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Understanding the effect of compensation on recovery from severe motor vehicle crash injuries: A qualitative study

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To explore the factors that influence recovery from serious injuries sustained in motor vehicle crashes, particularly differences between those with compensable and non-compensable injuries. Qualitative study using grounded theory and focus group methods within the trauma service of a university teaching hospital. 34 subjects (27 male, 7 female), of whom 21 were participants with a compensation claim and 13 were not. Each had sustained injuries in motor vehicle crashes between two and seven years previously. Themes identified from transcripts of the focus groups. The themes identified from participants claiming compensation were a strong sense of entitlement and injustice, a difficult claims and settlement process, an inability to move on with life during the claims process, an extreme dislike of medico-legal assessments, the necessity of legal representation to assist with the claims process, and a perceived lack of trust about having to prove an injury or disability. The themes common to all participants were the significance of the trauma experience, the importance of family and social support, and, if self-employed, financial hardship and difficult experiences in returning to work. The injury recovery experience was difficult for all subjects, but it was particularly stressful for those claiming compensation. Based on this study, the claims process, particularly medico-legal examinations, and other factors that could impact on injury recovery, are targets for further research, possible policy review, or legislative change.
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Understanding the effect of compensation on
recovery from severe motor vehicle crash injuries:
a qualitative study
Darnel F Murgatroyd,
1
Ian D Cameron,
1
Ian A Harris
2
ABSTRACT
Objective To explore the factors that influence recovery
from serious injuries sustained in motor vehicle crashes,
particularly differences between those with compensable
and non-compensable injuries.
Design and setting Qualitative study using grounded
theory and focus group methods within the trauma
service of a university teaching hospital.
Participants 34 subjects (27 male, 7 female), of whom
21 were participants with a compensation claim and 13
were not. Each had sustained injuries in motor vehicle
crashes between two and seven years previously.
Main outcome measure Themes identified from
transcripts of the focus groups.
Results The themes identified from participants claiming
compensation were a strong sense of entitlement and
injustice, a difficult claims and settlement process, an
inability to move on with life during the claims process,
an extreme dislike of medico-legal assessments, the
necessity of legal representation to assist with the
claims process, and a perceived lack of trust about
having to prove an injury or disability. The themes
common to all participants were the significance of the
trauma experience, the importance of family and social
support, and, if self-employed, financial hardship and
difficult experiences in returning to work.
Conclusions The injury recovery experience was
difficult for all subjects, but it was particularly stressful
for those claiming compensation. Based on this study,
the claims process, particularly medico-legal
examinations, and other factors that could impact on
injury recovery, are targets for further research, possible
policy review, or legislative change.
INTRODUCTION
The research evidence showing the impact of factors
relating to nancial compensation on peoples
health following injury is growing but disparate.
1e6
Compensation factors are usually described as claim
type, duration, and costs, and although quantiable,
do not provide information about what aspects of
claims and legal processes might inuence peoples
health following injury. Although studies have
shown that legal representation, litigation, and
perceived injustice affect outcomes, there are other
aspects that remain unknown.
7e9
Furthermore,
comparison between compensation schemes
remains problematic because they differ so widely.
Our aim was to explore factors that inuence
recovery from serious injuries sustained in motor
vehicle crashes; in particular, whether there would
be differences between people with compensable
and non-compensable injuries. In patients eligible
for compensation, we wished to investigate the
factors involved in the claims and legal processes
that might affect outcomes.
METHODS
Study population and design
Stratied purposeful sampling was undertaken for
recruitment. Patients aged 18 years and over who
were admitted to a major metropolitan trauma and
teaching hospital between 2002 and 2007 were
selected from its trauma database. Liverpool
Hospital provides services to South Western Sydney
and the surrounding region. The catchment area
has a strongly multicultural population and below
average household income. Patients were selected if
they had been involved in a motor vehicle or
motorcycle crash and had sustained upper and/or
lower limb fractures. The exclusion criteria were to
reduce heterogeneity in the sample and eliminate
those who could not logistically attend or be
contacted. These included patients with: a spinal
cord injury, Glasgow Coma Score (GCS) <12 on
admission, minor peripheral fracture or signicant
pre-existing cognitive impairment, and over one
hours travelling time to the hospital or no contact
address and telephone number. The study was
approved by the hospital and university human
research ethics committees.
Potential participants were mailed an invitation
letter with the selection criteria, aims, and practical
information, including time, duration, and location
for the focus groups. There was no payment to
attend but catering was provided. Transport and
parking payments were offered.
The mail-out occurred in two phases, in
September 2008 and July 2009. Potential partici-
pants were contacted by telephone within two
weeks and consent was obtained. Potential partic-
ipants were allocated to a focus group based on
whether they were claiming nancial compensa-
tion, and their availability to attend specic
sessions. We anticipated ve to eight attendees in
each group; based on our aims we stratied by
compensation status. A participation letter was
sent conrming their attendance, and all potential
participants received a reminder phone call the
evening before their session.
Data collection
Demographic data such as date of birth and gender,
and injury data including type, severity, date, and
crash type, were retrieved from the trauma data-
base. Injury severity was measured using the Injury
Severity Score (ISS).
10
1
Rehabilitation Studies Unit,
Sydney Medical School,
University of Sydney, Sydney,
NSW, Australia
2
South West Sydney Clinical
School, University of New South
Wales, Liverpool Hospital,
Liverpool, Sydney, NSW,
Australia
Correspondence to
Darnel Murgatroyd,
Rehabilitation Studies Unit,
Northern Clinical
School eSydney Medical
School, The University of
Sydney, PO Box 6, Ryde, NSW
1680, Australia; dmur0062@
uni.sydney.edu.au
Accepted 19 October 2010
Published Online First
11 November 2010
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Additional socio-demographic details obtained by telephone
were: level of education, occupation, claim (yes/no), and claim
type (Workers Compensation, Compulsory Third Party (CTP),
or other). In the state of New South Wales (NSW), CTP can
provide lump sum compensation for pain and suffering,
economic loss, and medical expenses, but no weekly benets for
wages. During the period studied it was fault-baseddthat is, the
injured person must establish that a vehicle driver or owner, or
someone (other than themselves), partially or completely caused
the crash in order to make a claim. Workers Compensation is
no-fault with similar entitlements, and regardless of who caused
the accident a claim can be made; it includes weekly benets.
Claimants are entitled to legal representation in both schemes,
with limited access to the court system unless liability is denied.
Each focus group was facilitated by an investigator (DM),
who had previously spoken with participants to arrange their
attendance. A script, including information on condentiality
and protocol, was followed for the introduction. We declared our
interest in compensation factors to participants.
