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

Research output: Contribution to JournalArticleAcademicpeer-review

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 (X 2 =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.

Original languageEnglish
Article numbere021283
JournalBMJ Open
Volume9
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

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General Practitioners
Rehabilitation
Randomized Controlled Trials
Guidelines
Education
Insurance
Pragmatic Clinical Trials
Quality of Life
Outcome Assessment (Health Care)
Insurance Carriers
Automobiles
Neck Pain
Ontario
Insurance Benefits
Canada
Neck
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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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 (X 2 =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.",
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author = "Pierre C{\^o}t{\'e} and Eleanor Boyle and Shearer, {Heather M.} and Maja Stupar and Craig Jacobs and Cassidy, {John David} and Simon Carette and {Van Der Velde}, Gabrielle and Wong, {Jessica J.} and Sheilah Hogg-Johnson and Carlo Ammendolia and Hayden, {Jill Alison} and {Van Tulder}, Maurits and Frank, {John W.}",
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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, 01.01.2019.

Research output: Contribution to JournalArticleAcademicpeer-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? 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 - 2019/1/1

Y1 - 2019/1/1

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 (X 2 =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.

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 (X 2 =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.

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KW - physician education

KW - physiotherapy

KW - randomized controlled trial

KW - treatment

KW - whiplash-associated disorders

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