Sorry if I am missing something, but which collared group had the best
results? The Philadelphia collar or the soft collar group?
Cathy
crm3a 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
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