RECOVER 2022 Conference Program

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.

Insurance Commissioner Neil Singleton will present an overview of recent work within Queensland’s Motor Accident Insurance Commission (MAIC).

On average, it takes a novel health technology 17 years to make the full transition from bench to bedside in the United States, which is a source of constant tension between patients searching for the latest innovations and clinicians who are attempting to adhere to evidence-based principles of best practice.

The Division of Rehabilitation Innovation at Mount Sinai was developed with the mission to accelerate the path of novel technologies so that they can reach the hands of those who need them the most as fast as possible. Our various centers work with an enormous range of human abilities - from people with severe paralysis to elite performance athletes. Our team has the opportunity to experiment with the latest in robotics, augmented and virtual reality, brain computer interfaces, artificial intelligence and many other technologies to ensure that those under our care have access to the most effective strategies and technologies to improve their daily performance, no matter their starting level of ability. 

The purpose of this session is to give attendees access to the inner workings of our centers, to show our colleagues that rapid and repeatable innovation is a replicable, tangible process that has the potential to greatly benefit both our patients and our entire profession as we bring the practice of rehabilitation and human performance into the 21^st Century.  

Authors: Scott Farrell, Adrián Campos, Pik-Fang Kho, Rutger MJ de Zoete, Michele Sterling, Mischa Lundberg, Miguel Rentería, Trung Thanh Ngo and Gabriel Cuéllar-Partida

Description: Chronic pain conditions are multifactorial and complex; our incomplete understanding of the complicated pathophysiology of chronic pain is a barrier to developing more effective clinical management. Large-scale genetic datasets and statistical methods represent a potential solution. In these studies, we leverage genome wide association study (GWAS) data for various regional chronic pain conditions (total N=196,963 cases, N=239,125 controls) and use genetic correlation and latent causal variable analyses to investigate links between chronic pain and brain structure, as well as relationships between chronic pain and >1400 biopsychosocial traits. Our results reveal shared underlying genetics – including potential causal relationships – between chronic pain risk and a wide range of traits including brain structure, clinical (e.g., obesity, cardiovascular disease), psychological (e.g., depression), lifestyle (e.g., diet, smoking) and social (e.g., socioeconomic, employment) factors. Findings provide new insight on the genetic mechanisms underlying chronic pain conditions and factors commonly associated with chronic pain, which can inform design of future targeted epidemiological and clinical investigations.

Authors: Dr Nicole Andrews, Dr Andrew Claus, Dr Riley O’Donohue, Megan Murdoch, Dr Hang Ding, Dr Atiyeh Vaezipour, A/Prof Paul Gray, Prof Trevor Russell

Description: There is a growing evidence and consensus that supports the importance of coordinated interdisciplinary self-management strategies to treat chronic pain. These self-management strategies are commonly delivered using group-based pain management programs worldwide.  Referral to these interdisciplinary programs is considered best practice as outlined in national guidelines. While research has suggested that there is a clear association between adherence to the self-management strategies taught during pain management programs and key patient-reported outcomes, little is known about the factors the influence attendance and initial uptake of pain management programs. This presentation will report on findings from a study that aimed to: 1) establish the uptake and attendance rates of the two group-based pain management programs that have run historically at the Royal Brisbane and Women’s Hospital, 2) explore possible reasons for poor uptake and adherence using qualitative methodology, and 3) explore perceptions towards a number of potential initiatives to improve uptake and adherence rates using qualitative methodology. 

Authors: Dr Hang Ding, Dr Joshua Simmich, Dr Nicole Andrews, Dr Megan Ross, Professor Trevor Russell

Description: Conversational agents (or chatbots) present new opportunities to assist in delivering health interventions. The use of chatbots in healthcare often involves artificial intelligence (AI) techniques, complex interventional strategies, and rigorous clinical evaluations. Relevant knowledge to achieve effective interventions remains unclear.

At RECOVER, we are exploring innovative chatbot applications for patient education on the self-management of whiplash ( a neck injury) such as managing stress and doing the exercises recommended. Recently, we have developed a prototype chatbot application through consumer group studies and are evaluating the application in pilot trials, focusing on functionality, safety, information quality, and user experience.  

At the conference, we will present and discuss the opportunities and challenges we experienced through the chatbot project. The objective is to share the knowledge and experience in the research community for improving chatbot interventions in healthcare.

Pain is an unpleasant experience associated with variable levels of emotional distress. For clinicians work with patients in pain, exposure to patient distress is inevitable. It is crucial that clinicians recognise and respond to patient distress – negative emotions such as anxiety, anger, and hopelessness shape patients’ experiences and expectations of care, and can disrupt patient engagement in shared decision-making and deter adherence to treatment advice. Despite the potential for patient distress to derail pain management outcomes, many clinicians are not equipped with skills to identify and respond to patient negative emotions.  In this presentation, Dr Ashton-James will present evidence-based strategies for identifying and responding to patient distress in a manner that builds trust and empowers patients to participate more collaboratively in their care. This presentation will be followed by a practical skills workshop which may be helpful for healthcare and workers compensation agents in their interactions with people seeking help managing pain.

Come and say hello to the authors and review their posters.

