The ROARI project – Road Accident Acute Rehabilitation Initiative: a randomised clinical trial of two targeted early interventions for road-related trauma

Objectives: To determine the effectiveness of an Early Rehabilitation Intervention (ERI ) versus a Brief Education Intervention (BEI) following road trauma. Primary objective: return to work or usual activities at 12 weeks (for minor/moderate injury) and 24 weeks for major injury. Secondary objectives: Reduction in pain, anxiety, depression, disability and incidence of Post Traumatic Stress Disorder and improved quality of life. Design: A multi-site single-blinded stratified randomized clinical trial (RCT). Methods: 184 patients (92 in each arm) were recruited over 18 months and followed for 12 weeks (minor/moderate injury) and 24 weeks (major injury). Screening questionnaires at 2-4 weeks and follow-up interviews by phone for all outcome measures were undertaken. For those in the ERI group with a positive screen for high risk of persistent symptoms, an early assessment and intervention by a Rehabilitation Physician was offered. Those in the BEI group were sent written information and advised to see their GP. Results: 89.4% of injuries were mild in this cohort. At 12 weeks 73.8% and 69.1% of patients in the ERI and the BEI groups respectively had returned to work or usual activities. There were no significant differences between the two intervention groups with respect to the primary or any secondary outcome measures. Conclusion: This is the first RCT of an ERI following road trauma in Australia. A targeted ERI is as effective as a BEI in assisting those with mild/moderate trauma to return to work or usual activities.

[1]  S. Faux,et al.  Outcomes of motor vehicle crashes with fracture: a pilot study of early rehabilitation interventions. , 2014, Journal of rehabilitation medicine.

[2]  M. Grotle,et al.  Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease , 2013, BMC Musculoskeletal Disorders.

[3]  R. Bryant,et al.  Stepped early psychological intervention for posttraumatic stress disorder, other anxiety disorders, and depression following serious injury. , 2012, Journal of traumatic stress.

[4]  B. Amatya,et al.  Systematic review of multidisciplinary rehabilitation in patients with multiple trauma , 2012, The British journal of surgery.

[5]  D. Boisson,et al.  Return to work following road accidents: factors associated with late work resumption. , 2011, Journal of rehabilitation medicine.

[6]  R. McClure,et al.  Bio-psychosocial determinants of persistent pain 6 months after non-life-threatening acute orthopaedic trauma. , 2010, The journal of pain : official journal of the American Pain Society.

[7]  Etienne Javouhey,et al.  Functional outcome after road-crash injury: description of the ESPARR victims cohort and 6-month follow-up results. , 2010, Accident; analysis and prevention.

[8]  T. Kroll,et al.  Beyond the Evidence‐Based Practice Paradigm to Achieve Best Practice in Rehabilitation Medicine: A Clinical Review , 2009, PM & R : the journal of injury, function, and rehabilitation.

[9]  G. Geffen,et al.  Emergency Department Assessment of Mild Traumatic Brain Injury and the Prediction of Postconcussive Symptoms: A 3‐Month Prospective Study , 2009, The Journal of head trauma rehabilitation.

[10]  M. Richardson,et al.  Predictors of Moderate or Severe Pain 6 Months After Orthopaedic Injury: A Prospective Cohort Study , 2009, Journal of orthopaedic trauma.

[11]  S. Wessely,et al.  Does Psychoeducation Help Prevent Post Traumatic Psychological Distress? , 2008, Psychiatry.

[12]  C. Maher,et al.  A Systematic Review of the Predictive Ability of the Orebro Musculoskeletal Pain Questionnaire , 2008, Spine.

[13]  Jane M. Young,et al.  The Effect of Compensation on General Health in Patients Sustaining Fractures in Motor Vehicle Trauma , 2008, Journal of orthopaedic trauma.

[14]  L. Connelly,et al.  The economic costs of road traffic crashes: Australia, states and territories. , 2006, Accident; analysis and prevention.

