Can you clarify your source for the Guromorthy article? I thought that he
was the one that found a Philadelphia collar was most effective?
Cheers, Ross
----- Original Message -----
From: Anna Lee, Principal <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 27, 2000 7:11 PM
Subject: Re: whiplash patients
>
> 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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