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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Abstract

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.

Original languageEnglish
Article numbere021283
JournalBMJ Open
Volume9
Issue number1
Number of pages17
ISSN2044-6055
DOIs
Publication statusPublished - 24. Jan 2019

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General Practitioners
Randomized Controlled Trials
Guidelines
Education
Quality of Life
Outcome Assessment (Health Care)
Insurance Carriers
Neck Pain
Ontario
Insurance Benefits
Wounds and Injuries

Keywords

  • activation
  • physician education
  • physiotherapy
  • randomized controlled trial
  • treatment
  • whiplash-associated disorders

Cite this

Côté, Pierre ; Boyle, Eleanor ; Shearer, Heather M ; Stupar, Maja ; Jacobs, Craig ; Cassidy, John David ; Carette, Simon ; van der Velde, Gabrielle ; Wong, Jessica J ; Hogg-Johnson, Sheilah ; Ammendolia, Carlo ; Hayden, Jill Alison ; van Tulder, Maurits ; Frank, John W. / 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. In: BMJ Open. 2019 ; Vol. 9, No. 1.
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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. / Côté, Pierre; Boyle, Eleanor; Shearer, Heather M; Stupar, Maja; Jacobs, Craig; Cassidy, John David; Carette, Simon; van der Velde, Gabrielle; Wong, Jessica J; Hogg-Johnson, Sheilah; Ammendolia, Carlo; Hayden, Jill Alison; van Tulder, Maurits; Frank, John W.

In: BMJ Open, Vol. 9, No. 1, e021283, 24.01.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders?

T2 - A pragmatic randomised controlled trial

AU - Côté, Pierre

AU - Boyle, Eleanor

AU - Shearer, Heather M

AU - Stupar, Maja

AU - Jacobs, Craig

AU - Cassidy, John David

AU - Carette, Simon

AU - van der Velde, Gabrielle

AU - Wong, Jessica J

AU - Hogg-Johnson, Sheilah

AU - Ammendolia, Carlo

AU - Hayden, Jill Alison

AU - van Tulder, Maurits

AU - Frank, John W

PY - 2019/1/24

Y1 - 2019/1/24

N2 - 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.

AB - 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.

KW - activation

KW - physician education

KW - physiotherapy

KW - randomized controlled trial

KW - treatment

KW - whiplash-associated disorders

U2 - 10.1136/bmjopen-2017-021283

DO - 10.1136/bmjopen-2017-021283

M3 - Journal article

VL - 9

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 1

M1 - e021283

ER -