Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals

Ritchie, Carrie; Smith, Ashley; Sterling, Michele

doi:10.1186/s12913-020-05146-0

Cited by 8 publications

(14 citation statements)

References 40 publications

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“…The utilization of the soft cervical collar seems to not only be related to the perceptions of effectiveness by both the patients and the providers, but the prescription and use of the cervical collar and radiography have been documented as being strongly influenced by payment policies; they determine higher refunds, reinforcing the cultural expectation of a worse clinical outcome [81]. Therefore, deimplementing collar use seems to be associated with motivational, economic, political, and legal factors/considerations in care delivery [82,83]. Providing updated evidence-based interventions requires a cultural shift in how clinicians may better influence WAD patients' outcomes [80].…”

Section: Discussionmentioning

confidence: 99%

“…Providing updated evidence-based interventions requires a cultural shift in how clinicians may better influence WAD patients' outcomes [80]. Accordingly, there is a need to inform the health providers, in order to implement the current guidelines routinely, with the final goal to promote early access to active treatment approaches for WAD patients (e.g., exercises), as well as to objectivize the associated impairments [81] and address the negative prognostic factors (e.g., fear avoidance, maladaptive beliefs) [82,84]. However, for certain well-selected patients with WAD [85][86][87][88], and, accordingly, for patient clinical presentations and preferences, an intermittent use of the collar for a short period and during the acute stage could be potentially indicated when appropriately combined with education and active approaches [24,53,70].…”

Section: Discussionmentioning

confidence: 99%

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Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

et al. 2021

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Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on the return to the ED, within three months of a road traffic collision. Methods: We conducted a retrospective observational study on WAD patients from two EDs in Verona (Italy). Patients in the earlier acute phase of WAD (within 48 h from the trauma) were included; those with serious conditions (WAD IV) were excluded. As an end point, we considered patients who returned to the ED complaining of WAD symptoms within three months as positive outcome for WAD persistence. Results: 2162 patients were included; of those, 85.4% (n = 1847/2162) received a soft cervical collar prescription. Further, 8.4% (n = 156/1847) of those with a soft cervical collar prescription, and 2.5% (n = 8/315) of those without a soft cervical collar (p < 0.001) returned to the ED within three months. The use of the soft cervical collar was an independent risk factor for ED return within three months, with an OR, adjusted for possible clinical confounders, equal to 3.418 (95% CI 1.653–7.069; p < 0.001). After the propensity score matching, 25.5% of the patients (n = 25/98) using the soft cervical collar returned to the ED at three months, compared to the 6.1% (n = 6/98) that did not adopt the soft cervical collar. The use of a soft cervical collar was associated with ED return with an OR = 4.314 (95% CI 2.066–11.668; p = 0.001). Conclusions: Our study shows that the positioning of the soft collar in a cohort of patients with acute WAD, following a rear-end car collision, is an independent potential risk factor to the return to the ED. Clinically, the use of the collar is a non-recommended practice and seems to be related to an increased risk of delayed recovery. There is a need to inform healthcare providers involved in the ED of the aim to limit the use of the soft cervical collar. A closer collaboration between clinicians (e.g., physicians, physical therapists, nurses) is suggested in the ED. Future primary studies should determine differences between having used or not having used the collar, and compare early physical therapy in the ED compared with the utilization of the collar.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

et al. 2021

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“…fall prevention, post-injury rehabilitation, neurological rehabilitation, and pulmonary rehabilitation) [ 25 , 26 ]. For instance, among a cohort of individuals with a transport-related whiplash injury in Victoria, Australia, between 2000 and 2013, there were more than three times as many compensation payments for physiotherapy services than for chiropractic services [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017

