Clinical utility of predictors of return-to-work outcome following work-related musculoskeletal injury.

INTRODUCTION: Clinical expertise is one source of evidence that is generally under-utilised in the development of an evidence-base in rehabilitation. The current study aimed to incorporate this valuable clinical expertise in determining the utility of multiple predictors of return-to-work outcome following injury. METHODS: Following systematic review of the rehabilitation literature and review, a total of 85 predictors were evaluated for clinical relevance by an expert panel of rehabilitation practitioners (n = 12). Each predictor was rated according the importance of the predictor in rehabilitation, its potential for modification and its classification into one of seven broad areas. In addition, practitioners were asked to provide a rationale as to why the predictor was important to rehabilitation. Analyses were conducted using inter-rater agreement statistics and text analysis. RESULTS: Predictors that were most commonly reviewed in the literature were not considered to be of greatest clinical utility, according to the current sample. From the total predictor set, only nine predictors were identified as clinically useful (i.e., both highly important and highly modifiable). Text analysis of the qualitative data revealed that these nine predictors highlighted the significance of time, context and engagement in rehabilitation practice. CONCLUSION: In the current study, predictors that were considered most clinically relevant were those that generally described workplace related processes. The findings confirmed the underlying supportive and collaborative processes that integrate predictors and account for their influence on outcome. Future rehabilitation efforts and indeed, individual outcomes, could benefit by incorporating these key predictors in targeted programs.

Outcome measurement in Australian rehabilitation environments.

OBJECTIVE: To determine the frequency and pattern of methods of outcome assessment used in Australian physical rehabilitation environments. DESIGN: Postal survey. METHODS: A questionnaire on service type, staffing, numbers of adults treated and outcome measures used for 7 conditions related to injury and road trauma as well as stroke and neuromuscular disorders was sent to 973 services providing adult physical rehabilitation treatment. RESULTS: Questionnaires were completed by 440 service providers for a response rate of 45%, similar to that reported in a recent European survey reported in this journal. A small number of measures were reported as in use by most respondents, while a large number of measures were used by a few respondents. Measures of physical changes were used more frequently than those of generic well-being or quality of life. Ease of use and reporting to other professionals were cited as the most important reasons in selection of outcome measures. CONCLUSION: This Australian-wide survey detected considerable heterogeneity in outcome measurement procedures used in rehabilitation environments. While the goal of measurement may vary between providers and differ between conditions, the results highlight opportunities for harmonization, bench-marking and measurement of health-related quality of life.

Long-term outcomes of seriously injured children: a study using the Child Health Questionnaire.

OBJECTIVE: To assess the health-related quality of life (HRQoL) in children 1-2 years after they had sustained an injury. METHODS: Parents of all children who were identified by the Queensland Trauma Registry during their admission to either of the two paediatric specialty hospitals in Brisbane, Australia, for the treatment of an injury, were invited to participate in this study. Parents who consented to participation received a copy of the Child Health Questionnaire (CHQ) that required them to provide information regarding their child's HRQoL following injury. The CHQ scores for the study respondents were compared with those of the Australian norms. This study was approved by the relevant ethics committees. RESULTS: Two hundred and forty-one completed questionnaires were returned. The majority of cases were male (65%) and there was even representation across all age groups. The majority of injuries were considered to be minor (81%) and were predominantly the result of falls and cycling accidents causing mainly fractures and intracranial injury. On the majority of subscales of the CHQ, study participants recorded scores that were statistically significantly below those of the Australian norms. None of the relevant variables collected by the Queensland Trauma Registry were found to predict scores on the CHQ in this study (for those children hospitalized for > 24 h). CONCLUSION: Injured children are worse off than their Australian counterparts in terms of HRQoL even up to 2 years following an injury. Further research needs to be undertaken to identify factors that predict lower HRQoL in order to reduce the burden of injury on children and their families.

Predictors of nonpathological dissociation in Northern Ireland: the affects of trauma and exposure to political violence.

Recent work has identified an empirical distinction between pathological and nonpathological dissociation. This study examined the correlates of nonpathological dissociation in a Northern Irish sample. The Dissociative Experiences Scale, the Traumatic Experiences Checklist, the Guilt Inventory, and the General Health Questionnaire, as well as two open-ended questions assessing exposure to political violence were completed by 119 participants. Nonpathological dissociation was predicted by age, perceived impact of traumatic events, and adherence to moral standards. Moreover, dissociation was found to be significantly higher in those exposed directly to political violence and those experiencing childhood emotional abuse. Results are consistent with previous theoretical and empirical work and it is proposed that nonpathological dissociation is related to traumatic experience in Northern Ireland.