The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders--a randomized controlled trial. Early intervention in whiplash-associated disorders: a comparison of two treatment protocols. Multimodal treatment to prevent the late whiplash syndrome. A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions. Simple educational intervention to improve the recovery from acute whiplash: results of a randomized, controlled trial. Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial. Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial. Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident.
To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders.
                A randomized controlled trial with follow-up at three and nine months after randomization.
                An interdisciplinary rehabilitation centre.
                Forty-seven patients with subacute disorders following a whiplash trauma.
                Patients were randomized to a supervised training group or a self-administered home training group.
                Primary outcome measures were the Self-Efficacy Scale, the Tampa Scale for Kinesiophobia and the Pain Disability Index. Secondary outcome measures were neck pain intensity, sensory and affective dimensions of pain, pain location and duration, muscle tenderness, grip strength, cervical mobility, sick leave and analgesic consumption.
                Forty patients (85%) completed the intervention period, and the drop-outs were followed up by intention-to-treat. The results showed that supervised training was significantly more favourable than home training, with a more rapid improvement in self-efficacy (P = 0.03), fear of movement/(re)injury (P = 0.03) and pain disability (P = 0.03) at three months. Further, supervised training significantly reduced the frequency of analgesic consumption (P = 0.03). The improvements were partly maintained at nine months, even though there was no amelioration in pain and physical disorders. Despite the favourable outcome, supervised intervention did not reduce sick leave.
                The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term, but additional research is needed to extend these findings and elucidate treatment strategies that also are cost effective. A prospective randomized trial in 97 patients with a whiplash injury caused by a motor vehicle collision.
                The study evaluates early active mobilization versus a standard treatment protocol and the importance of early versus delayed onset of treatment.
                There is no compelling evidence to date on the management of acute whiplash-associated disorders. The few studies describing treatment, however, provide evidence to support the recommendation that an active treatment in the acute stage is preferable to rest and a soft collar in most patients.
                Patients were randomized to four groups. Active versus standard treatment and early (within 96 hours) versus delayed (after 2 weeks) treatment. Measures of range of motion and pain were registered initially and at 6 months.
                Eighty-eight patients (91%) could be followed up at 6 months. Active treatment reduced pain more than standard treatment (P < 0.001). When type and onset of treatment were analyzed, a combined effect was seen. When active treatment was provided, it was better when administered early, and if standard treatment was provided, it was better when administered late for reduction of pain (P = 0.04) and increasing cervical flexion (P = 0.01).
                In patients with whiplash-associated disorders caused by a motor vehicle collision treatment with frequently repeated active submaximal movements combined with mechanical diagnosis and therapy is more effective in reducing pain than a standard program of initial rest, recommended use of a soft collar, and gradual self-mobilization. This therapy could be performed as home exercises initiated and supported by a physiotherapist. In order to assess the long-term efficacy of a multi-modal rehabilitation approach on whiplash injury, 60 patients were recruited within two months after neck injury. They were randomly allocated either to an experimental multimodal treatment (A) consisting of postural training, manual technique and psychological support or to a control treatment (B), using physical agents only, such as electrical and sonic modalities. Pain level, range of movement, self-rating scale of treatment efficacy and return-to-work delay were evaluated before and at the end of treatment, and later, 30 and 180 days after randomisation. The benefit obtained with treatment "A" was greater and longer lasting than that experienced using "B", despite the fact that the same benefit was obtained in joint mobility in the two groups. Patients undergoing the experimental treatment returned to their usual occupations sooner than the controls. The results seem to confirm the hypothesis of a multifactorial involvement as a possible mechanism for the late whiplash syndrome. Concealed allocation, multicenter, single-blind, randomized controlled clinical trial.
                To assess the efficacy of an educational video in the tertiary prevention of persistent WAD symptoms following rear-end motor vehicle collisions (MVCs).
                Whiplash-associated disorders (WAD) are an important and costly health problem. There is a lack of high quality evidence surrounding efficacy of treatments for WAD. Existing research supports active interventions and early return to regular activities.
                Consecutive patients presenting to four tertiary care emergency departments following rear-end MVCs were eligible. Following informed consent, patients were allocated, using central randomization, to receive an educational video plus usual care or usual care alone. The video provided reassurance, and advice about posture, return to regular activities, exercises, and pain-relief methods. Data were collected by telephone using standardized questionnaires. The primary outcome was presence of Persistent WAD Symptoms at 24 weeks postinjury, based on the frequency and severity of neck, shoulder, or upper back pain. The absolute difference in proportion of patients with persistent WAD symptoms and rate ratios were calculated. Changes in pain scores were compared using the Mann-Whitney U test.
                The intervention (n = 206) and control (n = 199) groups were similar at baseline (mean age 38.4 years; 64% female). Overall, the proportion of subjects with Persistent WAD Symptoms decreased from 89.1% at baseline to 33.6% at 24 weeks after injury. At 24 weeks, the proportion of subjects with persistent WAD symptoms in the intervention group was 7.9% (95% CI, -2.0, 17.8) lower than the control group. The median improvement in pain score at 24 weeks was 3 for the intervention group and 2 for the control group (P = 0.016).