Four previously unpiloted open ended questions were asked.
They were intended to explore injury recovery with specic
reference to the claims and legal process without providing an
opinion or direction. Questions 3 and 4 were only addressed to
the compensable group. The questions were as follows:
1. What were your experiences following your injury?
2. How do you think your experiences would have been
different if you did/did not have a compensation claim?
3. What was/is it like having a compensation claim?
4. Lets talk about having a lawyer, what are your thoughts on
this?
All participants were asked to comment for each question and
elaborate if appropriate. No directive feedback was provided.
The groups were recorded and transcribed with consent.
Another investigator (IC) took additional notes for four groups
(2, 4, 6, 8). The attending investigators had no prior relationship
with any of the participants and there was no contact after the
focus groups.
Data analysis
Content analysis of the transcripts was conducted indepen-
dently by two of the researchers (DM and IC). The content was
categorised into themes according to grounded theory method-
ology. This is where data collection begins around a topic
without predening a research question; it can become more
focused as the study evolves. Following data collection, content
analysis occurs and themes are developed that lead to
a hypothesis.
11
This can be tested in further qualitative or
quantitative research. We selected this methodology because it
gave us the opportunity to explore potential compensation
factors based on participantsresponses.
A coding frame for themes was derived from the transcripts
based on common topics, patterns, relationships, and the level of
importance as rated by participants.
12
All transcripts were
re-read to ensure the identied themes were inclusive of all
collected data. Following the second phase of focus groups, data
saturation was reacheddthat is, no new themes emerged in the
second phase.
RESULTS
From a total sample of 709 injured people, there were 381 poten-
tially eligible participants following exclusions for inadequate
contact details and geographical location. Based on the selection
criteria, all potentially eligible participants were extracted from
the trauma database; no further sampling was possible.
Of the 212 potential participants contacted by telephone, 54
agreed to attend (169 could not be contacted or had discon-
nected numbers). There were two main reasons for refusal: lack
of interest or inability to attend because of other commitments.
There were 34 participants who attended (21 compensable and
13 non-compensable). Of the 20 non-attendees, 8 were unable to
attend due to other commitments, usually work, and 12 gave
no reason. There were eight focus groups, four with compen-
sable participants (1, 4, 5, 8) and four without (2, 3, 6, 7).
The compensable group size varied from 7 to 4, while the
non-compensable group ranged from 4 to 2.
Table 1 illustrates the participant prole. There was incom-
plete data for education (3/34) and employment (12/34) because
some participants did not answer these questions.
The scales to measure occupation and education were taken
from the Australian Standard Classication of Occupations
(ASCO), 2nd edition and the Australian Standard Classication
of Education (ASCED) 2001.
13 14
Both scales are used widely
throughout Australia and have international comparability.
For data analysis there was agreement between the investi-
gators for all themes. The primary themes were identied in the
compensable groups, while the secondary themes were identied
in both the compensable and non-compensable groups. The
secondary themes did not specically relate to compensation.
Participants also had different views about compensation,
depending on whether or not they had a claim. The themes
are illustrated in table 2, and with anonymous quotes from
participants.
Injustice
Participants, particularly those not at fault, were angry and
upset about being involved in a crash:
I was the not at fault party so its really turned my life inside out.
(Group 5)
And what is upsetting also, the whole time that I was in hospital
and the whole 12 months I was recovering, he was driving around.
(Group 1)
Table 1 Participant profile in the eight focus groups (n¼34)
Variable
Compensable
(n[21)
Non-compensable
(n[13)
Age (years, range) 18e77 25e73
Gender
Male 15 12
Female 6 1
Injury severity score (median, range) 10, 6e43 9, 4e25
Time since injury (years, range) 2e72e6
Education
Primary school 1
Secondary school or less 11 5
Certificate/diploma 4 4
Bachelor degree or higher 5 1
Occupation
Managers, administrators; and professionals 1 1
Associate professionals 3 3
Tradespersons; and advanced clerical and
service workers
22
Intermediate clerical, sales, and service
workers; and intermediate production and
transport workers
22
Elementary clerical, sales, and service
workers; and labourers
33
Motor vehicle crash 15 8
Motorcycle crash 6 5
Injury Prevention 2011;17:222e227. doi:10.1136/ip.2010.029546 223
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I was an innocent victim.doing absolutely nothing wrong and I
was hit by someone who was drunk.the rest of my life is stuffed.
(Group 4)
Entitlement
There was a strong sense of entitlement to nancial compen-
sation, which was inuenced by perceived injury severity and
disability:
Like Im buckled, I want money, thats it.(Group 4)
They tried to give me $100 000 but my solicitor said no, youve
been badly damaged.(Group 1)
They make lots of money and I get very little.(Group 5)
Claims process
Participants felt the claims process was adversarial and stressful,
particularly communication and treatment approvals, and that
the negotiating settlement was gruelling:
I was using their lack of communication against them..the big
strain of trying to deal with them not talking to each other.I
went through nine Workers Compensation managers in three and
half years.(Group 8)
Ive had to see a lot of different doctors every time I needed
something approved it was like a ght.(Group 4)
Dealing with the insurance company, they not only make you
jump through hoops but theyre on re. Just to get some medication
or something.it will take weeks to approve.(Group 8)
Now were at the ner point of trying to settle and theyre just
procrastinating, dragging it out for as long as possible in order to
maximise my nancial hardship and to pressure me to take a lesser
settlement.(Group 5)
They offer you a ridiculous amount. So low, but you get to the
point where you get sick of it.just give me what you want, I just
want to get out of here.(Group 8)
Although the cost burden was eased by access to paid treat-
ment it didnt hasten injury recovery:
You dont have to worry about bills.(Group 1)
The money helped of course.but it had nothing to do with my
recovery.(Group 5)
Legal representation
Another consensus theme was the necessity of legal represen-
tation to navigate the claims process, receive reasonable
compensation, and have awareness of changes to regulations or
legislation:
I thought theres no way I could have done this on my own.
(Group 4)
The solicitor power negotiates everything you need.If you go
to the insurance company yourself you get nothing because
they know that you dont know what to say or what to do.
