Evidence map›Paper›PMID 37318019›Full record

Trial reportPain2023

Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial.

Trudy Rebbeck, Aila Nica Bandong, Andrew Leaver, Carrie Ritchie, Nigel Armfield, Mohit Arora, Ian D Cameron, Luke B Connelly, Roy Daniell, Mark Gillett and 8 more

Abstract readRandomized Controlled TrialMulticenter Study
PubMed Publisher
In one paragraph

Trial report in Pain, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Trudy RebbeckSydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Aila Nica BandongSydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Andrew LeaverSydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Carrie RitchieRECOVER 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.
Nigel ArmfieldRECOVER 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.
Mohit AroraJohn Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Ian D CameronJohn Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Luke B ConnellyCentre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia.
Roy DaniellBelconnen Physiotherapy Clinic, Canberra, Australia.
Mark GillettEmergency Department, Royal North Shore Hospital, Sydney, Australia.
Rodney IngramSydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Jagnoor JagnoorThe George Institute for Global Health, School of Population Health, University of New South Wales, New South Wales, Australia.
Justin KenardySchool of Psychology, The University of Queensland, Queensland, Brisbane, Australia.
Geoffrey MitchellPrimary Care Clinical Unit, School of Medicine, University of Queensland Brisbane, Australia.
Kathryn RefshaugeSydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Simone Scotti RequenaRECOVER 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.
Sarah RobinsRECOVER 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.
Michele SterlingRECOVER 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.ORCID 0000-0001-8242-2685

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Critical PathwaysWhiplash InjuriesAustraliaExercise TherapyHumansTreatment Outcome

Identifiers

PMID37318019

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.