Neck Collar, “Act-as-Usual” or Active Mobilization for Whiplash Injury?

In Brief Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to “act-as-usual,” or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12 months postinjury. Treatment effect was measured in terms of headache and neck pain intensity (0–10), disability, and work capability. Results. A total of 458 participants were included. At the 1-year follow-up, 48% of participants reported considerable neck pain, 53% disability, and 14% were still sick listed at 1 year follow-up. No significant differences were observed between the 3 interventions group. Conclusion. Immobilization, “act-as-usual,” and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury. It is unclear how early symptoms following whiplash injuries should be managed in order to avoid long-lasting pain and disability. This randomized trial compared immobilization, advice to “act-as-usual,” and active mobilization in a prospective trial including 458 participants. The risk of chronicity was not demonstrated to differ between these interventions. Hence, ordinary activity can generally be recommended to this group of patients.