Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry

Lindsay, Gail; Mior, Silvano; Côté, Pierre; Carroll, Linda; Shearer, Heather M.

doi:10.1016/j.jmpt.2016.01.005

Cited by 13 publications

(11 citation statements)

References 48 publications

(52 reference statements)

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“…The terminology of minor injury used in legislation and guidelines was identified by study participants as an issue in one study [ 57 ]. The study also reported that patients perceived the role of social insurers and healthcare practitioners as very important in the recovery process.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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“…Patients who are experiencing new and acute pain with usual activities may be confused by this recommendation to return to these activities, and subsequently may feel misunderstood. Reassurance and an optimistic outlook are important, however helping patients to understand pain processes and recovery trajectories may add to these recommendations and increase the likelihood that patients feel understood and believed [ 12 , 14 , 19 ]. Several participants in the present study, including three participants who had been in the single session control group, highlighted a sense of relief when the physiotherapists involved in the RCT clarified pain processes and recovery from WAD.…”

Section: Discussionmentioning

confidence: 99%

“…Gaining a more in-depth understanding of patient subjective experiences and the perceived effects of treatment may provide a deeper understanding of how pain and recovery fit into the lived experience. Additionally, integrating patients’ knowledge and experiences with health care is recognised as essential for the development of valid and relevant patient-reported outcome measures (PROM) [ 17 ] and clinical practice guidelines [ 18 , 19 ]. Detailed information gathered about the lived experience may help guide the development of future suggestions for guidelines and treatments [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Living with ongoing whiplash associated disorders: a qualitative study of individual perceptions and experiences

Ritchie

Ehrlich

Sterling

2017

BMC Musculoskelet Disord

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BackgroundWhiplash associated disorders (WAD) are the most common non-hospitalised injury resulting from a motor vehicle crash. Approximately 50% of individuals with WAD experience on-going pain and disability. Results from intervention trials for individuals with chronic WAD are equivocal and optimal treatment continues to be a challenge. It may be that traditional quantitative measures included in treatment trials have not captured the full benefits patients experience through participation in an intervention. The aim of the present study was to explore participant subjective experiences and perceptions of living with on-going WAD.MethodsTwenty-seven individuals with chronic WAD participated in a one-on-one, semi-structured individual telephone interview. All interviews were audio-taped, transcribed verbatim and data were analysed using an inductive thematic analysis process.ResultsTwo themes emerged that described the experience of living with chronic WAD. First, all participants described navigating the healthcare system after their whiplash injury to help understand their injury and interpret therapeutic recommendations. Participants highlighted the need to ‘find the right healthcare practitioner (HCP)’ to help with this process. Many participants also described additional complexities in navigating and understanding healthcare incurred by interactions with compensation and funding systems. Second, participants described a journey of realisation, and the trial and error used to establish self-management strategies to both prevent and relieve pain. Participants described trying to understand the impact of their initial injury in relation to the gradual realisation that there may be on-going residual deficit. Seeking information from multiple sources, including personal experience gained through trial and error, was important in the search for acceptable management strategies.ConclusionRecovery from a whiplash injury is an adaptive process and more than elimination of pain or disability, therefore may be different from common clinical patient reported outcomes. Early identification of patient understandings of pain, expectations of recovery, symptoms and therapy may help merge patient and HCP understandings. Additionally, helping individuals to recognise symptom triggers and develop appropriate strategies to minimise triggers may actively engage patients in their recovery. Finally, acknowledgement and validation of the whiplash injury by HCPs is seen by many as a necessary step in the recovery process.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1882-9) contains supplementary material, which is available to authorized users.

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“…The OPTIMa Collaboration developed the guideline using the principles of patient‐centred care and the Ontario Health Technology Advisory Committee framework (Johnson et al, ). Specifically, we developed the evidence‐based recommendations according to the following: Overall clinical benefits (i.e., effectiveness and safety of interventions based on our systematic reviews) (Varatharajan et al, ); Value for money (i.e., cost‐effectiveness of interventions when available based on our systematic review); Consistency with expected societal and ethical values (including persons’ lived experiences with their treatment based on our qualitative research) (Lindsay, Mior, Côté, Carroll, & Shearer, ). …”

Section: Methodsmentioning

confidence: 99%

“…• Overall clinical benefits (i.e., effectiveness and safety of interventions based on our systematic reviews) ; • Value for money (i.e., cost-effectiveness of interventions when available based on our systematic review); • Consistency with expected societal and ethical values (including persons' lived experiences with their treatment based on our qualitative research) (Lindsay, Mior, Côté, Carroll, & Shearer, 2016).…”

mentioning

confidence: 99%

Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration

Côté

Shearer

et al. 2019

European Journal of Pain

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Objectives To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic). Methods This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain. Results When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low‐load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension‐type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated. Conclusions Our evidence‐based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation. Significance Neck pain and headaches are very common comorbidities in the population. Tension‐type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension‐type and cervicogenic headaches should be patient‐centred.

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Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry

Cited by 13 publications

References 48 publications

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

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

Living with ongoing whiplash associated disorders: a qualitative study of individual perceptions and experiences

Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration

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