TY - JOUR
T1 - Soft-collar use in rehabilitation of whiplash-associated disorders - A systematic review and meta-analysis
AU - Christensen, Steffan Wittrup McPhee
AU - Rasmussen, Michael Bo
AU - Jespersen, Christoffer Lund
AU - Sterling, Michele
AU - Skou, Søren Thorgaard
N1 - Copyright © 2021 Elsevier Ltd. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - BACKGROUND: Active rehabilitation of Whiplash Associated Disorders (WAD) is favoured over passive modalities such as soft-collars. However, the effectiveness of soft-collar use remains unclear.OBJECTIVE: To investigate the effectiveness of soft-collar use on pain and disability in WAD.DESIGN: Systematic review.METHOD: Databases (AMED, CINAHL Complete, Cochrane Library, Embase, Medline, PEDro, PsycINFO, PubMed, SPORTDiscus) were searched for guidelines, reviews and RCTs on soft-collar use as part of WAD treatment. Reference lists of reviews and guidelines were screened for additional RCTs. Study quality was rated using the PEDro-scale and overall quality of evidence with GRADE.RESULTS: Four RCTs (n = 409) of fair-good quality (PEDro-scores) were included with three using a soft collar in addition to other conservative treatment while one study compared soft-collar use to act-as-usual. All studies found that an active or act-as-usual approach was more effective in reducing pain intensity compared to soft-collar use, confirmed by meta-analysis (two RCTs with data: SMD of -0.80 (-1.20, -0.41)). No studies reported disability outcomes while contrasting results were found between groups regarding total cervical range of motion (two RCTs with data: SMD of 0.16 (-0.21, 0.54)) or rotation (two RCTs with data: SMD of 0.54 (-0.19, 1.27)). Overall quality of the evidence was low to very low.CONCLUSION: All four RCTs favoured an active approach/act-as-usual over soft-collar treatment. However, due to methodological concerns and low certainty of evidence, future studies investigating soft collar use in combination with an active rehabilitation strategy for acute/subacute WAD are needed.
AB - BACKGROUND: Active rehabilitation of Whiplash Associated Disorders (WAD) is favoured over passive modalities such as soft-collars. However, the effectiveness of soft-collar use remains unclear.OBJECTIVE: To investigate the effectiveness of soft-collar use on pain and disability in WAD.DESIGN: Systematic review.METHOD: Databases (AMED, CINAHL Complete, Cochrane Library, Embase, Medline, PEDro, PsycINFO, PubMed, SPORTDiscus) were searched for guidelines, reviews and RCTs on soft-collar use as part of WAD treatment. Reference lists of reviews and guidelines were screened for additional RCTs. Study quality was rated using the PEDro-scale and overall quality of evidence with GRADE.RESULTS: Four RCTs (n = 409) of fair-good quality (PEDro-scores) were included with three using a soft collar in addition to other conservative treatment while one study compared soft-collar use to act-as-usual. All studies found that an active or act-as-usual approach was more effective in reducing pain intensity compared to soft-collar use, confirmed by meta-analysis (two RCTs with data: SMD of -0.80 (-1.20, -0.41)). No studies reported disability outcomes while contrasting results were found between groups regarding total cervical range of motion (two RCTs with data: SMD of 0.16 (-0.21, 0.54)) or rotation (two RCTs with data: SMD of 0.54 (-0.19, 1.27)). Overall quality of the evidence was low to very low.CONCLUSION: All four RCTs favoured an active approach/act-as-usual over soft-collar treatment. However, due to methodological concerns and low certainty of evidence, future studies investigating soft collar use in combination with an active rehabilitation strategy for acute/subacute WAD are needed.
KW - Neck pain
KW - Whiplash
KW - WAD
KW - Acute
KW - Subacute
KW - Soft-collar
U2 - 10.1016/j.msksp.2021.102426
DO - 10.1016/j.msksp.2021.102426
M3 - Review article
C2 - 34271416
SN - 2468-7812
VL - 55
JO - Musculoskeletal Science & Practice
JF - Musculoskeletal Science & Practice
M1 - 102426
ER -