Pain and mental health symptom patterns and treatment trajectories following road trauma: a registry-based cohort study

Abstract

Purpose

This study aimed to characterise recovery from pain and mental health symptoms, and identify whether treatment use facilitates recovery.

Methods

Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry participants without neurotrauma who had transport injury claims with the Transport Accident Commission from 2007 to 2014 were included (n = 5908). Latent transition analysis of pain Numeric Rating Scale, SF-12, and EQ-5D-3L pain and mental health items from 6 to 12 months, and 12 to 24 months post-injury were used to identify symptom transitions.

Results

Four transition groups were identified: transition to low problems by 12-months; transition to low problems at 24-months; stable low problems; and no transition from problems. Group-based trajectory modelling of pain and mental health treatments found three treatment trajectories: low/no treatment, a moderate treatment that declined to low treatment 3–12 months post-injury, and increasing treatment over time. Predictors of pain and mental health recovery transitions, identified using multinomial logistic regression, were primarily found to be non-modifiable socioeconomic and health-related characteristics (e.g., higher education, working pre-injury, and not having comorbidities), and low treatment trajectories.

Conclusions

Targeted and collaborative rehabilitation should be considered for people at risk of persistent pain or mental health symptoms to optimise their recovery, particularly patients with socioeconomic disadvantage.

IMPLICATIONS FOR REHABILITATION

• Two-thirds of people experience pain and/or mental health within the first 24-months after hospitalization for road trauma, of whom only 6–7% recover by 12-months, and a further 6% recover by 24-months post-injury.

• There were three main trajectories of administrative records of treatments received in the first two years after injury: 76 and 83% had low treatment, 18 and 12% had moderate then declining treatment levels, and 6 and 5% had stable high treatment for pain or mental health, respectively.

• People who recovered from pain or mental health symptoms generally had lower treatment and higher socioeconomic position, highlighting that coordinated rehabilitation care should be prioritized for people living with socioeconomic disadvantage.

Keywords:

• Pain
• mental health
• recovery
• healthcare use
• injury

Disclosure statement

All authors declare that they have no conflict of interest.

Data availability statement

The authors do not have approval from the data custodians at the VSTR, VOTOR to publish the original data. To access a dataset that is similar to that used in the present study researchers must submit a data request to the Victorian State Trauma Outcomes Registry and Monitoring Group, VOTOR, and the TAC, and data requests require ethics approval before data can be provided. There may be some other limits to data requests. To gain access to the exact same dataset as that used in the present study interested parties should contact the study corresponding author, and follow the same data custodian request processes outlined above.

Additional information

Funding

This work was supported by staff within Monash University Helix and the Monash eResearch Centre. The Secure eResearch Platform is underpinned by world-leading infrastructure to ensure ongoing security and privacy of any data is maintained. The Victorian State Trauma Registry (VSTR) is funded by the Department of Health, State Government of Victoria and the Transport Accident Commission. The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) is funded by the Transport Accident Commission. The researchers were supported by an Australian Research Council (ARC) Discovery Early Career Research Award (DE170100726) to M.J.G. and ARC Future Fellowship (FT170100048) to B.J.G.