Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references. Joud, A., Stjerna, J., Malmstrom, E., Westergren, H., Petersson, I. F., & Englund, M. 3(8):e003172.
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OBJECTIVES: Recent studies based on self-assessed data on exposure and outcome suggest a negative association between poor health before neck injury and recovery. Our aim was to study actual healthcare consultation and work disability before and after neck injury (whiplash). DESIGN: Cohort study with matched references studied prospectively and retrospectively via regional and national held registers. SETTING: Population-based study in Region Skane, Sweden (population=1.21 million) including all levels of healthcare. PARTICIPANTS: 1443 participants aged \textgreater/=18 (54% women) with acute neck injury, Whiplash, (International Classification of Diseases-10-SE code S13.4*) in 2007 or 2008 and no such diagnosis since 1998. Each patient with a neck injury was assigned four randomly selected population references matched for age, sex and area of residence (97% of the patients and 94% of the references were followed during the whole study period). PRIMARY AND SECONDARY OUTCOME MEASURES: We studied changes in healthcare consultations 3 years before to 3 years after diagnosis as well as sick leave episodes. Analyses were also stratified by preinjury frequency of consultation. RESULTS: Before the injury, the mean number of total consultations over 36 months among the neck injured (n=1443) and references (n=5772) was 9.3 vs 7.2 (p\textless0.0001) and postneck injury 12.7 vs 7.8 (p\textless0.0001). In the group of high-frequent consulters, there were more women compared with frequent and low-frequent consulters (70.6% vs 32.8%; p\textless0.0001). Among low-frequent and frequent consulters preinjury (n=967, 67% of the cohort), 16% became high-frequent consulters attributable to the injury. The number of days of sick leave preinjury was correlated with the number of preinjury and postinjury consultations (r=0.47 (99% CI 0.38 to 0.49), r=0.32 (99% CI 0.25 to 0.37)). CONCLUSIONS: People with a neck injury constitute a heterogeneous group. The preinjury level of healthcare consultation is associated with the postinjury level of consultation.
@article{joud_healthcare_2013,
	title = {Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references.},
	volume = {3},
	issn = {2044-6055 2044-6055},
	doi = {10.1136/bmjopen-2013-003172},
	abstract = {{OBJECTIVES}: Recent studies based on self-assessed data on exposure and outcome suggest a negative association between poor health before neck injury and recovery. Our aim was to study actual healthcare consultation and work disability before and after neck injury (whiplash). {DESIGN}: Cohort study with matched references studied prospectively and retrospectively via regional and national held registers. {SETTING}: Population-based study in Region Skane, Sweden (population=1.21 million) including all levels of healthcare. {PARTICIPANTS}: 1443  participants aged {\textgreater}/=18 (54\% women) with acute neck injury, Whiplash, (International Classification of Diseases-10-{SE} code S13.4*) in 2007 or 2008 and  no such diagnosis since 1998. Each patient with a neck injury was assigned four randomly selected population references matched for age, sex and area of residence (97\% of the patients and 94\% of the references were followed during the whole study period). {PRIMARY} {AND} {SECONDARY} {OUTCOME} {MEASURES}: We studied changes in healthcare consultations 3 years before to 3 years after diagnosis as well as  sick leave episodes. Analyses were also stratified by preinjury frequency of consultation. {RESULTS}: Before the injury, the mean number of total consultations  over 36 months among the neck injured (n=1443) and references (n=5772) was 9.3 vs 7.2 (p{\textless}0.0001) and postneck injury 12.7 vs 7.8 (p{\textless}0.0001). In the group of high-frequent consulters, there were more women compared with frequent and low-frequent consulters (70.6\% vs 32.8\%; p{\textless}0.0001). Among low-frequent and frequent consulters preinjury (n=967, 67\% of the cohort), 16\% became high-frequent consulters attributable to the injury. The number of days of sick leave preinjury was correlated with the number of preinjury and postinjury consultations (r=0.47 (99\% {CI} 0.38 to 0.49), r=0.32 (99\% {CI} 0.25 to 0.37)). {CONCLUSIONS}: People with a neck injury constitute a heterogeneous group. The preinjury level of healthcare consultation is associated with the postinjury level of consultation.},
	pages = {e003172},
	number = {8},
	journaltitle = {{BMJ} open},
	shortjournal = {{BMJ} Open},
	author = {Joud, Anna and Stjerna, Johanna and Malmstrom, Eva-Maj and Westergren, Hans and Petersson, Ingemar F. and Englund, Martin},
	date = {2013},
	pmid = {23996819},
	pmcid = {PMC3758980},
	keywords = {{EPIDEMIOLOGY}, Register, Treatment, Whiplash injury}
}
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