Presenters: Professor Michele Sterling

Research team: Rachel A. Elphinston PhD, Sue Pager SpPath MPH, Kelly Brown MClinPsych, Michele Sterling PhD, Farhad Fatehi MD PhD, Paul Gray MBBS PhD, Linda Hipper GradDipPsych MPH, Lauren Cahill, Jason P. Connor PhD

Description: Opioid therapy is an important part of chronic pain care. But there are significant risks associated with prescription opioid use, including adverse side effects and misuse (use other than as prescribed). Health system challenges contribute to delayed access to timely specialist treatments, and the lack of available best practice interventions to reduce opioid-related harms provides little guidance for treating health care professionals. These gaps suggest the need for new and innovative treatment approaches. Brief behavioural interventions delivered digitally, which are widely used in substance use treatment settings have the potential to reduce the risks of prescription opioid-related harms.

In this presentation, we will present the results from our first and second phases of co-designing a brief behavioural mobile App, OMED Assist, which aims to minimise the risks of opioid harms in people with chronic pain. We will also provide reflections on the co-design process from both the patient partner and clinician-researcher perspectives.

Presenter: Dr Scott Farrell

Authors: Dr Scott Farrell, Dr Nigel Armfield, Professor Michele Sterling

Description: Early after a whiplash injury, sensory hypersensitivity is a predictor of transition to long term pain and disability. In this study, we apply group-based trajectory modelling to investigate how hypersensitivity develops over time in a cohort of people across the 12 months following injury, including co-development with neck pain-related disability.

Presenter: Dr Carrie Ritchie

Research team: Carrie Ritchie, Jane Nikles, Rachel Elphinston, Sigfried Perez, Amy Johnston, Georgia Livesay, Rob Eley, Gerben Keijzer, Kirsten Strudwick, Michele Sterling

Description: Individuals with neck and lower back soft tissue injuries experienced from a road traffic crash often present to an Emergency Department (ED). While pain relief medicines are commonly prescribed for these injuries, there are limited data available about the challenges of pain management and opioid prescribing practices within ED. This presentation will report on findings from a qualitative study that explored ED health professionals experience of managing pain and prescribing medicines to patients with these types of injuries. Interviews were recorded and transcribed verbatim from ED doctors (n = 14), nurses (n = 12), and physiotherapists (n = 7) employed within four public, Queensland Health ED departments in Brisbane. Standard qualitative research strategies (e.g., content and thematic analysis) were used to analyse the data. Gaining a more in-depth understanding of ED management will provide us with information needed to help guide treatment recommendations for acute minor RTC injury, and the most effective ways these options might be discussed with patients.

Authors: Joshua Simmich¹, Megan Ross¹, Trevor Russell¹

Affiliation: ¹RECOVER Injury Research Centre, The University of Queensland

Background: Conventional physiotherapy can suffer from poor adherence and compliance, both of which can be influenced by satisfaction with quality of care. Telerehabilitation – the delivery of rehabilitation services using telecommunication technology – appears to have similar clinical effectiveness to in-person care. However, it remains unclear how patient satisfaction, adherence and compliance differ between telerehabilitation using real-time video communication and conventional in-person physiotherapy.

Method: A systematic review of PubMed, CINAHL, Embase and Cochrane databases was conducted. Studies were included if they were randomised controlled trials of adults receiving real-time video telerehabilitation for physiotherapy where adherence, compliance or satisfaction were compared between intervention and control groups.

Results: Seventeen articles were included in this review. Rates of adherence to scheduled rehabilitation sessions were usually higher for telerehabilitation. Differences in both compliance to home exercise programs and satisfaction with care were inconsistent across included studies. Some studies found telerehabilitation was superior in these outcome measures while other studies indicated no difference or inferiority of telerehabilitation.

Conclusion: Real-time telerehabilitation may be superior to conventional methods of healthcare delivery for achieving high rates of adherence to scheduled sessions, but the effect on compliance with unsupervised home programs and overall satisfaction are unclear.

Presenter: Professor Trevor Russell

Research team: Megan H Ross, Trevor Russell, Kim L Bennell, Penny K Campbell, Alex Kimp, Nadine E Foster, and Rana S Hinman.

Description: Technical issues are often cited as a barrier to the adoption of telehealth. This study investigated the frequency, nature and impact of technical issues experienced in a randomised clinical trial conducted in Australia investigating telerehabilitation compared to in-person physiotherapy consultations for people with knee osteoarthritis. A total of 120 consultations were randomly selected (40 in-person; 40 telerehabilitation consultations with technical issues; 40 telerehabilitation consultations without technical issues). The duration of each consultation component (set-up and introduction, assessment, exercise, physical activity, education and wrap-up) as well as total consultation duration and duration of technical issues were measured. Technical issues occurred in 37% and 19% of initial and final telerehabilitation consultations respectively, with issues most frequently occurring in the set-up phase of the consultation. Technical issues did not significantly increase overall consultation duration, or the duration of effective consultation time (total minus time spent troubleshooting technical issues). While technical issues do occur during telerehabilitation consultations, they are minor, transient and resolved quickly with minimal impact on clinical physiotherapy consultations.

Workshop topic 1: Dr Claire Ashton-James "Managing emotionally challenging patient encounters"

A practical skills workshop which may be helpful for healthcare and workers compensation agents in their interactions with people seeking help managing pain.

Workshop topic 2: Professor Trevor Russell “Reimagining rehabilitation with Virtual Reality. A practical workshop”

Virtual reality is increasingly being used in rehabilitation. This practical workshop will investigate some of the evidence for its effectiveness, provide an opportunity to experience VR in person and workshop a VR application relevant to your work environment.