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Evidence summaries

Treatments for Whiplash

Active interventions may be more effective than passive ones or placebo in the treatment of acute, subacute or chronic symptoms of whiplash-associated disorders, but the evidence is conflicting and of poor quality. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 23 studies with a total of 2 344 subjects. Only 8 studies were of high quality. Two studies included patients with chronic symptoms (longer than 3 months), 2 included subacute (4 to 6 weeks) symptoms, 2 had undefined duration of symptoms, and 17 studied patients with acute (less than 3 weeks) symptoms. A broad variety of conservative interventions were evaluated. Clinical and statistical heterogeneity and lack of data precluded pooling. Interventions were divided into passive (such as rest, immobilisation, ultrasound, etc) and active interventions (such as exercises, act as usual approach, etc.) and were compared with no treatment, a placebo or each other. Individual studies demonstrated effectiveness of one treatment over another, but the comparisons were varied and results inconsistent. Therefore, the evidence neither supports nor refutes the effectiveness of either passive or active treatments to relieve the symptoms of WAD, Grades 1 or 2.

A topic in Clinical Evidence 2 summarizes the evidence on treatments for acute whiplash injury. Two systematic reviews were found. They included one RCT in which 40 patients were randomized to either pulsed electromagnetic therapy or placebo. Patients in treatment group had better pain relief after 4 weeks but not after 3 months. Four RCTs compared early mobilisation physiotherapy to immobilisation, analgesics, rest, rest plus a neck collar, or education. Those in the mobilisation group had significantly better pain relief and improved range of movement at 4 and 8 weeks. The systematic review found no evidence of benefit from immobilisation, rest, traction, or other physical treatments in whiplash.

Comment: The quality of evidence was downgraded by serious limitations in study quality and important inconsistency.

    References

    • Verhagen AP, Scholten-Peeters GG, van Wijngaarden S, de Bie RA, Bierma-Zeinstra SM. Conservative treatments for whiplash. Cochrane Database Syst Rev 2007 Apr 18;(2):CD003338. [PubMed]
    • Binder A. Treatments for acute whiplash. Clinical Evidence 2005;13:1516-1524.

Primary/Secondary Keywords