Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial

Pierre Côté, Eleanor Boyle, Heather M Shearer, Maja Stupar, Craig Jacobs, John David Cassidy, Simon Carette, Gabrielle van der Velde, Jessica J Wong, Sheilah Hogg-Johnson, Carlo Ammendolia, Jill Alison Hayden, Maurits van Tulder, John W Frank

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Abstrakt

OBJECTIVE: To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I-II.

DESIGN: Pragmatic randomised clinical trial with blinded outcome assessment.

SETTING: Multidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada.

PARTICIPANTS: 340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury.

INTERVENTIONS: Participants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation.

PRIMARY AND SECONDARY OUTCOME MEASURES: Our primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury.

RESULTS: The median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ2=3.96; 2 df: p=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported.

CONCLUSIONS: Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.

TRIAL REGISTRATION NUMBER: NCT00546806.

OriginalsprogEngelsk
Artikelnummere021283
TidsskriftBMJ Open
Vol/bind9
Udgave nummer1
Antal sider17
ISSN2044-6055
DOI
StatusUdgivet - 24. jan. 2019

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