title: Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial.
abstract: METHODS
  Randomized, parallel-group trial.
  
  
  OBJECTIVE
  To compare the effect of 3 early intervention strategies following whiplash injury.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Immobilization, "act-as-usual," and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury.
authors.affiliation: Back Research Center, Clinical Locomotion Sciences, Backcenter Funen, University of Southern Denmark, Ringe, Denmark. alik@shf.fyns-amt.dk
authors.forename: Alice
authors.initials: A
authors.lastname: Kongsted
authors.forename: Erisela
authors.initials: E
authors.lastname: Qerama
authors.forename: Helge
authors.initials: H
authors.lastname: Kasch
authors.forename: Tom
authors.initials: T
authors.lastname: Bendix
authors.forename: Flemming Winther
authors.initials: FW
authors.lastname: Bach
authors.forename: Flemming
authors.initials: F
authors.lastname: Winther
authors.forename: Lars
authors.initials: L
authors.lastname: Korsholm
authors.forename: Troels Staehelin
authors.initials: TS
authors.lastname: Jensen
mesh_terms: D000063:Accidents, Traffic; D000203:Activities of Daily Living; D000328:Adult; D002908:Chronic Disease; D003718:Denmark; D004185:Disability Evaluation; D004434:Early Ambulation; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D026201:Musculoskeletal Manipulations; D019547:Neck Pain / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D009989:Orthotic Devices; D010147:Pain Measurement; D010349:Patient Compliance; D011446:Prospective Studies; D012017:Referral and Consultation; D012149:Restraint, Physical / Q000295:instrumentation*; D018582:Sick Leave; D013997:Time Factors; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D014938:Work Capacity Evaluation