A Reuters headline Thursday, April 10, read: “Physical therapy may not help whiplash pain. The lead in a USNews article said: "Just one exercise education session works as well as expensive, long-term physical therapy in reducing pain in whiplash patients, a new study shows."
Except that's not exactly right.
The articles are referring to a just-published study on chronic whiplash disorder in The Lancet, in which the authors found that receiving advice from a physical therapist was "equally as effective" as a comprehensive exercise program. The advice included a 30-minute consultation with a PT and follow-up telephone sessions with a PT for additional guidance and clarification, if necessary. All patients received a booklet on self-management of whiplash-associated disorders.
This is not the first study that has found cognitive-behavioral or patient education strategies to be effective in physical therapy treatment for whiplash injuries, but it does run counter to the findings of a 2012 Cochrane Review that found exercise to be more effective than patient education for neck pain.
PTs "Uniquely Suited"
It's not that physical therapy isn’t valuable for treating pain and mobility deficits due to whiplash. It's that one type of physical therapy intervention (patient education, according to this study) may be just as beneficial and more cost-effective than others.
Many PTs emphasize patient education in their practices for a variety of diagnoses or conditions. The Guide to Physical Therapist Practice identifies both patient/client-related instruction and direct interventions as 2 distinct components of physical therapy treatment. The Orthopaedic Section's clinical practice guideline (CPG) on neck pain recommends that to improve recovery in patients with whiplash-associated disorder, clinicians should (1) educate the patient that early return to normal, non-provocative pre-accident activities is important and (2) provide reassurance to the patient that good prognosis and full recovery commonly occurs (Recommendation based on strong evidence).
Patient education is part of—not in lieu of—comprehensive physical therapy care. Indeed, says Paul Mintken, PT, DPT, OCS, FAAOMPT, editor for PTNow tests and measures, PTs are "uniquely suited to give advice on pain management, exercise, activity modification, and a safe progression back to normal function."
The Real Evidence Takeaway: Empower Your Patients
The paper's lead author, Zoe Michaleff, PhD, of The George Institute, shared her insights on how PTs (and students) should interpret and apply these findings. According to Michaleff, the results suggest that “more treatment is not necessarily better for people with chronic whiplash” and that patient education and self-management can lead to just as good an outcome. “Our findings should not be interpreted as encouragement to abandon exercise or physiotherapy in these patients; rather, it should encourage physiotherapists to think, ‘How can I empower this patient with chronic whiplash to self-manage their condition with exercise and practical functional advice?'"
Clinicians, she adds, "must include a discussion (from the outset) about patients goals and expectations of their therapist and treatment" as well as patient education about "whiplash, the principles of progressing activity, the identification of patient-specific functional goals, and teaching patients simple neck and shoulder exercises aimed at improving posture, range of motion, coordination, and strength."
It's important to note that although this is a randomized controlled trial with a fairly large sample, it is only one study, not a systematic review or CPG.
Question for Readers
How much/how often do you incorporate patient education into treatment for whiplash? Would you say you emphasize it? Let us know in the comments, or tweet your answer (hashtag #PTNow).
We're interested to know.