Whiplash: Trials

Lamb S, Gates S, Williams M et al, Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomised controlled trial, Lancet, 16;381(9866):546-5, 2013

With this large RCT, the addition of 'active management consultations' in emergency department care did not provide benefit above usual care and a 4 month package of physiotherapy showed a modest benefit compared to a session of advice but was not cost effective.

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Kongsted A, Qerama E, Kasch H, Bendix T, Bach FW, Korsholm L, Jensen TS., Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial., Spine, Mar 15;32(6):618-26, 2007

Comparison of 3 treatments for 458 acute whiplash patients, with active mobilisation group using MDT principles. All groups reported reduced pain with most of the improvement occurring during the first 3 months, but there were no significant differences between the groups in any outcomes. About half of all patients sought additional care, and about half of all patients reported considerable neck pain and disability at one year.

 

Rosenfeld M, Gunnarsson R, Borenstein P, Early intervention in whiplash-associated disorders: a comparison of two treatment protocols., Spine, Jul 15;25(14):1782-87, 1999

Nearly 100 acute patients randomised to one of 4 arms: active (1) or standard (2) treatment, within 96 hours (1a, 2a) or after 2 weeks (1b, 2b), with follow-up at 6 months. If symptoms persisted in active treatment group beyond 20 days a McKenzie assessment was conducted and specific, rather than non-specific exercises used. Active treatment was significantly better than standard (initial rest, collar, gentle movements), early treatment better than delayed. Minimal or no symptoms at follow-up: 1a: 48%, 1b: 70%, 2a: 64%, 2b: 91%.

 

Rosenfeld M, Seferiadis A, Carlsson J, Gunnarsson R., Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial, Spine, Nov 15;28(22):2491-8, 2003

3-year follow-up of 73 patients (75%) from previous study. Still significant differences between active and standard treatment in pain intensity and sick leave. Only early active treatment group had similar range of movement to matched controls.

 

Rosenfeld M, Seferiadis A, Gunnarsson R., Active involvement and intervention in patients exposed to whiplash trauma in automobile crashes reduces costs: a randomized, controlled clinical trial and health economic evaluation., Spine, Jul 15;31(16):1799-804, 2006

An economic evaluation of previous study that showed that costs were significantly lower for the active intervention group at 6 and 36 months, as well as being more effective.

 

Skillgate E, Cote P, Cassidy JD, Boyle E, Carroll L, Holm L., Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study, Archives PM & R, 97, 739-46, 2016

This cohort study demonstrated that early intensive conservative care led to a slower recovery following a whiplash injury. This was independent of the expectation of recovery. The conclusions indicate that the best care post whiplash should focus on reassurance and education rather than potentially counterproductive intensive care.

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