Offering Advice to Patients with Chronic Whiplash-associated Disorders Reduces Pain Comparable to Physiotherapy

Simple advice is equally as effective as more intense and comprehensive physiotherapy exercise programs for chronic whiplash-associated disorders, according to the results of a recent Australian study published April 4, 2014, in Lancet.

For their pragmatic, randomized controlled PROMISE trial, Zoe A. Michaleff, PhD, of the George Institute for Global Health and Sydney Medical School and colleagues assigned 172 patients with a grade 1 or 2 whiplash-associated disorder lasting more than 3 months but less than 5 years to participate in either 20 sessions of a comprehensive exercise program or to receive advice at one session along with telephone support.

According to the study authors, the primary outcome was pain intensity measured on a scale of 0-10 at baseline, 14 weeks, 6 months, and 12 months by a hidden assessor. At the conclusion of the trial, the 20-session comprehensive exercise program delivered by physiotherapists was not more effective than simple advice on pain reduction, the researchers said. Central nervous system (CNS) hyperexcitability and symptoms of posttraumatic stress disorder (PTSD) did not modify the effect of treatment, and no serious adverse events were reported.

The study authors said their findings offer information that can help “identify effective and affordable strategies to prevent and treat acute through to chronic whiplash-associated disorders,” which they noted is an “important health priority.” Nevertheless, the researchers said future analyses are needed on “improving the understanding of the mechanisms behind persisting pain and disability, the timing of medications, and … content and delivery of education and advice.”

The present study received funding from the National Health and Medical Research Council of Australia, Motor Accidents Authority of New South Wales, and Motor Accident Insurance Commission of Queensland.