Earlier and More Frequent Physiotherapy Correlates w Improved Whiplash Outcomes

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

 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?

One possible answer lies in the timing and frequency of supervised physiotherapy treatment. We are reminded of this by a recently published study out of 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 timing of referral and number of sessions. In raw numbers (P>0.05), physiotherapy beginning in the acute phase (less than 7 days) and physiotherapy lasting longer than 20 sessions correlated with improved outcomes. For instance, in the study 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%).

Likewise, 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. The correlations charted in the current study concur with older studies showing that physiotherapy initiated in the acute phase provides the best outcomes.4-6 In fact, in terms of pain and range of motion measured three years after the MVC, it was best to receive physiotherapy within 96 hours of the injury.

Only those patients demonstrated a neck range of motion approaching normal. Given the cost of time off work and healthcare treatment over the three years, referral during the acute phase also proved the most economical.

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