Whiplash and its treatment.

Background: Active interventions show beneficial effect on recovery for patients with Whiplash-Associated Disorders grade 1 and 2. However, it is unclear who of the care providers in primary care is best able to provide these active treatment strategies. Methods: The objective of the study was to compare the effectiveness of general practitioner care (education and advice) and physiotherapy (education, advice and active exercise therapy) in the treatment of Whiplash-Associated Disorders. Whiplash patients with symptoms or disabilities at two weeks after accident were recruited in primary care. Eligible patients still having symptoms or disabilities at four weeks were randomly allocated to general practitioner care or physiotherapy. Primary outcome measures included neck pain intensity, headache intensity and work activities. Furthermore, functional recovery, cervical range of motion, disability, housekeeping and social activities, fear of movement, coping and general health status were measured by an independent blinded assessor. We assessed outcomes at 8, 12, 26 and 52 weeks after the accident. Results: 80 patients were randomized to either general practitioner care (n=42) or physiotherapy (n=38). At 12 and 52 weeks, no significant differences were found concerning the primary outcome measures. At 12 weeks physiotherapy was significantly more effective than general practitioner care for improving cervical range of motion (adjusted mean difference 12.3 degrees; 95% CI: 2.7 to 21.9). Long-term differences between the groups favored general practitioner care, but were statistically significant only for some secondary outcome measures including functional recovery (adjusted relative risk: 2.3; 95% CI: 1.0 to5.0), coping (adjusted mean difference 1.7 points; 95% CI: 0.2 to 3.3) and physical functioning (adjusted mean difference 8.9 points; 95% CI: 0.6 to 17.2). The use of co-interventions was higher for patients allocated to general practitioner care than for physiotherapy. Conclusions: We found no significant differences for the primary outcome measures. The long-term effects of general practitioner care seem to be better compared to physiotherapy for functional recovery, coping and physical functioning. But, PT is more effective than GP care on cervical range of motion at short-term follow-up. A referral for PT seems useful when patients indicate high initial neck pain or the aim of treatment is to improve cervical range of motion. However, PTs need to pay more attention to the ability to perform activities and the potential influence of psychosocial factors on recovery in their treatment