RESUMEN
OBJECTIVES: To determine the effectiveness of an Early Rehabilitation Intervention (ERI ) versus a Brief Education Intervention (BEI) following road trauma. PRIMARY OBJECTIVE: return to work or usual activities at 12 weeks (for minor/moderate injury) and 24 weeks for major injury. SECONDARY OBJECTIVES: Reduction in pain, anxiety, depression, disability and incidence of Post Traumatic Stress Disorder and improved quality of life. DESIGN: A multi-site single-blinded stratified randomized clinical trial (RCT). METHODS: 184 patients (92 in each arm) were recruited over 18 months and followed for 12 weeks (minor/moderate injury) and 24 weeks (major injury). Screening questionnaires at 2-4 weeks and follow-up interviews by phone for all outcome measures were undertaken. For those in the ERI group with a positive screen for high risk of persistent symptoms, an early assessment and intervention by a Rehabilitation Physician was offered. Those in the BEI group were sent written information and advised to see their GP. RESULTS: 89.4% of injuries were mild in this cohort. At 12 weeks 73.8% and 69.1% of patients in the ERI and the BEI groups respectively had returned to work or usual activities. There were no significant differences between the two intervention groups with respect to the primary or any secondary outcome measures. CONCLUSION: This is the first RCT of an ERI following road trauma in Australia. A targeted ERI is as effective as a BEI in assisting those with mild/moderate trauma to return to work or usual activities.
Asunto(s)
Accidentes de Tránsito/psicología , Actividades Cotidianas/psicología , Trastornos Mentales/terapia , Manejo del Dolor/psicología , Reinserción al Trabajo/psicología , Heridas y Lesiones/rehabilitación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/etiología , Trastornos de Ansiedad/prevención & control , Trastornos de Ansiedad/terapia , Trastorno Depresivo/etiología , Trastorno Depresivo/prevención & control , Trastorno Depresivo/terapia , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Trastornos Mentales/etiología , Trastornos Mentales/prevención & control , Persona de Mediana Edad , Nueva Gales del Sur , Manejo del Dolor/métodos , Modelos de Riesgos Proporcionales , Calidad de Vida , Reinserción al Trabajo/estadística & datos numéricos , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/prevención & control , Trastornos por Estrés Postraumático/terapia , Tiempo de Tratamiento , Heridas y Lesiones/etiología , Heridas y Lesiones/psicología , Adulto JovenRESUMEN
The fifth in a series of papers on practical aspects of telehealth, this paper discusses telehealth models that can facilitate the provision of specialist services to rural and remote patients closer to home. Some of the barriers to successful implementation of these models relates to workforce, funding and infrastructure at rural sites, as well as the traditional mindset of healthcare professionals. Therefore, the rural sector needs to be adequately resourced for telehealth models to be substantive and successful. This paper describes the development of a large teleoncology network over a vast geographical area in North Queensland. Adequate resourcing for the rural sites and undertaking quality improvement activities has continually enhanced the model over a 5- to 6-year period. The benefits of this model of care are twofold: (i) patients received their care closer to home and (ii) the workforce, service capabilities and infrastructure for the hospital in Mt Isa (a rural town 900 km away from its tertiary centre) has improved.
Asunto(s)
Área sin Atención Médica , Servicio de Oncología en Hospital/organización & administración , Servicios de Salud Rural/organización & administración , Telemedicina , Actitud del Personal de Salud , Humanos , Modelos Organizacionales , Prioridad del Paciente , Mejoramiento de la Calidad , Queensland , Población Rural , Telemedicina/métodos , Telemedicina/organización & administraciónRESUMEN
The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.
Asunto(s)
Relaciones Médico-Paciente , Telemedicina , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/psicología , Adenocarcinoma/secundario , Ira , Australasia , Neoplasias Colorrectales/patología , Barreras de Comunicación , Diabetes Mellitus Tipo 2/psicología , Emociones , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/psicología , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Negociación , Relaciones Profesional-Familia , Revelación de la Verdad , Comunicación por VideoconferenciaRESUMEN
The third in a series of articles about the practical aspects of telehealth, this paper gives guidance on suitable setup for video consultations, including layout of rooms, managing sound and image quality, scheduling, testing and best practice in telehealth videoconferencing.
Asunto(s)
Telemedicina/métodos , Telemedicina/normas , Comunicación por Videoconferencia/normas , Humanos , Sistemas de Registros Médicos Computarizados/normasRESUMEN
The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations.
Asunto(s)
Examen de Aptitud para la Conducción de Vehículos , Derivación y Consulta/economía , Población Rural , Telemedicina/economía , Anciano , Humanos , Masculino , Telemedicina/métodosRESUMEN
The first in a series of articles that demonstrate the practical aspects of telehealth, this paper provides three case studies that examine the suitability of telehealth for patients living in rural and remote areas who require ongoing specialist care.