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  • Management of acute whiplash: A randomized controlled trial of multidisciplinary stratified treatments

    Author(s)
    Jull, Gwendolen
    Kenardy, Justin
    Hendrikz, Joan
    Cohen, Milton
    Sterling, Michele
    Griffith University Author(s)
    Sterling, Michele
    Year published
    2013
    Metadata
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    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. ...
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    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.
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    Journal Title
    Pain
    Volume
    154
    Issue
    9
    DOI
    https://doi.org/10.1016/j.pain.2013.05.041
    Subject
    Biomedical and clinical sciences
    Physiotherapy
    Psychology
    Publication URI
    http://hdl.handle.net/10072/60175
    Collection
    • Journal articles

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