Improving outcome after musculoskeletal injuries in motor vehicle crashes: A controlled trial

1. Improving outcome after musculoskeletal injuries in motor vehicle crashes: A controlled trial Littleton S1,2, Poustie S1, Cameron ID3,Robinson B4,Butler JRG5, Hughes D, Smith PN1,2 1College of Medicine, Biology and Environment, Australian National University 2Trauma and Orthopaedic Research Unit, The Canberra Hospital 3Rehabilitation Studies Unit, The University of Sydney 4Insurance Australia Group 5Australian Centre for Economic Research on Health (ACERH), Australian National University

2. Background • 65,000 minor injury crashes a year in Australia • Estimated financial cost of > $950m1 • Recovery from minor injury reported from 1 week to> 2 years2 • Some research investigating factors that influence health outcomes for people injured in MVCs3 • Early intervention for musculoskeletal injury has been associated with quicker recovery and earlier return to work4 1 Connelly, L. B., R. Supangan, et al. (2006). "The economic costs of road traffic crashes: Australia, states and territories." Accident Analysis & Prevention 38(6): 1087-93 . 2 Rebbeck, T., D. Sindhusake, et al. (2006). "A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population." Injury Prevention 12(2): 93-8 3 Carroll, L. J., L. W. Holm, et al. (2008). "Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders." Spine 33(4 Suppl): S83-92 4 Rosenfeld, M., A. Seferiadis, et al. (2003). "Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial." Spine 28(22): 2491-8.

3. Factors influencing outcome • Demographic and socio-economic factors • female gender, age, level of education • Onset of symptoms • greater initial pain and disability • Psychological and social factors • coping styles, anxiety, depression • Crash related factors • head support, speed of impact, awareness of impending collision • Societal factors • compensation system, legal involvement, claim closure • Health system • access to medical and ancillary treatment

4. Accident Care EvaluationHypothesis Assessment by an ACE clinic will be associated with improved outcomes, reduced costs and a reduction in the duration and costs of compensable claims for people injured in motor vehicle crashes in the Australian Capital Territory (ACT)

5. Approach • Specialty referral assessment and treatment coordination clinic • Education program • Injured person • General practitioners, emergency doctors and treatment providers • Community and Stakeholder awareness program • Public launch, newsletters in professional body publications, mailers to GPs and allied health professionals

6. Who’s Involved PROJECT PARTNERS • NRMA-ACT Road Safety Trust • NRMA Insurance • Australian National University (ANU) • The University of Sydney CONSULTATIVE MEMBERS • ACT Health • Australian Medical Association • ACT Law Society • Australian Physiotherapy Association • Australian Orthopaedic Association • ACT Division of General Practice

7. Australian Capital Territory • 330,000 population • Median age: 34 years • 60% of workforce management/administrators, professionals, associate professionals • Average weekly earnings $1300 • Compulsory Third Party (CTP) scheme – largely common law, no caps or thresholds

8. Crash Data - ACT • 7000 crashes in 20051 • 48% rear-end collision • 15% right angle collision • 443 casualty crashes (crashes involving injury or fatality)1 • Approx 800 personal injury claims 1. Australian Bureau of Statistics 2007

9. Methods • Sequential cohort study design • Control / Intervention approx 90 in each arm • Participants recruited from Emergency Departments in The Canberra Hospital and The Calvary Public Hospital, ACT • Follow up baseline, 6 months and 12 months • Outcome measures • Short-Form 36 (SF36) • Functional Rating Index (FRI) • Hospital Anxiety and Depression Scale (HADS)

10. Inclusion/Exclusion Inclusion criteria • Involved in a road traffic crash within the last 7 days • Sustained mild to moderate musculoskeletal injury • including uncomplicated long bone fractures • Age 18 -70 years • Usually resident in the ACT Exclusion criteria • Inpatient greater than 3 days • Head or spinal injury • Pedestrians • Non English Speaking Background (NESB) • Pregnancy • Did not wait to be seen

11. Results Control Group • 524 patients screened during period September 2006 – July 2007 • Excluded 429 • 161 did not meet the inclusion criteria • 206 unable to be contacted • 62 declined • 95 participants consented and baseline data collected • 83 (87%) participants available for 6 month follow-up • There were no significant differences between the characteristics of baseline and 6 month respondents

12. Baseline Characteristics Control Group

13. Health Outcomes Data

14. Health Outcomes Data

15. Discussion • Significant pain and disability post crash • Highly anxious • Consider the demands and limitations of the system / environment • Access to and availability of medical care • Work environment • Home and family commitments • Logistical issues of repairing or replacing the damaged vehicle • Financial concerns

16. Summary • Car crashes are a significant problem in terms of social and economic cost • People who sustain minor soft tissue injury following a crash suffer in terms of both physical and mental well being • Most people recover well by 6 months • A small but significant number are still incapacitated at6 months • Treatment strategies should be targeted at this group

17. Acknowledgments Funding NRMA ACT Road Safety Trust The Canberra Hospital and Calvary Hospital Emergency Department staff Management Advisory Group