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Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Univ Hlth Network, Toronto Western Res Inst, Div Hlth Care & Outcomes Res, Toronto, ON, Canada.;Karolinska Inst, Inst Environm Med, Musculoskeletal & Sports Injury Epidemiol Ctr, Box 210, S-17177 Stockholm, Sweden.;Naprapathogskolan Scandinavian Coll Naprapath Man, Stockholm, Sweden..
Univ Ontario, Inst Technol, Fac Hlth Sci, Oshawa, ON, Canada.;Univ Ontario, Inst Technol, Canadian Mem Chiropract Coll, Ctr Study Disabil Prevent & Rehabil, Oshawa, ON, Canada.;Univ Toronto, Dalla Lana Sch Publ Hlth, Div Epidemiol, Toronto, ON, Canada..
Univ Hlth Network, Toronto Western Res Inst, Div Hlth Care & Outcomes Res, Toronto, ON, Canada.;Univ Toronto, Dalla Lana Sch Publ Hlth, Div Epidemiol, Toronto, ON, Canada.;Univ Southern Denmark, Fac Hlth, Dept Sports Sci & Clin Biomech, Odense, Denmark..
Univ Hlth Network, Toronto Western Res Inst, Div Hlth Care & Outcomes Res, Toronto, ON, Canada.;Univ Toronto, Dalla Lana Sch Publ Hlth, Div Epidemiol, Toronto, ON, Canada.;Univ Southern Denmark, Fac Hlth, Dept Sports Sci & Clin Biomech, Odense, Denmark..
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2016 (English)In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 5, 739-746 p.Article in journal (Refereed) PublishedText
Abstract [en]

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 (BRR=.68; 95% CI,.61.77), physician and high chiropractor utilization (BRR=.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.

Place, publisher, year, edition, pages
2016. Vol. 97, no 5, 739-746 p.
Keyword [en]
Cohort studies, Neck pain, Patient acceptance of health care, Rehabilitation, Whiplash injuries
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-297799DOI: 10.1016/j.apmr.2015.12.028ISI: 000375633300012PubMedID: 26808783OAI: oai:DiVA.org:uu-297799DiVA: diva2:943522
Available from: 2016-06-28 Created: 2016-06-28 Last updated: 2016-06-28Bibliographically approved

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