(Group 8)
Another pro with a solicitor is that theyre up to date with and in
touch with any legislation change.So if I was doing it myself.I
wouldnt have known.(Group 8)
You dont know what youre entitled to you dont know how to
say things.(Group 1)
Dont know who lies more, the insurance company or the solicitor
sometimes, but the good thing about having a lawyer is that they
know the games the insurance companies play.(Group 8)
However, participants did see negative aspects, such as
competency and high fees:
Its a worry when youve got a solicitor and youre not
working.you can see the solicitors fees going up.(Group 1)
I ditched my lawyer. I 100% percent believe that if I didnt ditch
her she wasnt going to do anything for me.(Group 4)
My solicitor would have been happy if I shut the doors of my
business.that would have been the best outcome for my
compensation because thats all hes thinking about.(Group 8)
The solicitor has taken awful lot of money. I had to pay the
amount up front.(Group 5)
Medico-legal assessments
Medico-legal assessments were unanimously disliked. These
assessments are arranged by insurers, defendant or plaintiff
lawyers with health professionals (usually medical practitioners)
to provide an opinion about factors such as diagnosis or future
treatment. Participants felt the value of such assessments was
questionable:
Then you start going forward, your doctors rst then you go to
their doctors to discredit those doctors.(Group 8)
I had one writing 50% and even I know I am not 50%, and another
writing 10 or 11 percent and thats all within a month of each
other.(Group 8)
Their doctor says there is nothing wrong with you.my doctor
says Im stuffed up, whos correct. Show me an honest doctor in
this industry.Its all about the dollar, I can go and pay this doctor
1800 bucks and hell tell me Im buggered for life.(Group 4)
I started this circus of going to see different doctors, rst the
doctors that actually cared.and then started the doctors that were
in it for the industry.Ive so far seen ten specialists that couldnt
give a rats about my condition, theyre only there to write a report,
and I nd that extremely difcult, I know how business works, its
a game that has been set up with perhaps good intentions, but
a bad outcome.(Group 4)
The barrister comes.but I need you to answer this, this, this and
this. So youve got to back through the same questions again. Its
a $1000 every time you go.(Group 5)
In addition, the practicalities such as number, frequency,
duration, and cost of assessments annoyed many participants.
Table 2 Primary and secondary themes
Theme
Primary A strong sense of injustice
A strong sense of entitlement
Difficult claims and settlement process
An inability to move on with life during the claims process
An extreme dislike of medico-legal assessments
Necessity of legal representation to assist with the claims process
A perceived lack of trust about having to prove an injury or disability
Secondary Significance of trauma experience
Importance of family and social support
Financial hardship and difficult return to work if self-employed
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Lack of trust
Participants perceived there was disbelief by insurers and some
health professionals about their injuries. It was obligatory to
prove you had an injury or disability:
Its one thing to try and cope with an injury, its another thing to
cope with people who try to call you a liar, like you can do this, you
can do that.(Group 4)
Dealing with the insurance company your lifes on hold, you cant
do anything for fear theyre looking over your shoulder, that
theyre going to interpret something as theres nothing wrong
with you.(Group 5)
You ve got to go through a different type of trauma, mentally and
emotionally when they go through your life.being self-employed
they want to go through all my books and records for the last seven
years.if we dont do it, its saying to the insurance company that
were hiding something.(Group 8)
Im working, so what are you doing following me around with
a camera for.it makes me feel like Im doing something wrong,
like Im trying to rort the system.(Group 4)
Inability to move on with life
There was consensus among participants that the claims process
meant constantly being reminded about the crash and restrained
their lives:
Its been so long.Ive spoken about my case so many times, Im
getting to a point Im sick of it.(Group 4)
We settled because I didnt want to put my life on hold anymore.
(Group 5)
You go to a doctor for your legal team and a doctor for the insurance
company, and they question you about every aspect of your life and
you have to relive the accident.and although I want to get over it
all.I should move on, but its something that changes your whole
life, and it will never be over in one way.(Group 4)
They destroy your life, youve gone through such a traumatic
period with recovery.Ive suffered depression and all sorts of
problems like that. And you just start to get on top of that. Ive had
my claim denied three times.(Group 8)
Significance of trauma
Many participants had sustained severe injuries, and regardless
of whether or not they had a compensation claim, they found
the experience of the crash traumatic:
I remember the chopper coming to take me away from the
accident, then I waited for a period of time in emergency.I was in
and out of consciousness.(Group 3)
I probably shouldnt be here because the worst thing about it all
was I was completely abandoned, no one ever tried to come and
help me.(Group 6)
I lost the use of hand for about 6 months .I was thinking all
doom and gloom my hand is never going to come back but.I
learnt how to use it again.(Group 2)
Immediately before the impact I knew that I was going to be
killed. And its amazing that I wasnt, however, that didnt stop the
ongoing emotional effect that had on me, knowing that I was going
to die, and I still havent got past that yet.(Group 4)
Well I was in the wrong, I hit a woman, she perished. That is the
thing I have got here for the rest of my life. Every second night I
think about it.
Psychologically it was all very taxing, all of a sudden I had to
worry about income, the doctor telling me it would be a few
months before I was able to walk and to work.(Group 8)
Family and social support
Strong family and social support was valued by all participants:
My youngest took time off her studies and she looked after
me.my family were excellent.(Group 1)
I was probably very, very lucky that I had a partner because
without her, yeah probably wouldnt have been able to do it
myself.(Group 7)
When you have that help, psychologically it makes things so
much better and I think you heal better too.(Group 6)
I am very lucky I have very good neighbours and they helped me
such a lot. I couldnt have managed.Im on my own(Group 1)
Financial hardship if self-employed
All self-employed participants struggled physically and nan-
cially with return to work. They felt unsupported and either
returned to work early given the severity of their injuries or
sustained signicant nancial losses:
I had to employ someone else to help me.I had to keep working
no matter what.(Group 2)
Im self-employed. I didnt get back to my business for over
400 days.(Group 8)
I have my own business so I had to get back and get things
running. So I had an odd assortment of crutches.(Group 4)
I lost my business and didnt have proper income protection,
foreclosed on the house.(Group 5)
Other issues: comparison of claim and no claim
Although participants with a claim felt it was benecial to have
access to paid treatment, they felt it was an extremely stressful
experience:
They denitely would have less stress during that process that we
go through, they would just miss out on some nancial backing.
(Group 4)
You havent got the psychological pressure the insurance company
is putting you under. And thats their game. Apply as much
psychological pressure as we can to get you to settle.(Group 5)
Making you out to be a liar even though they dont say it, but
basically that is what the report says when you read it.Thats
difcult and so the person thats not having a compensation claim,
they dont have that to face.(Group 4)
I didnt have to pay any of my bills.(Group 1)
I know if I didnt have insurance I probably wouldnt have ended
up with some of the treatments I did.(Group 8)
Participants without a compensation claim felt it would not
have affected their recovery but assisted with costs:
It would have been nice to forget the expenses.(Group 3)
It would have taken away the duress.no money coming in while
you were off.(Group 7)
Financially it would have given me a bit of relief because I was
losing a couple of jobs as it was.(Group 6)
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I dont see how compensation would have made any difference to
my recovery really.(Group 2)
I dont think it would make much difference to me really. I was on
a pension and I had no one to sue.(Group 3)
DISCUSSION
This study explored the inuence of claims and legal processes
on injury recovery following a motor vehicle crash. We found
that the injury recovery experience was difcult for all
people, but it was particularly stressful for people claiming
compensation. These results provide additional insight into
why compensation factors affect peoples health following
injury.
