A Briefer Approach to Chronic Whiplash

By: Michael Ferguson
Monday, December 15, 2014

For patients with chronic whiplash, one informative physical therapy session and follow-up support may be as effective as 20 more intensive sessions.

A 2014 study published by The Lancet suggests comprehensive exercise programs are no more effective for whiplash recovery than a single session followed by telephone support. Participants included patients who had experienced an automobile accident three months to five years prior to the study and suffered from chronic grade I or II whiplash-associated disorder as a result.

Patients were placed into two groups, one with a comprehensive program comprising 20 exercise sessions and the other consisting of a single, half-hour consultation with a physiotherapist. The physiotherapist provided patients in the second group a pamphlet about their condition, tips for self-management of pain, a basic exercise plan and phone support.

Authors of the study assessed the intensity of participants’ pain at baseline, 14 weeks, six months and 12 months. Results showed no significant difference in symptom resolution between the groups.

“Our findings should not be interpreted as encouragement to abandon exercise or physiotherapy in this population,” says Zoe Michaleff, PhD, BAppSc(Phty), lead author of the study and a researcher at Australia’s George Institute for Global Health. “But rather, [the findings] identified the need for clinicians to empower patients to self-manage their condition through the provision of advice, reassurance and a gentle exercise program aimed at graded return to normal function.”

Need for New Approaches

The study adds to the body of literature exploring the efficacy of more condensed therapeutic regimens.

Another study, published by The Lancet in 2013, found that active management consultation — made up of six physiotherapy sessions — demonstrated no measurable long-term benefit over a single advice session for patients with whiplash. The trial, conducted in the United Kingdom, showed that patients in the active management group saw greater symptom improvement at four-month follow-up visits but not at eight or 12 months. However, because active management is more expensive than traditional emergency room advice sessions, the more intense therapy regimens were not deemed cost-effective.

“Results of these studies suggest that we need to perhaps reconfigure the way in which we manage patients with grade I or II whiplash, and that for this population, more treatment does not translate into improved health outcomes,” Michaleff says.

In some cases, extended physiotherapy regimens can even impede relief from symptoms, she adds.

“A number of population-based cohort studies suggest that more intensive treatment programs may in fact inadvertently [encourage] patients to cope passively with their pain, increase patients’ reliance on clinicians, and ultimately reinforce maladaptive beliefs and behaviors, and therefore the perceived need for more care,” Michaleff says. “This is a concept that requires further evaluation.”