Too much treatment, too early after whiplash injury delays recovery

Whiplash patients who are treated too aggressively right after being injured may actually take longer to recover than those who get less treatment. That’s the conclusion of a recently published study by Institute Scientist Dr. Pierre Côté.

The study found that patients with whiplash injuries who visited their general practitioner (GP) once or twice in the first few weeks recovered much faster than those who visited family physicians or chiropractors more often in the month after injury. Whiplash is an injury to the neck that typically results from a motor vehicle collision. Whiplash is the most common type of traffic injury and affects 83 per cent of people involved in an automobile collision. We found that patients who visited a GP and/or consulted a chiropractor more than six times during the first 30 days after their injury took twice as long to recover as those who saw their GP only once or twice, says Côté. Those who received combined care from GPs and specialists also took longer to recover.

Côté analyzed data on 2,486 patients who had reported whiplash injuries to the Saskatchewan Government Insurance (SGI). The SGI is the province’s automobile insurer. We identified patients as either high- or low-users of health care, Côté explains. We also noted what kinds of health providers they consulted, including a GP, chiropractor, a combination of general practitioner and chiropractor, or a combination of GP and specialist, like an orthopedic surgeon.

Low-utilization was defined as making one or two visits to a GP and between one and six visits to a chiropractor. High utilization was defined as making more than two visits to a GP or more than six visits to a chiropractor. Recovery was measured by the number of days between the injury and the date the insurance claim was closed. An analysis showed that claim closure is a valid marker of health recovery because it is associated with clinically important improvements in neck pain and physical functioning, as well as reduced symptoms of depression.

The analysis accounted for a number of factors including the severity of each person’s whiplash injury and his or her prior health status. This was important because such factors could influence how often individual patients consulted their care providers and how long it takes them to recover, Côté explains. But even after these factors were considered, the researchers still found that patients in the low-utilization group recovered more quickly, even if their injuries were more severe or their prior health had been poor. Similarly, patients in the high-utilization group took longer to recover, regardless of the severity of their injury.

Whiplash is a very common injury, says Côté. Our findings suggest there is an opportunity for family physicians, chiropractors and specialists to reduce the physical, psychosocial and economic burden of whiplash. They can help prevent the development of chronic conditions by not treating patients too aggressively after the onset of injury. Our study supports previous research which emphasizes that clinicians should manage whiplash through pain control, reassurance, education and timely return to normal activities.

Côté’s study was funded by the Canadian Institutes of Health Research (CIHR) and the National Health Research and Development Program (NHRDP).  The study received ethics approval from the University of Saskatchewan.

Source: At Work, Issue 43, Winter 2006: Institute for Work & Health, Toronto