Welcome to the RECOVER Conference 2021: Research Driving Rehabilitation Program
Program overview
9:00am - 10:55am - Welcome, Speakers, Keynote speakers
10:55am - 11:15am - Break
11:15am - 12:30pm - Presentations by RECOVER staff
12:30pm - 1:00pm - Break
1:00pm - 2:00pm - Keynote speaker, Launch of Whiplash Navigator, Wrap up by Professor Trevor Russell
The full program is outlined below. Click on the links for detailed information about the presentations.
Morning presentations
9:10am–9:25am - Professor Bruce Abernethy, Executive Dean of the Faculty of Health and Behavioural Sciences.
Professor Bruce Abernethy is responsible for the academic and administrative leadership of the Faculty, ensuring that the Faculty (and the Schools and Centres within it), contribute effectively to the strategic mission and goals of the University.
9:40am-10:25am - Professor Sam McLean - Recovery after Road Traffic Accidents. Discoveries from the AURORA Study
Samuel McLean MD is a practising emergency medicine physician and Jeffery Houpt Distinguished Investigator at the University of North Carolina, where he directs the Institute for Trauma Recovery.
He is the organizing Principal Investigator of the NIMH-funded Advancing Understanding of RecOvery afteR traumA (AURORA) study. AURORA is a $40 million emergency department-based longitudinal study examining the development of chronic pain and other adverse post-traumatic neuropsychiatric (APNS) sequelae.
AURORA has evaluated more than 3,800 individuals presenting to the emergency department after road traffic accidents (~80% of enrolled) and other traumatic stress exposures, using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for one year. AURORA data collection was completed in June of 2021. Dr McLean will highlight the latest published and unpublished findings from AURORA analysis teams
10:25am-10:55am - Dr Francesca Beaudoin - Altering the transition from acute to chronic pain. New opportunities for existing therapeutics in the acute setting
Dr Francesca Beaudoin is an Associate Professor of Emergency Medicine, Epidemiology, and Health Services, Policy and Practice at Brown University in Providence, Rhode Island, USA. She is a practicing emergency physician and the Director of Clinical Research.
Her research interests involve the dynamic between acute and chronic pain, and the relationship between pain and substance use disorders.
Dr Beaudoin has recruited thousands of patients with painful conditions or substance use disorders in busy acute care settings. She has been the principal investigator of several clinical trials and observational studies aimed at understanding and improving outcomes after a traumatic event.
11:15am–11:30am - Professor Michele Sterling - A randomised controlled trial of implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT).
Michele Sterling1, Trudy Rebbeck2, Luke B Connelly3, Andrew Leaver2, Carrie Ritchie1 Aila Bandong2,9, Martin Mackey2, Ian D Cameron4,5, Geoffrey Mitchell6, Mohit Arora4,5, Sarah Robins1, Nigel R Armfield1,8
Affiliations:
1 RECOVER Injury Research Centre, NHMRC CRE in Road Traffic Injury Recovery, The University of Queensland, Australia
2 Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
3 Centre for Business and Economics of Health, The University of Queensland, Australia; and Faculty of Economics and Statistics, The University of Bologna, Italy
4 John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, New South Wales, Australia
5 Faculty of Medicine and Health, Sydney Medical School – Northern, The University of Sydney, New South Wales, Australia
6 Discipline of General Practice, School of Medicine, University of Queensland, Queensland
7 Discipline of General Practice, Sydney Medical School, University of Sydney, New South Wales, Australia
8 Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Australia
9 College of Allied Medical Professions, The University of the Philippines Manila, Philippines
Background: Whiplash-associated disorders (WAD) are a huge worldwide health and economic burden. A novel approach is to evaluate whether the care provided according to the risk of poor recovery improves health outcomes.
Aims: 1) To evaluate the effect of a guideline-based clinical pathway of care (CPC) for acute WAD. 2) To investigate if there is a differential effect of risk of recovery (‘low’ or ‘medium/high’ risk) on the CPC.
Method: 216 participants with acute WAD Grade I-III (< 6 weeks) were randomised to either the CPC or usual care. Outcomes were measured at baseline, 3, 6 and 12 months by a blinded assessor. Analysis was by intention to treat using linear mixed models. ACTRN 12615001367538.
Results: There was no difference between the CPC and usual care on the primary outcome of neck pain related disability at any time point. At 3 months the treatment effect on the 0-100 Neck Disability Index was -2.34 (95% CI -7.44 to 2.76), at 6-months -3.4 (95% CI -8.56 to 1.76), and at 12-months -2.87 (95% CI -7.5 to 1.76). For Global Recovery, the CPC intervention also did not provide a benefit over usual care at any time point. There was no difference between the interventions for the majority of secondary outcomes at any time. Exceptions were in favour of CPC where improvements in self-efficacy were found at 3 months. The results were not different for risk category (low or high risk).
