title: Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments.
abstract: Acute whiplash is a heterogeneous disorder that becomes persistent in 40% to 60% of cases. Estimates of recovery have not changed in recent decades. This randomized, single-blind, controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash (<4 weeks postinjury) could reduce the incidence of chronicity at 6 mo by 50% compared to usual care. Participants (n=101) were recruited from accident and emergency centres and the community. It was hypothesized that better recovery rates were achievable if the heterogeneity was recognised and patients received individualised interventions. Patients randomized to pragmatic intervention (n=49) could receive pharmaceutical management (ranging from simple medications to opioid analgesia), multimodal physiotherapy and psychology for post-traumatic stress according to their presentations. The treatment period was 10 wks with follow-up at 11 weeks and 6 and 12-months. The primary outcome was neck pain and disability (Neck Disability Index (NDI)). Analysis revealed no significant differences in frequency of recovery (NDI ≤ 8%) between pragmatic and usual care groups at 6 months (OR 95%, CI=0.55, 0.23-1.29), P=0.163) or 12 mo (OR 95%, CI=0.65, 0.28-1.47, P=0.297). There was no improvement in current nonrecovery rates at 6 mo (63.6%, pragmatic care; 48.8%, usual care), indicating no advantage of the early multiprofessional intervention. Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12 mo in both groups, suggesting that future research focus on finding early effective pain management, particularly for the subgroup of patients with initial high levels of pain and disability, towards improving recovery rates.
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia School of Psychology, Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Australia Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Australia Specialist Pain Medicine Physician and Rheumatologist, St Vincent's Clinical School, University of New South Wales, Australia.
authors.forename: Gwendolen
authors.initials: G
authors.lastname: Jull
authors.forename: Justin
authors.initials: J
authors.lastname: Kenardy
authors.forename: Joan
authors.initials: J
authors.lastname: Hendrikz
authors.forename: Milton
authors.initials: M
authors.lastname: Cohen
authors.forename: Michele
authors.initials: M
authors.lastname: Sterling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology*; D016037:Single-Blind Method; D016896:Treatment Outcome; D008061:Whipple Disease / Q000150:complications / Q000628:therapy*; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: Acute whiplash; Multidisciplinary management; Randomized controlled trial