346715
Participants not at faultfelt a strong sense of injustice
and entitlement linked to nancial compensation, often as
a reward. Other studies have reported the inuence of perceived
injustice on post-traumatic stress disorder (PTSD), pain, and
disability.
9 16 17
Findings from this study support the notion that
perceived injustice is a multidimensional construct. We also
found that people perceived blame, unfairness, injury severity,
and irreparability of loss were linked to a sense of entitlement.
16
Compensable participants expressed the view that the claims
process was adversarial, particularly for longer claims. Other
studies have shown that having a compensation claim, legisla-
tive change, and negotiating settlement can alter psychological
and physical outcomes.
1278
The difculties reported by participants in communicating
with insurers, high staff turnover, and obtaining treatment
approvals have been less well demonstrated in the literature.
While this could relate specically to New South Wales, it is
likely to also apply to other compensation schemes.
On the other hand, legal representation has been shown across
a number of different jurisdictions and injuries to be an indicator
of poorer outcomes.
1 7 8 15 18 19
We found that participants
believed they required legal representation to negotiate with
insurers and steer them through the claims process despite often
disliking the involvement of a lawyer. It is difcult to know
whether this is because of the claims process or personal choice
because not all participants were legally represented. However,
the importance of competent legal representation for many
claiming compensation indicates that the claims process is
a factor when determining whether to engage a lawyer.
Similarly, medico-legal assessments add complexity to the
claims process. In this study, compensable participants disliked
attending assessments for either party. Repeated attendance was
also associated with anger and a lack of trust by others of
a genuine injury or disability. This is an interesting nding and
to the authorsknowledge has not been reported previously.
Studies examining medico-legal assessments have focused on
reporting standards or medical impairment rather than their
impact on peoples health.
20e22
This lack of trust led to distress and a sense of frustration, and
when coupled with dissatisfaction of the claims process, meant
many participants felt unable to move on with life. This is
supported by other studies which show higher levels of
disability and poor psychological health during the life of
a claim.
3823
Despite having similar difculties with injury recovery phys-
ically, people without a compensation claim did not report
ongoing frustrations with limited life progress or increased
psychological stress. Many returned to work and other activities
out of necessity. This has also been shown in research where
there is a non-compensable comparison group.
3815
In addition, there were several themes across both compen-
sable and non-compensable groups. Self-employed participants
declared nancial hardship as a key motivator for early return to
work. This could be partly because many participants were
manual workers, or that nancial hardship is worse for CTP
claimants in New South Wales, where there is limited avail-
ability of nancial assistance. However, research shows that
return to work is inuenced by multiple occupational, work-
place, and compensation factors.
24e26
Other themes included that many participants found the
trauma experience distressing, and strong family and social
support aided their recovery. This is comparable to other
research, which shows that a greater perceived threat to life and
limited support networks are associated with poorer
outcomes.
27e29
Finally, comparing the two groups, the difference lay in their
perception of the claims process and its impact on injury
recovery, particularly access to nancial compensation and
treatment, and psychological stress.
These ndings provide supporting evidence that compensa-
tion factors impact on injury recovery following a motor vehicle
crash. The themes provide new information about what specic
factors might affect peoples health beyond the broad indicators
of claim type, duration, and cost. These themes support the
notion that specic aspects of the claims and legal process could
impact on peoples health following injury.
The ndings provide potential opportunities to develop new
policy and scheme design that aims to reduce the adversarial
nature of the claims process and simplify the regulatory envi-
ronment, particularly related to medico-legal assessments, legal
representation, and claims settlement. However, due to the
diversity of compensable schemes, the applicability of these
ndings to other jurisdictions may vary depending on scheme
design. Generalisability may also be limited as the participants
sustained serious injuries and were treated by a single metro-
politan trauma service in NSW. In addition, there was greater
What is already known on the subject
<Compensation factors have been shown to affect the health
status of people following injury.
<Currently compensation factors are primarily sourced from
administrative databases and provide limited insight into
exactly how the claims and legal process influences injury
recovery.
What this study adds
<Participants with a compensation claim often sought legal
representation to assist in an adversarial and stressful claims
and legal process and, if not at fault, felt entitled to
recompense.
<Compensated participants perceived they were not trusted,
and felt frustrated attending multiple medico-legal assess-
ments, which contributed to an inability to progress with life.
<Researchers should consider a more complex assessment of
compensation factors when investigating a compensable
population, and policy makers have a responsibility to address
the adversarial aspects of scheme design.
226 Injury Prevention 2011;17:222e227. doi:10.1136/ip.2010.029546
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recruitment of compensable participants, who possibly attended
because of their negative experiences. However, by using quali-
tative methods we gained valuable insight into compensation
factors, which would not have been possible otherwise. Other
strengths include careful conduct of the focus groups using
established methodology and similar themes being identied by
each group.
Additional research is needed to explore the injury recovery
experience with different injuries and socio-demographic back-
grounds, and in other compensable schemes, to identify any
shared themes. Furthermore, these ndings need to be explored
in larger quantitative studies.
In conclusion, people in this study with a compensation claim
reported a more complex and stressful injury recovery experience
than people without a compensation claim.
Acknowledgements We acknowledge Erica Caldwell for assistance with trauma
registry data.
Competing interests None.
Ethics approval This study was conducted with the approval of the Sydney South
West Area Health Service Human Research Committee and University of Sydney
Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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Injury Prevention 2011;17:222e227. doi:10.1136/ip.2010.029546 227
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injuries: a qualitative study
recovery from severe motor vehicle crash
Understanding the effect of compensation on
Darnel F Murgatroyd, Ian D Cameron and Ian A Harris
doi: 10.1136/ip.2010.029546
2011 17: 222-227 originally published online November 11, 2010Inj Prev
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... The majority of studies conducted in Australia to date have investigated RTW issues within a 'no fault' scheme (10,11,(15)(16)(17). There is strong evidence to suggest that different compensation schemes can significantly influence the social and working life of injured persons and subsequently the recovery from RTI (18,19). Data collected in jurisdictions operating under a 'no-fault' scheme might not be generalizable to regions operating under an 'at-fault' system. ...
