Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury

Abstract

Objectives: Standard therapy in Germany for acute whiplash injury has traditionally included a soft collar (cervical orthosis), an approach that is passive compared with early exercise and mobilisation. The purpose of this study is to examine the recovery in the first six weeks of groups of acute whiplash injury patients subjected to two different treatment approaches, the traditional approach of a collar compared with active, early mobilisation. Methods: Between August 1997 and February 2000 a randomised clinical trial with a total of 200 patients was performed. A total of 97 were randomly assigned to a collar therapy group, and 103 to the exercise group, treated by a physiotherapist. Study participants recorded average pain and disability twice (baseline and six week follow up) during a one week period by diary, using numeric visual analogue (VAS) rating scales ranging from 0 to 10. Results: The initial mean VAS pain intensity and VAS disability reported by the collar therapy group and the exercise group showed no statistical difference. The mean VAS pain rating reported by the collar therapy group after six weeks was 1.60 and mean VAS disability rating was 1.56. The mean VAS pain intensity of the exercise group was 1.04 and mean VAS disability was 0.92. These differences between the groups were both significant, as was the reduction in the prevalence of symptoms in the exercise therapy group compared with the collar group at six weeks. Conclusions: Early exercise therapy is superior to the collar therapy in reducing pain intensity and disability for whiplash injury.

Efficacy of Postural and Neck-Stabilization Exercises for Persons with Acute Whiplash-Associated Disorders: A Systematic Review

“…No additional studies were found through hand-searching reference lists and the tables of contents of selected journals or through contact with experts. Of the eight studies selected for inclusion, [15][16][17][18][19][20][21][22] only three were stand-alone studies. 15,16,22 Two of the remaining five constituted a pair, in which one study 21 was a follow-up to the other.…”

“…15,16,22 Two of the remaining five constituted a pair, in which one study 21 was a follow-up to the other. 20 The three remaining studies constituted a triplet in which two of the studies 18,19 were follow-ups to the first. 17 Methods, study population, interventions, and outcome measures used in the included studies are presented in Table 2, while the methodological quality assessment of the included studies is presented in Table 3.…”

“…Of the eight studies selected for inclusion, one standalone study 15 and one triplet of studies [17][18][19] were graded as high quality; one stand-alone study 22 and one pair of studies 20,21 were graded as moderate quality; and one stand-alone study was graded as low quality. 16 Because of the nature of the interventions, none of the studies was able to incorporate blinding of patients or care providers.…”

“…Two stand-alone studies 15,22 and one pair of studies 20,21 used neck-stabilization exercises as part of their intervention. One of the stand-alone studies 15 was graded as high quality, while the other was graded as moderate quality.…”

Prescribing Exercise for Neck Problems

“…Yapılan çalış-malarda aktif hareketlerin whiplash yaralanmalı hastalarda boyunluk ve istirahat önerilen hastalardan daha fazla ağrıyı azalttığı gösterilmiştir (22)(23)(24). Fizik tedavi ile birlikte aktif egzersizlerin travmadan sonraki ilk 14 gün içinde uygulandığı hastalarda iyileşmenin erken ve geç dönemde devam ettiği gözlenmiştir (25 …”