Citation

Skillgate E, Côté P, Cassidy JD, Boyle E, Carroll L, Holm LW. Arch. Phys. Med. Rehabil. 2016; 97(5): 739-746.

Affiliation

Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.apmr.2015.12.028

PMID

26808783

Abstract

OBJECTIVE: To determine whether the results from previous research suggesting that early intensive health care delays recovery from whiplash-associated disorders (WAD), was 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: A population based inception cohort. SETTING: All adults (≥18 years) injured in traffic collisions who received treatment from a regulated health professional, or reported their injuries to the single provincially administered motor-vehicle insurer. PARTICIPANTS: 5,204 participants with WAD. Self-report visits to physicians, chiropractors, physiotherapists, massage therapists, and other professionals during the first 42 days post-collision 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 to individuals who reported low utilization of physician services, recovery was slower for those with high health care utilization regardless of the type of profession. Specifically, those with high physician (HRR = 0.56 (95% CI: 0.42 - 0.75), physician and high physiotherapy utilization (HRR = 0.68 (95% CI: 0.61 - 0.77), physician and high chiropractor utilization (HRR = 0.74 (95% CI: 0.64 - 0.85) and physician and high massage therapy utilization (HRR = 0.78 (95% CI: 0.68 - 0.90) had significantly slower recovery.

CONCLUSION: 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 WAD focus on reassurance and education instead of intensive care.

Language: en