Development of a screening tool to predict the risk of chronic pain and disability following musculoskeletal trauma: protocol for a prospective observational study in the United Kingdom

• Published in: BMJ open Vol. 8; no. 4; p. e017876
• Main Authors: Rushton, Alison B, Evans, David W, Middlebrook, Nicola, Heneghan, Nicola R, Small, Charlotte, Lord, Janet, Patel, Jaimin M, Falla, Deborah
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2018; BMJ Publishing Group
• Subjects: Activities of Daily Living; Adolescent; Adult; Anxiety; Chronic Pain; Coping; Disability Evaluation; Emergency medical care; Female; Humans; Injuries; Male; Mental depression; Musculoskeletal Pain; Musculoskeletal System - injuries; Observational studies; Pain; Primary care; Prospective Studies; Quality of Life; Quantitative psychology; Questionnaires; Rehabilitation; Rehabilitation Medicine; Trauma; United Kingdom; United Kingdom; United Kingdom > UK; musculoskeletal trauma; pain mechanisms; precision rehabilitation
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-017876

IntroductionPain is an expected and appropriate experience following traumatic musculoskeletal injury. By contrast, chronic pain and disability are unhelpful yet common sequelae of trauma-related injuries. Presently, the mechanisms that underlie the transition from acute to chronic disabling post-traumatic pain are not fully understood. Such knowledge would facilitate the development and implementation of precision rehabilitation approaches that match interventions to projected risk of recovery, with the aim of preventing poor long-term outcomes. The aim of this study is to identify a set of predictive factors to identify patients at risk of developing ongoing post-traumatic pain and disability following acute musculoskeletal trauma. To achieve this, we will use a unique and comprehensive combination of patient-reported outcome measures, psychophysical testing and biomarkers.Methods and analysisA prospective observational study will recruit two temporally staggered cohorts (n=250 each cohort; at least 10 cases per candidate predictor) of consecutive patients with acute musculoskeletal trauma aged ≥16 years, who are emergency admissions into a Major Trauma Centre in the United Kingdom, with an episode inception defined as the traumatic event. The first cohort will identify candidate predictors to develop a screening tool to predict development of chronic and disabling pain, and the second will allow evaluation of the predictive performance of the tool (validation). The outcome being predicted is an individual’s absolute risk of poor outcome measured at a 6-month follow-up using the Chronic Pain Grade Scale (poor outcome ≥grade II). Candidate predictors encompass the four primary mechanisms of pain: nociceptive (eg, injury location), neuropathic (eg, painDETECT), inflammatory (biomarkers) and nociplastic (eg, quantitative sensory testing). Concurrently, patient-reported outcome measures will assess general health and psychosocial factors (eg, pain self-efficacy). Risk of poor outcome will be calculated using multiple variable regression analysis.Ethics and disseminationApproved by the NHS Research Ethics Committee (17/WA/0421).