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

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Ritchie, Carrie
Smith, Ashley
Sterling, Michele
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Background: Individuals with whiplash associated disorder (WAD) frequently experience neck pain in addition to other physical, psychological and social symptoms. Consequently, treatment is sought from a variety of health professionals. The limited data available about health services use in this population are conflicting. This study aimed to characterise health service use in individuals with WAD from a motor vehicle crash. Methods: Medical (general practitioner (GP), medical specialist, emergency services (ED), radiology - x-ray, computed tomography, magnetic resonance imaging, ultrasound) and allied health service (physiotherapy, chiropractor, psychologist, osteopath, occupational therapy) use during acute (< 12 weeks) and chronic (12 weeks to 2 years) post-injury periods were analysed in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 37,315). Results: Most WAD claimants had an acute post-injury health service payment (95%, n = 35,348), and approximately one-third (29%, n = 10,871) had a chronic post-injury health service payment. During an acute post-injury period, the most frequently compensated services were for: ED (82% of acute claimants), radiology (56%), and medical specialist (38%). Whereas, physiotherapy (64.4% of chronic claimants), GP (48.1%), and radiology (34.6%) were the most frequently paid services during the chronic period. Females received significantly more payments from physiotherapists (F = 23.4%, M = 18%, z = - 11.3, p <.001, r = 0.13), chiropractors (F = 7.4%, M = 5.6%, z = - 6.3, p <.001, r = 0.13), and psychologists (F = 4.2%, M = 2.8%, z = - 6.7, p <.001, r = 0.18); whereas, males received significantly more medical services payments from medical specialists (F = 41.8%, M = 43.8%, z = - 3.7, p <.001, r = 0.03), ED (F = 74.0%, M = 76.3%, z = - 4.9, p <.001, r = 0.03) and radiology (F = 58.3%, M = 60.1%, z = - 3.4, p <.001, r = 0.02). Conclusions: Individuals with WAD claimed for a range of health services. Radiology imaging use during the acute post-injury period, and physiotherapy and chiropractor service use during the chronic post-injury period appeared concordant with current WAD management guidelines. Conversely, low physiotherapy and chiropractic use during an acute post-injury period, and high radiology and medical specialists use during the chronic post-injury period appeared discordant with current guidelines. Strategies are needed to help inform medical health professionals of the current guidelines to promote early access to health professionals likely to provide an active approach to treatment, and to address unnecessary referral to radiology and medical specialists in individuals with on-going WAD.

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BMC Health Services Research
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Health services and systems
Public health
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Life Sciences & Biomedicine
Health Care Sciences & Services
Whiplash injuries
Neck pain
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Ritchie, C; Smith, A; Sterling, M, Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals, BMC Health Services Research, 2020, 20 (1), pp. 260