Biopsychosocial factors associated with non-recovery after a minor transport-related injury: A systematic review

Abstract

BackgroundGlobally, road transport accidents contribute significantly to mortality and burden of disability. Up to 50 million people suffer a transport-related non-fatal injury each year, which often leads to long-term disability. A substantial number of people with minor injuries struggle to recover and little is known about the factors leading to poor or non-recovery. The aim of this paper is to present a systematic review of biopsychosocial factors related to poor or non-recovery after a minor transport-related injury.Methods and findingsStudies were selected through searches of PubMed, Medline, Embase, and Cochrane library. Methodological quality was assessed using a Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklist for quantitative cohort studies and Standards for Reporting Qualitative Research (SRQR) checklist for qualitative articles. Data were extracted using the Cochrane data extraction tool based on the biopsychosocial model of health (BPS). In total, there were 37 articles included. However, heterogeneity of the techniques and tools used to assess factors and outcomes across studies meant that pooling of results to determine biopsychosocial factors most predictive of poor or non-recovery was not possible. Hence, a narrative synthesis was conducted and shown multiple factors to be associated with poorer outcomes or non-recovery, most being identified in the biological and psychological domain of the BPS model. Factors that were the most representative across studies and have shown to have the strongest associations with poor or non-recovery were high initial pain intensity, pain duration and severity, pre-accident physical and mental health status and pain catastrophising.ConclusionsThis review demonstrates the complexity of recovery and a challenge in reporting on predictors of recovery. It is evident that a range of multi-factorial biopsychosocial factors impact recovery. These factors are often inter-connected and multi-faceted and therefore, it was not feasible to select or focus on one single factor. In defining the most predictive factors, further research is required, yet the consensus around which tools to use to measure recovery outcomes is needed and is highly recommended. Regardless of the descriptive nature, the review demonstrated that high levels of post-injury pain are associated with poorer outcomes such as chronic pain and physical and mental disability. Therefore, early targeting of modifiable factors such as pain, pain catastrophizing and arising comorbidities such as PTSD, depression and anxiety may assist in reducing chronic pain and ongoing related disabilities.Systematic review trial registration numberSystematic review protocol was registered in International Prospective Register for Systematic Reviews (PROSPERO) on 14 December 2016. Registration number CRD42016052276.

Biopsychosocial barriers affecting recovery after a minor transport‐related injury: A qualitative study from Victoria

“…Previous research indicates differences in factors affecting recovery, yet the most commonly reported factors are high pain intensity, chronic pain, older age, pain catastrophizing, poor recovery expectations and poor pre‐accident health status . Other reasons suggested for a poor recovery, or even for permanent disability, include factors other than purely injury‐related ones.…”

System complexities affecting recovery after a minor transport-related injury: The need for a person-centred approach

“…Injuries from transport accidents are heterogeneous and recovery processes complex and challenging for patients, regardless of the type and severity of injury sustained (2,3). Multiple factors impact the recovery trajectory, including pain, poor pre-accident health state, psychological comorbidities, socioeconomic disadvantage and, in some instances, financial compensation (4)(5)(6).…”

‘I’ve got to be independent’: Views of older people on recovery following road traffic injury in New South Wales, Australia

“…For example, in 2017 Gopinath et al demonstrated biopsychosocial factors such as general health, catastrophising, pain, social support and compensation factors were better prognostic indicators of recovery than injury type or location [22] , whilst in 2018, a systematic review by Samoborec et al concluded multiple biopsychosocial factors in uenced recovery. The strongest associations occurred between poor recovery and high initial pain intensity; pain duration, severity and catastrophising; and pre-injury physical and mental health [23] . A subsequent qualitative study by Samoborec et al in 2019 was consistent with this evidence, nding recovery was multifaceted, complex, and in uenced by comorbidities including chronic pain, depression and anxiety [24] .…”