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Conservative treatments for whiplash
A P Verhagen1, G G M Scholten-Peeters, R A de Bie
1Dept. of General Practice, Erasmus Medical Centre, University of Rotterdam, PO Box 1738, 3000 DR Rotterdam, NETHERLANDS.
The Cochrane Database of Systematic Reviews
|February 20, 2004
Summary
Conservative treatments for whiplash-associated disorders (WAD) show limited evidence of effectiveness compared to no treatment. Active interventions may be more effective than passive ones, but clear conclusions are not yet possible due to poor study quality.
Area of Science:
- Orthopedics and Sports Medicine
- Physical Therapy and Rehabilitation
- Evidence-Based Medicine
Background:
- Previous reviews on conservative whiplash-associated disorders (WAD) treatments were published in 2001.
- WAD is classified into grades 0-4 based on symptom severity.
- New clinical trials have emerged since the last review.
Purpose of the Study:
- To evaluate the efficacy of conservative interventions for patients diagnosed with WAD Grades 1 or 2.
- To synthesize current evidence on treatments for acute and chronic whiplash injuries.
Main Methods:
- Comprehensive literature search of multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycLIT, PEDro) up to April 2003.
- Inclusion of randomized clinical trials assessing conservative treatments for WAD, measuring pain, perceived effect, or daily activity.
- Independent quality assessment using the Delphi list and data extraction; analysis based on levels of evidence due to heterogeneity.
Main Results:
- Fifteen studies met inclusion criteria, with only one focusing on chronic WAD.
- Overall methodological quality was poor, with only three studies meeting high-quality criteria.
- Limited evidence suggests both passive and active interventions are superior to no treatment; evidence comparing active versus passive interventions is conflicting.
Conclusions:
- The previous conclusion that 'rest makes rusty' is no longer supported by current data.
- A trend suggests active interventions may be more effective than passive ones, but definitive conclusions cannot be drawn.
- Insufficient high-quality evidence exists to determine the most effective therapy for chronic WAD.