Abstract
BackgroundStudies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful. However, whether EBC is broadly provided and whether delivery of EBC varies based on risk of non-recovery, is uncertain. Receiving EBC should improve recovery, though this relationship has yet to be established. Further, mitigating the effect of EBC is the relationship with the practitioner, a phenomenon poorly understood in WAD. This study aimed to determine the proportion of individuals with whiplash, at differing baseline risk levels, receiving EBC. This study also aimed to determine whether receiving EBC and the therapeutic relationship were associated with recovery at 3 months post injury.MethodsParticipants with acute whiplash were recruited from public hospital emergency departments, private physiotherapy practices, and State Insurance Regulatory Authority (SIRA) databases. Participants completed questionnaires at baseline (demographics, risk of non-recovery) and 3-months (treatment received, risk identification, therapeutic relationship) post injury. Primary health care providers (HCPs) treating these participants also completed questionnaires at 3-months. Recovery was defined as neck disability index ≤4/50 and global perceived effect of ≥4/5.ResultsTwo-hundred and twenty-eight people with acute whiplash, and 53 primary care practitioners were recruited. The majority of the cohort reported receiving EBC, with correct application of the Canadian C-spine rule (74%), and provision of active treatments (e.g. 89% receiving advice) high. Non-recommended (passive) treatments were also received by a large proportion of the cohort (e.g. 50% receiving massage). The therapeutic relationship was associated with higher odds of recovery, which was potentially clinically significant (OR 1.34, 95% CI 1.18–1.62). EBC was not significantly associated with recovery.ConclusionsGuideline-based knowledge and practice has largely been retained from previous implementation strategies. However, recommendations for routine risk identification and tailored management, and reduction in the provision of passive treatment have not. The therapeutic relationship was identified as one of several important predictors of recovery, suggesting that clinicians must develop rapport and understanding with their patients to improve the likelihood of recovery.
Highlights
Studies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful
In New South Wales (NSW), Australia, clinical practice guidelines for the management of acute whiplash associated disorders (WAD) were developed with the purpose of improving management and patient outcomes
We investigated the proportion of individuals experiencing clinically significant improvements in neck disability and Global Perceived Effect (GPE) (≥ 2-point increase on 11-point scale [37])
Summary
Studies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful. This study aimed to determine whether receiving EBC and the therapeutic relationship were associated with recovery at 3 months post injury. Since the majority of recovery in Australian cohorts occurs within the first 3 months following injury [1, 4], guidelines for the management of acute whiplash associated disorders (WAD) have an important role. Key recommendations were identified for implementation from these guidelines and included: (1) Appropriate imaging and selection of active treatments, (2) A reduction in the selection of passive treatments, and (3) An improvement in the process of care [6]. The translation of evidence to consumers, patients and clinicians, via evidence-based, specific, and simple recommendations is essential for achieving compliance [10, 11]
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