Treatment of whiplash associated disorders
Abstract
Whiplash injuries seem to have a substantial impact on health. Half the affected
patients have persistent pain and disability and significant costs are incurred to
society, mainly due to inability to return to work. The pathophysiology of the
condition is largely unknown and there has been much debate on how whiplashassociated
disorders (WAD) should be treated. In this dissertation, the treatment of
acute and chronic WAD has been elucidated. The evidence basis of many commonly used treatments for patients suffering
from WAD, both in the acute and chronic state was analyzed in a systematic
literature review. Twenty-six randomized controlled trials (RCT) were identified
through computer-assisted search of the databases Medline (from 1962 to May
2003), CINAHL (1960 to 2003), Embase (1976 to 2003) and Psychinfo (1960 to
2003) and manual check of the reference lists of relevant studies. Based on the
degrees of evidence and the practical obstacles the following treatments can be
recommended: Early physical activity in acute WAD, combination of cognitive
behavioral therapy with physical therapy interventions and coordination exercise
therapy in chronic WAD. The long-term (3-year) efficacy of active intervention (early mobilization with/without McKenzie treatment) in patients with acute WAD compared with
standard intervention (information broschure recommending initial rest and slow resumption of activity) and the effect of early versus delayed initiation of intervention was studied in an RCT. The active intervention was more effective in reducing pain intensity, sick leave and retaining/regaining total range of motion than the standard intervention. The effectiveness of 10 weeks of twice-weekly, 90-minute sessions of either Exercise Therapy (general conditioning, coordination, strengthening of deep cervical flexors, stretching and relaxation) or Basic Body Awareness Therapy (training comfortable posture and use of the body, balance and relaxation during movement) for patients with chronic WAD was compared in an RCT. Basic
Body Awareness Therapy resulted in slightly better effects on the physical functioning, social functioning and bodily pain domains of SF-36 and on pain frequency compared to Exercise Therapy at three months. The applicability of the fear avoidance model of chronic pain (FAM) in patients with WAD and the inclusion of a measure of guarded movement in the model were studied in a cross-sectional trial. Statistically significant correlations between all measures of the FAM were found and these measures explained part
of each other’s variance. Applying the FAM of chronic pain to patients suffering from chronic WAD appears valid.
Parts of work
I. Seferiadis A, Rosenfeld M, Gunnarsson R. A review of treatment interventions in whiplash-associated disorders. Eur Spine J. 2004 Aug; 13(5):387-97 ::pmid::15133721 II. Rosenfeld M, Seferiadis A, Carlsson J, Gunnarsson R. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial. Spine (Phila Pa 1976). 2003 Nov 15;28(22):2491-8 ::pmid::14624083 III. Seferiadis A, Ohlin P, Billhult A, Gunnarsson R. Basic body awareness therapy superior to exercise therapy for patients with chronic whiplash-associated disorders: a randomized controlled clinical trial. Manuscript IV. Seferiadis A, Ohlin P, Billhult A, Gunnarsson R. Applying the fear-avoidance model to patients with chronic whiplash associated disorders: a cross-sectional study. Manuscript
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Medicine. Department of Public Health and Community Medicine
Disputation
Fredagen den 10 september 2010, kl. 13.00, Sal 2119, Hus 2, Plan 1, Hälsovetarbacken, Göteborg
Date of defence
2010-09-10
aris.seferiadis@vgregion.se
Date
2010-08-30Author
Seferiadis, Aris
Keywords
whiplash-associated disorders
systematic review
randomized controlled trial
McKenzie method
fear-avoidance
chronic pain
exercise therapy
basic body awareness
Publication type
Doctoral thesis
ISBN
978-91-628-8158-0
Language
eng