Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Australia.
Disabil Rehabil. 2024 Aug;46(16):3643-3659. doi: 10.1080/09638288.2023.2254235. Epub 2023 Sep 14.
To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury.
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 ( = 15) or intervention ( = 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.
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.
Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma.IMPLICATIONS FOR REHABILITATIONAfter 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.
探讨针对重大创伤后应激障碍（PTSD）和疼痛症状提供递进式协作护理病例管理的可行性和可接受性。
参与者是澳大利亚维多利亚州有持续性疼痛或 PTSD 风险的重大创伤幸存者，且基线症状较高。参与者采用分组随机、按赔偿状况分层的方式分为常规护理（ = 15）或干预组（ = 17）（符合条件的患者的 46%）。干预措施改编自现有的递进式协作护理干预措施，同时也征求了跨学科专家和经历过创伤和残疾的人的意见。主动式病例管理干预针对 PTSD 和疼痛管理，为期 6 个月，采用动机访谈、认知行为治疗策略和协作护理。定性访谈探讨了干预措施的可接受性。
干预组参与者接受了中位数为 7 小时的病例经理联系，并报告说他们重视支持性和非评判性的倾听，以及从病例经理那里及时获得有效的策略、资源和治疗方法，这些在受伤后对他们很有帮助。参与者报告说，参与的缺点很少，对症状和康复结果有积极影响，与 1、3 和 6 个月时测量的 PTSD 和疼痛症状减少一致。
递进式协作护理成本低、可行且可被重大创伤后有 PTSD 或疼痛风险的人接受。
受伤住院后，人们可能难以及时获得支持，以管理创伤后应激、疼痛和其他问题。基于递进式病例管理的干预措施，为接受美国创伤中心治疗的患者提供了个性化支持和协作护理，减轻了 PTSD 症状的严重程度。我们表明，这种护理模式可以在澳大利亚维多利亚州的创伤系统中进行调整，以针对疼痛和心理健康问题。该干预措施成本低、可接受，且大多数参与者都非常重视，他们认为这有助于他们使用策略更好地管理创伤后症状，并获得与他们的需求相关的临床医生和治疗方法。
