Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): protocol of a randomised, controlled trial

Rebbeck, Trudy; Leaver, Andrew; Bandong, Aila Nica; Kenardy, Justin; Refshauge, Kathryn M.; Connelly, Luke B.; Cameron, Ian D.; Mitchell, Geoffrey; Willcock, Simon; Ritchie, Carrie; Jagnoor, Jagnoor; Sterling, Michele

doi:10.1016/j.jphys.2016.02.006

Cited by 28 publications

(32 citation statements)

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“…However, studies in a workers’ compensation setting have shown that early screening and intervention in people with musculoskeletal injuries with high chances of poor recovery resulted in significant cost reduction [22, 23]. This approach has also been shown to result in improved outcomes and reduced cost in low back pain in the UK [24], and is now being investigated in Australia for the management of whiplash [25]. For an optimal treatment approval process, it is recommended that claims managers in the compensation system not only approve evidence based treatment, but also encourage the use of psychosocial assessment tools, that for example, predict chronic pain and disability, after which they should offer the earliest intervention available.…”

Section: Discussionmentioning

confidence: 99%

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Elbers

Chase²,

Craig

et al. 2017

BMC Med Inform Decis Mak

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BackgroundProblems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers’ compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers’ compensation setting.MethodsThe study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers’ compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators’ clinical networks and the workers’ compensation government regulator’s website.ResultsParticipants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers’ compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management.ConclusionsOverall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers’ compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers’ compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0460-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Elbers

Chase²,

Craig

et al. 2017

BMC Med Inform Decis Mak

Self Cite

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“…For the whiplash clinical prediction rule, it is proposed that patients identified at low-risk of poor recovery require minimal treatment consisting of advice, reassurance and simple exercises [70]. In contrast, it is suggested that patients identified at high risk of poor recovery will require further assessment of potentially contributory factors including psychological distress, nociceptive processing, and neck movement and strength [70]. Whether or not this risk stratified targeted approach results in better patient outcomes is currently being evaluated with no data yet available.…”

Section: Patient Stratification and Sub-groupingmentioning

confidence: 99%

Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain

Sterling

Zoete

Coppieters

et al. 2019

JCM

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Neck pain, whether from a traumatic event such as a motor vehicle crash or of a non-traumatic nature, is a leading cause of worldwide disability. This narrative review evaluated the evidence from systematic reviews, recent randomised controlled trials, clinical practice guidelines, and other relevant studies for the effects of rehabilitation approaches for chronic neck pain. Rehabilitation was defined as the aim to restore a person to health or normal life through training and therapy and as such, passive interventions applied in isolation were not considered. The results of this review found that the strongest treatment effects to date are those associated with exercise. Strengthening exercises of the neck and upper quadrant have a moderate effect on neck pain in the short-term. The evidence was of moderate quality at best, indicating that future research will likely change these conclusions. Lower quality evidence and smaller effects were found for other exercise approaches. Other treatments, including education/advice and psychological treatment, showed only very small to small effects, based on low to moderate quality evidence. The review also provided suggestions for promising future directions for clinical practice and research.

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“…This qualitative descriptive study was nested within a larger investigation that aimed to improve recovery from WAD through the development of targeted treatment pathways based on whiplash CPR categorisation. 11 Focus group discussions were considered optimal in exploring clinicians’ understanding and practice behaviours regarding CPRs as comparison of multiple participants’ perceptions enables the identification of group norms and values, provides insight into how and why individuals think and act as they do and renders rich experiential data. 23 24 …”

Section: Methodsmentioning

confidence: 99%

“… 9 10 Additionally, a randomised controlled trial (Whiplash ImPaCT) is being conducted to determine whether targeted treatment based on CPR stratification is superior to usual care. 11 While the whiplash CPR's predictive accuracy has been demonstrated in a validation study, 9 a trial such as Whiplash ImPaCT is needed to determine whether adoption of the CPR improves patient outcomes and/or the cost-effectiveness of care. This process is required before widespread CPR implementation is advocated.…”

Section: Introductionmentioning

confidence: 99%

Health practitioners’ perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia

et al. 2017

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ObjectivesTo investigate health practitioners’ understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR.DesignQualitative study using six semistructured focus groups.SettingPrimary and secondary care in New South Wales and Queensland, Australia.ParticipantsPhysiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders.MethodsFocus group discussions (n=6) were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach.ResultsHealth practitioners’ understanding and use of CPRs were mixed. Clinicians considered components relating to acceptability (‘whether I agree with it’) and implementation (‘how I'll use it’) when deciding on whether to adopt a new CPR. Acceptability was informed by four themes: knowledge and understanding, CPR type, congruence and weighted value. Consideration of matters that promote implementation occurred once a CPR was deemed to be acceptable. Three themes were identified as potentially enhancing whiplash CPR implementation: the presence of an external driver of adoption, flexibility in how the CPR could be administered and guidance regarding communication of CPR output to patients.ConclusionsEducation on CPR purpose and fit with practice is needed to enhance the perceived acceptability of CPRs. Strategies that facilitate practitioner motivation, enable administrative flexibility and assist clinicians in communicating the results of the whiplash CPR could promote adoption of the whiplash CPR.

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Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): protocol of a randomised, controlled trial

Cited by 28 publications

References 0 publications

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain

Health practitioners’ perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia

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