et al. 2020

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Background Better understanding of the dynamics and temporal changes in manual therapy service utilisation may assist with healthcare planning and resource allocation. The objectives of this study were to quantify, describe, and compare service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. Methods Data regarding the number of services, total cost, and benefits paid were extracted for each manual therapy profession (i.e. chiropractic, osteopathy, and physiotherapy) for the period 2008–2017 from the Australian Prudential Regulation Authority. The number of registered providers for each profession were obtained from the Australian Health Practitioner Regulation Agency. Descriptive statistics were produced for two time periods (i.e. 2008–2012 and 2013–2017) for each manual therapy profession. Annual percentage change during each time period was estimated by fitting Poisson regression models. Test for the equality of regression coefficients was used to compare the trends in the two time periods within each profession, and to compare the trends across professions within a time period. Results A cumulative total of 198.6 million manual therapy services with a total cost of $12.8 billion was provided within the Australian private healthcare setting between 2008 and 2017. Although service utilisation and total cost increased throughout the ten-year period, the annual growth was significantly lower during 2013–2017 than 2008–2012. Whereas osteopathy and physiotherapy experienced significant annual growth in the number of services and total cost during 2013–2017, negative growth in the number of services was observed for chiropractic during the same period. The annual number of services per provider declined significantly for chiropractic and physiotherapy between 2013 and 2017. Conclusion Service provision under private health insurance general treatment cover constitute a major source of revenue for manual therapy professions in Australia. Although manual therapy service utilisation increased throughout the ten-year period from 2008 to 2017, the annual growth declined. There were diverging trends across the three professions, including significantly greater decline in annual growth for chiropractic than for osteopathy and physiotherapy.

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“…One factor is how the characteristics of the intervention are perceived by the potential adopters, and if they see a relative advantage in comparison with current practice [ 22 ]. Individuals with persistent WAD are difficult to rehabilitate, they are high consumers of health care services [ 25 ], and effective treatment is lacking, which may enhance physiotherapists’ willingness to use the method [ 6 , 7 , 26 , 27 ]. There is growing evidence that NSE has a significant effect in chronic whiplash-associated disorders (WAD), including in patients with severe symptoms (neurological signs) after the injury [ 8 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury: study protocol for a randomized controlled study using a hybrid 2 design

Peterson

Carlfjord

Strid

et al. 2022

BMC Musculoskelet Disord

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Background Persistent pain and disability in whiplash-associated disorders (WAD) grades II and III are common. In two randomized controlled trials (RCTs) of neck-specific exercises (NSE), we have seen promising results in chronic WAD, with a sustained clinically important reduction in pain and disability. NSE can also be delivered through internet support (NSEIT) and a few visits to a physiotherapist, saving time and cost for both patients and providers. NSE have been shown to have positive effects in other neck pain disorders and we will evaluate the diffusion of the exercises to other patients. The aims of the proposed study are to evaluate an implementation strategy for NSEIT and NSE in primary health care and to evaluate the effectiveness of NSEIT and NSE in clinical practice. Methods The proposed study is a prospective cluster-randomized mixed-design study with hybrid 2 trial design. Reg. physiotherapists working in twenty physiotherapy clinics will be included. The primary implementation outcome is proportion of patients with neck pain receiving neck-specific exercise. Secondary outcomes are; physiotherapists attitudes to implementation of evidence-based practice, their self-efficacy and confidence in performing NSEIT/NSE, number of patients visits, and use of additional or other exercises or treatment. To further evaluate the implementation strategy, two qualitative studies will be performed with a sample of the physiotherapists. The primary outcome in the patient effectiveness evaluation is self-reported neck disability according to the Neck Disability Index (NDI). Secondary outcomes are pain intensity in the neck, arm, and head; dizziness; work- and health-related issues; and patient’s improvement or deterioration over time. All measurements will be conducted at baseline and at 3 and 12 months. Physiotherapists´ self-efficacy and confidence in diagnosing and treating patients with neck pain will also be evaluated directly after their instruction in NSEIT/NSE. Discussion This trial will evaluate the implementation strategy in terms of adoption of and adherence to NSEIT and NSE in clinical primary health care, and measure diffusion of the method to other patients. In parallel, the effectiveness of the method will be evaluated. The results may guide physiotherapists and health care providers to sustainable and effective implementation of effective exercise programs. Trial registration The randomized trial is registered on ClinicalTrials.gov, NCT05198258, initial release date January 20, 2022.

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Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals

Cited by 8 publications

References 40 publications

Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017

Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury: study protocol for a randomized controlled study using a hybrid 2 design

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