Rebbeck T1,2, Nguyen H2, Kifley A2, Jagnoor J3, Nicholas M4, Cameron I2
1University of Sydney, Faculty of Health Sciences, Lidcombe, Australia, 2John Walsh Centre for Rehabilitation Research, Sydney Medical School/Northern, University of Sydney, Sydney, Australia, 3The George Institute for Global Health, Sydney, India, 4Pain Management Research Institute, University of Sydney, Sydney, Australia
Background: Musculoskeletal injures (including low back pain, whiplash and lower limb injuries) sustained after a road traffic accident (RTA), account for the highest rehabilitation costs of any injuries in many countries. Whilst some recover well, at least 50% of people have long term pain and disability. Early identification of those at risk of a poor prognosis is essential to determine appropriate care. To date, risk stratification tools that identify those with a poor prognosis have been independently validated for individual conditions such as low back pain and whiplash. However. a single tool validated across different musculoskeletal conditions after RTA has not been evaluated.
Purpose: To examine differences in recovery, return to work and health related quality of life in people with common musculoskeletal injures (low back pain, whiplash and lower limb injuries) stratified for risk using the Short form - Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ).
Methods: In an inception cohort study, people with acute musculoskeletal injury (low back pain, whiplash or lower limb injury) were recruited from hospital emergency departments and primary care within 4 weeks after injury. Data collected at baseline included demographic data, health related quality of life (SF-12). Participants were stratified at baseline into low (OMPSQ ≤ 50) and high risk (OMPSQ > 50) of non-recovery. The primary outcome was recovery measured by the Global Perceived Effect (GPE) at 6 months (range -5/5 vastly worse to 5/5 completely recovered). We considered recovery as GPE ≥4 on the scale. Secondary outcomes assessed were health related quality of life (SF-12) and return to work.
Results: Four-hundred and ninety-eight people (166 with neck, 78 with lower back and 254 with lower limb injuries) participated. The proportion of people recovered at 6 months was significantly higher in low risk compared with high risk groups for all injury types (eg proportion of people recovered low vs high risk were: low back 56.5% vs 14.3%, whiplash 68.5% vs 26.1%, lower limb 61.9% vs 17.2%). The adjusted risk ratio for recovery was significantly higher in the low than the high risk groups (2.96 [95% CI: 1.81 to 4.82]). Significantly more people in the low risk group returned to work (91%) than the high risk group (54.6%). People at low risk had higher SF-12 scores at baseline and 6-month follow-up than those at high risk. There were no differences between injury types.
Conclusion(s): The short form OMPSQ can be recommended as a generic prognostic tool to identify individuals with musculoskeletal injuries early after RTA who would have a higher or lower likelihood of recovering or returning fully to pre-injury work.
Implications: Busy clinicians are recommended to use the short form OSMPQ to identify those at risk of poor recovery after RTA. Those at low risk should recover well, and need less care. In contrast, those at higher risk are more likely to require comprehensive care. The tool will now be used to test a clinical pathway of care matched to risk for common musculoskeletal conditions.
Keywords: Risk stratification, road traffic accident, recovery
Funding acknowledgements: State Insurance Regulatory Authority (SIRA) of NSW, Australia . National Health and Medical Research Council (NHMRC) of Australia,Career Development Fellowship.
Purpose: To examine differences in recovery, return to work and health related quality of life in people with common musculoskeletal injures (low back pain, whiplash and lower limb injuries) stratified for risk using the Short form - Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ).
Methods: In an inception cohort study, people with acute musculoskeletal injury (low back pain, whiplash or lower limb injury) were recruited from hospital emergency departments and primary care within 4 weeks after injury. Data collected at baseline included demographic data, health related quality of life (SF-12). Participants were stratified at baseline into low (OMPSQ ≤ 50) and high risk (OMPSQ > 50) of non-recovery. The primary outcome was recovery measured by the Global Perceived Effect (GPE) at 6 months (range -5/5 vastly worse to 5/5 completely recovered). We considered recovery as GPE ≥4 on the scale. Secondary outcomes assessed were health related quality of life (SF-12) and return to work.
Results: Four-hundred and ninety-eight people (166 with neck, 78 with lower back and 254 with lower limb injuries) participated. The proportion of people recovered at 6 months was significantly higher in low risk compared with high risk groups for all injury types (eg proportion of people recovered low vs high risk were: low back 56.5% vs 14.3%, whiplash 68.5% vs 26.1%, lower limb 61.9% vs 17.2%). The adjusted risk ratio for recovery was significantly higher in the low than the high risk groups (2.96 [95% CI: 1.81 to 4.82]). Significantly more people in the low risk group returned to work (91%) than the high risk group (54.6%). People at low risk had higher SF-12 scores at baseline and 6-month follow-up than those at high risk. There were no differences between injury types.
Conclusion(s): The short form OMPSQ can be recommended as a generic prognostic tool to identify individuals with musculoskeletal injuries early after RTA who would have a higher or lower likelihood of recovering or returning fully to pre-injury work.
Implications: Busy clinicians are recommended to use the short form OSMPQ to identify those at risk of poor recovery after RTA. Those at low risk should recover well, and need less care. In contrast, those at higher risk are more likely to require comprehensive care. The tool will now be used to test a clinical pathway of care matched to risk for common musculoskeletal conditions.
Keywords: Risk stratification, road traffic accident, recovery
Funding acknowledgements: State Insurance Regulatory Authority (SIRA) of NSW, Australia . National Health and Medical Research Council (NHMRC) of Australia,Career Development Fellowship.
Topic: Musculoskeletal; Pain & pain management
Ethics approval required: Yes
Institution: University of Sydney
Ethics committee: Sydney Local Health District Ethics Committee; reference number
Ethics number: HREC/13/CRGH/67
All authors, affiliations and abstracts have been published as submitted.
