Journal of Rehabilitation Medicine 51-2 | Page 45

J Rehabil Med 2019; 51: 120–126 ORIGINAL REPORT SYSTEM COMPLEXITIES AFFECTING RECOVERY AFTER A MINOR TRANSPORT- RELATED INJURY: THE NEED FOR A PERSON-CENTRED APPROACH Stella SAMOBOREC, M BMed Sci Epi, Doctoral cand. 1 , Darshini AYTON, PhD 1 , Rasa RUSECKAITE, PhD 1 , Gary WINBOLT 2 and Sue M. EVANS, PhD 1 From the 1 Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, and 2 Transport Accident Commission, Geelong, VIC, Australia Objective: To understand clients’ experiences of the recovery journey through the compensation system and to identify areas and strategies for quality im- provement. Methods: A qualitative study of 23 participants with physical or mental disabilities caused by traffic acci- dents, which occurred, on average, 4 years ago. Pur- posive sampling of long-term recovery clients who made a compensation claim after their injuries was applied until data saturation was reached. Data were collected using semi-structured interviews and ana- lysed through conventional thematic analysis. Results: This study demonstrated that recovery is a complex phenomenon that can be impacted by nu- merous challenges of navigating the compensation system and using its services. Clients perceived the compensation provider as limited in rules around which services they could access. A common per- ception amongst clients was that the compensation provider did not have the capacity and knowledge to understand health and recovery processes nor did it provide adequate guidelines or instructions that would assist clients with their recovery. Many clients dealt with numerous case managers and felt insuf- ficiently informed on what to expect and do, which led to a lack of trust in rehabilitation management and case managers’ decisions. According to clients, financial impacts were neglected and not addressed effectively. Many clients felt abandoned by the sys- tem which led to perceived feelings of desertion and negligence. Conclusion: Understanding modifiable barriers to recovery in compensation systems presents oppor- tunities to amend current practices and consider a holistic, person-centred care approach. It is appa- rent that improved recovery management, commu- nication and adequate provision of guidelines are needed to meet clients’ needs and facilitate better outcomes. A person-centred care approach is likely to improve quality of life and help clients navigate the compensation system more effectively with as- sistance from health and compensation professio- nals, who should be actively involved in their reco- very processes. Key words: person-centred care; recovery; health outcomes; road trauma; minor injuries. Accepted Oct 2, 2018; Epub ahead of print Nov 14, 2018 J Rehabil Med 2019; 51: 120–126 LAY ABSTRACT Injuries from transport accidents are heterogeneous and recovery processes complex and challenging for people, regardless of the severity of injury sustained. Multiple factors influence the recovery trajectory, including pain, poor pre-accident health state, psychological comorbidi- ties, socioeconomic disadvantage and, in some instan- ces, financial compensation. In particular, the results on the effect of financial compensation on health outcomes following musculoskeletal injury remain controversial, indicating that further research is needed to understand the possible barriers and complexities involved in com- pensation processes and service delivery. This qualitati- ve study investigated compensation-related barriers and found that recovery is indeed impacted by numerous challenges in using compensation services after traffic accident. To overcome these issues, it is recommended that a person-centred approach is used as foundation to inform decision-making for interventions aimed at improving recovery outcomes. An improved recovery management, communication and adequate provision of guidelines is needed and highly recommended to meet clients’ needs and facilitate better outcomes. Correspondence address: Stella Samoborec, Department of Epidemio- logy and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, Aus- tralia 3004. E-mail: [email protected] T ransport-related accidents and injuries have been a longstanding public health problem (1). Injuries from transport accidents are heterogeneous and reco- very processes complex and challenging for patients, regardless of the type and severity of injury sustained (2, 3). Multiple factors impact the recovery trajectory, including pain, poor pre-accident health state, psycho- logical comorbidities, socioeconomic disadvantage and, in some instances, financial compensation (4–6). However, there is a lack of consensus as to what im- pact the compensation system has on health outcomes (7). Multiple studies have shown that patients claiming compensation have significantly poorer quality of life compared with those who do not claim (8–14). How­ ever, a recent systematic review revealed mixed results on whether financial compensation is associated with a poorer outcomes, yet no studies in the review reported association between compensation-related factors and improved health outcomes (13). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2500 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977