Psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis

High level of post-traumatic stress symptoms in patients with chronic neck pain is associated with poor mental health but does not moderate the outcome of a multimodal physiotherapy programme

INTRODUCTION

Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups.

METHODS

Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months.

RESULTS

115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group.

CONCLUSION

For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention.

Community support for injured patients: A scoping review and narrative synthesis

BACKGROUND

Community-based peer support (CBPS) groups have been effective in facilitating access to and retention in the healthcare system for patients with HIV/AIDS, cancer, diabetes, and other communicable and non-communicable diseases. Given the high incidence of morbidity that results from traumatic injuries, and the barriers to reaching and accessing care for injured patients, community-based support groups may prove to be similarly effective in this population.

OBJECTIVES

The objective of this review is to identify the extent and impact of CBPS for injured patients.

ELIGIBILITY

We included primary research on studies that evaluated peer-support groups that were solely based in the community. Hospital-based or healthcare-professional led groups were excluded.

EVIDENCE

Sources were identified from a systematic search of Medline / PubMed, CINAHL, and Web of Science Core Collection.

CHARTING METHODS

We utilized a narrative synthesis approach to data analysis.

RESULTS

4,989 references were retrieved; 25 were included in final data extraction. There was a variety of methodologies represented and the groups included patients with spinal cord injury (N = 2), traumatic brain or head injury (N = 7), burns (N = 4), intimate partner violence (IPV) (N = 5), mixed injuries (N = 5), torture (N = 1), and brachial plexus injury (N = 1). Multiple benefits were reported by support group participants; categorized as social, emotional, logistical, or educational benefits.

CONCLUSIONS

Community-based peer support groups can provide education, community, and may have implications for retention in care for injured patients.

The importance of self-regulation and mental health for effective recovery after traffic injuries: A comprehensive network analysis approach

OBJECTIVE

Traffic injuries significantly impact people's psychological, physical and social wellbeing, and involve complex self-regulation responses. Psychological impacts are seldom recognized and addressed holistically. This study employs network analysis to investigate the interconnectedness between different dimensions that influence mental health vulnerability and recovery after traffic injuries.

METHODS

120 adults with mild-to-moderate traffic injuries and 112 non-injured controls were recruited. The network investigation employed two main approaches. Four cross-sectional networks examined the interrelationships between self-regulation responses (cognitive and autonomic) and various health dimensions (psychological, physical, social) over time (1, 3, 6, 12 months). Three predictive networks explored influences of acute self-regulation responses (1 month) on long-term outcomes. Network analyses focused on between-group differences in overall connectivity and centrality measures (nodal strength).

RESULTS

An overall measure of psychological wellbeing consistently emerged as the most central (strongest) node in both groups' networks. Injured individuals showed higher overall connectivity and differences in the centrality of self-regulation nodes compared to controls, at 1-month and 12-months post-injury. These patterns were similarly observed in the predictive networks, including differences in cognitive and autonomic self-regulation influences.

CONCLUSIONS

Network analyses highlighted the crucial role of psychological health and self-regulation, in promoting optimal wellbeing and effective recovery. Post-traffic injury, increased connectivity indicated prolonged vulnerability for at least a year, underscoring the need of ongoing support beyond the initial improvements. A comprehensive approach that prioritizes psychological health and self-regulation through psychologically informed services, early psychological screening, and interventions promoting cognitive and autonomic self-regulation is crucial for mitigating morbidity and facilitating recovery.

TRIAL REGISTRATION

IMPRINT study, ACTRN 12616001445460.

Subjective and Objective Improvement in a 39-Year-Old Male Suffering From Severe Chronic Pain and Disability Using Chiropractic BioPhysics® Protocols Following Rear-Impact Motor Vehicle Crash With a 10-Month Long-Term Follow-Up

We present the case of a patient receiving structural rehabilitation following a rear-impact motor vehicle collision (MVC). Medications did not alleviate the symptoms of the crash injuries. Resolution of injury-caused pain and disability was found following postural and structural rehabilitation treatment. A 39-year-old male was injured in a rear-impact collision between two very large vehicles. Severe migraine headaches, neck pain, and radiculopathy, as well as lower back pain, were the result of the crash. Patient-reported outcomes (PROs) demonstrated that the symptoms were causing severe disability and poor health-related quality of life (HRQoL) measures. Radiographs found spine alignment abnormalities consistent with rear impact MVC. Chiropractic Biophysics® (CBP®) structural rehabilitation was performed. Following a treatment regimen involving strengthening weakened and damaged muscles, postural and spinal traction, postural spinal manipulative therapy (SMT), and home therapies resulted in the resolution of the symptoms. All outcome measures demonstrated improvement, including Short-Form 36 question health questionnaire (SF-36), quadruple visual analog scale (QVAS), headache disability index (HDI), neck disability index (NDI), revised Oswestry disability index (RODI), as well as significant measured improvements found on radiographs. Spine pain and altered alignment are frequent results of MVCs. If left uncorrected, these abnormalities increase the likelihood of chronic pain and disability. Combined low back pain (LBP), neck pain (NP), headache (HA), and radiculopathy, as found in our subject, significantly pre-dispose the individual to poor HRQoL, years lived with disability (YLDs) and increased the global burden of disease (GBD). Physicians who treat injured patients should have a repeatable, reliable, valid, and efficacious method to reduce pain, increase range of motion (ROM), improve spine alignment, and improve the performance of activities of daily living (ADLs). Further, larger studies of injured patients are necessary to determine if the CBP® protocol reduces GBD caused by MVC injuries.

Objectively and subjectively measured physical activity levels in individuals with whiplash associated disorder and aged-matched healthy controls

BACKGROUND

Whiplash associated disorders (WAD) are the most common non-hospitalised injuries resulting from a motor vehicle crash. Half of individuals with WAD experience ongoing pain and disability. Furthermore, individuals with persistent WAD have lower levels of aerobic capacity and isometric strength compared with age-matched controls. It is not known whether these differences are associated with increased levels of pain and disability, or with reduced physical activity (PA) participation.

OBJECTIVE

Our primary aim was to compare PA levels in individuals with persistent WAD with healthy controls. Secondary aims were to: compare objective and subjective measurements of PA; explore factors that may influence PA; and describe proportions of these populations meeting World Health Organisation PA guidelines.

METHODS

Objective (ActiGraph accelerometer; seven days) and subjective (International Physical Activity Questionnaire (IPAQ)) PA data were collected for n = 53 age-matched participants (WAD n = 28; controls n = 25).

RESULTS

Independent sample t-tests showed no significant difference in objectively measured PA (p>0.05) between WAD and controls. For the subjective measure (IPAQ), controls reported more overall weekly PA (t = 0.219, p<0.05), while WAD participants reported more weekly walking minutes (t = -0.712, p<0.05). Linear regression showed mental health quality-of-life predicted objectively measured moderate intensity PA (R2 = 0.225, F (2, 44) = 6.379, p<0.004) and subjectively reported overall PA (R2 = 0.132, F (1, 41) = 6.226, p<0.017). Bland-Altman analyses indicated that subjects over-reported MVPA and under-reported sedentary time using the IPAQ.

CONCLUSIONS

Individuals with WAD had levels of physical and mental health quality-of-life significantly lower than controls and below population norms yet participated in similar levels of PA. Given that increased perceptions of mental health quality-of-life were positively associated with objectively measured MVPA and subjectively reported overall PA, strategies to help people with WAD achieve adequate doses of MVPA may be beneficial. ActiGraph-measured and IPAQ-reported PA were discordant. Hence, IPAQ may not be a reliable measure of habitual PA in WAD.

Determinants of post-traumatic stress disorder among survivors of road traffic accidents in dessie comprehensive specialized hospital North-East Ethiopia

BACKGROUND

Post-traumatic stress disorder is the most common mental disorder occurring among survivors of road traffic accidents. However, it remains under-explored and is not taken into account in the health policies of Ethiopia. Therefore, this study aimed to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident patients in Dessie Comprehensive Specialized Hospital, North-East Ethiopia.