Conclusions: A CPC based on risk of poor recovery is no more beneficial than usual care.
11:30am–11:45am - Dr Atiyeh Vaezipour - Driving behaviour in individuals with Chronic Pain.
Authors: Atiyeh Vaezipour1, Oscar Oviedo-Trespalacios2, Mark Horswill3, Nicole Andrews1,4, Venerina Johnston1, Patricia Delhomme5
Affiliation:
1 RECOVER Injury Research Centre, The University of Queensland, Australia
2 Centre for Accident Research and Road Safety- Queensland (CARRS-Q), Queensland University of
Technology (QUT), Australia
3 School of Psychology, the University of Queensland, Australia
4 The Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Australia
5 Univ Gustave Eiffel, Université de Paris, LaPEA, F-78000 Versailles, France
Background: Driving is a complex task which requires both the ability to rapidly identify potential hazards and to respond appropriately to driving situations to avoid crashing. A great deal of research has sought to increase road safety by focusing on risky behaviours, very few of which have explored the effects of chronic pain on driving behaviour.
Method: This research investigates the effect of chronic pain on driving behaviour using a mixed-method design involving (i) qualitative interviews with Australian health professionals and individuals with chronic pain, drawing upon their lived experience, and (ii) quantitative cross-sectional component comparing driving behaviour between chronic pain and non-chronic pain participant groups in Australia.
Results: The findings highlighted the need for clearer guidelines and educational materials on the impact of chronic pain on an individual’s ability to drive. In addition, self-regulation strategies and current barriers and enablers for improving driving were identified. In the quantitative component, there were no significant differences observed in the hazard perception response time test, self-reported attention-related error and self-reported driving behaviour between the participant groups. However, there were significant differences in the scores of driving lapses, mental demand, physical demand and frustration levels of the driving task.
Conclusion: Overall, our findings contribute to the understanding of current driving behaviours, the challenges for people experiencing chronic pain, and the relationship between chronic pain and driving. Lastly, Evidence-based recommendations for practitioners and policymakers are proposed regarding the risks of driving and strategies to improve safe driving among people with chronic pain.
11:45am–12:00pm - Dr Carrie Ritchie - The accuracy of WhipPredict versus the Örebro Musculoskeletal Pain Screening Questionnaire to predict poor recovery after a whiplash injury.
Authors: Sterling, M1,2, Ritchie, C1,2, Rebbeck, T2,3,4, Cameron, I2,3, Griffin, A3,4, Jagnoor, J3,5, Nicholas, M6, Nguyen, H2,3, Warren, J7
Affiliation:
1 RECOVER Injury Research Centre, University of Queensland (UQ)
2 NHMRC Centre of Research Excellence in Recovery after Road Traffic Injury, UQ
3 John Walsh Centre for Rehabilitation Research, The University of Sydney/Kolling Institute
4 Sydney School of Health Sciences, The University of Sydney
5 The George Institute for Global Health, The University of New South Wales
6 Pain Management Research Institute, The University of Sydney/Kolling Institute
7 Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital
Background: The accuracy of a whiplash-specific risk screening tool (WhipPredict) was compared with that of the modified generic short-form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMPSQ) for predicting poor recovery in patients following whiplash injury.
Method: 202 participants with acute whiplash completed the WhipPredict and modified SF-ÖMPSQ at baseline. Poor recovery was measured at 6 and 12 months using the Neck Disability Index (greater than 10%), numeric pain-rating scale (greater than 3/10), global perceived recovery (less than +4), and inability to return to preinjury work level. Accuracy statistics were calculated to predict poor recovery.
Results: At baseline, agreement between the WhipPredict and modified SF-ÖMPSQ was fair (prevalence-and bias-adjusted κ = 0.26; 95% CI: 0.12, 0.39). Depending on the outcome, 20% to 72% of people had not recovered at 6 months and 12% to 71% had not recovered at 12 months. At 6 and 12 months, WhipPredict showed high sensitivity (88%-96%) and low specificity (all outcomes < 31%) on all 4 outcomes. The modified SF-ÖMPSQ showed moderate sensitivity (67%-75%) for the Neck Disability Index, numeric pain-rating scale, and global perceived recovery, high sensitivity for return to work (81%-90%), and moderate specificity (54%-77%) for all 4 outcomes.
Conclusion: Both tools showed acceptable accuracy in predicting poor recovery. WhipPredict is recommended to correctly identify patients who will not recover but may falsely classify those who recover well. Using the modified SF-ÖMPSQ will result in fewer patients falsely categorized as being at risk of poor recovery and may result in some people being undertreated.
