Psychosocial interventions for the prevention of disability following traumatic physical injury.
BACKGROUND
Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning.


OBJECTIVE
To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury.


METHODS
The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008.


METHODS
Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI).


METHODS
Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data.


RESULTS
We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients.


CONCLUSIONS
This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.
De Silva
Mary
M
Nutrition & Public Health Intervention Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK, WC1E 7HT.
Maclachlan
Malcolm
M
Devane
Declan
D
Desmond
Deirdre
D
Gallagher
Pamela
P
Schnyder
Ulrich
U
Brennan
Muireann
M
Patel
Vikram
V
D003863:Depression / Q000517:prevention & control; D006233:Persons with Disabilities / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D001523:Mental Disorders / Q000517:prevention & control*; D010174:Pamphlets; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000379:methods; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control; D014947:Wounds and Injuries / Q000523:psychology*