METHODS

A facility-based unmatched case-control study design was employed from February 15 to April 25, 2021, in Dessie Comprehensive Specialized Hospital, with a total sample size of 139 cases and 280 controls selected by using a simple random sampling technique. Data were collected by pretested, interview with a structured questionnaire. The data were entered using Epi-Info, then exported and analyzed using STATA. The bi-variable and multivariable binary logistic regression model was used to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident. Adjusted odds ratio with a 95% confidence level was used as a measure of association. Variables with a p-value less than 0.05 were considered as statistically significant.

RESULT

A total of 135 cases and 270 controls participated in this study, with a response rate of 97% and 96%, respectively. In the final multivariable analysis, being male [AOR = 0.43, 95% CI: 0.32-0.99], primary educational status [AOR = 3.4, 95% CI: 1.04-11], presence of personal psychiatric history [AOR = 2.12, 95% CI: 1.17-3.92], presence of fracture [AOR = 2.41, 95% CI: 1.2-4.8], witness of death [AOR = 2.25, 95% CI: 1.26-4.30], presence of comorbidity [AOR = 2.29, 95% CI: 1.28-4], good social support [AOR = 0.71, 95% CI: 0.12-0.68] were significantly associated with post-traumatic stress disorder among survivors of road traffic accident patients.

CONCLUSION

PTSD following road traffic accidents is common. A multi-disciplinary approach was therefore essential in the management of road traffic accident survivors at the orthopedic and trauma clinics. Patients with poor social support, bone fracture, witnessed death, comorbidity, and females should be routinely screened for post-traumatic stress disorder in all road traffic accident survivors.

A systematic review shows minimal evidence for measurement properties of psychological functioning outcomes in whiplash

OBJECTIVES

The aim of this study was to systematically identify, synthesize, and appraise studies on the measurement properties of patient-reported outcome measures (PROMs) for anxiety, depression, fear of movement, pain catastrophizing, post-traumatic stress, self-efficacy, and stress in people with whiplash-associated disorders (WAD).

STUDY DESIGN AND SETTING

PsycINFO, MEDLINE, EMBASE, CINAHL, PILOTS, Web of Science, and Scopus were searched (November 9, 2021). Studies evaluating any measurement property of relevant PROMs in WAD were included. Two reviewers independently screened the studies and assessed the measurement properties in accordance with the COSMIN guidelines.

RESULTS

Measurement properties of 10 PROMs were evaluated in WAD: Pictorial Fear of Activity Scale-Cervical (PFActS-C), Tampa Scale of Kinesiophobia-11, Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), PSEQ-4 item, PSEQ-2a, PSEQ-2b, Self-Efficacy Scale, Harvard Trauma Questionnaire, and Post-Traumatic Stress Diagnostic Scale. Content validity was not examined in any of these PROMs in whiplash. Moderate- or high-quality evidence showed adequate internal structure for the PSEQ, PCS, and PFActS-C, whereas the original structures of the remaining seven PROMs were not confirmed in whiplash.

CONCLUSION

Until further research on the measurement properties of these PROMs is available, researchers may opt to use the PSEQ, PCS, or PFActS-C if the construct is aligned with research aims.

Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study

BACKGROUND

Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery.

METHODS

This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery.

RESULTS

The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039).

CONCLUSIONS

Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.

Effects of acute pain medications on posttraumatic stress symptoms in early aftermath of trauma

Posttraumatic stress symptoms (PTSS) develop as sequelae from traumatic injuries. Limited studies suggest that using opioids to reduce acute pain immediately after trauma may also reduce subsequent PTSS, but other pain medications rarely have been examined for preventing acute PTSS. The current study examined the effects of commonly used pain medications, opioid and nonsteroidal anti-inflammatory drugs (NSAIDs), on PTSS after acute traumatic injuries. Participants ( n = 71) were categorized into opioid or NSAID group according to their medical records and self-reported medication use. Their PTSS were assessed using posttraumatic stress disorder checklist twice within 2 weeks after trauma. Participants' pain levels reduced from pretreatment to follow-up in both groups, F (1, 55) = 6.696, P = 0.012, partial η 2 = 0.109. Interestingly, a significant interaction between time and medication group on PTSS reached statistical significance, F (1, 69) = 6.014, P = 0.017, partial η 2 = 0.080. Follow-up analyses revealed that this interaction was driven by a significant PTSS reduction only in opioid but not in NSAID group. These findings suggested that pain reduction alone is not sufficient to reduce acute PTSS in the NSAID group, highlighting the need to continue further investigations into the mechanisms by which opioids reduce PTSS in the early posttrauma period.

International comparison of injury care structures, processes, and outcomes between integrated trauma systems in Québec, Canada, and Victoria, Australia

BACKGROUND

Quality improvement activities in trauma systems are widely based on comparisons between trauma centers within the same system. Comparisons across different trauma systems may reveal further opportunities for quality improvement.

OBJECTIVES

This study aimed to compare the integrated trauma systems in Québec, Canada and in Victoria, Australia, regarding their structures, care processes and patient outcomes.

METHODOLOGY

The elements recommended by the American College of Surgeons were used to compare trauma systems structures. Comparisons of care processes and patient outcomes were based on data from major trauma admissions extracted from trauma registries (2013 and 2017). Care processes included time to reach a definitive care facility, time spent in the emergency department, and time lapsed before the first head computed tomography (CT) scan. These care processes were compared using a z-test of log-transformed times. Hospital mortality and hospital length of stay (LOS) were compared using indirect standardization based on multiple logistic and linear regression.

RESULTS

Major differences in trauma system structure were Advanced Trauma Life Support at the scene of injury (Victoria), the use of validated prehospital triage tools (Québec), and mandatory accreditation of all trauma centers (Québec). Patients in Québec arrived at their definitive care hospital earlier than their counterparts in Victoria (median: 1.93 vs. 2.13 h, p = 0.002), but spent longer in the emergency department (median: 8.23 vs. 5.15 h, p<0.0001) and waited longer before having their first head CT (median: 1.90 vs. 1.52 h, p<0.0001). In-hospital mortality and hospital LOS were higher in Québec than in Victoria (standardized mortality ratio: 1.15, 95% CI: 1.09 - 1.20; standardized LOS ratio: 1.10, 95% CI: 1.09 - 1.11).

CONCLUSION

We observed important differences in the structural components and care processes in Québec and Victoria's trauma systems, which might explain some of the observed differences in patient outcomes. This study shows the potential value of international comparisons in trauma care and identifies possible opportunities for quality improvement.

Factors associated with long term work incapacity following a non-catastrophic road traffic injury: analysis of a two-year prospective cohort study

Background

Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain).

Methods

Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to ‘any’ or ‘full duties’ paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates.

Results

Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury.

Conclusions

Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW.

Trial registration

This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752).

Acupuncture Analgesia in Patients With Traumatic Rib Fractures: A Randomized-Controlled Trial

Pain management for traumatic rib fracture is important to prevent complications and reduce associated comorbidities. This trial investigated the analgesic efficacy of acupuncture on traumatic rib fracture. Patients with traumatic rib fracture were randomly assigned to traditional acupuncture (TA), laser acupuncture (LA) or sham laser acupuncture (SLA) groups in a 1:1:1 ratio. The intervention was performed on days 1 to 3 after treatment allocation. The acupoints included bilateral LI4 (Hegu), SJ6 (Zhigou), ST36 (Zusanli) and GB34 (Yanglingquan). The primary outcome was Numeric Rating Scale (NRS) scores for pain after the intervention. Secondary outcomes included sustained maximal inspiration (SMI) lung volume, stress responses, the use of analgesics, and associated complications. Data were analyzed via one-way analysis of variance (ANOVA) with Scheffé's post hoc testing or chi-squared testing. Of the 120 study participants, 109 completed all interventions and measurements. The primary outcomes, which indicated average pain intensity levels and pain while deep breathing, were both significantly lower in the TA and LA groups than in the SLA group after 2 treatments. No between-group differences were observed in SMI lung volume, stress response, analgesics use or associated complications. These findings suggest that TA and LA are safe and effective analgesic modalities for pain management for traumatic rib fracture.

