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Acute Treatment of Whiplash Neck Sprain Injuries: A Randomized Trial of Treatment During the First 14 Days After a Car Accident

Borchgrevink, Grethe E., PhD*; Kaasa, Aaste, MD*; McDonagh, David, MD*; Stiles, Tore C., PhD; Haraldseth, Olav, PhD; Lereim, Inggard, PhD*

Cervical Spine

Study Design. A single-blinded, randomized treatment study with a follow-up period of 6 months.

Objective. To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident.

Summary of Background Data. Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain.

Method. Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period.

Results. There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache.

Conclusions. The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.

From the *Emergency Clinic, University Hospital, Trondheim, the †Department of Psychiatry and Behavioural Medicine, University of Trondheim, and ‡The MR-Centre, Trondheim, Norway.

Supported in part by grants from The Association of Norwegian Insurance Companies.

Acknowledgment date: November 26, 1996.

Acceptance date: April 10, 1997.

Device status category: 1, 2, 7, 10.

Address reprint requests to: Grethe E. Borchgrevink, PhD; The Emergency Clinic; University Hospital; N-7006 Trondeim; Norway.

© Lippincott-Raven Publishers.