Abstract
Objective
To determine whether the results from previous research suggesting that early intensive
health care delays recovery from whiplash-associated disorders (WADs) were confounded
by expectations of recovery and whether the association between early health care
intensity and time to recovery varies across patterns of health care.
Design
Population-based inception cohort.
Setting
All adults (≥18y) injured in motor vehicle collisions who received treatment from
a regulated health professional or reported their injuries to the single provincially
administered motor vehicle insurer.
Participants
Participants with WAD (N=5204). Self-report visits to physicians, chiropractors, physiotherapists,
massage therapists, and other professionals during the first 42 days postcollision
were used to define health care intensity.
Interventions
Not applicable.
Main Outcome Measure
Self-perceived recovery.
Results
Individuals with high utilization health care had slower recovery independent of expectation
of recovery and other confounders. Compared with individuals who reported low utilization
of physician services, recovery was slower for those with high health care utilization,
regardless of the type of profession. For instance, those with high physician (hazard
rate ratio [HRR]=.56; 95% confidence interval [CI], .42–.75), physician and high physiotherapy
utilization (HRR=.68; 95% CI, .61–.77), physician and high chiropractor utilization
(HRR=.74; 95% CI, .64–.85), and physician and high massage therapy utilization (HRR=.78;
95% CI, .68–.90) had significantly slower recovery.
Conclusions
Our study adds to the existing evidence that early intensive care is associated with
slower recovery from WAD, independent of expectation of recovery. The results have
policy implications and suggest that the optimal management of WADs focuses on reassurance
and education instead of intensive care.
Keywords
List of abbreviations:
CI (confidence interval), HRR (hazard rate ratio), WAD (whiplash-associated disorder)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 22, 2016
Footnotes
Supported by the Saskatchewan Government Insurance and Ekhagastiftelsen.
Disclosures: none.
Identification
Copyright
© 2016 The American Congress of Rehabilitation Medicine.
