title: Comparison of randomized treatments for late whiplash.
abstract: BACKGROUND
  To compare 4 different treatment strategies in patients with late whiplash syndrome.
  
  
  METHODS
  Patients were randomly assigned to one of the following treatment groups: infiltration, physiotherapy, or medication. Group allocation was stratified according to gender, age, and education. Additionally, patients of each group were randomized 1:1 to cognitive-behavioral therapy (CBT) or no CBT. Patients were assessed at baseline, after an 8-week treatment period, and 3 and 6 months later. Main outcome measures were subjective outcome rating, pain intensity, and working ability.
  
  
  RESULTS
  Of 91 enrolled patients, 73 completed the study; 62% were women. After treatment, 47 patients (64%) were subjectively improved (48%), or free of symptoms (16%), with a preponderance of women (73% vs 50%, p = 0.047). There was no difference regarding outcomes among the 3 treatment groups in men and women. The most robust difference was achieved with CBT, associated with a higher rate of recovery (23% vs 9%), and improvement (53% vs 42%) (p = 0.024), and with a gender difference (p = 0.01). All treatments significantly improved pain intensity and working ability.
  
  
  CONCLUSIONS
  Intensive therapy in late whiplash syndrome can achieve improvement of different outcome measures including working ability in two-thirds of patients, more effective in women, persisting beyond 6 months in half. Additional cognitive-behavioral therapy was the most effective treatment modality.
  
  
  METHODS
  This interventional study provides Class III evidence that CBT used as an adjunct to infiltration, medication, or physiotherapy increases improvement rates in persons with late whiplash syndrome.
authors.affiliation: Departments of Neurology, Inselspital, Bern University Hospital, and University of Bern, Berne, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: Pato
authors.forename: G
authors.initials: G
authors.lastname: Di Stefano
authors.forename: N
authors.initials: N
authors.lastname: Fravi
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: M
authors.initials: M
authors.lastname: Curatolo
authors.forename: B P
authors.initials: BP
authors.lastname: Radanov
authors.forename: P
authors.initials: P
authors.lastname: Ballinari
authors.forename: M
authors.initials: M
authors.lastname: Sturzenegger
mesh_terms: D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005480:Flurbiprofen / Q000627:therapeutic use*; D006801:Humans; D018868:Insurance, Disability; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D018579:Patient Selection; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012737:Sex Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000628:therapy*
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005480:Flurbiprofen; D002045:Bupivacaine