Côté Pierre, Hogg-Johnson Sheilah, Cassidy J David, Carroll Linda, Frank John W, Bombardier Claire
Institute for Work and Health, University of Toronto, Ontario, Canada.
Arch Intern Med. 2005 Oct 24;165(19):2257-63. doi: 10.1001/archinte.165.19.2257.
Little is known about the most effective pattern of clinical care for acute whiplash. We designed a cohort study to determine whether patterns of early clinical care (involving visits to general practitioners, chiropractors, or specialists) were associated with different rates of recovery.
We studied 2486 Saskatchewan adults with whiplash injuries. We defined 8 initial patterns of care that integrated type of provider and number of visits. We used multivariable Cox models to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders.
There was an independent association between the type and intensity of initial clinical care and time to recovery. We found that patients in the low-utilization general practitioner group had the fastest recovery, even after controlling for injury severity and other confounders. Compared with this group, the high-utilization general practitioner group experienced a 1-year rate of recovery that was 27% slower (adjusted hazard rate ratio [HRR], 0.73; 95% confidence interval [CI], 0.61-0.87); for the high-utilization chiropractic group it was 39% slower (HRR, 0.61; 95% CI, 0.46-0.81); for the high-utilization general practitioner plus chiropractic combined group it was 28% slower (HRR, 0.72; 95% CI, 0.57-0.91); and for those who consulted general practitioners and specialists, it was 31% slower (HRR, 0.69; 95% CI, 0.55-0.87).
The type and intensity of clinical care initiated within the first month after the injury is associated with the rate of recovery from whiplash injuries. Our study does not support the hypothesis that early aggressive care promotes faster recovery.
对于急性挥鞭样损伤最有效的临床护理模式知之甚少。我们设计了一项队列研究，以确定早期临床护理模式（包括就诊于全科医生、脊椎按摩师或专科医生）是否与不同的恢复率相关。
我们研究了2486名萨斯喀彻温省患有挥鞭样损伤的成年人。我们定义了8种初始护理模式，综合考虑了提供者类型和就诊次数。我们使用多变量Cox模型来估计护理模式与恢复时间之间的关联，同时控制损伤严重程度和其他混杂因素。
初始临床护理的类型和强度与恢复时间之间存在独立关联。我们发现，低就诊率全科医生组的患者恢复最快，即使在控制了损伤严重程度和其他混杂因素之后也是如此。与该组相比，高就诊率全科医生组的1年恢复率慢27%（调整后风险率比[HRR]，0.73；95%置信区间[CI]，0.61 - 0.87）；高就诊率脊椎按摩师组慢39%（HRR，0.61；95%CI，0.46 - 0.81）；高就诊率全科医生加脊椎按摩师联合组慢28%（HRR，0.72；95%CI，0.57 - 0.91）；而就诊于全科医生和专科医生的患者慢31%（HRR，0.69；95%CI，0.55 - 0.87）。
损伤后第一个月内开始的临床护理的类型和强度与挥鞭样损伤的恢复率相关。我们的研究不支持早期积极护理能促进更快恢复这一假设。
