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Does Multidisciplinary Rehabilitation Benefit Whiplash Recovery?

2007; Lippincott Williams & Wilkins; Volume: 32; Issue: 1 Linguagem: Inglês

10.1097/01.brs.0000249526.76788.e8

1528-1159

J. David Cassidy, Linda Carroll, Pierre Côté, John Frank,

Myofascial pain diagnosis and treatment

In Brief 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. The effectiveness of group fitness training and multidisciplinary outpatient and inpatient rehabilitation has not been proven for whiplash injuries. Our evaluation of a province-wide program of community and hospital-based fitness training and multidisciplinary rehabilitation showed that outcomes were not better than the usual individual care provided by primary care practitioners.