Referral to specialist physiotherapists in the management of whiplash associated disorders: Perspectives of healthcare practitioners

Bandong, Aila Nica; Leaver, Andrew; Mackey, Martin; Sterling, Michele; Kelly, Joan; Ritchie, Carrie; Rebbeck, Trudy

doi:10.1016/j.msksp.2017.11.006

Cited by 16 publications

(12 citation statements)

References 35 publications

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“…Similarly, use of the website appeared to improve actual practice of specialist HCPs through the promotion of a shared care approach in managing people with WAD at medium and high risk of nonrecovery. This is in contrast to the results of a previous study where the same group of specialist HCPs preferred to provide direct treatment (60%) over shared care (22%) [43]. A shared care approach in management was perceived by primary HCPs to facilitate the referral process and recovery for people with WAD [43].…”

Section: Discussioncontrasting

confidence: 83%

“…This is in contrast to the results of a previous study where the same group of specialist HCPs preferred to provide direct treatment (60%) over shared care (22%) [43]. A shared care approach in management was perceived by primary HCPs to facilitate the referral process and recovery for people with WAD [43]. The strategies used to engage specialist HCPs along with the interactivity of the website may have contributed to the improvements in practice observed.…”

Section: Discussioncontrasting

confidence: 70%

“…Proceedings were audio-recorded, transcribed verbatim, and analyzed thematically [42]. Focus group methods have been described in detail elsewhere [43,44].…”

Section: Methodsmentioning

confidence: 99%

“…Specialist HCPs (n=20) were engaged through 2 targeted educational workshops. The content of the first educational workshop was based on results of a qualitative study, focusing on the role of specialist HCPs, management decisions for people with WAD at medium and high risk of nonrecovery, and effective communication with primary HCPs [43]. Key features and use of the website that facilitate the above were also discussed during the educational workshop.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation

Bandong¹,

Mackey²,

Leaver³

et al. 2019

JMIR Form Res

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Background Whiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management. Objective The study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process. Methods This study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice. Results The development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures. Conclusions A robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussioncontrasting

confidence: 70%

“…Proceedings were audio-recorded, transcribed verbatim, and analyzed thematically [42]. Focus group methods have been described in detail elsewhere [43,44].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation

Bandong¹,

Mackey²,

Leaver³

et al. 2019

JMIR Form Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Further, results of a study among injured workers showed that mandated risk assessment and early referral to psychologists of those at high-risk of delayed recovery improved outcomes and reduced costs [ 85 ]. A qualitative study exploring the perceptions of health professionals on WAD specialist referral also suggested that a standardised process for specialist review mandated by the insurers might promote good referral practices [ 86 ]. Another strategy could be to use WAD-specific standard reporting and referral forms, a strategy shown to improve compliance in other health populations [ 87 , 88 ].…”

Section: Discussionmentioning

confidence: 99%

Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Bandong

Leaver

Mackey

et al. 2018

BMC Health Serv Res

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BackgroundIn Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence.MethodsThis was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis.ResultsMedian time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5%) and most patients (90%) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9%); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8%); not using routine passive treatments (e.g. manual therapy, 94.0%); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8%). Over half of the claimants (59.0%) were referred to other professionals at 9–12 weeks post-injury, among which 31.2% were to psychologists and 68.8% to specialists (surgical specialists, 43.6%; WAD specialists, 20.5%). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01).ConclusionThere is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3439-5) contains supplementary material, which is available to authorized users.

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Agreement is very low between a clinical prediction rule and physiotherapist assessment for classifying the risk of poor recovery of individuals with acute whiplash injury

Kelly

Ritchie

Sterling

2019

Musculoskeletal Science and Practice

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Background: A prognostic clinical prediction rule (whiplash CPR) has been validated for use in individuals with acute whiplash associated disorders (WAD). The clinical utility of this tool is unknown.Objectives: To investigate: 1) the level of agreement between physiotherapist-and whiplash CPR-determined prognostic risk classification of people with acute WAD; 2) which clinical findings are used by physiotherapists to classify prognostic risk; and 3) whether physiotherapists plan to differ the number of treatment sessions provided based on prognostic risk classification. Design: Pragmatic, observationalMethod: 38 adults with acute WAD were classified as low, medium, or high risk of poor recovery by their treating physiotherapist (n=24) at the conclusion of the initial consultation. A weighted Cohen's kappa examined the agreement between physiotherapist estimated risk classification and the whiplash CPR. Physiotherapists' reasons for classification were provided and summarised descriptively. Kruskal-Wallis and post-hoc Dunn's tests compared projected number of treatment sessions between risk subgroups.Results: Physiotherapist agreement with the whiplash CPR occurred in 29% of cases (n=11/38), which was less than what is expected by chance (K= -0.03; 95%CI -0.17 to 0.12).Physiotherapists most frequently considered range of movement (n=23/38, 61%), a premorbid pain condition (n=14/38, 37%), response to initial physiotherapy treatment (n=12/38, 32%), and pain intensity (n=12/38, 32%) when classifying prognostic risk. The projected number of treatment sessions was not different between risk groups using classifications provided by the physiotherapists (χ 2 (2)=2.69, p=0.26).

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Referral to specialist physiotherapists in the management of whiplash associated disorders: Perspectives of healthcare practitioners

Cited by 16 publications

References 35 publications

An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation

An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation

Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Agreement is very low between a clinical prediction rule and physiotherapist assessment for classifying the risk of poor recovery of individuals with acute whiplash injury

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