Management of acute whiplash: A trial of multidisciplinary stratified treatments.

Acute whiplash is a heterogeneous disorder that becomes chronic in 40-60% of cases. Estimates of recovery have not varied in the past few decades. This randomized, single blind, controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash (<4 weeks post-injury) could lower the incidence of chronicity at 6-months by 50% compared to usual care. Participants (n=101) were brought from accident and emergency centres and the community. It was hypothesized that better recovery rates could be achieved if the heterogeneity was recognised and patients received individualised interventions. Patients randomized to pragmatic intervention (n=49) could receive pharmaceutical management (ranging from simple to opioid analgesia), multimodal physiotherapy and psychology for post-traumatic stress based on their presentations. The treatment period was 10-weeks with follow-up at 11-weeks, 6 and 12-months.

The main outcome was neck pain and disability (Neck Disability Index (NDI)). Analysis showed no significant differences in frequency of recovery (NDI8%) between pragmatic and usual care groups at 6 months or 12 months. There was no improvement in current non-recovery rates at 6 months (63.6% – pragmatic care; 48.8% – usual care), indicating no advantage of the early multi-professional intervention. Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12 months in both groups, suggesting that future research focus on finding early effective pain management especially for the sub-group of patients with initial high levels of pain and disability towards improving recovery rates.