Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial.

Only 32 people were enrolled, so the study cannot show whether the programme changes PTSD or pain. The authors say it was never designed to detect those effects. Recruitment began just before the COVID-19 pandemic, which stopped face-to-face contact on the trauma ward and cut the number of people recruited. The two groups were not well matched: the intervention group had more people with other health conditions and contained all the burn injuries, intentional injuries and head injuries, while the control group started with higher depression scores. The findings do not apply to people with severe traumatic brain injury or cognitive impairment, who were excluded, or to older people injured in a low fall, who were excluded partway through. Only people in the intervention group were interviewed, so the experiences of the control group were not explored, even though both groups had similar access to treatment. The case manager worked only 1 to 2 days per week, several participants wanted more face-to-face contact than pandemic restrictions allowed, and follow-up stopped at 6 months.

Funded by a project grant from the Rebecca L Cooper Medical Research Foundation, with additional salary support for some authors from Australian Research Council, NHMRC, US National Institutes of Health and Canadian Institutes of Health Research awards. The funders had no direct role in the trial, but a representative of the Transport Accident Commission, which funds the trauma registry used here, sat on the steering committee. The clinicians who developed the two models of care that this intervention combines, the Trauma Survivor Outcome Support intervention and the Toronto Transitional Pain Service, were investigators on the project team.

Do not read this as evidence that stepped case management improves pain or PTSD after major trauma. Both groups' PTSD symptoms fell by similar amounts, the intervention group actually reported more pain at 3 and 6 months, and with only 32 people the study was far too small to detect a difference even if one existed.