The effect of early intensive care on recovery from whiplash associated disorders - Results of a population based cohort study

Publication date: Available online 22 January 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Eva Skillgate, Pierre Côté, J David Cassidy, Eleanor Boyle, Linda Carroll, Lena W. Holm
ObjectiveTo 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.DesignA population based inception cohort.SettingAll 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.Participants5,204 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.InterventionsNot applicable.Main outcome measureSelf-perceived recovery.ResultsIndividuals 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.ConclusionOur 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.



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