Outcomes in musculoskeletal injuries following road traffic crashes : an evaluation of an early intervention programme
Creators: name: Littleton, Susannah
Publisher: name: The Australian National University
Year: 2011
Subjects: subject: RC1042.L58 2011
subject: Crash injuries Australia Australian Capital Territory
subject: Musculoskeletal system Wounds and injuries
subject: Traffic accidents Psychological aspects
subject: Traffic accident victims Rehabilitation

description: Introduction This thesis evaluates the effect of an early intervention programme on the physical and psychological health status of people with mild to moderate musculoskeletal injuries following road traffic crashes, and examines the influence of accident fault status and compensation claim status on recovery. Methods A sequential cohort of patients presenting to emergency departments in the Australian Capital Territory for treatment of mild to moderate musculoskeletal injuries sustained in road traffic crashes were recruited. A control group of 95 patients received the usual care provided. An Intervention group of 98 patients were referred to a specialist clinic for assessment, during which an individualised, proactive rehabilitation plan was established. Both physical and psychological health status were measured at baseline, six months and 12 months post-crash using the Short Form 36 (SF-36; Physical Component Score and Mental Component Score); the Hospital Anxiety and Depression Scale (HADS); and Functional Rating Index (FRI). Three analyses were performed using the health outcome data obtained. Firstly, the influence of fault status on baseline physical and psychological health was evaluated by comparing the health outcomes scores of patients who caused the crash in which they were involved with scores from patients who were not at fault. Secondly, the effect of claiming compensation was evaluated for the control group by comparing SF-36, HADS and FRI scores between patients of the control group who had claimed compensation and those who did not claim compensation. Finally, the effect of the early intervention programme was evaluated by comparing health outcome scores of the control and intervention groups. Results Patients were enrolled a mean of 9.3 days following the crash. In the immediate post-crash period, the cohort was characterised by severe disability (FRI 55.5, SD 21.04), moderate levels of pain (pain intensity sub-scale of the FRI 2.0, SD 0.81) and high levels of anxiety (HADS-a9.1, SD 4.55). Fault status had no effect on physical health; however, people that were not at fault had significantly worse psychological health at baseline as measured by SF-36 Mental Component Score. Claiming compensation was associated with a worse SF-36 Physical Component Score, greater HADS-anxiety and worse FRI. Retention of a lawyer was significantly associated with a lower SF-36 Mental Component Score at 12 months. The early intervention programme resulted in a statistically significant reduction in anxiety at 12 months. However, neither anxiety, nor any of the other measures of physical or psychological health were considered to be improved to a clinically significant level by the intervention. Conclusion Compensation status and psychological factors are independent determinants of longer term health following mild to moderate musculoskeletal injuries sustained in road traffic crashes. The early specialist assessment and proactive treatment planning implemented as part of this thesis, failed to improve health outcomes over usual care alone. Overall, recovery is influenced by both physical and psychological factors, and models of care need to address both of these components.