Clinical Trial Registration

[ClinicalTrials.gov], identifier [NCT03822273].

How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment

Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: -0.07; 95% confidence interval [CI]: -0.11, -0.04) and catastrophizing (IE: -0.07; 95%CI: -0.14, -0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: -0.11, -0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: -0.31, -0.03) and psychological flexibility (IE: -0.30; 95%CI: -0.41, -0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.

Psychological therapy using virtual reality for treatment of driving phobia: a systematic review

PURPOSE

Driving phobia is prevalent in injured individuals following motor vehicle crashes (MVCs). The evidence for virtual reality (VR) based psychological treatments for driving phobia is unknown. This systematic review synthesized the available evidence on the effectiveness, feasibility, and user experience of psychological treatments for driving phobia using VR.

METHODS

Three databases (PsycINFO, SCOPUS, and PubMed) were searched. Eligibility criteria included adults with clinical or sub-clinical levels of driving phobia manifesting as part of an anxiety disorder or post-traumatic stress disorder (PTSD). Primary outcomes were driving-related anxiety/fear or avoidance, PTSD symptoms and driving frequency/intensity, as well as treatment feasibility including recruitment, treatment completion and retention rates, user experience and immersion/presence in the VR program. Secondary outcomes were other health outcomes (e.g., depression) and VR technological features.

RESULTS

The 14 included studies were of low methodological quality. Clinical and methodological heterogeneity prevented quantitative pooling of data. The evidence provided in this review is limited by trials with small sample sizes, and lack of diagnostic clarity, controlled designs, and long-term assessment. The evidence did suggest that VR-based psychological interventions could be feasible and acceptable in this population.

CONCLUSIONS

For VR-based psychological interventions to be recommended for driving phobia, more high-quality trials are needed. Implications for rehabilitationVirtual reality (VR) based psychological treatments may be feasible and acceptable to patients with driving phobia.There is potential to increase accessibility to psychological therapies in patients with driving phobia following motor vehicle crashes through the use of digital psychiatry such as VR.

A randomized controlled trial of the influence of yoga for women with symptoms of post-traumatic stress disorder

Background

Survivors in motor vehicle accident (MVA) may have posttraumatic stress disorder (PTSD). Yoga is a complementary approach for PTSD therapy.

Methods

This randomized controlled trial explored whether yoga intervention has effects on reducing the symptoms of PTSD in women survived in MVA. Participants (n = 94) were recruited and randomized into control group or yoga group. Participants attended 6 45-minuite yoga sessions in 12 weeks. Depression Anxiety Stress Scales (DASS) and Impact of Events Scale-Revised (IES-R) were used to assess psychological distress.

Results

Post-intervention IES-R total score of yoga group was significantly lower than that of control group (p = 0.01). At both post-intervention and 3-months post intervention, the DASS-21 total scores of yoga group were both significantly lower than those of control group (p = 0.043, p = 0.024). Yoga group showed lower anxiety and depression level compared to control group at both post-intervention (p = 0.033, p < 0.001) and post-follow-up (p = 0.004, p = 0.035). Yoga group had lower levels of intrusion and avoidance compared to control group after intervention (p = 0.002, p < 0.001).

Conclusion

Results illustrate that yoga intervention may alleviate anxiety and depression and improve the symptoms of PTSD in women with PTSD following MVA.

Changes in esophagus interstitial cells of Cajal in response to acute stress

BACKGROUND

Thoracic trauma is common, and traffic accident-related traumatic injury can cause acute stress leading to esophageal motility disorders. Interstitial cells of Cajal (ICCs) are regarded as gastrointestinal pacemaker cells.

AIM

This study explored the mechanism underlying changes in lower esophagus ICCs under acute stress conditions.

METHODS

Fifty adult rabbits, randomly divided into one healthy control and four study groups, were subjected to right chest puncture using a Hopkinson bar. Thereafter, one group was immediately subjected to lower esophagectomy, whereas the other three groups were maintained for 24, 48 and 72 h after puncture and subjected to lower esophagectomy. Immunohistochemistry was used to detect ICC distribution, morphology and density, and TUNEL assays were used to determine ICC apoptosis. Enzyme-linked immunosorbent assays (ELISAs) were used to measure cortisol, epinephrine, dopamine, IL-9, cholecystokinin (CCK) and vasoactive intestinal peptide (VIP). Western blotting and RT-PCR were performed to detect changes in SCF/c-kit and nNOS pathways.

RESULTS

After puncture, lung tissue was hemorrhaged, alveoli in puncture areas were destroyed, esophageal pH was decreased, and serum cortisol, epinephrine and dopamine levels increased. ICC numbers increased and apoptotic ICCs decreased in all stress groups after puncture (all p < .01). IL-9, CCK and VIP levels in lower esophagus tissue were increased after puncture (all p < .01). Moreover, SCF/c-kit and nNOS pathways were upregulated in response to stress (all p < .01).

CONCLUSIONS

Acute stress promotes increases in lower esophageal ICCs that might affect esophagus ICC functions and esophageal motility.

A survey-based review of psychology provision in major trauma centres (MTCs) in England

Introduction

Following major trauma, individuals frequently experience psychological or neuropsychological consequences of their injuries. Clinical psychologists are well-placed to provide support for these individuals and the multidisciplinary teams that work with them. It is currently unclear as to the level of psychology provision in major trauma centres (MTCs), and the input they can provide. This study therefore aimed to identify psychology provision in major trauma centres in England to facilitate discussion and support service development.

Method

Electronic surveys were distributed via a mailing list to psychologists in MTCs to gather data on the role and resource of psychology provision in major trauma centres in England. Data were analysed quantitatively and qualitatively.

Results

Psychologists from 21/40 MTCs in England responded. Significant gaps in psychology service provision were found across all services, including not being able to provide consistent input throughout the week and not being able to provide a combination of assessment, formulation and intervention, amongst others. Common barriers to providing psychology input included lack of integration into multidisciplinary teams and reduced knowledge of patient transfers, underpinned by staff resource. These issues also contributed to psychologists in MTCs limiting the types of referrals they accept.

Conclusions

Psychology is presently under-resourced in MTCs in England, particularly in services for children. Recommendations for major trauma psychology roles and level of resource need to be provided in national service specifications in order improve service delivery and prioritise psychosocial outcomes of individuals with potentially life-changing injuries.

Barriers and Facilitators Associated with Return to Work Following Minor to Serious Road Traffic Musculoskeletal Injuries: A Systematic Review

Purpose To identify factors impeding or facilitating Return to Work (RTW) after minor to serious musculoskeletal Road Traffic Injuries (RTI). Methods Six electronic databases were searched for studies published 1997-2020. Quantitative and qualitative studies were included if they investigated barriers or facilitators associated with RTW in people with minor to serious musculoskeletal RTI aged over 16 years. Methodological quality was assessed using McMaster Critical Review Form for Quantitative studies and McMaster Critical Review Form for Qualitative Studies. Results are presented narratively as meta-analysis was not possible. Results Eleven studies (10 quantitative and 1 qualitative) were included. There was strong evidence that individuals with higher overall scores on the (short-form or long-form) Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) at baseline were less likely to RTW, and individuals with higher RTW expectancies at baseline were more likely to RTW after musculoskeletal RTI. There was weak evidence for higher disability levels and psychiatric history impeding RTW after musculoskeletal RTI. Conclusions Post-injury scores on the ÖMPQ and RTW expectancies are the most influential factors for RTW after minor to serious musculoskeletal RTI. There is a need to identify consistent measures of RTW to facilitate comparisons between studies.

