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. 2004 May;21(3):306–310. doi: 10.1136/emj.2003.010165

Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury

M Schnabel 1, R Ferrari 1, T Vassiliou 1, G Kaluza 1
PMCID: PMC1726332  PMID: 15107368

Abstract

Objectives: Standard therapy in Germany for acute whiplash injury has traditionally included a soft collar (cervical orthosis), an approach that is passive compared with early exercise and mobilisation. The purpose of this study is to examine the recovery in the first six weeks of groups of acute whiplash injury patients subjected to two different treatment approaches, the traditional approach of a collar compared with active, early mobilisation.

Methods: Between August 1997 and February 2000 a randomised clinical trial with a total of 200 patients was performed. A total of 97 were randomly assigned to a collar therapy group, and 103 to the exercise group, treated by a physiotherapist. Study participants recorded average pain and disability twice (baseline and six week follow up) during a one week period by diary, using numeric visual analogue (VAS) rating scales ranging from 0 to 10.

Results: The initial mean VAS pain intensity and VAS disability reported by the collar therapy group and the exercise group showed no statistical difference. The mean VAS pain rating reported by the collar therapy group after six weeks was 1.60 and mean VAS disability rating was 1.56. The mean VAS pain intensity of the exercise group was 1.04 and mean VAS disability was 0.92. These differences between the groups were both significant, as was the reduction in the prevalence of symptoms in the exercise therapy group compared with the collar group at six weeks.

Conclusions: Early exercise therapy is superior to the collar therapy in reducing pain intensity and disability for whiplash injury.

