Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study

Abstract

ObjectiveTo 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. DesignPopulation-based inception cohort. SettingAll 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. ParticipantsParticipants 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. 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 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. ConclusionsOur 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.