                The presence of persistent WAD symptoms following simple rear-end MVCs was high in this sample. The video group demonstrated a trend toward less severe WAD symptoms. We recommend evaluating other educational interventions that could reduce WAD symptoms. To determine if an educational intervention in the acute stage of whiplash injury may improve the recovery rate.
                Consecutive subjects were randomized to one of two treatment groups: educational intervention or usual care. The intervention group received an educational pamphlet based on the current evidence. The control group did not receive these materials but received usual emergency department care and a standard nondirected discharge information sheet. Both groups underwent follow-up by telephone interview at two weeks and three months. The primary outcome measure of recovery was the patient's response to the question, "How well do you feel you are recovering from your injuries?"
                A total of 112 subjects agreed to participate. Age, gender, precollision employment level and health, initial symptoms, collision parameters, and emergency treatments were similar between the groups. At two weeks postcollision, 7.3% in the treatment group reported recovery compared with 8.8% in the control group (absolute risk difference, -1.5%; 95% confidence interval = -12.6% to 9.7%). At three months postcollision, 21.8% in the treatment group reported complete recovery compared with 21.0% in the control group (absolute risk difference, 0.8%; 95% confidence interval = -14.4% to 16.0%). At three months, there were no clinically or statistically significant differences between groups in severity of remaining symptoms, limitations in daily activities, therapy use, medications used, lost time from work, or litigation.
                An evidence-based educational pamphlet provided to patients at discharge from the emergency department is no more effective than usual care for patients with grade 1 or 2 whiplash-associated disorder. Following introduction of the compulsory use of seat belts in cars, whiplash injuries of the cervical spine have become common in everyday practice. Current treatment approaches lead to resolution of the symptoms within a short time in most cases but cannot prevent a small proportion of patients developing persistent health problems. The effects of adjuvant treatment with laser acupuncture on the acute symptoms and the results one year after the injury were studied in this prospective, randomized, placebo-controlled single-blind study. One group of patients (n = 23) were treated with laser acupuncture (5 mW HeNe laser on 22 acupuncture points for 15 s each) plus cervical collar and a combination of paracetamol and chlormezanone; a second group (n = 22) received the same treatments but with the use of a placebo laser. The treatment was given three times per week until the patient was asymptomatic. No statistically significant advantage of the laser acupuncture treatment was found in the acute phase (mobility in all three planes, duration of pain and duration of use of a cervical collar) or the chronic phase (drug use and the incidences of chronic recurrent problems such as myofascial pain, headaches, vertigo and tinnitus).
                Adjuvant laser acupuncture with a 5 mW HeNe laser and an irradiation time of 15 s appears to be ineffective in the management of whiplash injuries. To compare two different home exercise programmes for patients with acute whiplash-associated disorders (WAD). A further aim was to describe the initial prognostic variables related to self-reported pain at six months follow-up.
                A randomized treatment study with a follow-up period of six months.
                The study was undertaken in an orthopaedic clinic at a university hospital.
                A total of 59 symptomatic (neck pain, stiffness, etc.) patients with acute whiplash injury.
                Patients were randomized to a regular treatment group (RT group) and an additional-exercise treatment group (AT group).
                Pain Disability Index (PDI), Self-Efficacy Scale (SES), Coping Strategies Questionnaire (CSQ), neck range of motion (ROM), head posture, kinaesthetic sensibility, visual analogue scale (VAS).
                Patients given an additional exercise did not improve more than patients with regular treatment. Only one CSQ item, 'Ability to decrease pain', showed a significant difference between the groups in its pattern of change over time: the AT group had a significant increase between three and six months whilst values in the RT group decreased. Nonsymptomatic patients at six months follow-up were characterized by initially better self-efficacy, lower disability and significantly different patterns in the use of 'behavioural coping strategies' when compared with symptomatic patients. The nonsymptomatic patients also reported more frequent training than symptomatic patients, i.e. they complied better with the treatment regime.
                This home exercise programme, including training of neck and shoulder ROM, relaxation and general advice seems to be sufficient treatment for acute WAD patients when used on a daily basis. Additionally, patients reporting low self-efficacy and high disability levels may profit from more attention initially, as these psychological factors are significant predictors of pain at long-term follow-up. Randomized, parallel-group trial.
                To compare the effect of 3 early intervention strategies following whiplash injury.
                Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only.
                Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12 months postinjury. Treatment effect was measured in terms of headache and neck pain intensity (0-10), disability, and work capability.
                A total of 458 participants were included. At the 1-year follow-up, 48% of participants reported considerable neck pain, 53% disability, and 14% were still sick listed at 1 year follow-up. No significant differences were observed between the 3 interventions group.
                Immobilization, "act-as-usual," and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury. A single-blinded, randomized treatment study with a follow-up period of 6 months.
                To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident.
                Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain.
                Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period.
                There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache.
                The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.
The current literature is of poor methodological quality and is insufficiently homogeneous to allow the pooling of results. Therefore, clearly effective treatments are not supported at this time for the treatment of acute, subacute or chronic symptoms of whiplash-associated disorders.