Effects of seeking compensation on the psychological health and recovery of injured patients: the role of stress vulnerability and injury-related disability

BACKGROUND

Seeking compensation has been shown to have an adverse effect on the psychological health and recovery of injured patients, however, this effect requires clarification.

METHODS

A total of 2019 adults sustaining a traffic injury were recruited. Of these, 709 (35.1%) lodged a compensation claim. Interviews occurred at 1-, 6- and 12-month post-injury. Outcomes were psychological distress (posttraumatic stress (PTS) and depressive symptoms) and health-related functioning (HrF) (quality of life measured by EQ-5D-3L and disability by WHODAS) over 12-months post-injury. Covariates included individual stress vulnerability (preinjury, injury-related factors).

RESULTS

Compared with non-compensation participants, compensation groups had higher stress vulnerability (more severe injuries and negative reactions) and poorer baseline outcomes (psychological health and HrF). After adjustment, we found an effect of compensation on HrF [β-0.09 (-0.11 to -0.07), p < 0.001] and PTS [β = 0.36 (0.16 to 0.56), p = 0.0003], but not on depression [β = -0.07 (-0.42 to 0.28), p = 0.7]. Both groups improved over time. Vulnerable individuals (β = 1.23, p < 0.001) and those with poorer baseline outcomes (PTS: β = 0.06, p = 0.002; HrF: β = -1.07, p < 0.001) were more likely to lodge a claim. In turn, higher stress vulnerability, poor baseline outcomes and claiming compensation were associated with long-term psychological distress and HrF. Nevertheless, concurrent HrF in the model fully accounted for the compensation effect on psychological distress (β = -0.14, p = 0.27), but not vice versa.

CONCLUSIONS

This study provides convincing evidence that seeking compensation is not necessarily harmful to psychological health. The person's stress vulnerability and injury-related disability emerge as major risk factors of long-term psychological distress, requiring a whole-systems approach to address the problem.

A Description-Experience Framework of the Psychology of Risk

The modern world holds countless risks for humanity, both large-scale and intimately personal—from cyberwarfare, pandemics, and climate change to sexually transmitted diseases and drug use and abuse. Many risks have prompted institutional, regulatory, and technological countermeasures, the success of which depends to some extent on how individuals learn about the risks in question. We distinguish between two powerful but imperfect teachers of risk. First, people may learn by consulting symbolic and descriptive material, such as warnings, statistics, and images. More often than not, however, a risk’s fluidity defies precise description. Second, people may learn about risks through personal experience. Responses to risk can differ systematically depending on whether people learn through one mode, both, or neither. One reason for these differences—and by no means the only reason—is the discrepancy in the cognitive impact that rare events (typically the risk event) and common events (typically the nonoccurrence of the risk event) have on the decision maker. We propose a description–experience framework that highlights not only the impact of each mode of learning but also the effects of their interplay on individuals’ and collectives’ responses to risk. We outline numerous research questions and themes suggested by this framework.

Determinants of long-term unplanned readmission and mortality following self-inflicted and non-self-inflicted major injury: a retrospective cohort study

PURPOSE

To describe the characteristics of major injury and identify determinants of long-term unplanned readmission and mortality after self-inflicted and non-self-inflicted injury to inform potential readmission screening.

METHOD

A retrospective cohort study of 11,269 individuals aged ≥ 15 years hospitalised for a major injury during 2013-2017 in New South Wales, Australia. Unplanned readmission and mortality up to 27-month post-injury were examined. Logistic regression was used to examine predictors of unplanned readmission.

RESULTS

During the 27-month follow-up, 2700 (24.8%) individuals with non-self-inflicted and 98 (26.1%) with self-inflicted injuries had an unplanned readmission. Individuals with an anxiety-related disorder and a non-self-inflicted injury who were discharged home were three times more likely (OR: 3.27; 95%CI 2.28-4.69) or if they were discharged to a psychiatric facility were four times more likely (OR: 4.11; 95%CI 1.07-15.80) to be readmitted. Compared to individuals aged 15-24 years, individuals aged ≥ 65 years were 3 times more likely to be readmitted (OR 3.12; 95%CI 2.62-3.70). Individuals with one (OR 1.60; 95%CI 1.39-1.84) or ≥ 2 (OR 1.88; 95%CI 1.52-2.32) comorbidities, or who had a drug-related dependence (OR 1.88; 95%CI 1.52-2.31) were more likely to be readmitted. The post-discharge age-adjusted mortality rate following a self-inflicted injury (35.6%; 95%CI 29.9-41.8) was higher than for individuals with a non-self-inflicted injury (11.0%; 95%CI 10.4-11.8).

CONCLUSIONS

Unplanned readmission after injury is associated with injury intent, age, and comorbid health. Screening for anxiety and drug-related dependence after major injury, accompanied by service referrals and post-discharge follow-up, has potential to prevent readmission.

The contribution of pre-injury vulnerability to risk of psychiatric morbidity in adults injured in a road traffic crash: Comparisons with non-injury controls

People who sustain injury in a road traffic crash (RTC) have significant risk of psychiatric morbidity, but effective screening for identifying at-risk individuals soon after the RTC is lacking. We investigated whether pre-injury vulnerability can assist as an early screen to manage this risk. We recruited 120 adults who sustained physical injury in a RTC and admitted to an emergency department (ED). They were comprehensively assessed for acute and long-term presence of psychiatric disorder/morbidity and disability over 12-months after the injury, with comparisons to a non-injury control. Propensity matching based on six pre-injury vulnerability factors (age, sex, education, socioeconomic status, prior mental health, prior physical health) with the control group was used to determine membership of high vulnerability (HV) and low vulnerability (LV) injury sub-groups. Compared to the LV sub-group and controls that had similar pre-injury vulnerability, the HV sub-group had a worrying post-RTC recovery profile, with significantly higher rates of long-term psychiatric morbidity (42.2% vs. 23.1% and 15.9% respectively, p = .002) including post-traumatic stress disorder and/or depression, and poorer psychological adjustment over the 12-months. In contrast, the HV and LV sub-groups were similar in injury-related characteristics and post-injury physical (pain, fatigue, physical functioning) and participation outcomes. Findings provide preliminary evidence that pre-injury vulnerability, primarily prior mental health status, is a promising screen for early identification of people at risk of psychiatric morbidity post-RTC. It is suggested this screen could be implemented in ED to prevent chronicity and improve recovery following a traumatic injury. Further research is warranted to enhance the screen's effectiveness.

Involvement in litigation in children with PTSD following motor vehicle accident: Associations with emotional distress and treatment outcomes

OBJECTIVES

Litigation is common in the context of Post-traumatic Stress Disorder (PTSD) and mild Traumatic Brain Injury (mTBI), adding contradicting motivations to individuals' engagement in psychotherapeutic interventions. This study's main goal was to explore the relationship between litigation status and emotional distress among children with PTSD following motor vehicle accidents (MVAs). We also present preliminary findings from a pilot study on treatment efficacy for children with PTSD, with and without litigation.

METHODS

Participants included 76 children with PTSD following MVA and their main caregiving parent. The associations between litigation status (litigation involvement, litigation phase, and litigation's emotional impact) and children's global distress, PTSD, persistent post-concussion symptoms (PPCS), and sub-optimal effort, and parents' PTSD symptoms were assessed before and after intervention for PTSD. Comorbid mTBI was explored as a possible moderating factor.

RESULTS

Involvement in litigation was not related to children's and parents' pre-intervention distress, nor to the presence of mTBI or to children's effort. However, higher emotional impact of litigation on parents was associated with children's higher PPCS pre-intervention. A pilot study on intervention outcomes found an improvement both in children with and without litigation involvement. A greater decrease in PPCS following intervention was found in children of parents with higher emotional impact of litigation.

CONCLUSIONS

The emotional impact of litigation on parents should be considered while addressing children in litigation context. However, this study's preliminary findings suggest that children with litigation involvement may benefit from treatment, thus litigation should not serve solely as an exclusion criterion for psychological intervention. A larger study should further explore this issue.

