Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study.

{"article_title":"Evidence-based care in high- and low-risk groups following whiplash injury: a multi-centre inception cohort study.","author":"Griffin A, Jagnoor J, Arora M, Cameron ID, Kifley A, Sterling M, Kenardy J, Rebbeck T","journal_title":"BMC health services research","issn":"1472-6963","isbn":"","publication_date":"2019 Nov 06","volume":"19","issue":"1","first_page":"806","page_count":"","accession_number":"31694622","doi":"10.1186\/s12913-019-4623-y","publisher":"BioMed Central","doctype":"Journal Article","subjects":"Evidence-Based Practice; Whiplash Injuries rehabilitation; Adult; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Surveys and Questionnaires; Young Adult","interest_area":["Internal\/Family Medicine"],"abstract":"Background: Studies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful. However, whether EBC is broadly provided and whether delivery of EBC varies based on risk of non-recovery, is uncertain. Receiving EBC should improve recovery, though this relationship has yet to be established. Further, mitigating the effect of EBC is the relationship with the practitioner, a phenomenon poorly understood in WAD. This study aimed to determine the proportion of individuals with whiplash, at differing baseline risk levels, receiving EBC. This study also aimed to determine whether receiving EBC and the therapeutic relationship were associated with recovery at 3 months post injury. Methods: Participants with acute whiplash were recruited from public hospital emergency departments, private physiotherapy practices, and State Insurance Regulatory Authority (SIRA) databases. Participants completed questionnaires at baseline (demographics, risk of non-recovery) and 3-months (treatment received, risk identification, therapeutic relationship) post injury. Primary health care providers (HCPs) treating these participants also completed questionnaires at 3-months. Recovery was defined as neck disability index ?4\/50 and global perceived effect of ?4\/5. Results: Two-hundred and twenty-eight people with acute whiplash, and 53 primary care practitioners were recruited. The majority of the cohort reported receiving EBC, with correct application of the Canadian C-spine rule (74%), and provision of active treatments (e.g. 89% receiving advice) high. Non-recommended (passive) treatments were also received by a large proportion of the cohort (e.g. 50% receiving massage). The therapeutic relationship was associated with higher odds of recovery, which was potentially clinically significant (OR 1.34, 95% CI 1.18-1.62). EBC was not significantly associated with recovery. Conclusions: Guideline-based knowledge and practice has largely been retained from previous implementation strategies. However, recommendations for routine risk identification and tailored management, and reduction in the provision of passive treatment have not. The therapeutic relationship was identified as one of several important predictors of recovery, suggesting that clinicians must develop rapport and understanding with their patients to improve the likelihood of recovery.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=31694622&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Griffin A, Jagnoor J, Arora M, Cameron ID, Kifley A, Sterling M, Kenardy J, Rebbeck T","Journal_Info":"Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE","Publication_Type":"Journal Article; Multicenter Study","Published_Date":"2019-11-06","Source":"BMC health services research [BMC Health Serv Res] 2019 Nov 06; Vol. 19 (1), pp. 806. Date of Electronic Publication: 2019 Nov 06.","Languages":"English","Electronic_ISSN":"1472-6963","MeSH_Terms":"Evidence-Based Practice*, Whiplash Injuries\/*rehabilitation, Adult ; Female ; Humans ; Male ; Middle Aged ; Physical Therapy Modalities ; Prospective Studies ; Surveys and Questionnaires ; Young Adult","Subjects":"Adult, Female, Humans, Male, Middle Aged, Physical Therapy Modalities, Prospective Studies, Surveys and Questionnaires, Young Adult, Evidence-Based Practice, Whiplash Injuries rehabilitation","Title_Abbreviations":"BMC health services research","Volume":"19"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"31694622","RelevancyScore":"836","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"836.150512695313"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=31694622&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=31694622&authtype=shib&custid=ns346513&group=main&profile=eds"}