title: Initial patterns of clinical care and recovery from whiplash injuries: a population-based cohort study.
abstract: 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.
authors.affiliation: Institute for Work and Health, University of Toronto, Ontario, Canada. pcote@iwh.on.ca
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Sheilah
authors.initials: S
authors.lastname: Hogg-Johnson
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.forename: Linda
authors.initials: L
authors.lastname: Carroll
authors.forename: John W
authors.initials: JW
authors.lastname: Frank
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003695:Delivery of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012525:Saskatchewan / Q000453:epidemiology; D013997:Time Factors; D015599:Trauma Severity Indices; D014911:Whiplash Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*