This presentation reports the results of a systematic review of information based interventions for injury recovery. It was presented at the Canadian Association for Research on Work and Health (CARWH) conference in 2012. The study has since been published in the Journal of Rehabilitation Medicine. A link to the study is here: http://www.ncbi.nlm.nih.gov/pubmed/22674232

1. Information interventions for injury recovery:
A systematic literature review
Fiona Clay1,2
, Alex Collie1,3
& Rod McClure2
1.Institute for Safety Compensation and Recovery Research, Melbourne, Australia
2.Injury Research Institute, Monash University
3.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Presentation to the Canadian Association of Research on Work and Health
Vancouver, 2nd
June 2012

2. Outline
• Why are early information interventions important?
• Review question & methods
• Heterogeneity of studies
• Paper-based interventions
• Face-to-face interventions
• Video/DVD interventions
• Conclusions

3. Why are early information-based
interventions potentially important?
• Lack of information and poor communication with compensation systems are
barriers to recovery for injured persons (Lippel, 2007; Roberts-Yates, 2003).
• Dissatisfaction, disempowerment, frustration
 Secondary victimisation
• The injured persons expectations of recovery are powerful predictors of actual
recovery.
• Returning to activity aids injury recovery and return to work, but the default
setting is still to ‘rest’ to aid recovery. (Rueda et al, 2012. Am J Pub Health)
Early, effective information provision may improve recovery of injured persons.
Potentially resource efficient & able to be widely disseminated.

4. Motor vehicle injury?
• WHO estimates that 20 to 50 million people per annum are injured in motor
vehicle crashes (Peden, 2005 Int J Inj Cont Safety Promot)
• In Australia in 2011, ~55,000 motor vehicle accident compensation claims
were made.
• 60-70% of claimants are of working age.
• In 2000, the annual cost of vehicle related trauma in Australia was estimated
to be $18 billion. (Bureau of Transport Economics, 2000)
• In Australia (and other jurisdictions), compensation for motor vehicle accidents
is regulated by government statutory authorities similar in nature to workers
compensation authorities.

5. Review Question
“Do targeted early information interventions improve outcomes
following vehicle-related traumatic injury in persons of working
age?”

6. What is an information intervention?
“Group based or individual intervention which predominantly
provides education or information about injury recovery including
future difficulties, constructive ways of coping or getting back to
normal activities.”

7. Search Strategy
• Ovid Medline, PsychINFO, EMBASE, Cochrane
• + hand searching of reference lists
• Period Jan 1990 to April 2011
• PICO format
• Search terms
• Injury terms (eg, wounds and injuries, trauma*) OR
• Motor vehicle terms (eg, automobile, motorcycle) AND
• Information-education terms (eg, internet, pamphlet) AND
• Study design terms (eg, randomised controlled trial)

8. Inclusion / Exclusion
• Inclusion criteria
• Peer-reviewed articles
• English language
• Available as full text
• RCT or pseudo-RCT
• Working age (15 to 64 years)
• >30% vehicle injury
• Recipient of intervention was injured
person
• Intervention occurred within 6
months post injury
• Exclusion criteria
• Non intervention studies
• Primary prevention studies
• Recipient of intervention was a
healthcare provider
• Psycho-education interventions (eg,
those that include CBT as a
component)
• Mixed information / other intervention
studies
• Studies of neck or back schools

9. Review process
Full text articles
retrieved for review by
2 authors
N=38
Search results
Database search
(N=807)
Hand-searching (N=12)
Total N=819
Duplicates removed
N=58
Articles included in the
review
N=16 articles
N=13 intervention
studies
Excluded on
abstract screen
N=723
Excluded on full
text screen
N=22

10. Risk of bias assessment
Type of Bias Potential Bias
Selection Random sequence generation / Allocation concealment
Performance Blinding of participants and personnel
Detection Blinding of outcome assessment
Attrition Incomplete outcome data
Reporting Selective reporting on study design or of results
Other Contamination between groups or due to co-interventions
Analysis was not intention to treat
Lack of compliance with intervention
• Studies were not excluded on the basis of quality.
• Findings of bias were taken into account when drawing conclusions about the
interventions.

11. Data extracted
• Population
• Recruitment method
• Baseline sample size
• Nature of injuries
• Mechanism of injuries
• Inclusion and exclusion criteria
• Study methods
• Trial type (RCT or pseudo-RCT)
• Outcome measures
• Follow-up time points
• Statistical analysis
• Intervention
• Mode of delivery
• Provider of intervention
• Delivery timeframe
• Reinforcement
• Duration
• Results
• Attrition
• Compliance with intervention
• Main results
• Side-effects

12. Results - heterogeneity of studies
• Injury type
• Whiplash / neck pain (N=5)
• Mild traumatic brain injury (N=4)
• Acute stress disorder (N=3)
• Not specified “physical injury” (N=1)
• Follow-up period
• 2 to 26 weeks post baseline (N=7)
• >12 months (N=6)
• Comparison conditions
• Usual care (N=9)
• Active comparison (N=4)
• Co-interventions (N=3)
• Outcomes
• N=75 different outcomes reported
• Symptom severity/frequency
• Mental health / Physical health
• Quality of life
• Health service utilisation
• Employment status / return to work
• Timing of intervention
• 24hrs to ~3mths post injury
• Provider of intervention
• Nurse (N=4), Self (N=3), Physiotherapist
(N=2), Psychologist (N=1), Therapist (N=1),
Clinician (N=1), Not specified (N=1)

13. Paper-based interventions
• 9 studies
• Format of intervention:
• 1 page pamphlet -> 64 page manual
• 3 studies reported a positive impact
• 4 reported no impact
• 2 studies reported an adverse impact of the intervention
• Both in PTSD –> increase in levels of depression & more request for
treatment

14. Face-to-face interventions
• 6 studies
• Interventions:
• Single session -> multiple sessions conducted over various time
periods
• At discharge -> in patient’s home
• Written information also provided in 4 studies
• 5 studies reported no impact
• 1 study reported a positive impact
• Reduction in symptoms following mild TBI

15. Video / DVD interventions
• 2 studies
• Both whiplash
• 20 minute educational video sent to the patient’s home
• Best practice management of whiplash
• Improved self-rating of pain frequency, severity and location.
• 12 minute educational DVD viewed at patient’s bedside (in hospital)
• Reduced pain ratings, less time away from work, less narcotic use and
less health service utilisation.
• BUT….66 outcome measures reported.

16. Methodological quality
• Generally poor
• All studies rated against CONSORT guidelines for RCTs
• 2 studies scored 12/37
• 2 studies reported 18/37
• No studies reported on all CONSORT items
• Common failure to report important aspects of study design
• Study population
• Compliance with intervention
• Attrition rate

17. Conclusions
• Heterogenous literature
• Quality of published reports is poor
• No clear evidence of effectiveness of information interventions following
motor vehicle injury.
• However…
• ? Does early intervention exacerbate symptoms of PTSD ?
Information interventions remain potentially important.
Well designed, run and reported studies are needed.

18. For more information
A/Prof Alex Collie
Chief Research Officer,
Institute for Safety Compensation and Recovery Research
Monash University
Melbourne, Victoria, Australia
Twitter - @axcollie
Web – www.iscrr.com.au

19. “This project is funded by WorkSafe Victoria and the Transport Accident Commission, through the
Institute for Safety, Compensation and Recovery Research.”