2 April 2009
Could traumatic injury outcomes be improved if we changed the way we manage the patients? Do some patients recover better than others after major trauma? If so, why?
Looking for answers, former physiotherapist turned researcher Dr Belinda Gabbe and her team developed a methodology to evaluate, measure and record the recovery of patients with serious injury. In the process, they gave the survivors a voice and produced sensitive new tools for monitoring trauma care.
Here Dr Gabbe explains to Dr Andi Horvath how she and her team approached this priority public health issue.
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Transcript of podcast
Voice-over: Welcome to this special National Health and Medical Research Council podcast on ten of the best research projects for 2008. Our podcasts aim to keep you in touch with major health and medical research issues and the people who shape them.
Introduction: Hi I’m Dr Andi Horvath and we’re here at the Department of Epidemiology and Preventive Medicine at Monash University. I’m about to meet Dr Belinda Gabbe. She’s a chief investigator of a project entitled Outcomes of Major Trauma and Sports Injury. The aim of this investigation was to reduce the burden of traumatic injury and it’s a public health priority. Let’s meet her.
Interviewer: Belinda, congratulations to you and your research team on the various research projects. Take us back in time as to what the premise of your investigation was. What did you know at the time, at the outset?
Dr Gabbe: Well we really started from the premise that we understand and we monitor outcomes of injury with respect to mortality very well and we’ve been doing that for quite some time but the majority of people who sustain an injury actually survive that injury and what we don’t understand and what we have very limited understanding of is what the quality of that survival is, so whether they go on to have ongoing disability, loss of function and inability to return to work, we haven’t really developed methodologies or ways of consistently monitoring that.
Interviewer: So how did that formulate your research question?
Dr Gabbe: A number of studies or many studies have looked at small samples of injured patients and then followed them up over time to see how they do, but what we wanted to do is use our experience with trauma registries and particularly our population based trauma registry, which measures mortality really well, but what we wanted to be able to do was implement a methodology where we could look at all survivors of trauma in this state or in the population rather than just a select group and also see whether there’s any change in their outcomes depending on changes in the way we manage patients.
Interviewer: Okay so what are the outcomes of this research project?
Dr Gabbe: Well what we’ve been able to do is develop a methodology for population based monitoring of patients that are captured by the trauma registry, so what we’re able to do now is look at six and twelve month outcomes of all major trauma patients in Victoria and we can look at their functional and quality of life outcomes, look at whether they’ve returned to work and while the work is still ongoing we have seen some consistent trends in the data and that are that there are certain groups of patients who tend to do poorly after major trauma, particularly women, patients covered by compensable schemes such as the Transport Accident Commission and Work Cover. They generally are more likely to have poorer outcomes, even taking into account or even adjusting for the severity of the injuries they sustained. We also see differences in age group as in that older patients tend to generally do worse after injury and we’re also seeing some consistent patterns with respect to recovery as well in that physical health outcomes improve from six to twelve months after injury but what we’re seeing is a consistent decline in Mental Health outcomes from six to twelve months probably as an adaptation to living with disability.
Interviewer: Belinda introduce us to the various team researchers.
Dr Gabbe: Well the group that I work with is called the Pre-Hospital Emergency and Trauma Group and particularly our involvement is with the Trauma Registries which use a large group of people. It’s a large population-based study so they require a whole variety of skill sets from clinical expertise to people who understand the trauma system and health care delivery, particularly in Victoria. We clearly need extensive data base involvement because we’re capturing information about thousands of patients a year and over a long time frame and also at multiple time points as well, so we have excellent data base expertise. We have a collection of staff members, coordinators, who look after various aspects of the registry such as the data collection within the hospitals and the data quality, also the ethics implications, you can imagine with so many health services involved we have quite complex ethics arrangements and we also, from my point of view for collecting the information from the patients I have a project coordinator who looks after and supervises all of our follow-up phone call stuff. All of the data collection at the six and twelve month time point is collected by interview so it requires an enormous group of people. We also have involvement from bio statisticians and we also have involvement from a complex and diverse group of steering committee members as well.
Interviewer: Wow, this is a major military manoeuvre. It’s almost like you’re a film producer and yet you started off life as a physio, is that right?
Dr Gabbe: Ah, yes I did, I started off life as a physio predominantly working in Sports Medicine. In fact my PhD was about injury risk factors in Australian Football players and I actually never thought that this would be the road that my research would take but it’s been a fantastic journey and I’ve really, really enjoyed it. The projects that I’m working on now are particularly large and quite complex but I really did start as a physio and I really had no intention of ever working in research. It was only an opportunistic process where I started to work part time for a very, very good researcher and I became particularly interested and was starting to lose quite a lot of interest in my clinical work.
Interviewer: She mentored you?
Dr Gabbe: She certainly did. Her name is Professor Caroline Finch and she was an excellent mentor. She has an incredible understanding of how research works, how to do good quality research and has incredibly high standards and I think that they are qualities that she imparted in me along the way and I’m certainly trying to do the same with my PhD students as well.
Interviewer: Belinda if you could sum up why you do this research in one or two sentences what would you say?
Dr Gabbe: I think my major interest is really to understand what the burden of injury is and to also give patients a voice, to give them the opportunity to tell us how they are after injury rather than us assuming that they’re okay and that’s been a major driving force behind the whole work.
Interviewer: Belinda tell us a research project anecdote that you like to tell colleagues.
Dr Gabbe: The telephone interviews can be very, very entertaining and some of them are just absolutely fabulous. You hear some amazing stories of recovery from incredibly severe injuries and they’re always really motivating but we also get some interesting patients who for example won’t answer the questions until we manage to find their wallet that was lost at a regional hospital seven or eight months ago and they just refuse to answer questions, but if we find their wallet they’ll be happy to answer our questions.
Interviewer: Belinda some final reflections on being a Chief Investigator. Will you do it all again and why?
Dr Gabbe: I think the answer has to be yes, in fact the work that I started in this program is actually continuing now and expanding, so I’ve had such good experiences and I’ve learnt so much along the way that it would be crazy not to continue the work and as we keep going it just keeps opening up new questions all the time and we just keep building on our knowledge.
Interviewer: I’ve been talking to Dr Belinda Gabbe, an NHandMRC Population Health Research Fellow and Deputy Head of the Pre-Hospital and Emergency and Trauma Group. Belinda Gabbe thank you.
Dr Gabbe: Thank you.
Voice-over: This podcast was brought to you by the National Health and Medical Research Council, working to build a healthy Australia. You’ll find more information about this and other health and medical research issues on our website at www.nhmrc.gov.au
Voice-over: This podcast was brought to you by the National Health and Medical Research Council working to build a healthy Australia. You'll find more information about this and other health and medical research issues on our website at www.nhmrc.gov.au.