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| Effectiviteit van fysiotherapie bij whiplashpatienten: een gerandomiseerd klinisch onderzoek (Effectiveness of physiotherapy and general practitioner care in patients with whiplash-associated disorders: a randomized clinical trial) [Dutch] |
| Scholten-Peeters GGM, Neeleman-van der Steen CWM, van der Windt DAWN, Hendriks HJM, Verhagen AP, Oostendorp RAB |
| Nederlands Tijdschrift voor Fysiotherapie [Dutch Journal of Physical Therapy] 2006;116(1):8-15 |
| clinical trial |
| 8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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BACKGROUND: Available evidence from systematic reviews indicates that active interventions are beneficial to patients with shiplash-associated disorders grade 1 and 2. However, it remains unclear which kind of treatment is most effective. OBJECTIVE: To compare the effectiveness of education and advice given by general practitioners with education, advice, and active exercise therapy given by physiotherapists for the treatment of patients with whiplash-associated disorders. METHODS: Whiplash patients with symptoms or disabilities for at 2 weeks after an accident were recruited in primary care. Eligible patients who still had symptoms or disabilities at 4 weeks were randomly allocated to general practitioner care or physiotherapy. Primary outcome measures included neck pain intensity, headache intensity, and work activities. Functional recovery, cervical range of motion, disability, housekeeping and social activities, fear of movement, coping, and general health status were measured by independent, blinded assessors. Outcomes were assessed at 8, 12, 26 and 52 weeks after the accident. RESULTS: Eighty patients were randomized to either general practitioner care (n = 42) or physiotherapy (n = 38). At 12 and 52 weeks, there were no significant differences in the primary outcome measures. The mean number of treatment sessions was 4 for the general practitioner group and 13 for the physiotherapy group. At 12 weeks physiotherapy was significantly more effective than general practitioner care for improving cervical range of motion. Long-term differences between the groups favoured general practitioner care but were statistically significant for only some secondary outcome measures, including functional recovery, coping and physical functioning. CONCLUSIONS: We found treatment provided by general practitioners and physiotherapists to be similarly effective in patients with whiplash-associated disorders. General practitioner care seems to have a better effect than physiotherapy on long-term functional recovery, coping, and physical functioning.
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