Social Work Support for Fractures

(SWRCT Trial)

Recruiting at 1 trial location

Overseen By Natalie Fleming, MSW

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Sheila Sprague

Disqualifiers: Incarceration, Terminal illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

2000 Participants Needed

Trial Summary

What is the purpose of this trial?

Every year, many Canadians sustain a fracture that requires surgical treatment and results in a long recovery period. During this recovery period, patients may experience new or worsening mental health issues including depression, anxiety, or post-traumatic stress disorder. Additionally, patients may experience new or worsening social and financial problems, such as food and housing insecurity, due to being unable to work or take care of other daily responsibilities. Current care for fracture patients is focused on treating their physical injuries and overlooks these other challenges. To address this gap in care, the investigators propose having a social worker available in the fracture clinic to provide patients with support beyond the care of their physical injury. The investigators propose a trial of 2,000 patients to determine if social worker support improves recovery for patients after a serious fracture by reducing the number of times they return to the emergency room or urgent care centre. This trial will also determine if social work support improves patients' mental health, financial security, ability to work, and level of satisfaction with the care they receive, and whether it reduces the amount of opioid medication they use and number of missed visits during their recovery. Patients will be randomly assigned to receive either support from a social worker or usual care. For patients assigned to receive social worker support, the social worker will assess their individual needs and provide support, information, and referrals to social support services. The social worker will continue to support patients for up to one year after they join the trial. Patients will complete questionnaires at enrollment and at 6 weeks and 3, 6, 9, and 12 months after enrollment. If this trial shows that support from a social worker in the fracture clinic during their recovery period is beneficial to patients who have experienced a serious fracture requiring surgery, it has the potential to change care for patients who experience these potentially life-changing injuries.

Eligibility Criteria

This trial is for Canadian patients recovering from a serious fracture requiring surgery. It's designed to see if social work support can help with their mental health, financial stability, and overall satisfaction during recovery. To join, patients must be willing to complete several questionnaires over the course of a year.

Inclusion Criteria

I have a broken bone in my arm or leg.

I had a bone fracture in the last 3 months.

Willing to comply with the protocol

Exclusion Criteria

Terminal illness with expected survival of less than 6 months

Expected injury survival of less than 6 months

Prior enrollment in the trial

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Vanguard Phase

Initial phase with two clusters enrolling participants for 8 months, with staggered introduction of social worker intervention

8 months

Batched Stepped-Wedge Phase

Participants are enrolled in batches, with staggered introduction of social worker intervention every 10 weeks

12 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Treatment Details

Interventions

• Social Work Support

Trial Overview The study is testing whether having a social worker in the fracture clinic helps reduce emergency room visits and improves mental health and financial security after a serious injury. Half of the 2,000 participants will get this extra support while the other half will receive usual care without additional social work services.

Participant Groups

Group I: Usual Care Arm Active Control 1 Intervention

Participants enrolled during the usual care phase will receive the current standard treatment for their fracture. The current standard of care post-surgery for fractures, in the fracture clinic, is to provide medical treatment for injuries including casts, monitoring for infection, x-rays, etc. This is provided by surgeons, nurses and technicians. Any psychosocial needs are managed at patient request either by the surgeon or another clinic health care professional (in the case of simple forms) or by a hospital social worker, who usually has a full-time workload outside of the fracture clinic.

Group II: Social Work Intervention Group Active Control 1 Intervention

Participants enrolled during the treatment phase at their clinic will receive social work support for 6 months from the time of enrollment. They will have an intake appointment with the social worker before or during their initial fracture clinic visit to assess their needs, identify goals that they can address with the support of the social worker, and collaboratively formulate a personalized care plan tailored to their specific circumstances. The social worker will then implement the plan, which may involve educating participants and their support network, coordinating delivery of care and benefits, making referrals to community services, advocating for the participant, and providing emotional support and brief counselling. The social worker will be accessible to participants for 6 months post-enrollment, following up via telephone, telemedicine or in-person to evaluate the effectiveness of the care plan and offer sustained ongoing support.

Who Is Running the Clinical Trial?

Sheila Sprague

Lead Sponsor

McMaster Surgical Associates

Collaborator

Trials

17

Recruited

46,500+

Orthopaedic Trauma Association

Collaborator

Trials

34

Recruited

5,100+