... Highlighted was the importance of early and appropriate treatment by health professionals, sufficient and flexible treatment support by the CTP insurer, and identification of high-risk individuals through early physical and psychological assessments. Similarly, studies conducted in Australian states operating a no-fault scheme have identified that rapid and early intervention is necessary for recovery following RTI, whereas inappropriate quality of care, disappointment with the health system, and difficulties in obtaining treatment approval from insurance companies were major barriers affecting recovery after these injuries (19,39,40,42,43,56). Identification of several health care-related barriers to RTW across different compensation schemes demonstrates the sub-optimal care provided after RTI regardless of the type of scheme. ...
... Long duration of claim processing was suggested to have a negative impact on RTW in a fault-based scheme, confirming the findings of previous research performed in a nofault scheme (41,42). The insurer's early contact with the injured person, their clarity and transparency about claim processes, and employing experienced case managers with health backgrounds were common factors suggested for the claim process, regulations or legislation, and the recovery pathways after RTI has consistently been emphasized in literature conducted in other Australian states (19,(39)(40)(41)(42)(43)(44) and internationally (45)(46)(47)(48). Delivering training on the health benefits of work, different compensation systems, the amount and type of medical intervention and the type of healthcare providers that can be consulted during recovery have been recommended in previous studies to address this RTW barrier (43,(49)(50)(51). ...
Article
Full-text available
Purpose This qualitative study conducted in Queensland, Australia aimed to explore various stakeholders’ perspectives on (1) the barriers and facilitators of Return to Work (RTW) for injured persons following minor to serious Road Traffic Injuries (RTI) in a fault-based scheme, and to investigate the changes needed to better support RTW following RTI. Methods The study was performed using the Interpretive Description methodological approach. Data were collected during interviews (n = 17), one focus group (n = 4), and an open-ended survey (n = 10) with five categories of stakeholders: treating health providers, workplace representatives, legal representatives, rehabilitation advisors, and insurers. Participants were eligible to participate if they had at least one year of employment history in their respective profession in Queensland, Australia, and were experienced in assisting the RTW of people with RTI. Thematic analysis was used to analyse the data. Results Seven themes were extracted reflecting the barriers and facilitators of RTW along with stakeholders’ recommendations to address these barriers. These themes were: (1) knowledge is power; (2) stakeholder expertise; (3) early and appropriate treatment matters; (4) insurers could do better; (5) necessity of employers’ support; (6) fix the disjointed system; (7) importance of individual factors pre- and post- injury. The main barriers identified were stakeholders’ insufficient communication and knowledge on RTW process following RTI. Conclusions Individual and system barriers identified in this study suggest that RTW after RTI occurs in a complex system requiring the commitment of all stakeholders. This is particularly important for managing knowledge-related barriers by provision of high quality and easily accessible information about the RTW process, disability schemes, and the nature of RTI.
... Although patients' perspectives after injury have previously been explored, they evaluated one type of injury (e.g., traumatic brain injury (TBI) or burn injuries) [26,27] or one type of trauma mechanism (e.g., motor vehicle accident) [28,29]. Therefore, results cannot be generalized to the entire trauma population. ...
... Therefore, results cannot be generalized to the entire trauma population. Research is focused on recovery from different types of injury (e.g., multi trauma, spinal cord injury, and TBI) [29] will provide a broader overview than currently available. ...
... Furthermore, satisfaction with care improved if a health care provider was interested and involved in patients' care and recovery [28,51]. Especially during rehabilitation, when patients struggled with resumption to work and financial stress, the need for positive support from their employer or authorities was high [26,29,52]. ...
Article
Full-text available
Background Injury can have physical, psychological and social consequences. It is unclear which factors have an impact on patients’ wellbeing after injury. This study aimed to explore, using focus groups, patients’ experiences and wellbeing after injury and which factors, impede or facilitate patients’ wellbeing. Methods Trauma patients, treated in the shock room of the Elisabeth-TweeSteden Hospital, the Netherlands, participated in focus groups. Purposive sampling was used. Exclusion criteria were younger than 18 years old, severe traumatic brain injury, dementia, and insufficient knowledge of the Dutch language. The interviews were recorded, transcribed verbatim, and analyzed using coding technique open, axial, and selective coding, based on phenomenological approach. Results Six focus groups (3 to 7 participants) were held before data saturation was reached. In total, 134 patients were invited, 28 (21%) agreed to participate (Median age: 59.5; min. 18 –max. 84). Main reasons to decline were fear that the discussion would be too confronting or patients experienced no problems regarding the trauma or treatment. Participants experienced difficulties on physical (no recovery to pre-trauma level), psychological (fear of dying or for permanent limitations, symptoms of posttraumatic stress disorder, cognitive dysfunction), social (impact on relatives and social support) wellbeing. These are impeding factors for recovery. However, good communication, especially clarity about the injury and expectations concerning recovery and future perspectives could help patients in surrendering to care. Patients felt less helpless when they knew what to expect. Conclusions This is the first study that explored patients’ experiences and wellbeing after injury. Patients reported that their injury had an impact on their physical, psychological, and social wellbeing up to 12 months after injury. Professionals with the knowledge of consequences after injury could improve their anticipation on patients’ need.
... Still, loss of (future) income and general compensatory damages will be relevant issues to patients in both settings. Additionally, feelings of psychological distress [7] and perceived injustice [23,28] will affect personal injury claim patients irrespective of country, suggesting that the similarities in personal injury claims between countries may outweigh the differences. This is in line with a meta-analysis of surgical treatment outcomes of patients with workers compensation or involved in litigation [15], where it was shown that the association Table 4. Improvement over time (between baseline and 12 months) and the proportion of patients reaching the MIC for VAS pain and function [19] Volume 00, Number 00 Outcomes in Personal Injury Claims between compensation and worse treatment outcomes was consistently present in the United States, Canada, Europe, and Australia. ...
