Minimal Care May Be Best for Whiplash

TORONTO, May 25 -- Whiplash patients may benefit from benign neglect, according to researchers here.

In a cohort of patients in the Canadian province of Saskatchewan, aggressive treatment of whiplash was associated with a slower time to recovery, according to Pierre Ct, D.C., Ph.D., of Toronto's University Health Network.

The finding replicated a previous observation by the same authors, but in an independent population and with a different medical insurance scheme, Dr. Ct and colleagues reported in the June issue of Arthritis Care & Research.

The best choice for patients was two or fewer visits to a generalist, while the worst was more than six visits to the doctor, combined with chiropractic care, the researchers found.

The researcher looked at medical and insurance records of 1,693 Saskatchewan adults who had claims for whiplash between July 1, 1994 and Dec. 31, 1994.

The cut-off date was chosen because the province's insurance system changed at the end of 1994 from a tort-based to a no-fault system. The earlier study had looked at 2,486 patients who made claims for whiplash from Jan. 1 to Dec. 31, 1995 -- after the switch to the no-fault system.

The researcher identified eight patterns of care, Dr. Ct and colleagues said:

• Two or fewer visits to a family doctor.
• More than two visits to a family doctor.
• One through six visits to a chiropractor.
• More than six visits to a chiropractor.
• Any number of visits to a family doctor, combined with one through six visits to a chiropractor.
• Any number of visits to a family doctor, combined with more than six visits to a chiropractor.
• Any number of visits to a family doctor, combined with any number of visits to a specialist.
• A general medical group -- any number of visits to a family doctor, but the submitted diagnosis wasn't whiplash.

The primary endpoint of the analysis was time to recovery, defined as the number of days between the beginning and the end of the insurance claim, the researcher said.

On the scale, patients in the general medical group did best, with a median time to recovery of 323 days, followed by those who had one or two visits to the doctor, at 362 days, and patients with more than six visits to a chiropractor, at 363 days.

The researchers also found:

• Patients with one through six visits to a chiropractor had a median time to recovery of 375 days.
• Patients who visited a generalist and a specialist had a time to recovery of 405 days.
• Patients who combined treatment by a family doctor with six or fewer trips to the chiropractor recovered in 516 days.
• Patients who made more than two visits to a family doctor recovered in 517 days.
• And patients who made any number of visits to a family doctor, combined with more than six visits to a chiropractor, had a median time to recovery of 689 days.

The results "support the hypothesis that the prognosis of whiplash injuries is influenced by the type and intensity of care received within the first month after injury," the researchers said.

One possible explanation for the finding, they said, is that over-reliance on medical care is a form of "passive coping strategy" that reinforces the view that whiplash often leads to disability.

In contrast, minimal care that promotes activation of the injured region is more likely to results in a quicker recovery, they said.