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Initial Patterns of Clinical Care and Recovery From Whiplash Injuries
A Population-Based Cohort Study
Pierre Côté, DC, PhD;
Sheilah Hogg-Johnson, PhD;
J. David Cassidy, DC, PhD, Dr Med Sc;
Linda Carroll, PhD;
John W. Frank, MD, MSc;
Claire Bombardier, MD
Arch Intern Med. 2005;165:2257-2263.
Background Little is known about the most effective pattern of clinical care for acute whiplash. We designed a cohort study to determine whether patterns of early clinical care (involving visits to general practitioners, chiropractors, or specialists) were associated with different rates of recovery.
Methods We studied 2486 Saskatchewan adults with whiplash injuries. We defined 8 initial patterns of care that integrated type of provider and number of visits. We used multivariable Cox models to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders.
Results There was an independent association between the type and intensity of initial clinical care and time to recovery. We found that patients in the low-utilization general practitioner group had the fastest recovery, even after controlling for injury severity and other confounders. Compared with this group, the high-utilization general practitioner group experienced a 1-year rate of recovery that was 27% slower (adjusted hazard rate ratio [HRR], 0.73; 95% confidence interval [CI], 0.61-0.87); for the high-utilization chiropractic group it was 39% slower (HRR, 0.61; 95% CI, 0.46-0.81); for the high-utilization general practitioner plus chiropractic combined group it was 28% slower (HRR, 0.72; 95% CI, 0.57-0.91); and for those who consulted general practitioners and specialists, it was 31% slower (HRR, 0.69; 95% CI, 0.55-0.87).
Conclusions The type and intensity of clinical care initiated within the first month after the injury is associated with the rate of recovery from whiplash injuries. Our study does not support the hypothesis that early aggressive care promotes faster recovery.
Author Affiliations: Institute for Work and Health (Drs Côté, Hogg-Johnson, Frank, and Bombardier); Departments of Public Health Sciences (Drs Côté, Hogg-Johnson, Cassidy, and Frank) and Health Policy, Management, and Evaluation (Drs Côté, Hogg-Johnson, and Bombardier), University of Toronto; Division of Outcomes and Population Health, Toronto Western Hospital Research Institute, University Health Network (Dr Cassidy); Population Health Program, Canadian Institute for Advanced Research (Dr Frank); Institute of Population and Public Health, Canadian Institutes of Health Research (Dr Frank); Toronto General Hospital Research Institute, University Health Network (Dr Bombardier); and Division of Rheumatology, Department of Medicine, Mt Sinai Hospital and University Health Network (Dr Bombardier), Toronto, Ontario; and the Department of Public Health Sciences, University of Alberta, Edmonton (Dr Carroll).
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