Hello, this may be of interest -
Three level II studies (Gennis et al 1996, Borchgrevink et al 1998
Gurumoorthy 1999) on 196, 178 and 220 whiplash patients respectively
concluded that
1. "soft collars do not influence the duration or degree of persistent pain"
;
2. "...... patients instructed to continue engaging in their normal
activities had a better outcome than patients who took sick leave and were
immobilised in a soft neck collar in the first 14 days after the accident."
3. " ........ early mobilisation followed by defined active exercise
programme is the best physical therapy approach to the treatment of acute
whiplash injuries"
more information available from the APA Neck pain position statement 1999
Cheers,
Anna.
Anna Lee
Principal,
Work Ready - Industrial Athlete Centre
Physiotherapist and Occupational Health Consultant
Write to me at [log in to unmask]
Visit me at www.workready.com.au
Snail mail:
Suite 3, 82 Enmore Road,
Newtown NSW 2042
Australia
Tel: (02) 9519 7436
Mob: 0412 33 43 98
Fax: (02) 9519 7439
----- Original Message -----
From: "Marc White" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, 28 March 2000 3:03
Subject: Re: whiplash patients
> The study was presented at the World Congress on Whiplash-Associated
> Disorders in Vancouver, February, 1999 and appears to have some
> methodological problems. Questions from the floor included discussion of
> the high attrition rates. I suggest the study should be thoroughly
> reviewed and replicated before recommendations arising from the study be
> implemented. Further discussion can be found at the conference website:
> www.whiplash99.org
>
>
> At 01:11 AM 3/27/00 -0800, you wrote:
> >
> >The following piece from Jim Meadows at Manual Therapy Online made me
> >think. It certainly presents findings most of us wouldn't have
> >predicted. Anyone else seen this work and and want to comment on the
findings?
> >
> >" Last November, I was fortunate enough to attend the 2nd Annual
American
> >Academy of<?xml:namespace prefix = o ns =
> >"urn:schemas-microsoft-com:office:office" />
> >
> > Orthopedic Manual Physical Therapy (AAOMPT) Conference in Biloxi MS.
> > Among the
> >
> > many fine presentations I heard, Lance Twomey's ranks among the
best.
> > A highlight of his
> >
> > presentation was a summary he gave of a student's doctoral thesis on
> > the independent
> >
> > benifit of a cervical collar for recent whiplash patients. The
> > student's name was
> >
> > Gurumoorthy and his thesis earned him a Ph.D. and will be published
> > soon in Spine.
> >
> > However, the information is so useful and for most therapists so
> > radical that I thought that
> >
> > it would be appropriate to summarise Dr. Twomey's summary. I
> > apologise in advance for
> >
> > any errors that I may make, they are inadvertent and caused by
> > galloping senility.
> >
> >
> >
> > 220 post whiplash victims were randomly divided into three groups
the
> > first being asked
> >
> > to wear a Philadelphia cervical collar for one month and then to
> > discard it. These subjects
> >
> > were then put into group two. Group two subjects were assigned an
> > active program from
> >
> > day 1 which consisted on non-painful range of motion and other
> > painfree exercises. Group
> >
> > 3 were left to the care of their physician (almost invariably a
> > general practitioner) who
> >
> > usually prescribed analgesics, a soft collar and some form of self
> > activation. The accident
> >
> > had to be within forty eight hours of attendence for the patient to
> > be included as a subject.
> >
> > The subjects were tested by blinded assessors for pain, range of
> > motion, strength and
> >
> > function. Pain was evaluated on a visual analogue scale, isometric
> > strength by
> >
> > dynamometer, range of motion by goniometry and funtion by return to
> > work. The subjects
> >
> > were evaluated at 4,6, 12, 26 and 52 weeks.
> >
> >
> >
> > In every category, the collared subjects did better than those in
the
> > other two groups.
> >
> > Perhaps one the most clear cut findings was in return to function.
> > 50% of the subjects in
> >
> > the collared group were back at full function by the 26th week
> > assessment. This figure
> >
> > was not achieved in either of the other two groups.
> >
> >
> >
> > This is almost unequivocal evidence of the value of a collar in the
> > early stages of
> >
> > post-whiplash. The most amazing thing about the study is that it
> > should have had to be
> >
> > carried out in the first place except as a means of confirming an
> > established and obvious
> >
> > practice. With even a little thought is is obvious that an acutely
> > injured neck requires the
> >
> > same care as an acute knee injury. That is rest while the
> > inflammation subsides. In the
> >
> > knee patient we would have no trouble understanding the need to have
> > the patient
> >
> > non-weight bearing, using a compression bandage, applying ice and
> > generally resting it.
> >
> > But in the whiplash patient, there seems to be a lack of common
sense
> > by many health
> >
> > care providers from all disciplines. The sports medicine model is
> > often applied
> >
> > indiscriminately with no thought to the fact that it is not an
> > athlete that we are treating nor
> >
> > is it a sport injury. In any event, an athlete with an acute knee
> > would be rested until the
> >
> > effusion had subsided and if this did not occur in a timely fashion,
> > considerable expense
> >
> > and time would be spent investigating the reason for delayed
> > recovery. If we (the
> >
> > combined health care professions) can be this concered about what is
> > essenially a
> >
> > self-inflicted injury, why cannot we be so with some poor soul hit
in
> > the rear sitting at a
> >
> > traffic light. " Jim Meadows -Manual Therapy Online
>
> Marc White, Executive Director
> Physical Medicine Research Foundation
> Suite 510, 207 West Hastings St.,
> Vancouver, B.C. V6B 1H7
> Tel: In North America +800 872-3105
> Elsewhere +1 604 684-4148 Fax: +1 604 684-6247
> Website: www.icpro.org
> Related Sites: www.whiplash99.org,
> www.health-sciences.ubc.ca/whiplash.bc/home.html
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