Effective management of acute whiplash injuries requires a pragmatic approach: An RCT with stratified treatments

机动车碰撞造成的颈部扭伤继续给社区和保险业带来巨大的个人和财政损失。目前在澳大利亚和国际上对急性颈部扭伤的治疗方法未能减少患慢性颈部疼痛的人数。40%到60%的人在受伤后6个月仍然感到疼痛。汽车事故保险委员会（Qld）的数据表明，20%的慢性挥鞭样损伤患者占60%的费用。必须防止从急性疾病转变为慢性疾病。急性期的管理迫切需要一个新的方向，因为一旦疼痛变成慢性，就很难提供帮助。本研究将对急性挥鞭样损伤进行一项新的随机对照试验。它将测试单独规定的多专业管理与常规护理，旨在减少继续发展慢性疼痛的人数。这将是第一个从一开始就承认颈部扭伤会以不同的方式伤害和影响人们的临床试验。我们先前对急性颈部扭伤患者的研究已经从身体、生理和心理角度记录了表现的变化。在本试验中，将根据个体可测量的疼痛、肌肉和心理障碍来指导治疗，而不是像其他试验那样将所有患者视为相同。本试验将提供个性化治疗;使用经验得出的治疗算法进行医学、物理治疗和/或心理治疗。该计划的成本效益将根据通常护理期间产生的成本效益进行评估。据预测，从长远来看，早期的多专业管理将比现有的方法更便宜。这项随机对照试验旨在扩展颈部扭伤相关疾病（WAD）的管理知识。

Whiplash injuries from a motor vehicle crash continue to incur substantial personal and financial costs to the community and the insurance industry. The current approaches to an acute whiplash injury in Australia and internationally have failed to lessen the rate of how many people develop chronic neck pain. Between 40 and 60% still have pain 6 months after injury. Motor Accident Insurance Commission (Qld) figures indicate that 20% of patients with chronic whiplash account for 60% of the costs. Transition from an acute to a chronic condition must be prevented. A new direction in management in the acute stage is urgently required as once the pain has become chronic, it is difficult to help. This research will conduct a novel randomised controlled trial for acute whiplash. It will test individually prescribed multi-professional management against usual care with the aim to lessen the numbers who go on to develop chronic pain. It will be the first clinical trial that acknowledges from the outset that the whiplash injuries and affects people in different ways. Our previous research with acute whiplash patients has documented the variations in presentation from physical, physiological and psychological perspectives. In this trial, management will be prescribed as directed by measurable pain, muscle and psychological impairments in the individual, rather than regard all patients as the same as in other trials. This trial will offer individualised treatments; medical, physiotherapy and-or psychological using an empirically derived treatment algorithm. Cost-effectiveness of the program will be evaluated against that incurred during usual care. It is predicted that early multi-professional management will be less expensive in the long term than existing approaches. This RCT stands to extend knowledge in the management of whiplash associated disorders (WAD).