Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial

Abstract

Purpose

To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury.

Materials and methods

Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability.

Results

Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months.

Conclusions

Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma.

IMPLICATIONS FOR REHABILITATION

• After hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns.

• Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers.

• We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia.

• The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.

Keywords:

• Trauma
• injury
• hospitalization
• brief intervention
• pain
• pTSD
• recovery

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The project was funded by a project grant from the Rebecca L Cooper Medical Research Foundation [PG2019336]. Two researchers were supported by an Australian Research Council Discovery Early Career Research Award [DE170100726] awarded to MJG and Future Fellowship [FT170100048] to BJG during the study. Services Australia is a government agency that delivers a range of payments and services, and provided the MBS and PBS data for this study. The Victorian State Trauma Registry (VSTR) is funded by the Transport Accident Commission (TAC) and the Department of Health (State Government of Victoria). The funders did not have any direct role in the trial; however, a representative of the TAC was on the steering committee to support knowledge translation. BG and JP were supported by NHMRC Investigator Grants [ID 2009998, ID 1174473]. DZ was supported by the United States, National Institutes of Health (NIH) Health Care Systems Research Collaboratory cooperative agreement 1UH2MH106338-01/4UH3MH106338-02 from the NIH Common Fund and by UH3 MH 106338-05S1 from the United States, National Institute for Mental Health (NIMH). JK was supported by a Canadian Institutes of Health Research Canada Research Chair in Health Psychology at York University. Study data were collected and managed using REDCap electronic data capture tool hosted and managed by Helix (Monash University) [71,72]. REDCap (Research Electronic Data Capture) is a secure, web-based software platform designed to support data capture for research studies, providing (1) an intuitive interface for validated data capture; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for data integration and interoperability with external sources.