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Does multidisciplinary rehabilitation benefit whiplash recovery?: results of a population-based incidence cohort
J David Cassidy1, Linda J Carroll, Pierre Côté
1University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Ontario, Canada. dcassidy@uhnresearch.ca
Study Design:
Population-based, incidence cohort.
Objectives:
To evaluate a government policy of funding community and hospital-based fitness training and multidisciplinary rehabilitation for whiplash.
Summary Of Background Data:
Although insurance benefits commonly include rehabilitation for whiplash, its effectiveness is unknown.
Methods:
All Saskatchewan adults treated for whiplash (n = 6,021) over a 2-year period were followed up at 6 weeks, 3, 6, 9, and 12 months. Recovery was defined by self-report of improvement. Recovery times were compared between those attending fitness training at health clubs (n = 833), multidisciplinary outpatient rehabilitation (n = 468), and multidisciplinary inpatient rehabilitation (n = 135) to those receiving usual insured individual care.
Results:
Recovery was 32% slower in those receiving fitness training within 69 days of injury (P = 0.001) and 19% slower when received within 119 days of injury (P = 0.041). Recovery was 50% slower in those receiving outpatient rehabilitation within 119 days of injury (P = 0.001). Attending inpatient rehabilitation did not influence recovery rates during the follow up (P = 0.131). Multivariable adjustment for important prognostic factors did not change these results.
Conclusions:
We found no evidence to support the effectiveness of a population-based program of fitness training and multidisciplinary rehabilitation for whiplash. Rehabilitation programs should be tested in randomized trials before being recommended to injured populations.