Whiplash-associated disorders from a physical therapy and health-economic perspective. A study of an active physical therapy involvement and intervention for the treatment of acute whiplash-associated disorders and an analysis of its costs and consequences.

摘要

Whiplash-associated disorders (WAD) resulting from a biomechanicalevent in motor vehicle collisions is a major cause of suffering and highcosts to society. The overall aim of this thesis was to evaluate the clinicalandcost-effectiveness of an early, active physiotherapy involvement andintervention in patients exposed to neck trauma in motor vehicle crashescompared to a standard intervention which has been common practice inSweden.The thesis consists of a review (I) and an interventions study (II-IV).The objective of Paper I was to review the literature systematically toanalyse the evidence basis of many commonly used treatments forpatients suffering from WAD both in the acute phase and for patientswith persistent symptoms. The methodological quality of 26 randomisedclinical trials was analyzed. The median quality scores for all threeinstruments were poor. Based on the degree of evidence and practicalconsiderations, the following treatments can be recommended: Earlyphysical activity in acute WAD, combination of cognitive behaviouraltherapy with physical therapy interventions, and coordination exercisetherapy in chronic WAD. High-quality RCTs are not common in the fieldof WAD. More research is needed, particularly on the treatment ofchronic WAD.The objective of Paper II was to evaluate an active physical therapyinvolvement and intervention versus a standard intervention and theimportance of early versus delayed onset of treatment. Paper III aimedto compare long-term efficacy of active physical therapy involvementand intervention with standard intervention and the effect of early versusdelayed initiation of intervention. The aim of Paper IV was to comparethe costs of an active physical therapy involvement and interventionversus a standard intervention and to relate them to the clinical benefits inpatients exposed to whiplash trauma in automobile crashes to facilitatedecision making regarding intervention and resource allocation. Theresults of the inter-vention study showed that the active physical therapyinvolvement and intervention was significantly superior in reducing painintensity and sick leave. Costs were significantly lower after 6 and 36months with an active involvement and intervention as compared to thestandard intervention. In conclusion, active involvement and interventionis a cost-saving alternative with positive consequences for healthcompared to a standard intervention in patients exposed to whiplashtrauma, when costs related to physical therapy treatment and productivity were considered. It should thus be considered in the choice of treatmentof these patients.