Education

Rating

Category: Allied Health Options

Injury Type: Acute/Chronic

What is it?

Education may include the provision of information about any of the following: the mechanisms involved in whiplash, the nature of whiplash injuries, prognosis, recovery processes, advice to return to normal activities as soon as possible, how best to manage pain and reduce disability, and the potential treatments available.

Information may be provided verbally and/or you may be provided additional written information or a video to take home.

How does it work?

It is thought that appropriate education can minimise anxiety and distress; both of which may delay recovery from whiplash. Distinguishing between activities that hurt and those that are harmful may help to reduce unnecessary fear and avoidance of normal movement. Fear and avoidance of normal movement may impair recovery. Education may also provide information on the most effective methods of rehabilitation, meaning that you are more likely to be aware of treatments that work.

Is it effective?

Educational videos appeared to be more effective than usual emergency department care in reducing pain after whiplash in two studies. However, an educational pamphlet was no better than usual emergency department care in another study. A recent study showed no difference in outcomes when comparing education and advice delivered orally to education and advice in a pamphlet. A review of 11 scientific studies concluded that there was strong evidence to support the use of education regarding self management in the first two weeks following whiplash injury.

The person providing the education and advice does not seem to matter according to one study. It reported there was no difference in pain or work activity between people receiving education and advice by their GP, and people receiving education, advice and exercises by their physiotherapist. For some outcomes, however, (level of function and coping) advice from the GP was better in the longer term. A study showed that "The Whiplash Book" was effective in changing the beliefs about the consequences of whiplash for the better among a group of professionals. Optimistic beliefs may help to reduce stress and anxiety and improve compliance with management.

A recent systematic review investigated the effectiveness of educational interventions for various neck disorders, including whiplash, at various stages of the healing process. The authors of this review concluded that, on its own, there is no strong evidence for the effectiveness of educational interventions.

A paper reviewing 163 scientific articles summarised its findings in 'The Whiplash Book' which included the following recommendations:

  1. There has been no serious damage. After a whiplash injury the neck is simply not moving and working properly. The muscles and joints have been affected but they have a natural ability to repair and restore, which is helped by activity.
  2. It should improve rapidly with an active approach; there is no reason why long term disability should ensue. Although symptoms may persist for a while, the acute pain will improve within a few days or weeks, certainly enough to get on with life.
  3. Headache, arm pain, jaw pain and dizziness are common and not a reason for concern.
  4. Use simple analgesia; it's an aid to increasing early activity. Try to find a way to relax and don't worry.
  5. Avoiding daily activities slows recovery. Some activities may involve some pain, but hurt is not the same as harm.
  6. Keep moving, don't stay in one position too long, move about before you stiffen up, and don't completely avoid things. Most daily activities and an early return to work are helpful.
  7. Simple neck and shoulder exercises are safe and effective—stretching, strengthening and coordination exercises should be done regularly each day; initial soreness is not a reason for concern.
  8. Don't worry and don't be frightened of movement or pain—activity and a positive approach are the keys to avoiding long term problems. Don't be an avoider.

A recent systematic review concluded that it is appropriate for a health care provider to provide education as part of a biopsychosocial approach of patients with whiplash. The authors of this review explain that such education should target removing therapy barriers, enhancing therapy compliance and preventing and treating chronicity of the condition. The results of a large randomised controlled trial suggest that enhanced psychoeducationsl interventions in emergency departments are no more effective than usual care advice is reducing the burden of acute whiplash injuries.

A recent study investigated the role of education (through an information booklet and didactic discussion) and imaginal and direct exposure desensitization on reducing fear of movement in patients with WAD. The authors of this study found that reduction in fear of movement was the most important predictor of improvement in neck disability and pain. The authors highlight that addressing this fear with educational interventions or via exposure therapy could improve funciton and recovery.

Are there any disadvantages?

There do not appear to be any disadvantages associated with education or the provision of information.

Where do you get it?

You may receive educational material in hospital, from your GP or any other health professional involved in assisting your recovery following whiplash injury.

Recommendations

It seems that you are more likely to make a better recovery if you are provided with the appropriate information, in a timely manner. It would seem that this information should include advice to reduce fear associated with movement of the neck. However there is no clear evidence on the one 'best' way this information should be provided.

