More intensive therapy doesn't speed up recovery from whiplash

'Our findings suggest that that more enhanced forms of treatment (active management consultations) that include positive messages about recovery, exercise, and early return to normal activities as well as pain management, do not speed recovery,' says lead researcher Professor Sallie Lamb of the Universities of Oxford and Warwick. 

'What is more, although additional physiotherapy beyond a single advice session did offer a modest benefit, it was not cost-effective,' she adds. 

The study is published in the medical journal The Lancet. 

Whiplash is estimated to cost the UK economy around £3.1 billion every year. Yet little is known about the effectiveness of different approaches used to treat whiplash injuries. 

Professor Lamb and colleagues' study included 3,851 adults with acute whiplash injuries attending 15 emergency departments at UK hospitals. Patients were randomly assigned to receive either active management of their whiplash (2,253 patients) or the usual level of care (1,598). 

Usual care for whiplash injuries tends to consist of some non-specific advice to exercise, advice sheets that contain inconsistent information, with no guidance on expectations for recovery. 

All study participants completed questionnaires on how their neck pain was restricting everyday activities like sleeping, driving, and work. 

The researchers found little difference in patients' recovery at 4, 8, or 12 months whether they received active management of their whiplash injuries or the usual care consultations. 

In a second part of the study, patients whose symptoms persisted after 3 weeks were invited to participate in physiotherapy sessions. Of these, 599 patients were randomly assigned to receive either a single advice session with a physiotherapist or a package of up to six physiotherapy sessions. 

Patients given the full physiotherapy package did report a modestly quicker recovery at 4 months compared with the single session – but not at 8 or 12 months. 

Neither the active management consultations nor the physiotherapy package (which are more expensive) would be cost effective for the NHS, the researchers found. 

'Emergency departments should continue to provide usual care for whiplash injuries together with a single follow-up physiotherapy advice session for persisting symptoms,' concludes Professor Lamb of the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS).