Acute whiplash is a heterogeneous disorder that becomes persistent in 40 to 60% of cases. Estimates of recovery have not changed in recent decades. This randomized, single blind, controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash (< 4 weeks post-injury) could reduce the incidence of chronicity at 6-months by 50% compared to usual care. Participants (n = 101) were recruited from accident and emergency centres and the community. It was hypothesized that better recovery rates were achievable if the heterogeneity was recognised and patients received individualised interventions. Patients randomized to pragmatic intervention (n = 49) could receive pharmaceutical management (ranging from simple to opioid analgesia), multimodal physiotherapy and psychology for post-traumatic stress based on their presentations. The treatment period was 10-weeks with follow-up at 11-weeks, 6 and 12-months. The primary outcome was neck pain and disability (Neck Disability Index (NDI)). Analysis revealed no significant differences in frequency of recovery (NDI8%) between pragmatic and usual care groups at 6 months (OR (95%CI) 0.55 (0.23 to 1.29), p = 0.163) or 12 months (OR (95%CI) 0.65 (0.28 to 1.47), p = 0.297). There was no improvement in current non-recovery rates at 6 months (63.6% pragmatic care; 48.8% usual care), indicating no advantage of the early multi-professional intervention. Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12 months in both groups, suggesting that future research focus on finding early effective pain management particularly for the sub-group of patients with initial high levels of pain and disability towards improving recovery rates. Australian Clinical Trials Registry (ACTRN12605000109606).

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