Pscyho-social factors prove as good indicators in whiplash associated disorder prognosis

Hiring a lawyer immediately after an accident, overusing multidisciplinary medical treatments within the first month and operating in a tort system all have a negative impact on the recovery time from a whiplash associated disorder (WAD), said Dr. Pierre Côté, a scientist in the Division of Health Care and Outcomes Research at the Toronto Western Research Institute.Côté spoke at the LMH Group’s Before the MIG Hits the Fan seminar in Toronto on Apr. 29. He suggested to delegates that a WAD, often only ever viewed in the context of neck pain, might also be affected by psycho-social factors. Côté studied Saskatchewan WAD claimants in 1994-95. During this period, Saskatchewan’s government switched from a tort system to a no-fault insurance system.”Under the tort system, it took a median of more than 400 days for individuals to recover from their injuries,” Côté said. “Changing the system overnight reduced that by half, and the time to recovery – measured by time on benefits – was now under 200 days.”Côté said nothing had changed in the clinical interventions done for these individuals. “It suggests to us that removing some of the incentives to remain sick actually has an impact on recovery,” he said.A decade later, he conducted another study, also related to recovery time. But this time he examined whether there was a relationship between recovery time and the type and intensity of health care the patient received within the first month following the accident. Individuals consulting a family physician once or twice during the first month after an accident took just over 200 days to recover, he said. An individual seeing a chiropractor one to six times also had a slightly higher recovery time. “But when we went to the high-utilization categories, [for] individuals that saw a chiropractor more than six times in the first month or received a combination of chiropractor and general physician treatment on a frequent basis, the time to recover doubled.”Hiring a lawyer within that first month and going to see a chiropractor frequently increased the median number of days to recovery to 700, he noted.”In other words, it increased the recovery time by one year.”