Dr Giummarra and her team investigated the impact of individualised case management on recover outcomes after serious injury. The project sought to involve relevant organisations and experts from the Victorian trauma system so that the intervention was likely to ultimately be suitable for implementation into routine practice.
The intervention used case management to meet the individual needs of each person, including:
- Care coordination and referrals, especially with rehabilitation providers, mental health specialists, primary care coordinators, pain specialists, and social services;
- Therapeutic supports via regular telephone or video contact, including medication management, relaxation training, support to identify and apply strategies to manage symptoms;
- Discussion to encourage people to reduce their engagement in behaviours that increase their risk of reinjury and poor recovery (e.g., drug and alcohol use) using motivational interviewing, a strategy that empowers the individual to identify and commit to behaviour change.
The project examined whether this way of providing support was acceptable to patients, including people who may not ordinarily seek out treatment or support early after injury, and if it showed signs of improving recovery. To do this the researchers examined participant experiences through qualitative interviews, and through analysis of treatment access and pain and mental health outcomes up to 6-months post-injury.
Outcomes
The people who participated had a broad range of trauma experiences and support needs after injury, including injury management (e.g., after burns or amputation), addiction treatment, and coping with life stressors (e.g., work or relationship problems) in addition to pain or trauma-related distress post-injury.
The study primarily focused on establishing the procedures to implement this intervention, and to demonstrate the feasibility and acceptability of the intervention. Therefore, the sample was not designed to demonstrate statistically significant impacts on outcomes. There were, however, significant reductions in pain at 1, 3 and 6-months post-injury, and PTSD symptoms from baseline to 6-months post-injury which were similar for the intervention group and those who accessed usual care.
The intervention was very acceptable to most participants, and there were high levels of engagement. Participants shared the following aspects of their experiences:
- Participants were satisfied with their access to treatment for pain and mental health and valued having a consistent source of support and communication from the case manager who provided supportive listening, assisted participants to access appropriate healthcare that was not organised through the hospital or their primary care provider, and helped them learn strategies to manage their symptoms.
- The case manager was felt to be dependable, knowledgeable and caring, but also supported by a team of experts. Support was provided in a consistent and reliable yet flexible way to accommodate changing needs or availability.
- The intervention was perceived to have aided their recovery and led to benefits in their knowledge and skills. It supported a shift in perspective about the injury and its impacts, and aided their ability to manage and reduce stressors.
- The main challenges and areas for improvement were to schedule supports around busy rehabilitation schedules, and to have further help to overcome isolation which was made worse by the pandemic.
- Overall nearly all participants were so satisfied that they thought it should be universally available.
Early intervention with individualised case management helped people to navigate their recovery and the health system after serious injury. Psychologically-informed case management enabled people to learn and apply strategies to better manage post-trauma symptoms, as well as other life stressors (e.g., anxiety about work, coping with upcoming legal proceedings), that altogether helped support overall recovery.