[15]  F. Cicuttini,et al.  OUTCOMES OF PATIENTS WITH ORTHOPAEDIC TRAUMA ADMITTED TO LEVEL 1 TRAUMA CENTRES , 2006, ANZ journal of surgery.

[16]  B. Löwe,et al.  A brief measure for assessing generalized anxiety disorder: the GAD-7. , 2006, Archives of internal medicine.

[17]  J. Ponsford.  Rehabilitation interventions after mild head injury , 2005, Current opinion in neurology.

[18]  A. Tricco,et al.  A systematic review of treatments for mild traumatic brain injury , 2005, Brain injury.

[19]  Antoni Serrano-Blanco,et al.  Assessing depression in primary care with the PHQ-9: Can it be carried out over the telephone? , 2005, Journal of General Internal Medicine.

[20]  J. Powell,et al.  The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial. , 2005, Archives of physical medicine and rehabilitation.

[21]  L. D. De Souza,et al.  Early Intervention for the Management of Acute Low Back Pain: A Single-Blind Randomized Controlled Trial of Biopsychosocial Education, Manual Therapy, and Exercise , 2004, Spine.

[22]  Joseph A Kufera,et al.  Life-altering outcomes after lower extremity injury sustained in motor vehicle crashes. , 2004, The Journal of trauma.

[23]  J. Brazier,et al.  A comparison of the EQ-5D and SF-6D across seven patient groups. , 2004, Health economics.

[24]  F. Keefe,et al.  Psychological aspects of persistent pain: current state of the science. , 2004, The journal of pain : official journal of the American Pain Society.

[25]  B. Koes,et al.  Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. , 2003, The Cochrane database of systematic reviews.

[26]  S. Linton,et al.  Early Identification of Patients at Risk of Developing a Persistent Back Problem: The Predictive Validity of The Örebro Musculoskeletal Pain Questionnaire , 2003, The Clinical journal of pain.

[27]  C. Stevenson,et al.  The burden of disease and injury in Australia. , 2001, Bulletin of the World Health Organization.

[28]  C. Paniak,et al.  A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. , 2000, Brain injury.

[29]  D. Koren,et al.  Acute stress response and posttraumatic stress disorder in traffic accident victims: a one-year prospective, follow-up study. , 1999, The American journal of psychiatry.

[30]  M F Swiontkowski,et al.  Return to work following injury: the role of economic, social, and job-related factors. , 1998, American journal of public health.

[31]  C. Watkins,et al.  Estimating total Barthel scores from just three items: the European Stroke Database 'minimum dataset' for assessing functional status at discharge from hospital. , 1998, Age and ageing.

[32]  E. Nickel,et al.  Validity of the CAGE questionnaire in screening for alcohol dependence in a walk-in (triage) clinic. , 1995, Journal of studies on alcohol.

[33]  D. Mayfield,et al.  The CAGE questionnaire: validation of a new alcoholism screening instrument. , 1974, The American journal of psychiatry.

[34]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[35]  S. Schug,et al.  APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute Pain Management: Scientific Evidence , 2010 .

[36]  Graham Turpin,et al.  A randomised controlled trial of the effectiveness of writing as a self-help intervention for traumatic injury patients at risk of developing post-traumatic stress disorder. , 2009, Behaviour research and therapy.

[37]  A. Prins,et al.  Identifying PTSD in primary care: comparison of the Primary Care-PTSD screen (PC-PTSD) and the General Health Questionnaire-12 (GHQ). , 2008, Journal of anxiety disorders.

[38]  M. Sullivan,et al.  A psychosocial risk factor--targeted intervention for the prevention of chronic pain and disability following whiplash injury. , 2006, Physical therapy.

[39]  B. Koes,et al.  Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. , 2000, The Cochrane database of systematic reviews.

[40]  M. Barnes,et al.  Rehabilitation after traumatic brain injury. , 1999, British medical bulletin.