A key partnership is funding a study that aims to improve the independence of people seriously injured in road traffic accidents to ensure insurance premiums remain affordable.

Researchers involved in a joint project between the Physiotherapy Research Foundation (PRF), the Insurance Commission of Western Australia (Insurance Commission) and Curtin University are keen to develop a model of care that will provide a more holistic approach to treating neck and back pain associated with vehicle accidents.

The research aims at improving the outcomes of those at high risk of unresolved neck and/or back pain, through piloting an innovative integrated physiotherapy and psychology intervention—stratified cognitive functional therapy (CFT).

Previous trials in back pain have shown that CFT produces large, sustained improvements in functional recovery.

The feasibility randomised controlled trial is set to test the potential for an integrated multidisciplinary version of CFT to be applied to crash-related spinal pain, including quantifying expected cost savings, compared with usual care.

Trial coordinator and lead psychology investigator Dr Rob Schutze says the study has the potential to help inform healthcare practitioners (GPs, physiotherapists and psychologists), funders, and policy-makers about better care for individuals with these common injuries.

‘We hope to create a model of care that will provide more effective high-value patient-centred care.

"We want to find out which might be best and what the associated costs of each are.

'Currently, it is uncertain which treatment approach is best for neck and back pain and the benefits of treatment is often short term.’

The Insurance Commission manages personal injury claims for people injured in crashes on the road, and reports spine and neck injuries as being the most frequent and costly complaint, with compensable traffic injury claims presenting a $2.8 billion liability.

Many claims involve the injured person requiring rehabilitation to help them return to work and the community.

In 2019, the Insurance Commission paid $70 million for about 400,000 health services for 15,000 injured Western Australians, says Insurance Commission secretary Kane Blackman.

‘This included about 100,000 physiotherapy consultations for claimants.

'Effective rehabilitation delivered by allied health professionals can help people recover from injuries quicker and, consequently, reduce the cost of claims and the premiums paid by motorists and employers.’

Kane says the partnership with the APA through the PRF enables the government insurer to take a proactive approach in identifying and promoting innovative ways to increase the independence of people injured each year.

‘While the best way to increase independence is avoiding a crash to start with, getting in early with effective rehabilitation and treatment is the next best option.

'We recognise the important role that physiotherapists have in the recovery programs for our claimants in helping them to get back as close as possible to the precrash condition. We want to help increase their independence.’

The Insurance Commission has provided $90,000 towards the research, granting a similar amount to Occupational Therapy Australia for additional research.

Rob, a clinical psychologist and research fellow with Curtin University, says the focus for people following an injury must be on rehabilitation, as a lack of recovery results in a significant costs and challenges for them and their families, their workplaces and then insurers.

‘What we’re trying to do is look at better ways to help people with whiplash and back pain… the best way to manage recovery after a car crash is to reassure people and keep them moving and get them slowly back to their usual activities.’

Sixty people will be involved in the pilot study, titled ‘A feasibility trial of stratified cognitive functional therapy for high-risk neck and back injuries following road traffic crash’, that at the time of writing was set to start formally on 1 October (until November 2021), having been delayed due to the impact of COVID-19.

It involves a national collaboration with project chief investigator and lead of the physiotherapy team Professor Peter O’Sullivan (Curtin University), and fellow researchers Professor Anne Smith, Associate Professor Peter Kent (Curtin University), Dr Joao Paulo Caneiro (Curtin University), Professor Michele Sterling (University of Queensland) and Professor Michael Nicholas (University of Sydney).

Physiotherapists will lead the patient-centred, individualised treatment, integrating it with collaborative care from psychologists using a common clinical-reasoning framework in cases where psychological risk factors predict poor prognosis.

The time-limited non-interventional treatment will use an evidence-based self- management approach that targets modifiable risk factors.

Adds Peter O’Sullivan: ‘CFT targets unhelpful pain beliefs, negative emotional responses to pain and provocative functional behaviours that act as a barrier to recovery.

'This approach has previously been shown to have greater efficacy than traditional physiotherapy approaches in people with chronic back pain for reducing pain and disability.’

Participants will be randomly allocated to one of two groups. Group one offers the existing treatment pathway (considered current best practice) used for motor vehicle injury claims, and involves whatever the patient or health professional, such as a GP, decide on, and the Insurance Commission agrees to fund.

Group two participants will be allocated to the integrated rehabilitation pathway, which involves receiving care from a GP, plus attending up to 10 sessions with a physiotherapist and, if the patient elects to see, a psychologist for six months.

Physiotherapy treatment is undertaken at a physiotherapy clinic and will involve education on pain and ways to manage the individual problem, specific movement training, as well as lifestyle and physical activity training.

The physiotherapist, psychologist and GP will communicate throughout the trial and integrate their care to align with each participant’s goals and needs.

Results will inform the development of a future definitive trial that tests the clinical and cost-effectiveness of stratified CFT for neck and back injuries.

‘We’re trying to achieve person-centred care,’ Rob says.

‘It’s not about treatment that ticks the boxes for the individual clinician, but about discovering the treatment that works best for the individual. So consumer involvement in the development of this model of care is vital to the research.’

For more information on the Insurance Commission grant awarded to Peter O'Sullivan click here

Photo Caption: APA WA Branch President Darren Elliott (left) with Insurance Commission secretary Kane Blackman, trial coordinator Rob Schutze and chief investigator Peter O’Sullivan.