For Whiplash Treatment: Education and Advice As Good As Prolonged PT

MedicalResearch.com Interview with:
Zoe Michaleff
PhD Student, Musculoskeletal Division
The George Institute for Global Health
Sydney NSW 2000 Australia

MedicalResearch.com: What are the main findings of the study?

Answer: Our study showed that a 30 minute advice session with two phone call follow ups was as effective for chronic whiplash as the comprehensive physiotherapy exercise program in which participants received twenty, one-hour individually-tailored and supervised exercise sessions over a 12-week period. While people’s pain and activity improved in both treatment groups, the most important finding is that there were no differences between groups. This finding held true for all outcome measures except for two secondary outcome measures of self rated recovery (global perceived effect) and functional ability (patient specific functional scale) which were in favour of the comprehensive exercise program however the size of these effects were too small to be considered clinically meaningful.
There is evidence to suggest that whiplash patients are not all the same and that their response to treatment may differ depending on individual patient characteristics for example the presence of symptoms suggestive of sensory hypersensitivity or post traumatic stress and the duration of injury. Our secondary analyses did not reveal a differential response to treatment based on these factors nor did a longer duration of symptoms affect participant’s response to treatment.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Yes, the results of our randomised controlled trial were definitely unexpected. The primary hypothesis of our study was that the comprehensive exercise program would be more effective than a single advice session in reducing pain, disability and improving quality of life for people with chronic whiplash. This hypothesis was supported by a strong biological and theoretical rationale and confirmed by the results of a small pilot study. We were therefore quite surprised with the finding that that the comprehensive exercise program was equally effective as one advice session with the option of two phone call follow ups.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The results of our study suggest that more treatment is not necessarily better for people with chronic whiplash and that people can have just as good an outcome by attending only one session of physiotherapy and learning how to self manage their condition. If the whiplash wasn’t the person’s fault and they were in, for example, a car accident then they may benefit from looking into getting a whiplash settlement for a car accident that affected them. This would mean they may be able to get compensation so they can afford treatment for their whiplash. The victim should contact a Personal Injury Lawyer Orange County to see if they can get help getting compensation.Our study actually adds to the growing body of literature that suggests that we need to rethink how we deliver treatment to people with a chronic whiplash injury, and perhaps for these people intensive treatment is not required. Traditionally physiotherapy involved long courses of one-to-one care. More recently, it’s become clear that to deliver physiotherapy more efficiently traditional treatments need to be reconfigured from long programs of care to effective, simple and shorter treatments where the patient is actively involved.

Patient’s expectations of treatment and their health practitioner need to be better aligned with current evidence and this study highlights the importance of getting patients actively involved in treatment. Clinicians have an important role in educating and empowering patients with the information required to allow them to self manage their condition and therefore become more self reliant. This information must include educating patients about whiplash, the principles of progressing activity, the identification of patient specific functional goals and teaching patients simple neck and shoulder exercises aimed at improving posture, range of motion, coordination and strength.

MedicalResearch.com:What recommendations do you have for future research as a result of this study?

Answer: For the future we need to identify the best ways in which to deliver simple self management advice and education. Education and advice has been shown to be as effective as more costly interventions and yet we need to better understand how to deliver these to patients in the most effective manner. This may involve the development and use of verbal, written, or multimedia approaches that reflect the cultural diversity within Australia.

In general, we need to identify effective and affordable strategies to prevent and treat musculoskeletal conditions, as these are one of the leading causes of disability and chronic pain in the latest Global Burden of Disease study. This is especially true for those with chronic whiplash-associated disorders because most have tried and failed previous treatments and their continuing symptoms mean they would be unlikely to pursue more of the same approaches.

Citation:

Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial

Dr Zoe A Michaleff PhD,Prof Chris G Maher PhD,Chung-Wei Christine Lin PhD,Trudy Rebbeck PhD,Prof Gwendolen Jull PhD,Prof Jane Latimer PhD,Prof Luke Connelly PhD,Prof Michele Sterling PhD
The Lancet – 4 April 2014
DOI: 10.1016/S0140-6736(14)60457-8

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