Article Text

Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials
  1. Alison Rushton1,
  2. Chris Wright1,
  3. Nicola Heneghan1,
  4. Gillian Eveleigh1,
  5. Melanie Calvert1,
  6. Nick Freemantle2
  1. 1School of Health and Population Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, UK
  2. 2Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
  1. Correspondence to Dr Alison Rushton; a.b.rushton{at}


Objective To evaluate effectiveness of physiotherapy management in patients experiencing whiplash associated disorder II, on clinically relevant outcomes in the short and longer term.

Design Systematic review and meta-analysis. Two reviewers independently searched information sources, assessed studies for inclusion, evaluated risk of bias and extracted data. A third reviewer mediated disagreement. Assessment of risk of bias was tabulated across included trials. Quantitative synthesis was conducted on comparable outcomes across trials with similar interventions. Meta-analyses compared effect sizes, with random effects as primary analyses.

Data sources Predefined terms were employed to search electronic databases. Additional studies were identified from key journals, reference lists, authors and experts.

Eligibility criteria for selecting studies Randomised controlled trials (RCTs) published in English before 31 December 2010 evaluating physiotherapy management of patients (>16 years), experiencing whiplash associated disorder II. Any physiotherapy intervention was included, when compared with other types of management, placebo/sham, or no intervention. Measurements reported on ≥1 outcome from the domains within the international classification of function, disability and health, were included.

Results 21 RCTs (2126 participants, 9 countries) were included. Interventions were categorised as active physiotherapy or a specific physiotherapy intervention. 20/21 trials were evaluated as high risk of bias and one as unclear. 1395 participants were incorporated in the meta-analyses on 12 trials. In evaluating short term outcome in the acute/sub-acute stage, there was some evidence that active physiotherapy intervention reduces pain and improves range of movement, and that a specific physiotherapy intervention may reduce pain. However, moderate/considerable heterogeneity suggested that treatments may differ in nature or effect in different trial patients. Differences between participants, interventions and trial designs limited potential meta-analyses.

Conclusions Inconclusive evidence exists for the effectiveness of physiotherapy management for whiplash associated disorder II. There is potential benefit for improving range of movement and pain short term through active physiotherapy, and for improving pain through a specific physiotherapy intervention.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Rushton A, Wright C, Heneghan N, et al. Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2011;1:e000265. doi:10.1136/bmjopen-2011-000265

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Contributors AR and GE are senior lecturers in Physiotherapy and NH is a lecturer. MC and CW are both senior lecturers. NF is Professor of Clinical Epidemiology and Biostatistics. AR, MC, CW and NF have longstanding professional interests in the quality and reporting of randomised controlled trials in medicine and physiotherapy. AR, NH and GE have a professional focus to musculoskeletal physiotherapy. AR and CW were responsible for the conception of the study. All authors have contributed to the systematic review and have been involved in developing the content of the article. AR wrote the first draft of the paper and developed it initially with CW. AR has worked with all authors reworking content into subsequent drafts. All authors gave final approval of the version to be published. AR is the guarantor.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.