Article
Full-text available
Background: A small proportion of patients treated for a hand or wrist condition are also involved in a personal injury claim that may or may not be related to the reason for seeking treatment. There are already indications that patients involved in a personal injury claim have more severe symptoms preoperatively and worse surgical outcomes. However, for nonsurgical treatment, it is unknown whether involvement in a personal injury claim affects treatment outcomes. Similarly, it is unknown whether treatment invasiveness affects the association between involvement in a personal injury claim and the outcomes of nonsurgical treatment. Finally, most studies did not take preoperative differences into account. Questions/purposes: (1) Do patients with a claim have more pain during loading, less function, and longer time to return to work after nonsurgical treatment than matched patients without a personal injury claim? (2) Do patients with a personal injury claim have more pain, less function, and longer time to return to work after minor surgery than matched patients without a personal injury claim? (3) Do patients with a personal injury claim have more pain, less function, and longer time to return to work after major surgery than matched patients without a personal injury claim? Methods: We used data from a longitudinally maintained database of patients treated for hand or wrist disorders in the Netherlands between December 2012 and May 2020. During the study period, 35,749 patients for whom involvement in a personal injury claim was known were treated nonsurgically or surgically for hand or wrist disorders. All patients were invited to complete the VAS (scores range from 0 to 100) for pain and hand function before treatment and at follow-up. We excluded patients who did not complete the VAS on pain and hand function before treatment and those who received a rare treatment, which we defined as fewer than 20 occurrences in our dataset, resulting in 29,101 patients who were eligible for evaluation in this study. Employed patients (66% [19,134 of 29,101]) were also asked to complete a questionnaire regarding return to work. We distinguished among nonsurgical treatment (follow-up at 3 months), minor surgery (such as trigger finger release, with follow-up of 3 months), and major surgery (such as trapeziectomy, with follow-up at 12 months). The mean age was 53 ± 15 years, 64% (18,695 of 29,101) were women, and 2% (651 of 29,101) of all patients were involved in a personal injury claim. For each outcome and treatment type, patients with a personal injury claim were matched to similar patients without a personal injury claim using 1:2 propensity score matching to account for differences in patient characteristics and baseline pain and hand function. For nonsurgical treatment VAS analysis, there were 115 personal injury claim patients and 230 matched control patients, and for return to work analysis, there were 83 claim and 166 control patients. For minor surgery VAS analysis, there were 172 personal injury claim patients and 344 matched control patients, and for return to work analysis, there were 108 claim and 216 control patients. For major surgery VAS analysis, there were 129 personal injury claim patients and 258 matched control patients, and for return to work analysis, there were 117 claim and 234 control patients. Results: For patients treated nonsurgically, those with a claim had more pain during load at 3 months than matched patients without a personal injury claim (49 ± 30 versus 39 ± 30, adjusted mean difference 9 [95% confidence interval (CI) 2 to 15]; p = 0.008), but there was no difference in hand function (61 ± 27 versus 66 ± 28, adjusted mean difference -5 [95% CI -11 to 1]; p = 0.11). Each week, patients with a personal injury claim had a 39% lower probability of returning to work than patients without a claim (HR 0.61 [95% CI 0.45 to 0.84]; p = 0.002). For patients with an injury claim at 3 months after minor surgery, there was more pain (44 ± 30 versus 34 ± 29, adjusted mean difference 10 [95% CI 5 to 15]; p < 0.001), lower function (60 ± 28 versus 69 ± 28, adjusted mean difference -9 [95% CI -14 to -4]; p = 0.001), and 32% lower probability of returning to work each week (HR 0.68 [95% CI 0.52 to 0.89]; p = 0.005). For patients with an injury claim at 1 year after major surgery, there was more pain (36 ± 29 versus 27 ± 27, adjusted mean difference 9 [95% CI 4 to 15]; p = 0.002), worse hand function (66 ± 28 versus 76 ± 26, adjusted mean difference -9 [95% CI -15 to -4]; p = 0.001), and a 45% lower probability of returning to work each week (HR 0.55 [95% CI 0.42 to 0.73]; p < 0.001). Conclusion: Personal injury claim involvement was associated with more posttreatment pain and a longer time to return to work for patients treated for hand or wrist disorders, regardless of treatment invasiveness. Patients with a personal injury claim who underwent surgery also rated their postoperative hand function as worse than similar patients who did not have a claim. Depending on treatment invasiveness, only 42% to 55% of the personal injury claim patients experienced a clinically relevant improvement in pain. We recommend that clinicians extensively discuss the expected treatment outcomes and the low probability of a clinically relevant improvement in pain with their personal injury claim patients and that they broach the possibility of postponing treatment. Level of evidence: Level III, therapeutic study.
... Indeed, prior research showed that lodging a claim and seeking compensation following a landtransport crash increases risk of psychological distress in claimants [22][23][24]. Prolonged exposure to the insurance scheme also increases the likelihood of participants coming into contact with system complexities which are known to be stressful [23] including; numerous assessments [25] and the overall adversarial nature of contacts with claims staff [26,27]. Hence, these mechanisms could underlie the strong link between lodging a CTP insurance claim and low HL in our study. ...
Article
Full-text available
Background: Health literacy (HL) is rarely addressed in rehabilitation research and practice but can play a substantial role in the recovery process after an injury. We aimed to identify factors associated with low HL and its relationship with 6-month health outcomes in individuals recovering from a non-catastrophic road traffic injury. Methods: Four hundred ninety-three participants aged ≥17 years who had sustained a non-catastrophic injury in a land-transport crash, underwent a telephone-administered questionnaire. Information was obtained on socio-economic, pre-injury health and crash-related characteristics, and health outcomes (quality of life, pain related measures and psychological indices). Low HL was defined as scoring < 4 on either of the two scales of the Health Literacy Questionnaire that covered: ability to actively engage with healthcare providers ('Engagement' scale); and/or understanding health information well enough to know what to do ('Understanding' scale). Results: Of the 493, 16.9 and 18.7% scored < 4 on the 'Understanding' and 'Engagement' scale (i.e. had low HL), respectively. Factors that were associated with low HL as assessed by both scales were: having pre-injury disability and psychological conditions; lodging a third-party insurance claim; experiencing overwhelming/great perceived sense of danger/death during the crash; type of road user; low levels of social satisfaction; higher pain severity; pain catastrophizing; and psychological- and trauma-related distress. Low HL (assessed by both scales) was associated with poorer recovery outcomes over 6 months. In these longitudinal analyses, the strongest association was with disability (p < 0.0001), and other significant associations were higher levels of catastrophizing (p = 0.01), pain severity (p = 0.04), psychological- (p ≤ 0.02) and trauma-related distress (p = 0.003), lower quality of life (p ≤ 0.03) and physical functioning (p ≤ 0.01). Conclusions: A wide spectrum of factors including claim status, pre-injury and psychological measures were associated with low HL in injured individuals. Our findings suggest that targeting low HL could help improve recovery outcomes after non-catastrophic injury.
... Moreover, the mental health impacts of the WSIB process described by participants lend support to previous injured worker studies describing feelings of frustration, helplessness and hopelessness resulting from "adversarial" and unjust workers' compensation experiences, 3,34-38 and the consequent negative ramifications of these processes and experiences on career plans, hobbies and community involvement, finances and mental health of claimants. 30,31,36,[38][39][40] We also found some very preliminary evidence that stress related to claims and appeals was different across groups. "Also treating you with, you know, basic human respect and dignity." ...