NeuroRegen Scaffolds Combined with Autologous Bone Marrow Mononuclear Cells for the Repair of Acute Complete Spinal Cord Injury: A 3-Year Clinical Study

Spinal cord injury (SCI) remains among the most challenging pathologies worldwide and has limited therapeutic possibilities and a very bleak prognosis. Biomaterials and stem cell transplantation are promising treatments for functional recovery in SCI. Seven patients with acute complete SCI diagnosed by a combination of methods were included in the study, and different lengths (2.0–6.0 cm) of necrotic spinal cord tissue were surgically cleaned under intraoperative neurophysiological monitoring. Subsequently, NeuroRegen scaffolds loaded with autologous bone marrow mononuclear cells (BMMCs) were implanted into the cleaned site. All patients participated in 6 months of rehabilitation and at least 3 years of clinical follow-up. No adverse symptoms associated with stem cell or functional scaffold implantation were observed during the 3-year follow-up period. Additionally, partial shallow sensory and autonomic nervous functional improvements were observed in some patients, but no motor function recovery was observed. Magnetic resonance imaging suggested that NeuroRegen scaffold implantation supported injured spinal cord continuity after treatment. These findings indicate that implantation of NeuroRegen scaffolds combined with stem cells may serve as a safe and promising clinical treatment for patients with acute complete SCI. However, determining the therapeutic effects and exact application methods still requires further study.

There's Nothing Broken. You've Had a Whiplash, That's It: A Qualitative Study of Comorbid Posttraumatic Stress Disorder and Whiplash Associated Disorders

BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms are common in chronic Whiplash associated disorders (WAD) and have been found to be associated with higher levels of pain and disability. Theoretical frameworks have suggested that PTSD and pain not only coexist, but also mutually maintain one another. Although the comorbidity has been subject to increasing quantitative research, patients' experiences of the comorbidity and symptom interaction remain largely uninvestigated using qualitative methods.

OBJECTIVE

The present study set out to explore the potential relationship of PTSD and pain in people with WAD and properly assessed PTSD after motor vehicle accidents.

METHODS

A qualitative explorative study of eight individual face-to-face semistructured interviews were conducted. Interviews were recorded and transcribed verbatim and analyzed using framework analysis.

RESULTS

Through the analysis, we developed three overarching themes. The first theme illustrated the complex and burdensome comorbidity with overlapping and transdiagnostic symptoms, whereas the second theme highlighted how several circumstances, some related to the health care system, could extend and amplify the traumatic response. The final theme illustrated symptom associations and interactions, particularly between pain and PTSD, both supporting and rejecting parts of the mutual maintenance framework.

CONCLUSIONS

These findings underlined the great complexity and variability of the comorbidity and the traumatic event, but also emphasized how experiences of psyche and soma seem closely connected in these patients. The results provide support for the importance of thorough assessment by multidisciplinary teams, minimizing distress post-injury, and a critical approach to the idea of mutual maintenance between pain and PTSD.

Prevalence and determinants of posttraumatic stress disorder and depression among survivors of motor vehicle accidents from a hilly Indian state

BACKGROUND

Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite apparent. With a significant focus of treatment on physical health, psychological consequences linked to these traumas are often neglected.

AIM

The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well as the determinants of these disorders among survivors of MVAs.

MATERIALS AND METHODS

An institution-based, cross-sectional descriptive study was conducted among 250 survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total enumerative sampling. Data were collected with standardized and validated tools that consisted of sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean percentage) and inferential statistics (Mann-Whitney, Kruskal-Wallis, and binary logistic regression).

RESULTS

The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio [OR] = 5.52; 95% confidence interval [CI] = 0.92-3.06), loss of valuables (OR = 2.62; 95% CI = 0.78-9.04), self-blame (OR = 6.06; 95% CI = 1.15-31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89-46.85) acted as determinants in the occurrence of PTSD and depression.

CONCLUSION

A considerably large proportion of the population suffered from psychiatric disorders following the trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental health services across all hospitals' trauma units.

The role of stress reactivity and pre-injury psychosocial vulnerability to psychological and physical health immediately after traumatic injury

BACKGROUND

Traumatic injuries can have long-term negative impacts on health, especially psychological health. A biopsychosocial approach is recommended to identify those likely to experience psychosocial stress, however large individual differences exist in stress reactivity and post-injury health that remain unexplored. Therefore, we investigated autonomic nervous system (ANS) stress responses and pre-existing psychosocial vulnerability as contributors to health in individuals who sustained a traffic-related injury.

METHODS

120 adults with traffic-related injury and 112 non-injury controls underwent an integrative ANS (cardiac and skin conductance) assessment and a health-related assessment at 3-6 weeks post-injury. Propensity score matching based on six pre-injury psychosocial vulnerability factors (age, sex, education, prior mental/physical health, socioeconomic status) guided the definition of high vulnerability (HV) and low vulnerability (LV) injury subgroups, with the LV subgroup having similar propensity scores to non-injury controls. A three-group comparative analysis of ANS responsivity (baseline, reactivity, recovery/rebound) and post-injury health was performed.

RESULTS

The HV subgroup exhibited the most negative immediate post-injury mental health profile and less adaptive ANS response patterns, indicating greater stress vulnerability/reactivity. Significant differences were found for psychological health (elevated psychological distress and catastrophizing), but not physical health (injury factors, pain, fatigue, physical wellbeing). HV participants showed sympathetic predominance at resting baseline (lower parasympathetic activity and/or elevated heart rate) compared to the LV and control groups, as well as smaller parasympathetic decrease during a cognitive task compared to controls. Despite preserved capacity for restoring initial homeostasis in both injury subgroups during recovery, there was some indication of blunted post-task sympathetic deactivation (larger sympathetic decrease) and reduced overall ANS adaptability (reduction in total power of heart rate variability spectrum), suggesting relative reduced capacity to face stressors compared to controls.

CONCLUSIONS

Findings suggest that baseline resting ANS regulation, particularly parasympathetic activity, and pre-injury psychosocial factors are key contributors to individual psycho-biological responses following traumatic injury, and are therefore potential stress vulnerability markers. Post-stress recovery patterns may represent a novel physiological signature for a "biological intrinsic" vulnerability early after the injury. These findings provide direction for improved early identification and management of injured individuals, including innovative preventive interventions that target ANS regulation.

The nosological classification of whiplash-associated disorder: a narrative review

Whiplash-associated disorder (WAD) is the most common complaint and purported cause of chronic disability associated with motor vehicle collisions in North America. However, its construct validity remains controversial. This narrative review of the literature summarises the evidence underlying the most commonly theorised biological and psychosocial mechanisms of WAD pathogenesis. While the face validity of WAD is good, empirical evidence supporting the various constructs suggesting a causal link between a trauma mechanism and the development of symptoms is poor. Because individual expectations of recovery are outcome-predictive, future research is necessary to develop a better understanding of how to enhance expectancies in order to help affected motorists gain a greater sense of control over their health and wellbeing.

Assessing unmet rehabilitation needs and the feasibility of a telehealth rehabilitation consultation service for road trauma survivors recently discharged from hospital

PURPOSE

Persistent activity limitations are common among road trauma survivors, yet access to rehabilitation in hospital and in the community remains variable. This study aimed to identify unmet rehabilitation needs following road trauma and assess the feasibility of a novel rehabilitation consultation service delivered via telehealth following hospitalization.

METHODS

A pilot cohort study was conducted with survivors of road trauma who were hospitalized but did not receive formal inpatient rehabilitation. All participants received a multidisciplinary rehabilitation consultation via telehealth 1-3 weeks post-discharge, to assess rehabilitation needs and initiate treatment referrals as required. Functional and qualitative outcomes were assessed at baseline (1-7 days); one month and three months post-discharge.

