Background & Aims

Whiplash disorder (WAD) is a common condition and can cause major individual and societal challenges. It is defined as an injury caused by rapid acceleration immediately followed by rapid deceleration of the head and neck. Over 40% of patients who experience WAD become chronic. Not only do they suffer from pain, but their emotional state and quality of life are significantly affected. Given the prevalence and high cost of WAD, the development of effective therapies is of great importance. They should help to reduce pain and the risk of chronification. However, the knowledge about the efficacy of different conservative treatment modalities for WAD is limited. Thus, this systematic review aims to find the most effective therapeutic intervention between manual therapy (MT), exercise therapy (ET), pharmacological therapy, and educational therapy compared to other interventions for remaining symptoms in patients with acute WAD.

Methods

Systematic review (SR) with meta-analysis. A professional librarian searched five databases in October 2021 (OVID Med-line All, Embase (Ovid Interface), CINAHL (Ebsco Interface), Scopus, Cochrane Library) with specific keywords considering the treatments and WAD, without limitation in the year of publication and language. Randomized controlled trials including adults suffering from acute WAD were included. Subjects were required to undergo at least one of these treatments: MT, ET, pharmacological-, or educational therapy, compared to any kind of other intervention (e.g., placebo, no-treatment, active comparator group). The first and second screening as well as data extraction and Risk of Bias (RoB) assessment were performed by two independent reviewers. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to assess overall evidence quality. The all data was described qualitatively and when possible, the data were pooled in a meta-analysis.

Results

Around 28.870 studies were identified and after the first screening, 125 papers met the requirements for the WAD review, but just 15 studies presented all inclusion criteria and were included. The main analysis focused on differences (before and after treatment and follow-up period) for pain intensity, disability, total cervical range of motion, flexion/extension, rotation right/left, lateral flexion, and emotional functioning. The results of this SR showed advantages in combining MT with ET over a cervical collar on pre-post pain intensity scores (SMD [95%CI] 0.31 [0.17, 0.46], p=0.0002) and disability (SMD [95%CI] -0.60 [-0.82, -0.38], p=0.04). No accurate conclusion can be drawn for pharmacological treatments because of the lack of data. All studies showed a high RoB and reasons included inadequate blinding of participants, heterogeneity of baseline data between groups and high dropout rates. The quality of evidence was rated low (n=13 comparisons) and very low (n=15 comparisons).

Conclusions

MT combined with ET appears to be more effective than a cervical collar in changing pain intensity and disability in acute WAD. Because all studies have a high risk of bias and the quality of the evidence was rated low to very low, the results of this systematic review must be taken with caution. Further research and higher-quality evidence are needed to confirm this conclusion.

References

1. Wiangkham T, Duda J, Haque S, Madi M, Rushton A. The effectiveness of conservative management for acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2015;10(7):e0133415.
2. Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, et al. A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 2–interventions for acute WAD. Pain Research and Management. 2010;15(5):295-304.
3. Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. The Spine Journal. 2016;16(12):1598-630.
4. Peloso PM, Gross AR, Haines TA, Trinh K, Goldsmith CH, Aker P. Medicinal and injection therapies for mechanical neck disorders: a Cochrane systematic review. The Journal of rheumatology. 2006;33(5):957-67.

Presenting Author

Jordana Barbosa-Silva

Poster Authors

Jordana Barbosa da Silva

PhD

University of Applied Sciences Osnabrück - Hochschule Osnabrück

Lead Author

Ana Izabela Sobral de Oliveira Souza

Hochschule Osnabrück

Lead Author

Linus Zur-Lienen

BSc

Lead Author

Fabian Niestrat

BSc

Lead Author

Nikolaus Ballenberger

PhD

University of Applied Sciences Osnabrück - Hochschule Osnabrück

Lead Author

Susan Armijo-Olivo

PhD

Hochschule Osnabrück

Lead Author

Topics

  • Models: Acute Pain