STUDY DESIGN: A systematic review of the literature. OBJECTIVES: To assess the efficacy of conservative treatment in patients with whiplash injuries. SUMMARY OF BACKGROUND DATA: Many treatments are available for patients with a whiplash injury, but there continues to be no evidence for their accepted use. METHODS: A computerised literature search of Medline, Embase, CINAHL, Psychlit and the Cochrane Controlled Trial Register was performed. Studies were selected if the design was a (randomised) clinical trial; if all patients had sustained a whiplash injury; if the type of intervention was a conservative one; if pain, global perceived effect and participation in daily activities were used as one of the outcome measures, and if the publication was written in English, French, German, or Dutch. The methodologic quality was independently assessed by two reviewers by using the Masastricht-Amsterdam list. Three quality scores were calculated using this criteria list: the overall methodologic quality score, the internal validity score, and the Delphi Quality Score. The conclusion of the review was based on articles that scored a quality score of at least 50% of the maximum available score on two of three quality scores. RESULTS: Eleven studies met the inclusion criteria. Only three studies satisfied at least 50% on two of three ways of calculating a quality score, indicating overall poor methodology. There was a high rank correlation among the three ways of calculating a quality score. No statistical pooling was performed because of the heterogeneity of the interventions. This review indicates that active treatments show a beneficial long-term effect on at least one of the primary outcome measures. CONCLUSION: Caution is needed when drawing a valid conclusion on the efficacy of conservative treatments in patients with whiplash injury. It appears that "rest makes rusty", whereas active interventions have a tendency to be more effective in patients with whiplash injury.
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