title: Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study.
abstract: 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.
  
  
  
  Population-based inception cohort.
  
  
  
  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 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.
  
  
  
  Not applicable.
  
  
  
  Self-perceived recovery.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada; Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden; Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden. Electronic address: eva.skillgate@ki.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Skillgate
authors.affiliation: Faculty of Health Sciences and University of Ontario Institute of Technology - Canadian Memorial Chiropractic College Center for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.affiliation: School of Public Health and Injury Prevention Center, University of Alberta, Edmonton, AB, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Carroll
authors.affiliation: Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Lena W
authors.initials: LW
authors.lastname: Holm
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D000071066:Patient Reported Outcome Measures; D061665:Time-to-Treatment; D014911:Whiplash Injuries / Q000209:etiology / Q000628:therapy*
keywords: Cohort studies; Neck pain; Patient acceptance of health care; Rehabilitation; Whiplash injuries