Early aggressive care and delayed recovery from whiplash: Isolated finding or reproducible result?

Authors

  • Pierre Côté,

    Corresponding author
    1. Institute for Work & Health, the University of Toronto, and the Toronto Western Research Institute and Rehabilitations Solutions, Toronto, Ontario, Canada
    • Toronto Western Hospital, Fell Pavilion 4-124, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8
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  • Sheilah Hogg-Johnson,

    1. Institute for Work & Health, the University of Toronto, and Mt. Sinai Hospital, Toronto, Ontario, Canada
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  • J. David Cassidy,

    1. University of Toronto, and the Toronto Western Research Institute and Rehabilitations Solutions, Toronto, Ontario, Canada
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    • Dr. Cassidy has received consulting fees (less than $10,000) from the Insurance Bureau of Canada.

  • Linda Carroll,

    1. Alberta Centre for Injury Control and Research, Edmonton, Canada
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  • John W. Frank,

    1. Institute for Work & Health, the University of Toronto, and the Institute of Population and Public Health, Toronto, Ontario, Canada
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  • Claire Bombardier

    1. Institute for Work & Health, the University of Toronto, the Toronto General Hospital Research Institute, and Mt. Sinai Hospital, Toronto, Ontario, Canada
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  • This study is based in part on nonidentifiable data provided by the Saskatchewan Department of Health. The interpretations and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Saskatchewan Department of Health.

Abstract

Objective

To test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery.

Methods

We analyzed data from a cohort study of 1,693 Saskatchewan adults who sustained whiplash injuries between July 1, 1994 and December 31, 1994. We investigated 8 initial patterns of care that integrated type of provider (general practitioners, chiropractors, and specialists) and number of visits (low versus high utilization). Cox models were used to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders.

Results

Patients in the low-utilization general practitioner group and those in the general medical group had the fastest recovery even after controlling for important prognostic factors. Compared with the low-utilization general practitioner group, the 1-year rate of recovery in the high-utilization chiropractic group was 25% slower (adjusted hazard rate ratio [HRR] 0.75, 95% confidence interval [95% CI] 0.54–1.04), in the low-utilization general practitioner plus chiropractic group the rate was 26% slower (HRR 0.74, 95% CI 0.60–0.93), and in the high-utilization general practitioner plus chiropractic combined group the rate was 36% slower (HRR 0.64, 95% CI 0.50–0.83).

Conclusion

The observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery.

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