No added benefit of active management in ER; PT package more costly, modest early benefit
TUESDAY, Dec. 18 (HealthDay News) -- For patients with acute whiplash, usual care in the emergency department and a single session with a physical therapist are recommended, according to a study published online Dec. 18 in The Lancet.
Sarah E. Lamb, D.Phil., from the University of Warwick in Coventry, U.K., and colleagues conducted a two-step study to compare the effectiveness of treatments for acute whiplash injury in 12 National Health Service (NHS) Trust Hospitals. In step 1, patients were randomly allocated to usual care (1,598 patients) or active management (2,253 patients) in the emergency department. In step 2,599 patients with persisting symptoms were randomized to receive one physical therapy advice session (299 patients) or a physical therapy package (300 patients).
The researchers found that 70 percent of patients from step 1 and 80 percent from step 2 provided follow-up data at 12 months. For step 1, there was no difference between active management and usual care in the neck disability index. For step 2, there was a modest benefit in the neck disability index at four months with the physical therapy package versus a single session, but no difference at eight or 12 months. Compared with usual care and single advice sessions, active management and the physical therapy package were more expensive. There were no treatment-related serious adverse events or deaths.
"Our findings show that no additional benefit exists to providing active management consultations in the emergency department," the authors write. "A package of physical therapy has a modest effect on early recovery of persisting symptoms but is not cost effective from a U.K. NHS perspective."
Abstract (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61304-X/abstract )Full Text (subscription or payment may be required) (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61304-X/fulltext )Editorial (subscription or payment may be required) (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61416-0/fulltext )