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Does Multidisciplinary Rehabilitation Benefit Whiplash Recovery?: Results of a Population-Based Incidence Cohort Study

Cassidy, J David, PhD, DrMedSc*†‡; Carroll, Linda J., PhD§; Côté, Pierre, DC, PhD‡¶; Frank, John, MD, MSc‡¶∥

doi: 10.1097/01.brs.0000249526.76788.e8
Health Services Research

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.

From the *University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Ontario, Canada; †Division of Outcomes and Population Health, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada; ‡Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada; §Department of Public Health Sciences and Alberta Centre for Injury Control and Research, University of Alberta, Edmonton, Alberta, Canada; ¶Institute for Work & Health, Toronto, Ontario, Canada; and the ∥Institute of Population and Public Health, Canadian Institutes of Health Research, Toronto, Ontario, Canada.

Acknowledgment date: September 21, 2005. First revision date: January 9, 2006. Second revision date: February 18, 2006. Acceptance date: February 21, 2006.

Supported by a grant from Saskatchewan Government Insurance. Dr. Carroll is supported by a Health Scholar Award from the Alberta Heritage Foundation for Medical Research. Dr. Côté is supported by the Canadian Institute of Health Research through a New Investigator Award and by the Institute for Work & Health and the Workplace Safety and Insurance Board of Ontario.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Other funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to J. David Cassidy, PhD, Toronto Western Hospital, Fell 4-114, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.