Whiplash study says no benefits from intensive treatment

Crash test dummy About a third of people with whiplash have long-term pain

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Intensive whiplash treatment is no better than standard care, a study suggests.

The study, in the Lancet looked at the treatment of more than 2,700 people with mild to moderate whiplash.

No additional benefits were seen in those who had more intensive care - which included suggesting a rapid return to normal activities.

A Canadian expert said the study showed the lack of benefit from "unnecessary treatments".

Whiplash injuries cost the UK economy about £3.1bn a year, mainly due to the expense of treating those with chronic symptoms (between 30-50%) and their subsequent need to take time off work.

Long-term problems can include pain from even the smallest movement, difficulty sleeping and even being unable to work.

Compensation claims for whiplash injury have risen, with about 1,500 made every day in the UK, even though there has been a fall of about 20% in road accidents since 2006.

Earlier this year, the government promised to take action to reduce the number of claims.

Positive messages

There has been debate since the 1980s about how best to deal with whiplash injury, but little research to support any specific approach.

Some researchers have suggested that training A&E staff to provide more intensive treatment - with more positive messages about recovery and specific advice on beneficial exercises as well as advising an early return to work and normal activities - could help people recover more quickly.

Start Quote

Emergency departments are providing evidence-based and cost-effective treatment when they do less, not more”

End Quote Robert Ferrari,

The University of Warwick researchers compared this "active management" approach, with the standard care - general advice to exercise and advice sheets.

Patients from 12 NHS hospitals across the UK were followed up for a year. But the researchers found no difference in how those with the more intensive care fared with those who had the usual treatment.

Those whose symptoms persisted for more than three weeks were also invited to take part in a physiotherapy trial.

The 599 patients who participated were randomly assigned to receive either a single advice session with a physiotherapist or a package of up to six physio sessions.

But it was found that having the longer course did not offer any major benefit and, while it appeared people who had more physio recovered more quickly initially, there was no difference between the groups at the eight or 12-month mark.

'Societal expectations'

Prof Sarah Lamb, who led the study, said: "Our findings suggest that that more enhanced forms of treatment that include positive messages about recovery, exercise, and early return to normal activities as well as pain management, do not speed recovery.

"What is more, although additional physiotherapy, beyond a single advice session, did offer a modest benefit, it was not cost-effective."

She added: "I think it's clear from this that the NHS shouldn't be involved in providing people with a long course of physio."

Writing in the Lancet, Robert Ferrari, from the University of Alberta in Canada, said: "The challenge now is to change societal expectations about whiplash injury.

"Legislative changes could reduce the extent to which expectations can be met - less contact with lawyers, insurers, and the treatment industry could reduce the encouragement of these expectations and the behaviour that follows.

"Not prescribing unnecessary treatment might also help to change beliefs about the nature of the injury, and thus studies like that of Lamb and colleagues are needed.

"At the very least, to reduce health-care costs, Lamb and colleagues have shown that the emergency departments are providing evidence-based and cost-effective treatment when they do less, not more."

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