Educational sessions as effective as physiotherapy for chronic whiplash pain [PROMISE trial]
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1. Multiple compressive and personalized therapy sessions were no more beneficial in reducing whiplash symptoms than advice sessions.
2. The study recorded no serious adverse events.
Evidence Rating Level: 2 (Good)
Study Rundown: The pain and debilitation caused by a whiplash injury may persist over a period of months to years, long after the initial treatment. The current recommended approach consists of multiple intense physiotherapy sessions. Previous studies of acute whiplash injuries have demonstrated that intensive physiotherapy sessions may be no more beneficial than a single educational session. In the current study, the investigators were able to replicate this finding across a group of chronic whiplash patients. The study found that the intensive rounds of physical therapy offered little additional benefit when compared with the advice alone. These results suggest that the more expensive and regimented therapy sessions may be unnecessary and uneconomical. The study was limited by the small number of participants (n=86 for each cohort). It is also important to note that neither the participants nor the treatment providers were blinded.
The study was funded by the National Health and Medical Research Council of Australia, Motor Accidents Authority of New South Wales, and Motor Accident Insurance Commission of Queensland.
Click to read the study, published today in The Lancet
Relevant Reading: Course and prognostic factors of whiplash: a systematic review and meta-analysis
In-Depth [randomized controlled trial]: This study compared the efficacy of intensive physiotherapy to advice and education in treating pain associated with grade 1 or 2 whiplash-associated disorder. 172 participants with chronic (>3 months, < 5 years) whiplash were randomly assigned to received either 20 hour-long sessions of physical therapy (n=86), or one informational session and subsequent phone support (n=86).
The primary outcome was pain intensity. This was measured at several intervals (14 weeks, 6 months, and 1 year) by a blinded investigator using a 10-point scale. CNS hyper-excitability and neuropathic pain were also assessed. At 14 weeks, 6 months, and 1 year, the treatment effect was 0.0 (95% CI -0.7 to 0.7), 0.2 (CI -0.5 to 1), and -0.1 (CI -0.8 to 0.6) respectively. None of the recorded measurements reached a clinically significant level for treatment effect. Additionally, CNS hyper-excitability of the participants did not significantly impact the treatment effect. Post-hoc sensitivity analyses indicated that the study results were robust against the effects of missing data.
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