Petrina Casey [PhD candidate], Rehabilitation Studies Unit, Sydney Medical School Northern, University of Sydney, Sydney, NSW.

[Investigators : P Casey, Prof Ian D Cameron, Dr Anne Marie Feyer ]

Predictors of recovery and legal representation in a

compensation setting 12 months post injury: The

Whiplash Outcome Study [WOS]

Executive Summary

At 12 months post injury

50% of study population remained unrecovered

Physical and Mental Health [SF36], whilst significantly improved remained below the Australian population

Of those in paid employment 28% continued to have some work incapacity

Legal representation was not associated with poorer health [SF36] or disability [FRI]

Higher levels of disability and initial effect on work capacity associated with legal representation

Background to WOS and Study Design

Prospective cohort study: 246 people with Whiplash who lodged a claim in the NSW CTP compensation scheme from Nov 2007- June 2009

Recruitment: Participants were identified through an Insurance database

Eligibility criteria: Whiplash, > 18 years, no interpreter required, no concurrent workers compensation claim, < 3 mths post injury

Data Collection: Baseline, 12 months and 24 months via postal questionnaire

Demographic, socio-economic, insurance claim information and standardised health measures[SF36,FRI,PCS], GP WAD classification at baseline

Study Aim: Understand predictors of health and insurance outcomes in a WAD population

Ethics: Royal Rehabilitation Centre Sydney and University of Sydney Ethics Committees.

WOS Population

Study Factor Variable N Category % Mean

(SD)

Demographic Age, SD 246 4315

Gender 246 Female 78%

Socio-Demographic Country of Birth 246 Australia 68%

Other 32%

Weekly Household Income 234 $A599 or less 27%

> $A600 73%

Education Level 244 No Secondary

Education 23%

Post Secondary

Education 77%

Married Status 246 Married 54%

Other language Spoken 246 Yes 26%

Insurance Factors Legally Represented 246 Yes 11%

Previous Claim 174 Yes 29%

WOS Population cont.

Study Factor Variable N Category % Mean (SD)

Work Factors Self Employed 246 Yes 15%

Usual Work Status 246 Full time Paid Work 52%

Part Time Paid Work 21%

Other 28%

Profession 232 Blue Collar 13%

White Collar 63%

Unemployed 24%

Health Risk Factors Regular Smoker 243 Yes 12%

Weekly Alcohol intake 244 Non Drinker 53%

1 10 Drinks 44%

BMI, SD 238 Underweight 2% 26.09 6

Normal Weight 47%

Overweight [25-29.9] 32%

Obese 30 19%

Injury Factors GP WAD Grade 195 Grade 0 1%

Grade I 23%

Grade II 74%

Grade III 2%

Hospital Attendance 244 Attended 39%

Not Attended 61%

12 Month Follow Up

Specific aims of the 12 month data analysis:

[86% follow up rate - response received 373 days post injury].

Understand health status at 12 months and change in health status from baseline data;

Identify the predictors of recovery from WAD at 12 months;

Understand the profile of those engaging a lawyer, and identify predictors of engaging at lawyer 12 months

Changes over study period

Recovery, Workability, insurance factors

Study Factor Variable

Baseline

(n=246)

12 Month

(n=212)

Participation Rate 100% 86%

Recovery [ 25 on FRI] 23% 47%

Work Factors Workability Affected* 38% 28%

Insurance Factors Claim Finalised 9% 52%

Legally Represented 11% 25%

*Workability Affected - includes those who had returned to work but in a reduced capacity, those who had to change jobs and those unable to work at all.

Health Status and change over time

8

0 50 100

Physical Functioning

Role - Phyisical

Bodily Pain

General Health

Vitality

Social Functioning

Role- Emotional

Mental Health

Physical ComponentScore

Mental ComponentScore

Australian Population Norms

SF36 Scores at 12 months

SF36 Scores at baseline

SF 36 scores at baseline and 12 months

compared with Australian population data

Health

Measure

Mean Change in

score (SD) t-statistic p-value

FRI 10.32 16 9.491

Comparison of Recovered and Unrecovered groups

9

Poorer health on all measures used [SF36, PCS, SF36, MCS, PCS] at baseline and at

12 months post injury

Older

Language other than English spoken at home

Less people earning >$600 p/w

More obese people

More smokers

Work capacity affected at baseline

Insurance Factors

Unrecovered Group at 12 months*

Health, demographics and work

More had a previous claim

Less had closed claim at 3 mths

More had a lawyer at claim lodgement

*Only significant differences shown, p

Independent Predictors of non recovery

10

The significant independent predictors of disability [measured by FRI] were

helplessness [PCS scale]

having had a prior compensation claim, and

older age

Linear Regression Model: r 2=0.450, p

Comparison of Group with a Lawyer and without a Lawyer

11

Group With Legal Representation at 12 months*

*Only significant differences shown, p$600 p/w

More blue collar and unemployed people

More smokers

Attended Hospital

Work capacity affected at baseline

More had a previous claim

Less had closed claim at 3 mths

Longer time to claim lodgement

Legal representation increased

from 11% to 25% at 12 mths

Legal representation means

engaging a lawyer to assist with

the claim

Independent Predictors of having a Lawyer

12

The significant independent predictors of having a lawyer at 12 months were

higher initial levels of disability [FRI]

Initial work incapacity

Logistic Regression , p

Discussion

Usefulness of PCS [Helplessness subscale] in identifying those at risk of prolonged disability

High work incapacity rates [1 in 4] highlight the need for a return to work [RTW] focus in traffic

crash schemes.

Lawyer retention was not associated with poorer health outcomes

Higher disability levels and work incapacity was associated with lawyer retention

Discussion

Profile of people who consult lawyers within compensation schemes need to better address the reverse causality issue

Data suggests:

lower SES profile

More males

Blue collar workers

Higher levels of disability

More likely to have previous claim

Strengths and Limitations

Strengths

Prospective study - 86% follow up rate at 12months

Comprehensive comparison of those recovered and unrecovered those legally represented and those not

Broad range of health measures used

Compensation factor of interest - lawyer retention has been defined and collected in such a way to be used as a predictor

and dependant variable.

Limitations

The study only includes people who claimed compensation

Limited information on co-morbidities

No information on pre-injury health status

Acknowledgements

Investigators

Petrina Casey

Professor Ian Cameron,

Dr Anne Marie Feyer

The assistance of NRMA CTP Insurance in the identification of potential participants , project assistance and funding in the initial data collection stage is acknowledged