12:00pm–12:15pm - Dr Nicole Andrews - Engaging young adults with persistent pain through technology.
Authors: Andrews, N.E 1,2,3
Affiliation:
1 RECOVER Injury Research Centre, The University of Queensland
2 Royal Brisbane and Women’s Hospital, Occupational Therapy Department
3Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service
A large proportion of individuals who are admitted to hospital following a road traffic crash are young adults who will go onto develop chronic pain. Anecdotally, this cohort are difficult to treat with clinicians often citing poor engagement and motivation as factors contributing to poorer treatment outcomes. This presentation will compare young adults to both an adult and paediatric population and consider key differences in communication, pain education needs and preferred learning styles. The need for a different treatment approach for this cohort will be considered. The potential role of technology including artificially intelligence-based conversation agents (i.e., chatbots) and gamification will be discussed.
12:15pm–12:30pm - Dr Scott Farrell - Chronic pain, C-reactive protein, psychosocial & lifestyle factors and medical comorbidities – a study using UK Biobank data
Authors: Scott F Farrell1,2, Nigel Armfield1,3, Rachel Elphinston1,2, Peter Cabot4 & Michele Sterling1,2
Affiliation:
1RECOVER Injury Research Centre, The University of Queensland, Herston QLD, Australia
2NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Herston QLD, Australia
3Centre for Health Services Research, The University of Queensland, Brisbane QLD, Australia
4School of Pharmacy, The University of Queensland, St Lucia QLD, Australia
Background: Systemic inflammation has been observed in chronic musculoskeletal pain conditions. It is unclear this inflammation is related to chronic pain per se, or if it reflects the confounding effects of demographic, psychosocial & lifestyle factors and medical comorbidities. This study sought to assess the influence of such factors on the relationship between inflammation and chronic pain.
Method: A cross-sectional study using UK Biobank data, comparing people reporting regional chronic pain conditions (N=194,395 total) with pain-free controls (N=197,098). Blood concentrations of C-reactive protein (CRP, mg/L) were compared between the chronic pain types (back, neck/shoulder, hip, knee, multisite, widespread, any site) and controls. Logistic regression models characterised the relationship between CRP and chronic pain, using demographic (e.g., age, sex), socioeconomic (e.g., education, income), psychological (prior mental health care), medical (co-morbidities) and lifestyle (e.g., sleep, smoking) factors as co-variates.
Results: Blood CRP was higher in all chronic pain types compared with controls: median (IQR) control CRP 1.16 (1.75) mg/L, compared to pain at any site (1.57 [2.51]), neck/shoulder (1.53 [2.47]), back (1.59 [2.57]), hip (1.83 [2.91]), knee 1.74 [2.73]), multisite pain (1.75 [2.80]) and widespread pain (2.56 [4.22]) (P<0.001). After adjusting for co-variates, the relationships between CRP and the various chronic pain types were attenuated but remained statistically significant.
Conclusion: These large-scale data indicate that the relationship between chronic pain and CRP can be partly attributed to the confounding effects of demographic, psychosocial, medical and lifestyle factors. The remaining association between chronic pain and CRP could reflect a pathophysiological relationship between systemic inflammation with chronic pain, or unknown confounding factors.
Afternoon presentations
1:00pm–1:45pm - Professor Kim Bennell - Experiences with allied telehealth during COVID–19 and what does the future hold?
Kim Bennell is a Redmond Barry Distinguished Professor, Dame Kate Campbell Fellow and NHMRC Investigator in the Department of Physiotherapy at the University of Melbourne. She leads the Centre for Health, Exercise and Sports Medicine and the NHMRC Centre of Research Excellence in Translational Research in Musculoskeletal Pain. She is also a fellow of the Australian Academy of Health and Medical Sciences. Her research focuses on non-drug, non-surgical management of hip and knee osteoarthritis as well as ways to address evidence-practice gaps around uptake of pain management and lifestyle interventions by clinicians and patients. She has a special interest in telehealth interventions.
1:45pm–1:55pm - Professor Michele Sterling - Introduces My Whiplash Navigator, a new on-line tool to assist injured people and their health care providers.
Professor Michele Sterling introduces My Whiplash Navigator:
Whiplash Navigator is a self-directed program that has been developed to guide people in their recovery following whiplash injury. Most people recover well from a whiplash injury although at different rates. No injury is the same as another. Therefore, this comprehensive program has been developed with information and exercises to help you track and take control of your recovery.
Whiplash Navigator is based on the best available scientific evidence about whiplash. Throughout your recovery you will work with your nominated health professional. In some cases, you will also be guided by another health professional with specialist expertise in whiplash treatment.