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Selected References

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  1. Berglund A., Alfredsson L., Cassidy J. D., Jensen I., Nygren A. The association between exposure to a rear-end collision and future neck or shoulder pain: a cohort study. J Clin Epidemiol. 2000 Nov;53(11):1089–1094. doi: 10.1016/s0895-4356(00)00225-0. [DOI] [PubMed] [Google Scholar]
  2. Borchgrevink G. E., Smevik O., Nordby A., Rinck P. A., Stiles T. C., Lereim I. MR imaging and radiography of patients with cervical hyperextension-flexion injuries after car accidents. Acta Radiol. 1995 Jul;36(4):425–428. [PubMed] [Google Scholar]
  3. Brühlmann P., Stucki G., Michel B. A. Evaluation of a German version of the physical dimensions of the Health Assessment Questionnaire in patients with rheumatoid arthritis. J Rheumatol. 1994 Jul;21(7):1245–1249. [PubMed] [Google Scholar]
  4. Cassidy J. D., Carroll L. J., Côté P., Lemstra M., Berglund A., Nygren A. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med. 2000 Apr 20;342(16):1179–1186. doi: 10.1056/NEJM200004203421606. [DOI] [PubMed] [Google Scholar]
  5. Chrubasik S., Junck H., Zappe H. A., Stutzke O. A survey on pain complaints and health care utilization in a German population sample. Eur J Anaesthesiol. 1998 Jul;15(4):397–408. doi: 10.1046/j.1365-2346.1998.00317.x. [DOI] [PubMed] [Google Scholar]
  6. Ferrari R. Prevention of chronic pain after whiplash. Emerg Med J. 2002 Nov;19(6):526–530. doi: 10.1136/emj.19.6.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ferrari R., Schrader H. The late whiplash syndrome: a biopsychosocial approach. J Neurol Neurosurg Psychiatry. 2001 Jun;70(6):722–726. doi: 10.1136/jnnp.70.6.722. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ferrari Robert, Russell Anthony S. Regional musculoskeletal conditions: neck pain. Best Pract Res Clin Rheumatol. 2003 Feb;17(1):57–70. doi: 10.1016/s1521-6942(02)00097-9. [DOI] [PubMed] [Google Scholar]
  9. Gargan M. F., Bannister G. C. The rate of recovery following whiplash injury. Eur Spine J. 1994;3(3):162–164. doi: 10.1007/BF02190579. [DOI] [PubMed] [Google Scholar]
  10. Gennis P., Miller L., Gallagher E. J., Giglio J., Carter W., Nathanson N. The effect of soft cervical collars on persistent neck pain in patients with whiplash injury. Acad Emerg Med. 1996 Jun;3(6):568–573. doi: 10.1111/j.1553-2712.1996.tb03466.x. [DOI] [PubMed] [Google Scholar]
  11. Hildingsson C., Toolanen G. Outcome after soft-tissue injury of the cervical spine. A prospective study of 93 car-accident victims. Acta Orthop Scand. 1990 Aug;61(4):357–359. doi: 10.3109/17453679008993536. [DOI] [PubMed] [Google Scholar]
  12. Kjellman G. V., Skargren E. I., Oberg B. E. A critical analysis of randomised clinical trials on neck pain and treatment efficacy. A review of the literature. Scand J Rehabil Med. 1999 Sep;31(3):139–152. doi: 10.1080/003655099444489. [DOI] [PubMed] [Google Scholar]
  13. Logan A. J., Holt M. D. Management of whiplash injuries presenting to accident and emergency departments in Wales. Emerg Med J. 2003 Jul;20(4):354–355. doi: 10.1136/emj.20.4.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mayou R., Bryant B. Outcome of 'whiplash' neck injury. Injury. 1996 Nov;27(9):617–623. doi: 10.1016/s0020-1383(96)00114-3. [DOI] [PubMed] [Google Scholar]
  15. McKinney L. A. Early mobilisation and outcome in acute sprains of the neck. BMJ. 1989 Oct 21;299(6706):1006–1008. doi: 10.1136/bmj.299.6706.1006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Obelieniene D., Schrader H., Bovim G., Miseviciene I., Sand T. Pain after whiplash: a prospective controlled inception cohort study. J Neurol Neurosurg Psychiatry. 1999 Mar;66(3):279–283. doi: 10.1136/jnnp.66.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Partheni M., Constantoyannis C., Ferrari R., Nikiforidis G., Voulgaris S., Papadakis N. A prospective cohort study of the outcome of acute whiplash injury in Greece. Clin Exp Rheumatol. 2000 Jan-Feb;18(1):67–70. [PubMed] [Google Scholar]
  18. Partheni M., Miliaras G., Constantoyannis C., Papadakis N. Whiplash injury. J Rheumatol. 1999 May;26(5):1206–1210. [PubMed] [Google Scholar]
  19. Peeters G. G., Verhagen A. P., de Bie R. A., Oostendorp R. A. The efficacy of conservative treatment in patients with whiplash injury: a systematic review of clinical trials. Spine (Phila Pa 1976) 2001 Feb 15;26(4):E64–E73. doi: 10.1097/00007632-200102150-00006. [DOI] [PubMed] [Google Scholar]
  20. Radanov B. P., di Stefano G., Schnidrig A., Ballinari P. Role of psychosocial stress in recovery from common whiplash [see comment]. Lancet. 1991 Sep 21;338(8769):712–715. doi: 10.1016/0140-6736(91)91441-v. [DOI] [PubMed] [Google Scholar]
  21. Schrader H., Obelieniene D., Bovim G., Surkiene D., Mickeviciene D., Miseviciene I., Sand T. Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet. 1996 May 4;347(9010):1207–1211. doi: 10.1016/s0140-6736(96)90733-3. [DOI] [PubMed] [Google Scholar]
  22. Spitzer W. O., Skovron M. L., Salmi L. R., Cassidy J. D., Duranceau J., Suissa S., Zeiss E. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine (Phila Pa 1976) 1995 Apr 15;20(8 Suppl):1S–73S. [PubMed] [Google Scholar]
  23. Weinhardt C., Heller K. D. Wert der Physiotherapie bei der Halswirbelsäulendistorsion: ein systematischer Uberblick. Z Orthop Ihre Grenzgeb. 2002 Sep-Oct;140(5):499–502. doi: 10.1055/s-2002-34008. [DOI] [PubMed] [Google Scholar]
  24. Zink A., Braun J., Listing J., Wollenhaupt J. Disability and handicap in rheumatoid arthritis and ankylosing spondylitis--results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol. 2000 Mar;27(3):613–622. [PubMed] [Google Scholar]

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