Article

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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS