1 Symptoms after Trauma: Saskatchewan Cohort Setting J. David Cassidy, PhD, DrMedSc Senior Scien)st and Professor of Epidemiology University Health Network and University of Toronto Toronto, Canada Globalisa)on Professor Faculty of Health, University of Southern Denmark Odense, Denmark
2 Learning Objec)ve To describe the study secng. To describe the study design. To describe the study methods.
3 Canada British Columbia Vancouver Saskatoon Regina Ontario Quebec Saskatchewan Toronto
4 Saskatchewan Population: 1,000,000; Economy is Agriculture, mining and knowledge
5 City of Saskatoon Population: 200,000; Economy is University and Technology based. Saskatoon is Cree for berries by the river.
6 Royal University Hospital Main Research Centre in Saskatchewan
7 Saskatchewan Winters are cold, often -30 C or colder!
8 Saskatchewan Government Insurance (SGI) Provides all traffic injury insurance in Sask. Pays for all hospital care and ambulatory care by registered health professionals. Most onen an insurance claim is opened for an injury by submission of a treatment claim by the health care prac))oner. Some)mes an injury claim is opened by the claimant without treatment.
9 SGI Outcomes Study Purpose of Study: To determine the clinical effec)veness of rehabilita)on programs for pa)ents aner traffic injuries.
10 Study Popula)on Collision Dates (incep)on) 16,167 Claims Dec. 1, 1997 to Nov. 30, 1999 Inclusion Criteria: 1. Incep)on cohort of all Saskatchewan residents requiring treatment for a road traffic injury. 2. Includes adults 18 years or older. 3. Claim filed within 42 days of the injury. 2,095 incomplete claims 1,721 under 18 years 1,453 out of province 792 injured before study 456 others (not specified) 352 died 207 lawyers refused 295 WCB claims 134 duplicate claims 98 unable to answer (injury) 71 non- English 41 unable to answer (disability) 25 accommoda)on files 8,634 Eligible Claims
11 Design Popula)on- based, incep)on cohort of all treated adult traffic injuries in Saskatchewan over 2 years. Subjects Collision Dates (incep)on) N=8,634 Dec. 1, 1997 to Nov. 30, 1999 Index ques)onnaire (Proof of Claim) and follow up by computer- aided telephone interviews (CATI). IQ F- U 1 F- U 2 F- U 3 F- U 4 F- U 5 Exit 0 6 weeks 3 months 6 months 9 months one year Feb. 5, 2001
12 Measurements 1. Baseline Ques)onnaire (Proof of Claim): Sociodemographics, collision- related factors, injury- related symptoms, pain measures (intensity and loca)on), depression, comorbid health condi)ons, general health (before and aner the injury), previous injuries, work (status and sa)sfac)on) and expecta)on for recovery. 2. CATI follow- up interviews: Self- assessment of recovery, pain intensity, coping with pain (PMI), ac)vity limita)ons and disability, symptoms, depression (CES- D), health- related quality of life (SF- 12), health provision and work status.
13 Primary Outcome 1. Self- reported recovery: How well do you feel you are recovered from your injuries? Are you All beier (cured) Feeling quite a bit of improvement Feeling some improvement Feeling no improvement GeCng a liile worse GeCng much worse Recovered defined as all beier (cured), or quite a bit of improvement.
14 Self-Reported Recovery Index of recovery Neck pain (NRS 0-10) 6 weeks Follow-up 12 weeks follow-up 24 weeks follow-up 36 weeks follow-up One year follow-up Recovered Not recovered Pain-related disability (PDI 0-70) Recovered Not recovered Depression (CES-D 16) Recovered Not recovered
16 CES-D Total score is 60. Score of 16 suggests depression.
17 Publica)ons from SGI Cohort 1. Palmlöf L, Côté P, Holm LW, Carroll LJ, Cassidy JD, Skillgate E. Are prevalent self- reported cardiovascular disorders associated with delayed recovery from whiplash- associated disorders: a popula)on- based cohort study. Clin J Pain 2014, May Cassidy JD, Boyle E, Carroll LJ. A Popula)on- Based, Incep)on Cohort Study of the Incidence, Course and Prognosis of Mild Trauma)c Brain Injury aner Motor Vehicle Collisions. Arch Phys Med Rehabil 2014;95(3 Suppl 2):S Hartvigsen J, Boyle E, Cassidy JD, Carroll LJ. Mild trauma)c brain injury aner motor vehicle collisions: What are the symptoms and who treats them? A popula)on- based one- year incep)on cohort study. Arch Phys Med Rehabil 2014;95(3 Suppl 2):S Carroll LJ, Ferrari R, Cassidy JD, Côté P. Coping and recovery in whiplash- associated disorders: early use of passive coping strategies is associated with slower recovery of neck pain and pain- related disability. Clin J Pain : Bohman T, Côté P, Boyle E, Cassidy JD, Carroll LJ, Skillgate E. Prognosis of Pa)ents with Whiplash Associated Disorders consul)ng Physiotherapy: Development of a predic)ve model for recovery. BMC Musculoskeletal Disorders 2012, 13: Carroll LJ, Jones DC, Ozegovic D, Cassidy JD. How well are you recovering? The associa)on between a simple ques)on about recovery and pa)ent reports of pain intensity and pain disability in whiplash- associated disorders. Disabil Rehabil 2012;34: Ozegovic D, Carroll LJ, Cassidy JD. What influences posi)ve return to work expecta)on? Examining associated factors in a popula)on based cohort of whiplash- associated disorders. Spine 2010;35:E Ozegovic D, Carroll LJ, Cassidy JD. Factors Associated With Recovery Expecta)ons Following Vehicle Collision A Popula)on Based Study. J Rehabil Med 2010;42: Zhang S, Carroll LJ, Cassidy JD, Paniak C. Factors influencing the self- rated health of people with traffic- related mild trauma)c brain injury. J Rehabil Med 2009;41: Ozegovic D, Carroll LJ, Cassidy JD. Does expec)ng mean achieving? The associa)on between expec)ng to return to work and recovery in whiplash associated disorders: a popula)on- based prospec)ve cohort study. Eur Spine J 2009;18: Carroll LJ, Ferrari R, Holm L, Ozegovic D, Cassidy JD. Recovery in Whiplash- Associated Disorders: Do You Get What You Expect? J Rheum 2009;36: Cassidy JD, Carroll LJ, Côté P, Frank J. Does mul)- disciplinary rehabilita)on benefit whiplash? Spine 2007;32:
18 Acknowledgements: University of Southern Denmark Danish Globalization Fund Department of Sports Science and Clinical Biomechanics, SDU Toronto Acknowledgements: University Health Network University of Toronto Odense