RESULTS

38 participants were enrolled. All (100%) reported functional limitations at baseline; 86.5% were found to have unmet rehabilitation needs, and 75.7% were recommended rehabilitation interventions. Functional ability improved over time, but more than half the cohort continued to report activity limitations (67.6%), pain (64.7%) and/or altered mood (41.2%) for up to three months. Participants found the telehealth service to be acceptable, convenient, and helpful for recovery.

CONCLUSIONS

A high proportion of mild-moderate trauma survivors report unmet rehabilitation needs following hospital discharge. Telehealth appears to be a feasible, convenient and acceptable mode of assessing these needs.Implications for rehabilitationSurvivors of road-related injuries often experience ongoing impairments and activity limitations.Among those who don't receive rehabilitation in hospital, we found a high proportion (86.5%) had unmet rehabilitation needs after discharge.A telehealth rehabilitation service was feasible to deliver and could successfully identify unmet rehabilitation needs.The piloted telehealth intervention was viewed as acceptable, convenient and beneficial by patients.

Different Patterns of Mental Health Outcomes among Road Traffic Crash Survivors: A Prospective Cohort Study

This study aimed to investigate factors associated with the symptoms of mental disorders following a road traffic crash (RTC). A prospective cohort of 200 people was followed for 6 months after experiencing an RTC. The cohort was comprised of uninjured survivors and injured victims with all levels of road traffic injury (RTI) severity. Multivariable logistic regression analyses were performed to evaluate the associations between the symptoms of depression, posttraumatic stress disorder and anxiety one and six months after the RTC, along with sociodemographic factors, health status before and after the RTC, factors related to the RTI and factors related to the RTC. The results showed associations of depression, anxiety, and posttraumatic stress disorder symptoms with sociodemographic factors, factors related to the health status before and after the RTC and factors related to the RTC. Factors related to the RTI showed associations only with depression and posttraumatic stress disorder symptoms. Identifying factors associated with mental disorders following an RTC is essential for establishing screening of vulnerable individuals at risk of poor mental health outcomes after an RTC. All RTC survivors, regardless of their RTI status, should be screened for factors associated with mental disorders in order to successfully prevent them.

Regulating Road Rage

Road rage has been a problem since the advent of cars. Given the ubiquity of road rage, and its potentially devastating consequences, understanding road rage and developing interventions to curb it are important priorities. Emerging theoretical and empirical advances in the study of emotion and emotion regulation have provided new insights into why people develop road rage and how it can be prevented and treated. In the current article, we suggest an integrative conceptual framework for understanding road rage, based upon a psychological analysis of emotion and emotion regulation. We begin by defining road rage and other key constructs. We then consider the interplay between road rage generation and road rage regulation. Using an emotion regulation framework, we describe key points at which emotion-regulation difficulties can lead to road rage, followed by strategies that may alleviate these difficulties. We suggest that this framework usefully organizes existing research on road rage, while exposing key directions for future research.

Equestrian Road Safety in the United Kingdom: Factors Associated with Collisions and Horse Fatalities

Simple Summary

Horse riders report they frequently experience incidents with other road users, including dangerous near-misses and accidents. The British Horse Society has been collecting information about horse-related road incidents via their website since 2010. The aim of this study was to describe the incidents reported, how they have changed over time and across different UK regions, and the factors which may increase or reduce the risk of collision incidents and those resulting in horses being killed. Road rage and speeding were reported in 40% of incidents while drivers passing the horse too closely were reported in over 80% of incidents. Close passing distance, alone or when combined with speeding, contributed significantly to collisions while speeding alone contributed significantly to horse deaths. Wearing high visibility clothing reduced the risk of having a collision. A horse death caused by a road accident was almost 12 times as likely to result in severe to fatal injury to the rider/handler. Loose horses were more likely to be killed than ridden horses or those pulling a horse-drawn vehicle. Driver behaviour of how to pass horses safely on UK roads needs further improvement and will help reduce the risk of collisions and horse and human fatalities.

Abstract

Over 60% of UK horse riders report having experienced a road-related near-miss or accident. The aim of this study was to describe horse-related road incidents (n = 4107) reported to the British Horse Society (2010–2020) and to identify factors associated with higher odds of collisions with another vehicle and horse fatalities using multivariable logistic regression modelling. Drivers passed the horse too closely in 84.2% of incidents while road rage and speeding were reported in 40.3% and 40.1% of incidents, respectively. Close passing distance alone (odds ratio [OR] 18.3, 95% confidence interval [CI] 6.5, 51.6) or in combination with speeding (OR 4.4, CI 1.7, 11.7) was associated with higher collision odds compared to speeding alone. Speeding was, however, associated with higher horse fatality odds (OR 2.3, CI 1.2, 4.6). Wearing high visibility clothing reduced odds of collision (OR 0.2, CI 0.1, 0.4). A fatal injury to a horse was almost 12 times as likely to result in severe to fatal rider/handler injury. Loose horses contribute significantly to road-related horse fatalities. Driver behaviour of how to pass horses safely on UK roads needs further improvement and will help reduce the risk of collisions and horse and human fatalities.

A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash-related Injury

OBJECTIVE

Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients.

METHODS

From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment.

RESULTS

Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months.

CONCLUSIONS

We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.

Prognostic Role of Demographic, Injury and Claim Factors in Disabling Pain and Mental Health Conditions 12 Months after Compensable Injury

Identifying who might develop disabling pain or poor mental health after injury is a high priority so that healthcare providers can provide targeted preventive interventions. This retrospective cohort study aimed to identify predictors of disabling pain or probable mental health conditions at 12 months post-injury. Participants were recruited 12-months after admission to a major trauma service for a compensable transport or workplace injury (n = 157). Injury, compensation claim, health services and medication information were obtained from the Victorian Orthopaedic Trauma Outcome Registry, Victorian State Trauma Registry and Compensation Research Database. Participants completed questionnaires about pain, and mental health (anxiety, depression, posttraumatic stress disorder) at 12 months post-injury. One third had disabling pain, one third had at least one probable mental health condition and more than one in five had both disabling pain and a mental health condition at 12 months post-injury. Multivariable logistic regression found mental health treatment 3-6 months post-injury, persistent work disability and opioid use at 6-12 months predicted disabling pain at 12 months post-injury. The presence of opioid use at 3-6 months, work disability and psychotropic medications at 6-12 months predicted a mental health condition at 12 months post-injury. These factors could be used to identify at risk of developing disabling pain who could benefit from timely interventions to better manage both pain and mental health post-injury. Implications for healthcare and compensation system are discussed.

I've got to be independent': views of older people on recovery following road traffic injury in New South Wales, Australia

BACKGROUND

Mild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia.

METHODS

A qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ).

RESULTS

Nineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches. Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning.

CONCLUSION

Older people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people's recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision.

TRIAL REGISTRATION

Australia New Zealand clinical trial registry identification number ACTRN12613000889752 .

Muscle fat infiltration following whiplash: A computed tomography and magnetic resonance imaging comparison

Here we present a secondary analysis from a parent database of 97 acutely injured participants enrolled in a prospective inception cohort study of whiplash recovery after motor vehicle collision (MVC). The purpose was to investigate the deep and superficial neck extensor muscles with peri-traumatic computed tomography (CT) and longitudinal measures of magnetic resonance imaging (MRI) in participants with varying levels of whiplash-related disability. Thirty-six underwent standard care imaging of the cervical spine with CT at a level-1 trauma designated emergency department. All 36 participants were assessed with MRI of the cervical spine at <1-week, 2-weeks, 3-, and 12-months post-injury and classified into three groups using initial pain severity and percentage scores on the Neck Disability Index (recovered (NDI of 0–8%), mild (NDI of 10–28%), or severe (NDI ≥ 30%)) at 3-months post MVC. CT muscle attenuation values were significantly correlated to muscle fat infiltration (MFI) on MRI at one-week post MVC. There was no significant difference in muscle attenuation across groups at the time of enrollment. A trend of lower muscle attenuation in the deep compared to the superficial extensors was observed in the severe group. MFI values in the deep muscles on MRI were significantly higher in the severe group when compared to the mild group at 1-year post MVC. This study provides further evidence that the magnitude of 1) deep MFI appears unique to those at risk of and eventually transitioning to chronic WAD and that 2) pre- or peri-traumatic muscular health, determined by CT muscle attenuation, may be contribute to our understanding of long-term recovery.

