Treatment of whiplash-associated disorders - Part I: Non-invasive interventions
A Conlin | R Teasell | S Bhogal | K Sequeira
BACKGROUND: A whiplash-associated
disorder (WAD) is an injury due to an acceleration-deceleration
mechanism at the neck. WAD represents a very common
and costly condition, both economically and socially.
In 1995, the Quebec Task Force published a report
that contained evidence-based recommendations regarding
the treatment of WAD based on studies completed before
1993 and consensus-based recommendations.
objective of the present article - the first installment
of a two-part series on interventions for WAD - is
to provide a systematic review of the literature
January 1993 and July 2003 on noninvasive interventions
for WAD using meta-analytical techniques.
OF THE REVIEW: Three
medical literature databases were searched for identification
of all studies on the treatment of WAD. Randomized
controlled trials (RCTs) and epidemiological studies
were categorized by treatment modality and analyzed
by outcome measure. The methodological quality of
the RCTs was assessed. When possible, pooled analyses
of the RCTs were completed for meta-analyses of the
data. The results of all the studies were compiled
and systematically reviewed.
RESULTS: Studies were categorized
as exercise alone, multimodal intervention with exercise,
mobilization, strength training, pulsed magnetic
field treatment and chiropractic manipulation. A
total of eight RCTs and 10 non-RCTs were evaluated.
The mean score of methodological quality of the RCTs
was five out of 10. Pooled analyses were completed
across all treatment modalities and outcome measures.
The outcomes of each study were summarized in tables.
CONCLUSIONS: There exists consistent
evidence (published in two RCTs) in support of mobilization
as an effective noninvasive intervention for acute
WAD. Two RCTs also reported consistent evidence that
exercise alone does not improve range of motion in
patients with acute WAD. One RCT reported improvements
in pain and range of motion in patients with WAD
of undefined duration who underwent pulsed electromagnetic
field treatment. Conflicting evidence in two RCTs
exists regarding the effectiveness of multimodal
intervention with exercise. Limited evidence, in
the form of three non-RCTs, exists in support of
chiropractic manipulation. Future research should
be directed toward clarifying the role of exercise
and manipulation in the treatment of WAD, and supporting
or refuting the benefit of pulsed electromagnetic
field treatment. Mobilization is recommended for
the treatment of pain and compromised cervical range
of motion in the acute WAD patient.