Intense treatment no better than advice and exercise at reducing pain from chronic whiplash

Results of a new trial of treatments for chronic whiplash pain, published in The Lancet, suggest that expensive, intense physiotherapy sessions do not show any additional benefit over a single physiotherapy session of education and advice with phone follow-up.

The findings are in line with previous studies on the subject, which have reported minimal additional benefit of longer physiotherapy programmes over briefer physiotherapy programmes for acute whiplash-associated disorders. The current study supports those claims, finding that while intensive physiotherapy has remained the recommended intervention, a briefer programme encouraging self-management might be equally effective.

Study participants were solicited in Sydney and Brisbane, Australia, through advertisements in local newspapers, radio, and online, and via referral from a statutory authority set up to monitor motor vehicle and personal injury insurance plans.

The study included participants who had suffered a motor vehicle accident resulting in chronic whiplash, recruiting patients whose accident occurred no sooner than three months prior to signing up to the study, and no later than five years after the accident. Patients were enrolled between September 2009 and February 2012.

A total of 172 people were enrolled into the study, with participants randomly divided into two groups. The advice group received a single half-hour consultation with a trained physiotherapist who went over a pamphlet that provided information on whiplash-related disorders, suggestions on how to self-manage , and a simple exercise routine. Participants assigned to this group could have two additional phone consultations with the physiotherapists if desired.

Study participants included in the exercise group received a more complex treatment, including twenty individually tailored physiotherapy sessions lasting one hour each, over the course of twelve weeks. These sessions included a comprehensive exercise programme, posture re-education, stretching training and exercises, scapular training, aerobic exercise, and strength training.

The primary outcome of the study, in which the authors had expected to see a difference between groups of patients, was reduction in pain reported during the previous week, measured at 14 weeks, six months, and 12 months after the intervention. Secondary outcomes included pain during the previous twenty four hours, self-reported recovery, and an improvement in flexibility. However, no clinically meaningful differences were reported between groups for either primary or secondary outcomes during any of the reporting periods.

According to study author Dr Zoe Michaleff, of The University of Sydney, Australia, "Musculoskeletal disorders are one of the leading causes of disability and chronic pain globally. The need to identify effective and affordable strategies to prevent and treat musculoskeletal disorders should be an important health priority. This is especially true for those with chronic whiplash-associated disorders because most patients have tried and failed previous treatments, and their continuing symptoms mean they would be unlikely to pursue more of the same approaches. The need for an extended course of treatment for whiplash-associated disorders is being challenged, and our study provides further evidence that prolonged expensive clinical interventions for chronic whiplash injury are no more effective than briefer treatment programs that teach the patient how to self-manage their pain."

Writing in a linked Comment, Jo Nijs and Kelly Ickmans, of Vrije Universiteit Brussel, in Brussels, Belgium, said, "The study by Michaleff and colleagues advances our understanding of whiplash-associated disorders and provides physiotherapists with clear information about how to treat patients with chronic whiplash-associated disorders. These findings should not be interpreted as encouragement to abandon exercise therapy in these patients: the question is how and when to exercise people with chronic whiplash-associated disorders."

More information: www.thelancet.com/journals/lan… (14)60130-6/abstract

add to favorites email to friend print save as pdf

Related Stories

Osteoarthritis improved by extra physiotherapy programmes

Jul 24, 2013

Aanual physiotherapy or regular exercise programmes make a significant difference for people with painful osteoarthritis in the knee and hip joints, and are cost-effective, new research from the University of Otago shows.

Recommended for you

Recorded Ebola deaths top 7,000

22 hours ago

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

Dec 20, 2014

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

Dec 19, 2014

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

Dec 19, 2014

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.