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

Eva Skillgate; Pierre Côté; J David Cassidy; Eleanor Boyle; Linda Carroll; Lena W Holm

doi:10.1016/j.apmr.2015.12.028

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

Arch Phys Med Rehabil. 2016 May;97(5):739-46. doi: 10.1016/j.apmr.2015.12.028. Epub 2016 Jan 22.

Authors

Eva Skillgate¹, Pierre Côté², J David Cassidy³, Eleanor Boyle³, Linda Carroll⁴, Lena W Holm⁵

Affiliations

¹ 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. Electronic address: eva.skillgate@ki.se.
² 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.
³ 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.
⁴ School of Public Health and Injury Prevention Center, University of Alberta, Edmonton, AB, Canada.
⁵ 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.

PMID: 26808783
DOI: 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: Cohort studies; Neck pain; Patient acceptance of health care; Rehabilitation; Whiplash injuries.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Accidents, Traffic
Adult
Cohort Studies
Critical Care / methods*
Female
Humans
Male
Middle Aged
Patient Acceptance of Health Care / statistics & numerical data*
Patient Reported Outcome Measures
Time-to-Treatment*
Whiplash Injuries / etiology
Whiplash Injuries / therapy*