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 accessOne-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 RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management.Spine (Phila Pa 1976). 1995; 20: 1S-73S
- 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
- Delayed recovery in patients with whiplash-associated disorders.Injury. 2012; 43: 1141-1147
- Initial patterns of clinical care and recovery from whiplash injuries: a population-based cohort study.Arch Intern Med. 2005; 165: 2257-2263
- Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?.Arthritis Rheum. 2007; 57: 861-868
- Does multidisciplinary rehabilitation benefit whiplash recovery?: results of a population-based incidence cohort study.Spine (Phila Pa 1976). 2007; 32: 126-131
- What characterizes individuals developing chronic whiplash?: The Nord-Trondelag Health Study (HUNT).J Psychosom Res. 2013; 74: 393-400
- Expectations for recovery important in the prognosis of whiplash injuries.PLoS Med. 2008; 5: e105
- Recovery in whiplash-associated disorders: do you get what you expect?.J Rheumatol. 2009; 36: 1063-1070
- 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
- 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
- A self-reported depression scale for research in the general population.Appl Psychol Measur. 1977; 1: 385-401
- 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
- Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial.Ann Intern Med. 2012; 156: 1-10
- Does early management of whiplash-associated disorders assist or impede recovery?.Spine (Phila Pa 1976). 2011; 36: S275-S279
- “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
- Prognostic factors associated with minimal improvement following acute whiplash-associated disorders.Spine (Phila Pa 1976). 2006; 31 (discussion E66): E759-E765
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.