Psychosocial interventions for the prevention of disability following traumatic physical injury

Silva, Mary De; MacLachlan, Malcolm; Devane, Declan; Desmond, Deirdre; Schnyder, Ulrich; Brennan, Mark A.; Patel, Vikram

doi:10.1002/14651858.cd006422.pub3

Cited by 24 publications

(25 citation statements)

References 76 publications

(44 reference statements)

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“…PTSD symptoms include intrusions of the traumatic event, avoidance of stimuli related to the event, emotional numbness, and hyperarousal [6]. Until now, efforts to prevent PTSD onset, for example, psychological debriefing, have been unsuccessful [7,8]. Early treatment of PTSD, or its precursor Acute Stress Disorder, with 4-5 sessions of trauma-focused cognitive behavioral therapy (CBT) was found to be effective in preventing chronic PTSD [9].…”

Section: Introductionmentioning

confidence: 99%

Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

Mouthaan¹,

Sijbrandij²,

Vries³

et al. 2013

J Med Internet Res

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BackgroundPosttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms.ObjectiveTo determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients.MethodsAdult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale—Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented.ResultsThe mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001).ConclusionsOur results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).

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Section: Introductionmentioning

confidence: 99%

Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

Mouthaan¹,

Sijbrandij²,

Vries³

et al. 2013

J Med Internet Res

View full text Add to dashboard Cite

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“…A recent Cochrane review found some evidence that identifying, targeting and monitoring patients at risk of poor outcome following a traumatic injury may reduce secondary disability. 12 The primary limitation of this study was in participant numbers. Higher numbers would have enabled the study to analyse outcomes based on different premorbid conditions.…”

Section: Discussionmentioning

confidence: 98%

“…This has been the subject of a Cochrane review. 12 Quantifying how the trauma itself may contribute to poorer outcomes may be harder to do. The use of simple tools such as the SF12, 13 a quick survey designed to assess mental and physical functioning, could give an early indication of those at risk of psychological distress.…”

Section: Introductionmentioning

confidence: 99%

The impact of preexisting disease on outcomes of simple orthopaedic trauma: A prospective cohort study

Quested

Wiltshire

Sommerville

et al. 2019

Journal of Orthopaedics, Trauma and Rehabilitation

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Background: This article describes a prospective cohort study trial which aims to determine what risk factors might be associated with increased levels of pain, disability and psychological distress following simple orthopaedic trauma. Methods: Patients were recruited from two large tertiary referral hospitals. Outcome measures were return to work, measurement of the visual analogue scale for pain and the SF 12 physical component score (PCS) and mental health component score. Results: Fifty-five participants were recruited. Overall, participants had significant improvement in their levels of pain, and all who were working before the injury returned to work. Those with a preexisting disease had a significantly lower ( p = 0.007) initial PCS with no significant changes in either mental health component score or PCS. Conclusions: Differences in outcomes were observed in patients with and without preexisting disease.

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“…Although all these ideas to help keep people healthy and employed are presented in the literature, little, if any, large-scale research has tested the effectiveness of these approaches to preventing disability. A few studies have tested strategies to prevent disability in specific populations (e.g., the frail elderly [9], people with back pain [5], individuals with traumatic injury [2], or people who have already had a medical-related work absence [15]); however, no studies to date have evaluated programs to prevent disability among currently working individuals with a wide spectrum of chronic mental and physical conditions.…”

Section: Preventing Disabilitymentioning

confidence: 99%

Working Well – The Texas Demonstration to Maintain Independence and Employment: 18-month outcomes

Bohman

Wallisch

Christensen

et al. 2011

Journal of Vocational Rehabilitation

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Uninsured working adults with chronic mental, behavioral and physical health conditions may have greater difficulty in accessing needed health care due to health care costs and crowded public health systems. Untreated medical conditions can lead to poorer health, which is linked to loss of employment and eventual applications for and receipt of federal benefits such as Supplemental Security Income and Social Security Disability Insurance (SSI/SSDI). The Working Well study was designed to determine whether a coordinated set of health benefits and employment supports could help low-income, working adults maintain their employment and remain independent of publicly funded disability assistance. Patients from the Harris County Hospital District, a large public health system providing indigent care in the Houston metroplex, were recruited and randomized to the intervention (N = 904) and control (N = 712) groups. The Working Well case management intervention included health navigation, employment/vocational supports, expedited appointments, free medications, and no co-pays for medical visits. Participant outcomes were measured through surveys, health claims data, and state agency employment data. Intervention group participants reported greater access to care, greater likelihood of outpatient medical visits and less likelihood of receiving SSI/SSDI benefits. These findings suggest that public health care systems can provide disability prevention programs, improve access to care and reduce reliance on publicly funded disability assistance.

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Psychosocial interventions for the prevention of disability following traumatic physical injury

Cited by 24 publications

References 76 publications

Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

The impact of preexisting disease on outcomes of simple orthopaedic trauma: A prospective cohort study

Working Well – The Texas Demonstration to Maintain Independence and Employment: 18-month outcomes

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