Bandong AN1,2, Mackey M1, Leaver A1, Ingram R1, Sterling M3,4, Ritchie C3,4, Kelly J5, Rebbeck T1,6
1University of Sydney, Faculty of Health Sciences, Sydney, Australia, 2University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, 3University of Queensland, Recover Injury Research Centre, Brisbane, Australia, 4University of Queensland, Centre of Research Excellence in Road Traffic Injury Recovery, Brisbane, Australia, 5Griffith University, Menzies Health Institute Queensland, Gold Coast, Australia, 6University of Sydney, John Walsh Centre for Rehabilitation Research, Sydney, Australia

Background: Whiplash-associated disorders (WAD), a worldwide health and economic burden, require novel approaches to management. Potential contributors to this burden are considerable variations in practice, poor guideline adherence and lack of identifying and addressing risk factors to non-recovery. Online tools can be an effective strategy to implement a targeted, risk-based clinical pathway of care for WAD.

Purpose: To develop, implement and evaluate an online tool to support WAD management.

Methods: This is a collaborative project of the University of Sydney, the University of Queensland, NSW State Insurance Regulatory Authority and QLD Motor Accidents Insurance Commission. We followed a robust process involving the first three stages of a research translation framework (idea generation, feasibility, efficacy). Development involved consultation amongst stakeholders (researchers, health care professionals (HCPs), industry partners, state insurance regulators and people with WAD) to discuss content, design concepts, features and functionality. Surveys and focus group discussions were conducted amongst HCPs and people with WAD to further inform website development and assess feasibility. Implementation strategies included classroom education, educational meetings and educational outreach. Evaluation involved website metrics, logs of specialist HCP treatment decisions, acceptability and self-rated improvements in knowledge amongst HCPs.

Results: An interactive, user-friendly website, My Whiplash Navigator, was developed. Three sections were incorporated including; automated risk stratification, resources for people with WAD targeted to risk category, guideline-based resources for primary HCPs, and information for specialist HCPs to assist in performing more complex assessments and making management decisions. The website also links HCPs and people with WAD, which facilitates the process of specialist HCP referral for people at high risk of non-recovery. These features were identified following the consultative meetings, surveys and focus groups amongst stakeholders. Implementation of the website resulted to 320 registrations recorded from June 2016 to March 2018, including 175 students, 65 primary HCPs, 20 specialist HCPs and 60 people with WAD. Effective strategies to engage users were through classroom education (81% student uptake) and educational meetings (43% HCP uptake). The most popular pages visited were those that provided information about WAD, advice, exercises and risk assessment. Evaluation showed that HCPs agreed that their knowledge regarding provision of exercise (87.6%) and risk management (81.4%) improved. Specialist HCPs most commonly chose the 'shared care' pathway as management decision, demonstrating improvement from a previous cohort. Further suggestions to enhance the website included additional features to improve navigation and access to outcome measures.

Conclusion(s): The robust process delivered an innovative and acceptable website tailored to the needs of people with WAD and HCPs who manage them. Classroom education and educational meetings were effective implementation strategies to engage HCPs. Evaluation amongst HCPs showed that use of the website improved knowledge and practice to be more consistent with a risk-based WAD management. These results provide sufficient evidence for future large-scale implementation.

Implications: The website could potentially promote practice change and assist in improving patient outcomes through access to evidence-based information and timely and appropriate referral. The end vision is for the website to be publicly-available to people with WAD, HCPs and insurance providers.

Keywords: Whiplash injuries, decision support systems, primary health care

Funding acknowledgements: This project was funded by the New South Wales State Insurance Regulatory Authority and the Queensland Motor Accident Insurance Commission.

Topic: Musculoskeletal: spine; Primary health care; Robotics & technology

Ethics approval required: Yes
Institution: The University of Sydney and Griffith University
Ethics committee: Human Research Ethics Committees
Ethics number: Protocol number: 2015/444 and Protocol number: 2015/707

All authors, affiliations and abstracts have been published as submitted.

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