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Active Whiplash Management No Better Than Usual Care

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When comparing the speed of recovery, intensive treatment of whiplash is no better than standard care, according to a new study published last month in The Lancet.

Researchers led by Sarah Lamb of the University of Warwick looked at over 3,800 whiplash patients in the UK, comparing a more intensive treatment against usual care at 15 hospital emergency departments.

The more intensive approach (active management) included pain control together with positive messages about recovery and specific advice related to exercise and early return to normal activities. The usual care included non-specific advice on exercise, no guidance on when a recovery could be expected and an advice sheet with inconsistent data.

Researchers found similar recovery levels between usual care and active management at four, eight and 12 months after initial treatment in the emergency department.

Almost 600 patients who still had whiplash symptoms three weeks after treatment in the emergency department were subsequently assigned either a single advice session with a physiotherapist, or up to six physiotherapy sessions. Those who had the physiotherapy sessions showed quicker recovery at four months, but not at eight or 12 months. The physiotherapy sessions also cut the number of work days lost by four, on average, over a 12-month period.

The team of researchers concluded that active management and physiotherapy sessions were costlier than usual care and physiotherapy advice. Moreover, these additional and more expensive efforts do not hasten recovery, the study suggests. The modest benefits of the additional physiotherapy, beyond the single advice session, were not cost-effective, the lead researcher said.

Dr Victor Khabie, a US orthopaedic and spine expert, welcomed the research but commented that not all neck injuries are the same and some may require more intensive treatment, so treating physicians need to make an individualised care plan for each injury.