were conducted for patients. High risk patients were offered consultation with a rehabilitation physician 4 weeks after injury. Patients at low risk were sent a letter informing them of local health resources. (n=92, 80 completed; high risk: 59; low risk: 21, Mean age: 41.5 [18-81], 55M/34F)
Comparison: BEI: Patients were enrolled in a Brief Educational Intervention (BEI) program, and received treatment appropriate to their risk factor. Low risk patients were sent a letter informing them about their local health resources. High risk patients were sent a letter advising them to seek further care from their General Practitioner. (n=92, 81 completed; high risk: 67; low risk: 14, Mean age: 41.4 [18-78], 43M, 47F)
Outcomes: The primary outcome of interest was the return to work or usual activities, determined by a self-reported questionnaire. Additional outcomes were Hierarchal Modified Barthel Index, Experienced Pain Index (EPI), Generalized Anxiety Disorder 7 Questionnaire (GAD-7), Patient Health Questionnaire 9 (PHQ9), CAGE questionnaire, Short Form 6D (SF6D), and Primary Care - Post Traumatic Stress Disorder (PC-PTSD) screen.
Methods: RCT; multicenter, single-blind, stratified
Time: Assessments were made at initial screening and 12 weeks after intervention. Patients with major injuries were followed up at 24 weeks after intervention.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.