title: Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?
abstract: OBJECTIVE
  To test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery.
  
  
  METHODS
  We analyzed data from a cohort study of 1,693 Saskatchewan adults who sustained whiplash injuries between July 1, 1994 and December 31, 1994. We investigated 8 initial patterns of care that integrated type of provider (general practitioners, chiropractors, and specialists) and number of visits (low versus high utilization). Cox models were used to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders.
  
  
  RESULTS
  Patients in the low-utilization general practitioner group and those in the general medical group had the fastest recovery even after controlling for important prognostic factors. Compared with the low-utilization general practitioner group, the 1-year rate of recovery in the high-utilization chiropractic group was 25% slower (adjusted hazard rate ratio [HRR] 0.75, 95% confidence interval [95% CI] 0.54-1.04), in the low-utilization general practitioner plus chiropractic group the rate was 26% slower (HRR 0.74, 95% CI 0.60-0.93), and in the high-utilization general practitioner plus chiropractic combined group the rate was 36% slower (HRR 0.64, 95% CI 0.50-0.83).
  
  
  CONCLUSIONS
  The observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery.
authors.affiliation: Institute for Work & Health, University of Toronto, Toronto Western Research Institute and Rehabilitations Solutions, Toronto, Ontario, Canada. pierre.cote@uhnresearch.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; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic; D009819:Office Visits / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D015203:Reproducibility of Results; D012525:Saskatchewan / Q000453:epidemiology; D014911:Whiplash Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*