Psychological Distress in Workers' Compensation Claimants: Prevalence, Predictors and Mental Health Service Use

Purpose To determine the prevalence and predictors of psychological distress among injured and ill workers and their mental health service use. Methods Cross-sectional national survey of adults with work-related musculoskeletal or mental health conditions, accepted workers' compensation claims and at least 1 day off work. Psychological distress was measured using the Kessler-6 scale. Mental health service use was measured using self-report. Results A total of 3755 workers were included in the study (Musculoskeletal disorder = 3160; Mental health condition = 595). Of these, 1034 (27.5%) and 525 (14.0%) recorded moderate and severe psychological distress, respectively. Multivariate ordinal logistic regression revealed that being off work, poor general health, low work ability, financial stress, stressful interactions with healthcare providers and having diagnosed mental health conditions had the strongest associations with presence of psychological distress. Of the subgroup with musculoskeletal disorders and psychological distress (N = 1197), 325 (27.2%) reported accessing mental health services in the past four weeks. Severe psychological distress, being off work, worse general health and requiring support during claim were most strongly associated with greater odds of service use. Conclusions The prevalence of psychological distress among workers' compensation claimants is high. Most workers with musculoskeletal disorders and psychological distress do not access mental health services. Screening, early intervention and referral programs may reduce the prevalence and impact of psychological distress.

Outcomes after traffic injury: mental health comorbidity and relationship with pain interference

BACKGROUND

Mental health symptoms, like depressive mood (DM) and post-traumatic stress (PTS), and pain interference (PI) with daily functioning often co-occur following traffic injury and their comorbidity can complicate recovery. This study aimed to map the course and overlapping trajectories of mental health symptoms, and associations with PI in a traffic injury population.

METHODS

In total, 2019 adults sustaining minor-to-moderate traffic injury were recruited within 28 days post-injury and assessed using phone interviews at 1, 6 and 12-months post-injury. Trajectories of DM, PTS and PI were established and relationships between DM, PTS and PI trajectories were explored using dual trajectory modelling. Bio-psychosocial predictors (e.g. pre-injury health, catastrophizing, acute distress, quality of life, social support) of mental health trajectories were investigated.

RESULTS

Up to five typical post-trauma trajectories were identified for DM, PTS and PI. Most people were in a resilient mental health trajectory (over 60%, DM or PTS), or in a chronic PI trajectory (almost 60%) 12 months post-injury. While recovery/resilient mental health trajectories were strongly interrelated (73.4% joint probability and > 94% conditional probabilities), DM/PTS comorbidity in chronic trajectories was not straightforward, suggesting a possibly asymmetric relationship. That is, persistent DM was more likely associated with persistent PTS (90.4%), than vice versa (31.9%), with a 22.5% probability that persistent PTS was associated with none or milder depression (i.e. following a recovery/resilient DM trajectory). An asymmetrical relationship was also found between mental health and PI. The majority of those with persistent PI were likely to be in a recovery/resilient DM/PTS trajectory (almost 70%), but those in a non-resilient DM/PTS trajectory showed a high risk of persistent PI. Predictors of non-resilient mental health trajectories included poorer pre-injury health and social support, and shared factors like acute psychological distress and pain catastrophizing.

CONCLUSIONS

Strong interrelations were confirmed between mental health symptoms and PI following traffic injury. However, persistent DM was more strongly linked to persistent PTS, than vice versa. Persistent PI was only linked with persistent DM/PTS in vulnerable subgroups. Early psychiatric/psychological interventions should target elevated psychological distress and negative appraisals in vulnerable individuals, to reduce long-term mental health morbidity/comorbidity and PI.

TRIAL REGISTRATION

ACTRN12613000889752.

Predictors of Mental Health Outcomes in Road Traffic Accident Survivors

Mental health outcomes of road traffic accidents (RTAs) are always investigated in assessments of those involved. The aim of this study was to investigate the psychological consequences and associated factors in all RTA survivors, irrelevant of their injury status. A cohort of 155 people was assessed one month after experiencing a RTA using self-reported measures for posttraumatic stress disorder (PTSD), depression, and anxiety. Associations between mental health outcomes and sociodemographic factors, pre-RTA health status, injury-related factors, and RTA details were analyzed. RTA survivors reported substantial rates of PTSD (32.3%) and depression (17.4%) symptoms, and low rates of anxiety (5.8%). Symptoms of depression were associated with below-average self-perceived economic status, irreligiousness, medication use, psychiatric medication use, and injury-related factors. PTSD symptoms were associated with female gender, below-average self-perceived economic status, previous psychiatric illness, medication use, psychiatric medication use, not being at fault in the relevant RTA, claiming compensation, and injury-related factors. Anxiety symptoms were associated with previous chronic or psychiatric illness, previous permanent pain, psychiatric medication use, and self-perceived threat to life, but not with sustaining injury. Along with the evaluation and treatment of RTA injuries, health care providers should evaluate the pre-RTA health status of all RTA victims. Psychological support to those at risk may prevent psychological disorders after RTAs.

Non-whiplash soft tissue injuries following low-velocity impact collisions: A retrospective analysis

Whiplash is the most common injury reported in low-velocity impact road traffic accidents, but claimants report a range of other soft tissue injuries and we looked at the prevalence of these and any patterns. We retrospectively reviewed reports from the medico-legal practice of an orthopaedic surgeon. We collected data on 609 claimants. Sixty-two per cent were women (p < 0.0001). Majority (90.3%) reported an injury to at least one other area than neck, and 48% of claimants reported shoulder pain. Hand/wrist injuries were almost exclusive to drivers (p = 0.0013). Those with knee injuries were older than those without (p = 0.001). There was a significant difference in the age of patients with different spinal injury patterns (p < 0.0001). Occupational status did not appear to influence the pattern of injuries (p = 0.06). Psychological symptoms were associated with a greater number of body parts injured (p < 0.01). Our data confirm a strong association between these soft tissue injuries and psychological symptoms.

Predictors for Psychological Distress 2 Months After Mild Traumatic Brain Injury

Objective: To predict psychological distress at 2 months for patients with mild traumatic brain injury.

Method: A prospective cohort study of 162 patients with mild traumatic brain injury (MTBI) admitted consecutively to an outpatient clinic at Haukeland University Hospital, Norway. Demographic data were obtained from Statistics Norway and injury characteristics were obtained from the hospital records. Sick leave data from the last year before the injury were obtained from The Norwegian Labor and Welfare Service. Self-report questionnaires were used to obtain history about earlier disease and symptom profiles. The Hospital Anxiety and Depression Scale (HAD) detecting states of depression and anxiety were used as the dependent variable in a stepwise linear regression. Pre-injury factors and injury-related factors were examined as potential predictors for HAD.

Results: In the first steps we observed a significant association between HAD at 2 months and education, whiplash associated disorder (WAD), and earlier sick listed with a psychiatric diagnosis. In the final step there was an association only between HAD and self-reported anxiety and WAD. There were no associations between HAD and injury-characteristics like severity at Glasgow Coma Scale or intracranial injury.

Conclusion: Patients with low education, earlier psychiatric diagnosis, self-reported earlier anxiety and WAD were more likely to develop a psychological distress after a MTBI. These findings should be taken into consideration when treating patients with MTBI.

Mortality and health-related quality of life following injuries and associated factors: a cohort study in Chandigarh, North India

INTRODUCTION

Injuries are among the 10 leading causes of deaths worldwide. In recent years, the quality and reporting of injury mortality has improved but little or no data are available on the morbidity burden and impact of non-fatal injuries in India. This study evaluates health recovery status postinjury, identifying predictors of recovery in North India.

