Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial.

To evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I-II. Pragmatic randomised clinical trial with blinded outcome assessment. Multidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada. 340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury. Participants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation. Our primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury. The median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life. NCT00546806.

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Déclaration de conflit d'intérêts

Competing interests: PC reports grants from Aviva Canada, during the conduct of the study; other from European Spine Society, personal fees from European Spine Society, grants from Ontario Ministry of Finance, grants from Canadian Institutes of Health Research—Canada Research Chair Program, other from North American Spine Society, grants from Ontario Trillium Foundation, grants from French Chiropractic Association, other from International Academy of Independent Medical Evaluators, other from Griffith University—Whiplash Symposium 2017, other from World Federation of Chiropractic, personal fees from Canadian Chiropractic Protective Association, outside the submitted work. JDC and EB report grants from Aviva Canada, during the conduct of the study.