• Trudy Rebbeck, Aila Nica Bandong, Andrew Leaver, Carrie Ritchie, Nigel Armfield, Mohit Arora, Ian D Cameron, Luke B Connelly, Roy Daniell, Mark Gillett, Rodney Ingram, Jagnoor Jagnoor, Justin Kenardy, Geoffrey Mitchell, Kathryn Refshauge, Scotti RequenaSimoneSRECOVER Injury Research Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia.Centre, Sarah Robins, and Michele Sterling.
• Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
• Pain. 2023 Oct 1; 164 (10): 221622272216-2227.

AbstractCurrent pathways of care for whiplash follow a "stepped care model," result in modest treatment outcomes and fail to offer efficient management solutions. This study aimed to evaluate the effectiveness of a risk-stratified clinical pathway of care (CPC) compared with usual care (UC) in people with acute whiplash. We conducted a multicentre, 2-arm, parallel, randomised, controlled trial in primary care in Australia. Participants with acute whiplash (n = 216) were stratified for risk of a poor outcome (low vs medium/high risk) and randomised using concealed allocation to either the CPC or UC. In the CPC group, low-risk participants received guideline-based advice and exercise supported by an online resource, and medium-risk/high-risk participants were referred to a whiplash specialist who assessed modifiable risk factors and then determined further care. The UC group received care from their primary healthcare provider who had no knowledge of risk status. Primary outcomes were neck disability index (NDI) and Global Rating of Change (GRC) at 3 months. Analysis blinded to group used intention-to-treat and linear mixed models. There was no difference between the groups for the NDI (mean difference [MD] [95% confidence interval (CI)] -2.34 [-7.44 to 2.76]) or GRC (MD 95% CI 0.08 [-0.55 to 0.70]) at 3 months. Baseline risk category did not modify the effect of treatment. No adverse events were reported. Risk-stratified care for acute whiplash did not improve patient outcomes, and implementation of this CPC in its current form is not recommended.Copyright © 2023 International Association for the Study of Pain.

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