Expert consensus and perspectives on recovery following road traffic crashes: a Delphi study

Figures & data

Table 1. Definitions of recovery following minor and moderate injuries following a road traffic crash and how often each definition was selected by the experts.

	Definition	How often selected (n (%))^a
Definition 1	Recovery is multifaceted and includes return to ADLs, work and social/leisure activities with minimal ongoing pain and symptoms, where both physical and mental health are similar to pre-injury	15 (38%)
Definition 2	Recovery is complex and does not have a uniform meaning for individuals, it is important to establish what “recovery” means to the individual	7 (18%)
Definition 3	Recovery can be defined as return to pre-injury functional status with the ability and confidence to manage ongoing pain and symptoms	5 (13%)
Definition 4	Recovery is when the injured individual self-reports they are recovered	4 (10%)
Definition 5	Recovery can be defined as return to pre-injury functional status without ongoing medication or treatment	3 (8%)
Definition 6	Recovery can be defined as return to life roles relevant to the individual with minimal impediment	3 (8%)
Definition 7	Recovery is when the injured individual is satisfied with their current state of being	3 (8%)
Definition 8	Recovery is when the individual is able to return to ADLs, work and social/leisure activities with no or minimal ongoing pain and symptoms	2 (5%)
Definition 9	Recovery is when the individual is able to return to ADLs, work and social and leisure activities	1 (3%)

ADLs: Activities of Daily Living. ^an = number of votes; % = percentage of experts selecting the definition; all percentages add up to >100% as some experts selected multiple definitions.

Table 2. Expert agreement and median rating for factors that influence recovery following minor and moderate road traffic crash-related injuries.

Category^a	Factors that experts believe have an influence on recovery	% Expert agreement^b	Median rating^c
General Health (−)	Pre-existing psychosocial problems	97	5.0
Insurance (−)	Focus on claim and compensation instead of recovery	97	5.0
Workplace (−)	Lack of support in the workplace	97	5.0
Psychosocial (+)	Having positive expectations and beliefs towards recovery	97	5.0
Psychosocial (−)	Poor recovery expectations	95	5.0
Psychosocial (−)	Negative thoughts	95	5.0
Psychosocial (+)	High resilience	95	5.0
Psychosocial (+)	Effective coping skills	95	5.0
Workplace (+)	Supportive work environment	95	4.5
Psychosocial (−)	Low self-efficacy	95	4.5
Psychosocial (−)	Catastrophic beliefs	92	5.0
Healthcare (−)	Lack of collaborative approach between injured individual, treating providers and claim handlers	92	5.0

^aFactors that have negative influence are indicated with (−) and positive influence with (+).

^bPercentage of experts who selected a rating of a 4 (very influential) or 5 (extremely influential).

^cMedian rating based on rating of all experts (on a scale from 1 to 5; 1 = Not at all influential; 2 = Slightly influential; 3 = Somewhat influential; 4 and 5 see ^b).

Table 3. Additional education/training resources and tool/material resources that could help to identify risk of poor recovery following minor and moderate injuries sustained in a road traffic crash and how often they were selected in the top 5 by the experts.

	How often selected for TOP 5
	n	%
Education / Training resources
Training for clinicians to become aware of and how to deal with important psychosocial factors	26	70%
Educational resources for clinicians dealing with road traffic crash injuries ensuring that the existing clinical framework for  health care delivery is being used optimally	16	43%
Education for health professionals regarding when to refer to other specialisms (e.g., psychologist, multidisciplinary programs)	15	41%
Training to deliver pain and behavioural education embedded in conversations with injured individuals	15	41%
Education for the injured person and family to shift community views and expectations	14	38%
Educational resources for clinicians dealing with road traffic crash injuries ensuring that proper communication channels are  established between primary stakeholders	12	32%
Educational resources for clinicians dealing with road traffic crash injuries to empower healthcare professionals to take the  initiative in maintaining proper communication between primary stakeholders	12	32%
Education in pain management	12	32%
Guidelines for the case manager	11	30%
Information brochures for the injured person	9	24%
Education for the injured person and family about common medical terminology, assessment and treatment methods	9	24%
Training and skills in motivational interviewing	8	22%
Training to become confident with critical conversations	8	22%
An injury or rehabilitation hotline where injured people can call allied health professionals to get hints and tips on recovery	8	22%
Education for community-based private practice clinicians	7	19%
In-person training & training materials around reading human behaviour and communication	3	8%
Tool / Material resources
Use of outcome measures at regular intervals targeting physical and psychological recovery	25	68%
An easy to administer (e.g., checklist with numerical values) and quick tool with a range of personal factors to identify  risk of poor recovery	22	59%
Assessment of beliefs and expectations of pain and recovery	21	57%
Tools to assess risk designed for use by primary care practitioners	20	54%
Standardised early intervention protocols	19	51%
A tool that not only covers main biopsychosocial factors but also specific patients' needs	18	49%
A fully validated 'gold standard' tool for evaluation of health outcomes following RTC	14	38%
Tools to predict recovery designed for use by insurance case managers	12	32%
A risk assessment tool designed specifically for clients injured in RTCs	12	32%
Assessment of work ability (e.g., work ability index + functional capacity evaluation)	8	22%
A tool to assess procedural justice and social impact	3	8%
Assessment of healthcare experiences	2	5%
A tool to assess cervical mobility	2	5%
Point-of-care diagnostics (bedside tests)	2	5%
Frailty scores	2	5%
Assessment of compensation experience when relevant	1	3%
A psychometric test to identify personality types	1	3%
Tools that measure workplace satisfaction	1	3%
A simple isometric neck strength test	0	0%

Table 4. Strategies to identify risk of poor recovery following minor and moderate injuries sustained in a road traffic crash and percentage of experts who selected the strategy as high or low priority.

Strategies	Median score^a	% High priority^b	% Low priority^b
Tools to identify risk of poor recovery designed for use by primary care practitioners	5.0	49%	8%
Education / training for the health care professional	4.0	35%	27%
Tools to identify risk of poor outcomes	4.0	27%	30%
Education of the injured person	4.0	27%	30%
Tools to identify risk of poor recovery designed for use by insurance case managers	4.0	22%	35%
Education / training for the case/injury manager	3.0	16%	27%
Tools to identify risk of poor recovery specific for the road traffic crash population	3.0	24%	43%

^aStrategies were ranked in order of priority and received a score from 7(highest priority) to 1 (lowest priority).

^bHigh priority: scores of 6 and 7; Low priority: scores of 1 and 2.