WHIPLASH 1997-8
Article References & Abstracts
(see also Pathology, Litigation, Prognosis)
 
THERAPY
Article References & Abstracts
 
12.  AUTHOR Pettersson K; Toolanen G
INSTITUTIONDepartment of Orthopaedics, Umea University, Sweden.
TITLE High-dose methylprednisolone prevents extensive sick leave after whiplash injury. A prospective, randomized, double-blind study.
SOURCE Spine 1998 May 1;23(9):984-9 ISSN 0362-2436
ABSTRACTSTUDY DESIGN: A prospective, randomized, double-blind study comparing high-dose methylprednisolone with placebo. OBJECTIVES: To evaluate the efficacy of high-dose methylprednisolone when administered within 8 hours after whiplash injury. SUMMARY OF BACKGROUND DATA: Whiplash injury often results in chronic symptoms. The management of whiplash injuries is controversial, and pharmacologic therapy has received little evaluation. In recent reports, dysfunction of the central nervous system has been indicated in several cases. Methylprednisolone administered within 8 hours after the injury to patients with acute spinal cord injury has been demonstrated to improve the outcome. This procedure was also adopted in a randomized study of cases of whiplash injury in car accidents. METHODS: Forty patients, 22 men and 18 women with a mean age of 35 years (range, 19-65), were included in the study, 20 in each of two groups. They were treated for whiplash injury, which they had sustained in car accidents. The patients were enrolled if their diagnoses were complete and treatment had begun within 8 hours after injury. Disabling symptoms severe enough to prevent the patient from returning to work, number of sick days before and after injury, and sick-leave profile after injury were used as parameters for the evaluation of the effects of the treatment. Baseline demographic data were controlled for when statistical analysis had been performed. RESULTS: At the follow-up examination 6 months after initial treatment, there was a significant difference in disabling symptoms between the actively treated patients and the placebo group (P = 0.047), total number of sick days (P = 0.01), and sick-leave profile (P = 0.003). CONCLUSIONS: The results of this study indicate that acute treatment with high-dose methylprednisolone may be beneficial in preventing extensive sick leave after whiplash injury. However, the number of patients studied was small, and therefore further prospective, controlled studies are needed.
13.  AUTHOR Borchgrevink GE; Kaasa A; McDonagh D; Stiles TC; Haraldseth O; Lereim I
INSTITUTIONEmergency Clinic, University Hospital, Trondheim, Norway.
TITLE Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident.
SOURCE Spine 1998 Jan 1;23(1):25-31 ISSN 0362-2436 
ABSTRACTSTUDY DESIGN: A single-blinded, randomized treatment study with a follow-up period of 6 months. OBJECTIVE: To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident. SUMMARY OF BACKGROUND DATA: Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain. METHOD: Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period. RESULTS: There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache. CONCLUSIONS: The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.
14.  AUTHOR Giebel GD; Edelmann M; Huser R
INSTITUTIONIl. Lehrstuhl fur Chirurgie, Universitat zu Koln.
TITLE [Sprain of the cervical spine: early functional vs. immobilization treatment] Vernacular Title [Die Distorsion der Halswirbelsaule: fruhfunktionelle vs. ruhigstellende Behandlung.]
SOURCE Zentralbl Chir 1997;122(7):517-21 ISSN 0044-409X
ABSTRACTNeck sprains are very common injuries often treated with immobilisation of different duration. The treatment with collars was tested against physiotherapy in a prospective randomised trial. Endpoints were defined as state of health, pain and costs. Ninety-seven patients with whiplash injuries were splitted by randomisation into two groups. One group was treated with a certain scheme of physiotherapy. Another group was treated with collar immobilisation for 3 weeks. Concerning symptoms at the time of admittance, age and sex distribution the groups were comparable. Fifty healthy persons with the same age and sex distribution served as a control group. Regarding to physical state of health and pain, which were examined by valid questionnaires, significant advantages of physiotherapy after two weeks were found. After 12 weeks the physical state of health corresponds to that of the control group. No influence on psychical state of health was seen. Physiotherapy for treatment of neck sprain is highly recommended. It has clear advantages over the treatment with collars with regard to state of health and pain, and it seems to be economically favourable.
15.  AUTHOR Olson VL
INSTITUTIONHealth East-St John's Hospital, Maplewood, Minn, USA.
TITLE Whiplash-associated chronic headache treated with home cervical traction.
SOURCE Phys Ther 1997 Apr;77(4):417-24 ISSN 0031-9023 
ABSTRACTThe subject of this case report was a 56-year-old woman who sustained a whiplash-associated disorder as a result of a motor vehicle accident. Within a few hours after the accident, she developed a headache, which became chronic, creating disability and hindering the quality of her life. In the following year, a variety of diagnostic tests, medications, and physical therapy were unsuccessful in determining the cause of her complaints or in relieving them. After this year, she expressed anger, frustration, and a reluctance to undergo additional physical therapy. By listening to her explain how she coped with her problem and observing that she lacked the ability to reduce her cervical lordosis, the therapist developed and implemented a home program of supine cervical traction and exercise. After 30 days of treatment, she was able to reduce and control her headache. This treatment and the approach used to develop the treatment may benefit other patients who have whiplash-associated chronic headache.
 
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