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Active Intervention in Patients with Whiplash-Associated Disorders Improves Long-Term Prognosis: A Randomized Controlled Clinical Trial

Rosenfeld, Mark, RPT*†; Seferiadis, Aris, RPT*; Carlsson, Jane, RPT, PhD*; Gunnarsson, Ronny, MD, PhD†‡

doi: 10.1097/01.BRS.0000090822.96814.13
Randomized Trial

Study Design.  Three-year follow-up of a prospective randomized trial in 97 patients exposed to whiplash trauma in motor vehicle collisions.

Objectives.  To compare the long-term efficacy of active intervention with that of standard intervention and the effect of early versus delayed initiation of intervention.

Summary of Background Data.  There is no strong evidence for many treatments for whiplash-associated disorders. Some studies provide weak evidence supporting active intervention.

Method.  Patients were randomized to an intervention using frequent active cervical rotation complemented by assessment and treatment according to McKenzie’s principles or to a standard intervention of initial rest, recommended soft collar, and gradual self-mobilization. To test the time factor, interventions were either made within 96 hours or delayed 14 days from collision. The effects of the two interventions and the time factor on pain intensity, cervical range of motion, and sick leave were analyzed at 6 months and 3 years. Cervical range of motion at 3 years was also compared with that in matched, unexposed individuals.

Results.  Pain intensity and sick leave were significantly (P < 0.05) reduced if patients received active intervention compared with standard intervention. Delaying intervention 2 weeks did not affect outcome variables. However, at 3 years, only patients receiving early active intervention had a total cervical range of motion similar to that of matched unexposed individuals.

Conclusion.  In patients with whiplash-associated disorders, active intervention is more effective in reducing pain intensity and sick leave, and in retaining/regaining total range of motion than a standard intervention. Active intervention can be carried out as home exercises initiated and supported by appropriately trained health professionals.

From the *Institute of Occupational Therapy and Physiotherapy, Faculty of Health and Caring Sciences, The Sahlgrenska Academy at Göteborg University; the

†Research and Development Unit in Primary Health Care, Southern Elfsborg County, and the

‡Department of Primary Health Care, Göteborg University, Sweden.

Supported by the local research committee in southern Elfsborg County, the Swedish National Health Insurance, and the Vårdal Foundation.

Acknowledgment date: July 18, 2002.

First revision date: February 4, 2003.

Acceptance date: March 17, 2003.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional and Foundation funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Mark E. Rosenfeld, RPT, Fagerhult Östergården 14, 517 94, Töllsjö, Sweden. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.