Ontario Moving Closer to a New Treatment Protocol for Minor Injuries

On a recent snowy morning, a group of auto insurance stakeholders got together at Lakeridge Health in Oshawa for an all-day information session on some of the research findings of the Minor Injury Treatment Protocol Project (MITPP).  This was the first public presentation (although it was by invitation only) of the research team's work.

The MITPP originated in FSCO's Report on the Five Year Review of Automobile Insurance which recommended that examining the feasibility of expanding the PAF Guidelines to provide a more extensive continuum of care and to include the treatment and assessment of other soft tissue injuries (Recommendation #23).  Following an open competitive Request for Proposal process, a two-year contract was awarded to team of researchers led by Dr. Pierre Côté from the University of Ontario Institute of Technology and the Canadian Memorial Chiropractic College in the spring of 2012.

The project team will be delivering a report to the Superintendent later this year that provides:

• Recommendations regarding a treatment protocol for minor injuries and
• Recommendations regarding a clinical predictive rules to screen for patients who may be a risk of developing chronic pain.

There have been significant progress made by the project team and to date have completed the following tasks:

• The project team has developed a methodology for developing a new tasks including a process for identifying relevant studies for consideration.
• The project team has updated the research carried out by the World Health Organization's Neck Pain Task Force (NPTF) study which was released in February 2008.
• The project team has also now finished reviewing research on the treatment of neck pain.

There are some significant tasks that still need to be completed before the final report is submitted to the Superintendent.  Those tasks include:

• The project team will need to complete the review of research on the treatment of other minor injuries, not related to neck pain (for example, headaches, low back pain, injuries to extremities, temporomandibular disorders, minor brain traumatic brain injuries).
• Make recommendations regarding a treatment protocol for minor injuries.
• Make recommendations regarding a clinical predictive rules to screen for patients who may be a risk of developing chronic pain.

The project team developed some rigorous standards which were used to decide whether to consider a study for the project.  Their literature search produced over 100,000 papers.  Only published studies that underwent peer review and followed appropriate research protocols were considered.  For example, opinion papers and unpublished documents were not included.  A team of graduate students reviewed the papers to determine if they met the standards.   Many studies were inadmissible because of small sample sizes or possible bias.  In the end fewer than 200 papers made the cut.

The day was filled by research associates presenting on topics related to the treatment of neck pain.  Unfortunately, I cannot report on any of the findings.  The information is being embargoed until it is published as a series of papers in a scientific journal later this year.  A similar approach was taken by the NPTF which published its finding in a special supplement of Spine Journal on April 28, 2008.

The final report of the MITPP will be considered by the government later this year.  Implementation will not only require the release of a new Minor Injury Guideline by FSCO but will likely require regulation changes and an extensive education campaign directed at health care providers, insurance adjusters and the public.