Article
Introduction Individuals experience negative physical, social and psychological ramifications when they are hurt or become ill at work. Ontario’s Workplace Safety and Insurance Board (WSIB) is intended to mitigate these effects, yet the WSIB process can be difficult. Supports for injured workers can be fragmented and scarce, especially in underserved areas. We describe the experiences and mental health needs of injured and ill Northwestern Ontario workers in the WSIB process, in order to promote system improvements. Methods Community-recruited injured and ill workers (n = 40) from Thunder Bay and District completed an online survey about their mental health, social service and legal system needs while involved with WSIB. Additional Northwestern Ontario injured and ill workers (n = 16) and community service providers experienced with WSIB processes (n = 8) completed interviews addressing similar themes. Results Northwestern Ontario workers described the impacts of workplace injury and illness on their professional, family, financial and social functioning, and on their physical and mental health. Many also reported incremental negative impacts of the WSIB processes themselves, including regional issues such as “small town” privacy concerns and the cost burden of travel required by the WSIB, especially during COVID-19. Workers and service providers suggested streamlining and explicating WSIB processes, increasing WSIB continuity of care, and region-specific actions such as improving access to regional support services through arm’s-length navigators. Conclusion Northwestern Ontario workers experienced negative effects from workplace injuries and illness and the WSIB process itself. Stakeholders can use these findings to improve processes and outcomes for injured and ill workers, with special considerations for the North.
... There could be several explanations for these results. For example, a previous study reported that the process for WC (e.g., preparation and application for compensation, submitting claims) for injuries itself was stressful (Collie et al. 2020;Kim and Choi 2016;Murgatroyd et al. 2011). The firefighters who went through these stressful processes might expect that their claims would be accepted, but if a claim was rejected, they could feel frustrated and stressed. ...
Article
Full-text available
Objectives This study sought to examine whether the experience of occupational injuries was associated with depressive symptoms and whether the rejection of workers’ compensation claims was associated with depressive symptoms among Korean firefighters.Methods We conducted a nationwide survey of 6793 Korean firefighters in 2015. Based on the experience of occupational injuries and workers’ compensation claims over the past year, respondents were classified into four groups: “Not injured”, “Injured, not applied”, “Injured, applied, but rejected” and “Injured, applied, and accepted.” Depressive symptoms over the preceding week were assessed using the 11-item version of the Centers for Epidemiologic Studies Depression Scale.ResultsCompared to firefighters who did not get injured, injured firefighters had a higher prevalence of depressive symptoms (PR 2.01, 95% CI 1.83, 2.22) after controlling for confounders including job assignment. Also, when we restricted the analysis to injured firefighters, a higher prevalence of depressive symptoms was observed among “Injured, applied, but rejected” (PR 1.70, 95% CI 1.11, 2.59) group, compared to “Injured, applied, and accepted” group.Conclusions This finding suggests that rejection of workers’ compensation claims, as well as the experience of occupational injuries, may increase the risk of depressive symptoms among Korean firefighters.
... Citing it as an additional burden and stress to the victims. This could influence their perception towards coping from the experienced phenomenon and their course of recovery (Murgatroyd, Cameron & Harris, 2011). ...
Article
Purpose: This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI. Methods: The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants (n = 18) aged 18-65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data. Results: Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support. Conclusions: Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme.IMPLICATIONS FOR REHABILITATIONThis study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme.Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury.Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI.Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work.
Article
Introduction Les accidents du travail et les maladies professionnelles ont des répercussions physiques, sociales et psychologiques négatives sur les personnes qui en sont victimes. Bien que la Commission de la sécurité professionnelle et de l’assurance contre les accidents du travail (WSIB) de l’Ontario ait pour mandat d’atténuer ces effets, son processus de fonctionnement peut conduire à des difficultés. Les soutiens qui sont offerts aux travailleurs blessés peuvent être fragmentés et rares, notamment dans les régions qui sont mal desservies. Nous décrivons les expériences vécues par des travailleurs blessés ou malades du Nord­Ouest de l’Ontario dans le cadre de leurs démarches auprès de la WSIB, de même que les besoins en santé mentale de ces travailleurs, dans le but de promouvoir l’amélioration du système en place. Méthodologie Des travailleurs blessés et malades (n = 40) recrutés dans la collectivité de Thunder Bay et son district ont répondu à un sondage en ligne sur leurs besoins en matière de santé mentale, de services sociaux et de services juridiques lors de leurs démarches auprès de la WSIB. Des entrevues portant sur des thèmes similaires ont aussi été réalisées avec 16 autres travailleurs blessés et malades ailleurs dans le Nord-Ouest de l’Ontario ainsi qu’avec 8 fournisseurs de services communautaires connaissant bien le fonctionnement de la WSIB. Résultats Les travailleurs du Nord­Ouest de l’Ontario ont décrit les répercussions que leur accident du travail ou leur maladie professionnelle avait eues sur leur situation professionnelle, familiale, financière et sociale, ainsi que sur leur santé physique et mentale. Beaucoup ont aussi souligné les effets négatifs accrus attribuables aux processus mêmes de la WSIB, notamment les problèmes locaux liés à la protection de la vie privée dans les « petites villes » et le fardeau financier associé aux déplacements exigés par la WSIB, en particulier durant la pandémie de COVID­19. Les travailleurs et les fournisseurs de services ont proposé de rationaliser et de clarifier les processus de la WSIB, d’améliorer la continuité des soins offerts par la WSIB et de mettre en place des mesures spécifiques à la région, telles que l’amélioration de l’accès aux services de soutien régionaux par l’intermédiaire d’intervenants­pivots indépendants. Conclusion Les travailleurs du Nord­Ouest de l’Ontario subissent des effets négatifs dus à la fois aux blessures ou maladies professionnelles et au fonctionnement de la WSIB. Les intervenants pourront utiliser les constatations de cette recherche afin d’améliorer les démarches et la situation des travailleurs blessés et malades, en tenant compte plus particulièrement de la région du Nord.