Key References

  • Brisson, RJ, Hartling, L, Dostaler, S, Leger, A, Rowe, BH, Stiell, I & Pickett, W 2005, 'A randomized controlled trial of an educational intervention to prevent chronic pain of associated disorders following rear-end vehicle collisions', Spine, vol. 30, no. 16, pp. 1799-1807.
  • Coudeyrea, E, Demaille-Wlodykab, S, Poizata, S, Burtonc, K, Hamonetd, M, Reveld, M, & Poiraudeaud, S 2007, 'Could a simple educational intervention modify beliefs about whiplash; a preliminary study among professionals working in a rehabilitation ward', Annales de réadaptation et de médecine physique, vol. 50, no. 7, pp. 552–557.
  • Ferrari, R, Rower, BH, Majumdar, SR, Cassidy, JD, Blitz, S, Wright, SC & Russell, AS 2005, 'Simple education intervention to improve the recovery from acute whiplash: results of a randomised, controlled trial', Academic Emergency Medicine, vol. 12, pp. 699-706.
  • Haines T, Gross A, Burnie SJ, Goldsmith CH & Perry L 2009, 'Patient education for neck pain with or without radiculopathy', Cochrane Database of Systematic Reviews, issue: 1, art. No.: CD005106, doi: 10.1002/14651858.CD005106.pub3.
  • Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, 'Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders', European Spine Journal, vol. 17, no. 1, pp. 123-152.
  • Lamb, SE, Gates, S, Williams, MA, Williamson, EM, Mt-Isa, S, Withers, EJ, Castelnuovo, E, Smith, J, Ashby, D, Cooke, MW, Petrou, S & Underwood, MR 2013, 'Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomised controlled trial', Lancet, vol. 381, pp. 546-56.
  • Meeus, M, Nijs, J, Hamers, V, Ickmans, K & Oosterwijck, JV 2012, 'The efficacy of patient education in whiplash associated disorders: a systematic review', Pain Physician, vol. 15, pp. 351-361.
  • Mercer, C, Jackson, A & Moore, A 2007, 'Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)', International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 50-54.
  • McClune, T, Burton, AK & Waddell, G 2002, 'Whiplash associated disorders: a review of the literature to guide patient information and advice', Emergency Medicine Journal, vol. 19, no. 6, pp. 499-506.
  • Oliveria, A, Gervirtz, R & Hubbard, D 2006, 'A Psycho-Educational Video used in the Emergency Department provides effective treatment for whiplash injuries', Spine, vol. 31, no. 15, pp. 1652-1657.
  • Poorbaugh, K, Brismée, J, Phelps, V & Sizer, P 2008, 'Late whiplash syndrome: a clinical science approach to evidence-based diagnosis and management', Pain Practice, vol. 8, no. 1, pp. 65-89.
  • Robinson, JP, Theodore, BR, Dansie, EJ, Wilson, HD & Turk, DC 2013, 'The role of movement in subacute whiplash-associated disorders grades I and II', Pain, vol. 154, pp.393-401.
  • Schofferman, J, Bogduk, N & Slosar, P 2007, 'Chronic whiplash and whiplash associated disorders: an evidence based approach', Journal of the American Academy of Orthopaedic Surgeons, vol. 15, no. 10, pp. 596-606.
  • Scholten-Peeters, GGM, Neeleman-van der Steen, CWM, van der Windt, DAWM, Hendriks, EJM, Verhagen, AP & Oostendorp, RAB 2006, 'Education by General Practitioners or education and exercises by physiotherapists for Whiplash-Associated Disorders? A Randomized Clinical Trial', Spine, vol. 31, no. 7, pp. 723-731.
  • Kongsted, A, Qerama, E, Kasch, H, Winther Bach, F, Korsholm, L, Staehelin Jensen, T & Bendix, T 2008, 'Education of patients after whiplash injury; is oral advice any better than a pamphlet?', Spine, vol. 33, no. 22, pp. 843-848.
  • Verhagen, A, Scholten-Peeters, G, Van Wijngaarden, S, De Bie, R & Bierma-Zeinstra, S 2007, 'Conservative treatments for whiplash', Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003338. DOI: 10.1002/14651858.CD003338.pub3.
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