Whiplash-associated disorders (WAD) remain one of the most troublesome consequences related to the use of the world’s roadways and accounts for a large proportion of medical disabilities. In 2003 Rosenfeld and colleagues performed a randomized controlled clinical trial to measure the effectiveness of an active intervention compared to a standard intervention for those who recently suffered WAD. The study participants were 97 subjects who sought medical advice following a recent WAD. The subjects were randomized to one of four interventions groups:
Group 1 & 3: Active intervention (within 96 hours of injury or delayed 14 days).
Group 2 & 4: Standard intervention (within 96 hours of injury or delayed 14 days).
The subjects were assessed at 6 months and 3 years post injury. The outcomes measures were pain intensity using a visual analog scale, cervical range of motion (ROM) measurement and the amount of sick leave required due to the WAD.
The active intervention consisted of an active exercise protocol incorporating the idea of early and repeated movement and consisted of 2 phases.
Phase 1 was given to all patients and included information on postural control, and cervical rotation exercises that were to be performed 10 times every 1 hour as far as pain permits. This phase was meant to encourage safe and frequent home exercising and appropriate pain coping behavior.
Phase 2 was initiated at 20 days post injury if symptoms persisted, and consisted of a standard dynamic mechanical assessment. The evaluation was administered by a physical therapist that has been formally trained in Mechanical Diagnosis and Therapy (MDT). The MDT program consisted of end range spinal movements and/or manual therapy techniques. MDT also incorporates advice on appropriate postures, pain coping behavior, and home exercise.
The standard intervention consisted of written information on the injury mechanism, advice on suitable activities, and postural advice. The advice was to rest the neck during the first weeks after trauma and that a soft cervical collar could provide comfort as well as prevent the neck from excessive movement. The patients were instructed to perform active movements of the neck and shoulders 2-3 times daily starting a few weeks after trauma.
The main finding in this study was that active intervention in patients with WAD resulted in a significantly greater reduction in pain intensity, a greater chance to retain or regain ROM, and reduced sick leave compared with a standard intervention. The main clinical implication is that patients with acute WAD should be instructed in self-mobilization as soon as possible. If symptoms persist more than 20 days after trauma, patients should seek treatment from a health professional trained in MDT. Despite this evidence, standard intervention continues to be recommended to patients (Rosenfeld, Seferiadis, Carlsson, & Gunnarsson, 2003, p. 2491).
Rosenfeld, M., Seferiadis, A., Carlsson, J., & Gunnarsson, R. (2003). Active intervention in patients with whiplash associated disorders improves long term prognosis: A Randomized controlled clinical trial. Spine, 28 (22), 2491-2498
Don Stover PT
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Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
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