Article
Objectives/Hypothesis Chronic dizziness (CD) and imbalance have multiple etiologies. CD is strongly linked with psychiatric and psychological comorbidities, thus an interdisciplinary approach, including psychopharmacological interventions, is recommended. Despite the use of this comprehensive treatment approach, the recovery of individuals with CD that pursue long-term disability (LTD) insurance or legal claims (LC) appears hampered. As such, we aimed to compare symptom recovery from CD in an interdisciplinary setting between patients receiving LTD/LC versus those who were not, and to explore the factors that may contribute to changes in symptom severity. Study Design Retrospective cohort study. Methods Dizziness-related diagnoses were extracted from the charts of 195 adults in an outpatient interdisciplinary neurotology clinic in Toronto, Canada. Patients with baseline Dizziness Handicap Inventory (DHI) and Dizziness Catastrophizing Scale (DCS) assessments between August 2012 and July 2018 and a mean follow-up visit within approximately 10 months were included. The study participants were categorized as “LTD/LC+” (n = 92) or “LTD/LC−” (n = 103), referring to either receiving or pursuing LTD/LC or not, respectively. Results There were differences in the mean percentage changes in DHI (t[187] = 3.02, P = .003) and DCS (t[179] = 2.63, P = .009) scores between LTD/LC+ and LTD/LC− patients. LTD/LC+ patients showed 8.0% and 7.6% mean increases in DHI and DCS scores, respectively, whereas LTD/LC− patients showed 21.5% and 25.9% reductions in DHI and DCS scores, respectively, controlling for age, sex, and baseline illness severity. Conclusions Patients receiving or pursuing LTD insurance or a legal claim did not improve from CD and dizziness catastrophizing compared to those who were not. Future studies are required to test these findings prospectively and to determine the factors that may contribute to symptom recovery, including the anxiety-aggravating effects of the LTD/LC process and the deleterious consequences of developing a sick-role while afflicted with a chronic illness. Level of Evidence 3 Laryngoscope, 2021
Book
Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.
Article
The present study assessed the role of pain and pain-related psychological variables in the persistence of post-traumatic stress symptoms following whiplash injury. Individuals (N=112) with whiplash injuries who had been admitted to a standardized multidisciplinary rehabilitation program were asked to complete measures of pain, post-traumatic stress symptoms, physical function and pain-related psychological variables at three different points during their treatment program. The findings are consistent with previous research showing that indicators of injury severity such as pain, reduced function and disability, and scores on pain-related psychological were associated with more severe post-traumatic stress symptoms in individuals with whiplash injuries. Contrary to expectations, indicators of pain severity did not contribute to the persistence of post-traumatic stress symptoms. Univariate analyses revealed that self-reported disability, pain catastrophizing and perceived injustice were significant determinants of the persistence of post-traumatic stress symptoms. In multivariate analyses, only perceived injustice emerged as a unique predictor of the persistence of post-traumatic stress symptoms. The results suggest that early adequate management of pain symptoms and disability consequent to whiplash injury might reduce the severity of post-traumatic stress symptoms. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of post-traumatic stress symptoms consequent to whiplash injury.
Article
To determine predictors of moderate or severe pain 6 months after orthopaedic injury. Prospective cohort study. Two adult level 1 trauma centers in Victoria, Australia. A total of 1290 adults admitted with orthopaedic injuries and registered by the Victorian Orthopaedic Trauma Outcomes Registry. Participant self-reported pain and health status using an 11-point numerical rating scale and the 12-item Short-Form health survey, respectively. The prevalence of moderate or severe pain was 48% [95% confidence interval (CI), 45-51] at discharge and 30% (95% CI, 28-33) at 6 months postinjury. Failure to complete high school [adjusted odds ratio (AOR) 1.5 (95% CI, 1.1-1.9)], self-reported preinjury pain-related disability [AOR 1.8 (95% CI, 1.3-2.5)], eligibility for compensation [AOR 2.1 (95% CI, 1.6-2.8)], and moderate or severe pain at discharge from the acute hospital [AOR 2.4 (95% CI, 1.8-3.1)] were found to be independent predictors of moderate or severe pain at 6 months postinjury. Moderate or severe pain is commonly reported 6 months after orthopaedic trauma. Pain intensity at discharge and the effects of a "no-fault" compensation system are potentially modifiable factors that might be addressed through intervention studies to reduce the burden of persistent pain after orthopaedic trauma.
Article
An audit of one insurance company's files on all employer's liability and third party motor claims settled over two years for 5000 pounds or more presented an opportunity to review the medical reports on the patients involved. A stratified random sample of files on 203 patients contained 602 reports prepared by 400 consultants. Content analysis was undertaken to evaluate compliance with published guidance on reports prepared for medico-legal purposes and to ascertain how well reports met recipients' requirements. While clinical topics were well covered, generally to a high standard, other functional, psychosocial and occupational topics, reflecting the wider clinical and non-clinical frame of reference within which lawyers and insurers normally seek information and advice, were covered less frequently, extensively and comprehensively--leaving considerable scope to improve these aspects of assessment and reporting. Further review of this aspect of professional practice should include attention to the appropriateness of existing guidance, postgraduate training requirements and the involvement of other agencies or professions in some aspects of assessment for medico-legal purposes.
Article
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than 2,000 persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma. The score is easily derived, and is based on a widely used injury classification system, the Abbreviated Injury Scale. Use of the Injury Severity Score facilitates comparison of the mortality experience of varied groups of trauma patients, thereby improving ability to evaluate care of the injured.
Article
A prospective longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident, again at 3 months, and at 1 year. The prevalence of posttraumatic stress disorder (PTSD) was 23.1% at 3 months and 16.5% at 1 year. Chronic PTSD was related to some objective measures of trauma severity, perceived threat, and dissociation during the accident, to female gender, to previous emotional problems, and to litigation. Maintaining psychological factors, that is, negative interpretation of intrusions, rumination, thought suppression, and anger cognitions, enhanced the accuracy of the prediction. Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year. Rumination, anger cognitions, injury severity, and prior emotional problems identified cases of delayed onset.
Article
A study was set up to determine the trends in medical impairment and work disability ratings for persons affected by whiplash associated disorders (WAD) and other injuries secondary to road traffic collisions, and into the influence of age, gender, professional status, and final medical impairment rating on final work disability. A cross-sectional study was carried out of insurance files of 2,523 subjects in 1989 and 3,223 subjects in 1994 judged to have a permanent medical impairment of 10% or more and work disability due to road traffic injury. Files were obtained from the Swedish Road Traffic Injury Commission. The main outcome measures were the crude frequency and age-specific, standardized percentage of traffic injuries with a medical impairment of 10% or more for the years 1989 and 1994. Final work disability status was analysed with respect to age, gender, type of injury, degree of medical impairment, and professional status. The proportion of medical impairment due to WAD was found to have increased from 16% in 1989 to 28% in 1994, but the proportion of work disability was found to have remained the same. Age over 40 years, low professional status, and having a medical impairment judgement of 15% or more were independently associated with reduced or full work disability.