METHODS

Prospective cohort study recruiting patients from one tertiary-level and two secondary-level hospitals in North India between April and June 2014 hospitalised due to any injury. Health-related quality of life was assessed at baseline and at 1-month, 2-month, 4-month and 12-month postinjury using the EuroQol five-dimensional (EQ-5D-5L) questionnaire. Multivariable linear regressions with generalised estimating equations were used to examine the relationship between sociodemographic and injury-related factors with the EQ-5D-5L single utility score and the visual analogue scale (VAS) score.

RESULTS

A total of 2416 eligible patients aged ≥18 years were enrolled in the study. Of these, 2150 (74%) completed baseline and all four follow-up EQ-5D-5L questionnaires. Almost 7% (n=172) patients died by the first follow-up and the overall mortality at 12 months was 9% (n=176). Both EQ-5D-5L utility and VAS scores dropped significantly at 1-month postinjury but gradually improved at 2, 4 and 12 months. Severe injuries, defined as those requiring a hospital stay of ≥7 days, were associated with lower utility scores at 1-month, 2-month and 4-month follow-ups (p<0.001).

CONCLUSION

This is the first study to examine health outcomes following injuries in India. The findings highlight the need to understand the social, psychological and biological factors influencing recovery outcomes. High mortality following discharge emphasises the need to invest in secondary and tertiary injury prevention in India.

The Risk of Hospitalization for Motor Vehicle Accident Injury in Narcolepsy and the Benefits of Stimulant Use: A Nationwide Cohort Study in Taiwan

STUDY OBJECTIVES

To examine the risk of hospitalization for motor vehicle accident injury (MVAI) in patients with narcolepsy and the effects of stimulant use on MVAI occurrence in patients with narcolepsy.

METHODS

This is a population-based, retrospective cohort study using Taiwan's National Health Insurance Research Database between 2000 and 2013. We included patients with narcolepsy based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, 347. The case and matched control participants were selected in a ratio of 1:3, and the traffic accident (ICD-9-CM codes: E810-E819) plus injury codes (ICD-9-CM codes: 800.xx-999.xx) due to MVAI following hospitalization were used for the study outcome. The type of injury, causes, intentionality, and the effects of stimulant use on patients with narcolepsy were also assessed.

RESULTS

A total of 1,316 participants were enrolled, including 329 participants with narcolepsy and 987 participants without narcolepsy. During a 14-year follow-up period, a total of 104 participants had MVAI, of whom 47 (1,559.54 per 100,000 person-years) belonged to the narcolepsy cohort and 57 (556.21 per 100,000 person-years) to the non-narcolepsy cohort. After adjusting for covariates, the risk of hospitalization for MVAI among participants with narcolepsy was still significantly higher than those without narcolepsy (adjusted hazard ratio = 6.725; 95% confidence interval = 4.421-10.231; P < .001). The use of modafinil or methylphenidate, as monotherapy or combined treatment, was associated with a lower risk of MVAI in the narcolepsy cohort.

CONCLUSIONS

Patients with narcolepsy may have a higher risk of hospitalization for MVAI and stimulant use could mitigate such risk.

Biopsychosocial barriers affecting recovery after a minor transport-related injury: A qualitative study from Victoria

Objective

The aim of the study was to understand the recovery phenomena and to explore participants' perspectives on the biopsychosocial facilitators and barriers affecting their recovery after a minor transport injury.

Methods

A qualitative method was used involving semi‐structured interviews with 23 participants who sustained a minor transport injury. Interviews and analysis were guided by the biopsychosocial model (BPS) of health. The outcomes were themes capturing biopsychosocial barriers to, and personal experiences of, recovery using a previously defined framework.

Results

The themes indicate that recovery is a multifaceted phenomenon affected by comorbidities such as chronic pain, depression and anxiety. A range of subsequent complexities such as the inability to self‐care and undertaking daily domestic duties, and incapacity to participate in recreational activities were major barriers to recovery. These barriers were found to be an on‐going source of frustration, dissatisfaction and a perceived cause of depressive symptomatology in many participants. Most participants reported mixed feelings of the care received. Other common issues raised included a lack of understanding of the assessment time, regular follow‐up, guidance and on‐going support.

Conclusion

This study revealed that recovery after a minor transport‐related injury was a challenging, complex, demanding and a long‐term process for the individuals in this study. Findings from this limited cohort suggested that, for participants to return to their pre‐accident health status, a more coordinated approach to information and care delivery may be required.

Factors influencing outcomes among patients with whiplash-associated disorder: A population-based study in Japan

Introduction

Only a few, large population-based studies, have reported on whiplash-associated disorder (WAD). However, none of them have investigated the influence of crash severity on WAD outcome. In the present study, we aimed to determine whether crash severity predicts outcomes among patients with no-fault government insurance for acute WAD.

Methods

We utilized data from a compulsory, no-fault government automobile liability insurance agency in Japan. Individuals involved in a car accident between April 2001 and June 2015 with residual disabilities reported at the end of the treatment between October 2014 and September 2015 were included. Crash severity was assessed based on property damage costs, size of the other vehicle (large car, medium car, small car, or two-wheeled vehicles), and collision types (rear-end collision, contact with vehicle moving in the same direction, or in the opposite direction). Outcomes included the time to claim closure and the number of treatment visits.

Results

We analyzed data for a total of 52,251 individuals (28,571 male and 23,680 female) with a median age of 44 years (range: 2–95 years). The median time to claim closure was 220 days (range: 1–4,938 days), and the median number of treatment visits was 102 (range: 1–2,492). There was no significant association between outcomes and property damage costs or size of the other vehicle. Collision types exhibited no consistent association with outcomes. However, older age and affected body parts, in addition to the neck, were independent risk factors for delayed claim closure and a large number of visits, although, all odds ratios were low (often less than 2.0).

Conclusions

There was no obvious association of outcomes with property damage costs, size of the other vehicle, or collision types in acute WAD patients. Further studies should investigate the influence of psychological factors, compensation systems, and cultural conditions.

Biomarkers of autonomic regulation for predicting psychological distress and functional recovery following road traffic injuries: protocol for a prospective cohort study

INTRODUCTION

Psychological distress is a prevalent condition often overlooked following a motor vehicle crash (MVC), particularly when injuries are not severe. The aim of this study is to examine whether biomarkers of autonomic regulation alone or in combination with other factors assessed shortly after MVC could predict risk of elevated psychological distress and poor functional recovery in the long term, and clarify links between mental and physical health consequences of traffic injury.

METHODS AND ANALYSIS

This is a controlled longitudinal cohort study, with follow-up occurring at 3, 6 and 12 months. Participants include up to 120 mild to moderately injured MVC survivors who consecutively present to the emergency departments of two hospitals in Sydney and who agree to participate, and a group of up to 120 non-MVC controls, recruited with matched demographic characteristics, for comparison. WHO International Classification of Functioning is used as the framework for study assessment. The primary outcomes are the development of psychological distress (depressive mood and anxiety, post-traumatic stress symptoms, driving phobia, adjustment disorder) and biomarkers of autonomic regulation. Secondary outcomes include indicators of physical health (presence of pain/fatigue, physical functioning) and functional recovery (quality of life, return to function, participation) as well as measures of emotional and cognitive functioning. For each outcome, risk will be described by the frequency of occurrence over the 12 months, and pathways determined via latent class mixture growth modelling. Regression models will be used to identify best predictors/biomarkers and to study associations between mental and physical health.

ETHICS AND DISSEMINATION

Ethical approvals were obtained from the Sydney Local Health District and the research sites Ethics Committees. Study findings will be disseminated to health professionals, related policy makers and the community through peer-reviewed journals, conference presentations and health forums.

TRIAL REGISTRATION NUMBER

ACTRN12616001445460.