Advertisement

Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study

  • Eva Skillgate
    Correspondence
    Corresponding author Eva Skillgate, PhD, Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden.
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

    Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden

    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
    Search for articles by this author
  • Pierre Côté
    Affiliations
    Faculty of Health Sciences and University of Ontario Institute of Technology - Canadian Memorial Chiropractic College Center for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, ON, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
    Search for articles by this author
  • J. David Cassidy
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
    Search for articles by this author
  • Eleanor Boyle
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
    Search for articles by this author
  • Linda Carroll
    Affiliations
    School of Public Health and Injury Prevention Center, University of Alberta, Edmonton, AB, Canada
    Search for articles by this author
  • Lena W. Holm
    Affiliations
    Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
    Search for articles by this author
Published:January 22, 2016DOI:https://doi.org/10.1016/j.apmr.2015.12.028

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Spitzer W.O.
        • Skovron M.L.
        • Salmi L.R.
        • et al.
        Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management.
        Spine (Phila Pa 1976). 1995; 20: 1S-73S
        • Carroll L.J.
        • Holm L.W.
        • Hogg-Johnson S.
        • et al.
        Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
        Spine (Phila Pa 1976). 2008; 33: S83-S92
        • Dufton J.A.
        • Bruni S.G.
        • Kopec J.A.
        • Cassidy J.D.
        • Quon J.
        Delayed recovery in patients with whiplash-associated disorders.
        Injury. 2012; 43: 1141-1147
        • Cote P.
        • Hogg-Johnson S.
        • Cassidy J.D.
        • Carroll L.
        • Frank J.W.
        • Bombardier C.
        Initial patterns of clinical care and recovery from whiplash injuries: a population-based cohort study.
        Arch Intern Med. 2005; 165: 2257-2263
        • Cote P.
        • Hogg-Johnson S.
        • Cassidy J.D.
        • Carroll L.
        • Frank J.W.
        • Bombardier C.
        Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?.
        Arthritis Rheum. 2007; 57: 861-868
        • Cassidy J.D.
        • Carroll L.J.
        • Cote P.
        • Frank J.
        Does multidisciplinary rehabilitation benefit whiplash recovery?: results of a population-based incidence cohort study.
        Spine (Phila Pa 1976). 2007; 32: 126-131
        • Myrtveit S.M.
        • Wilhelmsen I.
        • Petrie K.J.
        • Skogen J.C.
        • Sivertsen B.
        What characterizes individuals developing chronic whiplash?: The Nord-Trondelag Health Study (HUNT).
        J Psychosom Res. 2013; 74: 393-400
        • Holm L.W.
        • Carroll L.J.
        • Cassidy J.D.
        • Skillgate E.
        • Ahlbom A.
        Expectations for recovery important in the prognosis of whiplash injuries.
        PLoS Med. 2008; 5: e105
        • Carroll L.J.
        • Holm L.W.
        • Ferrari R.
        • Ozegovic D.
        • Cassidy J.D.
        Recovery in whiplash-associated disorders: do you get what you expect?.
        J Rheumatol. 2009; 36: 1063-1070
        • Ngo T.
        • Stupar M.
        • Cote P.
        • Boyle E.
        • Shearer H.
        A study of the test-retest reliability of the self-perceived general recovery and self-perceived change in neck pain questions in patients with recent whiplash-associated disorders.
        Eur Spine J. 2010; 19: 957-962
        • Carroll L.J.
        • Jones D.C.
        • Ozegovic D.
        • Cassidy J.D.
        How well are you recovering? The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders.
        Disabil Rehabil. 2012; 34: 45-52
        • Radloff L.S.
        A self-reported depression scale for research in the general population.
        Appl Psychol Measur. 1977; 1: 385-401
        • Scholten-Peeters G.G.
        • Neeleman-van der Steen C.W.
        • van der Windt D.A.
        • Hendriks E.J.
        • Verhagen A.P.
        • Oostendorp R.A.
        Education by general practitioners or education and exercises by physiotherapists for patients with whiplash-associated disorders? A randomized clinical trial.
        Spine. 2006; 31: 723-731
        • Bronfort G.
        • Evans R.
        • Anderson A.V.
        • Svendsen K.H.
        • Bracha Y.
        • Grimm R.H.
        Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial.
        Ann Intern Med. 2012; 156: 1-10
        • Cote P.
        • Soklaridis S.
        Does early management of whiplash-associated disorders assist or impede recovery?.
        Spine (Phila Pa 1976). 2011; 36: S275-S279
        • Williamson E.
        • Nichols V.
        • Lamb S.E.
        “If I can get over that, I can get over anything”-understanding how individuals with acute whiplash disorders form beliefs about pain and recovery: a qualitative study.
        Physiotherapy. 2015; 101: 178-186
        • Dufton J.A.
        • Kopec J.A.
        • Wong H.
        • et al.
        Prognostic factors associated with minimal improvement following acute whiplash-associated disorders.
        Spine (Phila Pa 1976). 2006; 31 (discussion E66): E759-E765