Whiplash Physiotherapy: How Much is Enough?

Whiplash associated disorder (WAD) encompasses a syndrome of symptoms that may result from an acceleration/deceleration injury of the neck - especially disability and neck pain.

Unfortunately, current healthcare practice leaves many patients with chronic pain. Studies consistently report that only 50% of individuals with WAD experience full recovery.1,2 Making matters worse, WAD is fairly common. For instance, it ranks as the most common non-hospitalised injury resulting from a motor vehicle crash (MVC), accounting for roughly 75% of all survivable MVC injuries.3 What can we do to improve outcomes?

Getting Enough Physiotherapy for Whiplash

One improvement may be as simple as less rationing when it comes to the number of physiotherapy visits people receive. There is some interesting data in a recent study from universities in the Netherlands, Belgium, Germany, and Sweden.1 Researchers followed 523 patients referred to primary care physiotherapy practices with WAD grade 1 to 3. The study was primarily structured to measure whether physiotherapists could reliably predict the number of supervised sessions before guidelines recommended discharge. The physiotherapists did so with fair to moderate reliability. However, their data also tallied patient-reported recovery by number of sessions.

Only 12% of patients in the study received more than 20 supervised physiotherapy sessions. However, that frequency correlated with the highest rate of recovery. Compared to patients receiving 6 to 10 sessions, patients receiving 20+ sessions proved 60% more likely to report recovery (33% versus 53%). The timing and frequency that correlated most with patient-reported recovery proved to be the least used.  

Starting Physiotherapy as Early as Possible

Last month, we reported on studies showing that waiting to start physiotherapy is counterproductive. This new study by Oostendorp et al. had similar data. The most common timing for physiotherapy initiation was at three to six months (phase 5). Patients who began physiotherapy in the acute phase proved 88% more likely to report recovery than patients who began in phase 5 (64% versus 34%).

Conclusion

The research suggests that patients with whiplash get the best recoveries from starting physiotherapy as soon as possible, even during the acute phase, and continuing physiotherapy for a full course. Doing your home exercises faithfully also improves outcomes.

References

  1. Oostendorp RA, Elvers JH, van Trijffel E, Rutten GM, Scholten-Peeters GG, De Kooning M, Nijs J, Roussel N, Samwel H. Differences between physiotherapists estimated and actual care episodes and number of sessions, and associations between care-related and patient-reported outcomes in patients with whiplash associated disorder. Annals of Physiotherapy Clinics. 2021;3(1).
  2. Sterling M, Hendrikz J, Kenardy J. Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: a prospective study. Pain. 2010 Jul 1;150(1):22-8.
  3. Connelly LB, Supangan R. The economic costs of road traffic crashes: Australia, states and territories. Accident Analysis & Prevention. 2006 Nov 1;38(6):1087-93.

 

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