Early intervention in whiplash-associated disorders - A comparison of two treatment protocols

Study Design. A prospective randomized trial in 97 patients with a whiplash injury caused by a motor vehicle collision. Objectives. The study evaluates early active mobilization versus a standard treatment protocol and the importance of early versus delayed onset of tre atment. Summary of Background Data. There is no compelling evidence to date on the management of acute whiplash-associated disorders. The few studies describi ng treatment, however, provide evidence to support the recommendation that an active treatment in the acute stage is preferable to rest and a soft col lar in most patients. Methods. Patients were randomized to four groups. Active versus standard tr eatment and early (within 96 hours) versus delayed (after 2 weeks) treatmen t. Measures of range of motion and pain were registered initially and at 6 months. Results. Eighty-eight patients (91%) could be followed up at 6 months. Acti ve treatment reduced pain more than standard treatment (P < 0.001). When ty pe and onset of treatment were analyzed, a combined effect was seen. When a ctive 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). Conclusions. in patients with whiplash-associated disorders caused by a mot or vehicle collision treatment with frequently repeated active submaximal m ovements combined with mechanical diagnosis and therapy is more effective i n reducing pain than a standard program of initial rest, recommended use of a soft collar, and gradual self-mobilization. This therapy could be perfor med as home exercises initiated and supported by a physiotherapist.