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A.N. Bandong1, A. Leaver2, M. Sterling3, C. Ritchie3, T. Rebbeck2,4
1The University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, 2The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 3The University of Queensland, RECOVER Injury Research Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Better Health Outcomes for Compensable Injury, Brisbane, Australia, 4The University of Sydney, John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, Sydney, Australia
Background: Clinical guidelines for whiplash recommend referral to specialist physiotherapists in cases where recovery is delayed. The role of specialist physiotherapists and their influence of service delivery however has not been previously evaluated.
Purpose: Compare service delivery for patients at medium/high-risk of poor recovery who had specialist physiotherapy input in their care and usual care.
Methods: This is a descriptive study embedded within a randomised controlled trial. Patients at medium/high-risk of poor recovery were identified using a prognostic risk assessment tool (WhipPredict). Participants were primary healthcare professionals (PHCPs) and specialist physiotherapists who provided treatment for the RCT. Patients in the intervention group were referred to a specialist physiotherapist and the control group received usual care.
Service delivery data were captured using an online questionnaire completed by specialist physiotherapists and PHCP’s at 3-month follow-up. Data included information about assessment (use of Quebec Task Force classification, risk category and consistency with the WhipPredict, referral for imaging), treatment (number and type of treatment, provision of educational resources), and considerations for management (risk factors, goals, indicators of recovery, barriers encountered). Additional data collected from the specialist physiotherapists included approach to care, outcome measures used, and advice provided.
Service delivery data were captured using an online questionnaire completed by specialist physiotherapists and PHCP’s at 3-month follow-up. Data included information about assessment (use of Quebec Task Force classification, risk category and consistency with the WhipPredict, referral for imaging), treatment (number and type of treatment, provision of educational resources), and considerations for management (risk factors, goals, indicators of recovery, barriers encountered). Additional data collected from the specialist physiotherapists included approach to care, outcome measures used, and advice provided.
Results: 46 PHCP’s (intervention=23; control=23) and 16 specialist physiotherapists, who consulted 64 patients, participated.
Most specialist physiotherapists used Quebec Task Force (QTF) classification (n=51; 80%). Three(5%) patients were referred for imaging. Shared-care was chosen in 55% of cases and the mean number of treatments was 3±2.5 over 12±5.4 weeks. Advice to PHCPs included modifications in interventions and monitoring psychosocial factors.
PHCP’s used QTF classification in 13(57%) patients in the intervention group and 12( 52%) patients in the control group. Risk category was consistent with WhipPredict in 16(70%) of cases in the intervention group and 14(61%) in the control group. The number of treatments was 14±10.3 over 15±11.3 weeks (intervention) and 11±8.7 over 13±13.5 weeks (control). Most provided recommended treatments, however the use of ‘not recommended’ treatments were high in both groups. There was higher use of supportive educational resources with 13(57%) in the intervention group and 12( 52%) in the control group. Referral to medical specialists was infrequent, but occurred earlier (6 referrals 26% at mean 3 weeks) in the intervention compared with control (9 referrals 39% at 5 weeks).
Most specialist physiotherapists used Quebec Task Force (QTF) classification (n=51; 80%). Three(5%) patients were referred for imaging. Shared-care was chosen in 55% of cases and the mean number of treatments was 3±2.5 over 12±5.4 weeks. Advice to PHCPs included modifications in interventions and monitoring psychosocial factors.
PHCP’s used QTF classification in 13(57%) patients in the intervention group and 12( 52%) patients in the control group. Risk category was consistent with WhipPredict in 16(70%) of cases in the intervention group and 14(61%) in the control group. The number of treatments was 14±10.3 over 15±11.3 weeks (intervention) and 11±8.7 over 13±13.5 weeks (control). Most provided recommended treatments, however the use of ‘not recommended’ treatments were high in both groups. There was higher use of supportive educational resources with 13(57%) in the intervention group and 12( 52%) in the control group. Referral to medical specialists was infrequent, but occurred earlier (6 referrals 26% at mean 3 weeks) in the intervention compared with control (9 referrals 39% at 5 weeks).
Conclusions: Results suggest that there are few differences in service delivery between patients at medium/high-risk who were seen by specialist physiotherapists and those who were not. The engagement of specialist physiotherapists in the management of people with whiplash at medium/high-risk of poor recovery appeared to facilitate early referral to medical and other specialists, low use of imaging, and provision of supportive educational resources.
Implications: Routine early referral to specialist physiotherapists for patients with at medium/high-risk of poor recovery did not appear to influence service delivery outcomes; however, this study was exploratory in nature and not powered to demonstrate statistical difference.
Funding acknowledgements: Funding provided by a partnership grant from NHMRC, QLD Motor Accidents Insurance Commission and NSW State Insurance Regulatory Authority (APP1075736).
Keywords:
Whiplash
Service delivery
Specialist referral
Whiplash
Service delivery
Specialist referral
Topics:
Service delivery/emerging roles
Musculoskeletal: spine
Disability & rehabilitation
Service delivery/emerging roles
Musculoskeletal: spine
Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: The University of Sydney and Griffith University
Committee: The University of Sydney and Griffith University Human Research Ethics Committees
Ethics number: Sydney University: 2014/778; Griffith University: AHS/10/14/HREC
All authors, affiliations and abstracts have been published as submitted.
