The aim of this study was to examine the clinical effectiveness..

The aim of this study was to examine the clinical effectiveness of a stepped care approach over a 12-month period after an acute whiplash injury and to estimate the costs and costs-effectiveness. 

A total of 3851 patients were recruited for the trial. In step 1, patients received either usual care advice (mostly advice to exercise) or The whiplash Book/active management advice. In step 2 participants with persistent symptoms received either a single session of advice from a physiotherapist or up to six sessions of physiotherapy treatment ranging from manual therapy, exercise to brief psychological interventions and advice. 

There were no significant differences observed in any outcomes between usual care and active management advice. The physiotherapy package resulted in improvements in neck disability at 4 months in comparison with a single advice session, but these effects were small at the population level. However, an important benefit of the physiotherapy package was a reduction in workdays lost, and as such, the intervention may prove cost-effective at the societal level. > From: Lamb et al., Health Technol Assess 16 (2012) 49. All rights reserved to Queen’s Printer and Controller of HMSO.