Emergency Care and Rehabilitation

WMSEmergency Care

Whiplash

Managing Injuries of the Neck (MINT)

A multi-centred randomised controlled trial of education and advice versus a targeted intervention to prevent late whiplash syndrome

  

Acknowledgements

We wish to acknowledge that MINT is funded by the UK Department of Health, NIHR Health Technology Assessment Programme.

Any opinions expressed here are those of the authors and do not necessarily reflect those of the UK National Health Service or the Department of Health. 

  

Aim of the Project

  

Primary

To estimate the clinical effectiveness of a stepped care approach over a 12 month period after an
acute injury

Step One: The Whiplash Booklet versus usual care advice in Emergency Department (ED)
Step Two: In patients with symptoms persisting at approximately 3 weeks (Whiplash Associated Disorder
Grade I-III), supplementary treatment comprising either a package of physiotherapy treatments
and re-enforcement of advice versus re-enforcement of advice provided at the initial ED
contact only.
The combined effect of the various treatments using a linked design.

Secondary

To estimate the clinical effectiveness in pre-specified sub-groups of patients - those with prior neck
problems, psychological or physical risk factors for poor outcome, and those seeking compensation.

To estimate the costs of each strategy including treatment and subsequent health care costs over a
period of 12 months and to estimate cost effectiveness.

All patients recruited into the trial will receive standard emergency care comprising a routine clinical consultation to screen out fracture/dislocation if required. The overall aim is to undertake a high quality definitive trial of treatments that if effective, can be readily disseminated into NHS departments dealing with acute injuries. We will include a qualitative sub-study to explore the acceptability of different treatments, and provide a consumer perspective. The study will comply with good practice guidelines and MRC guidance on evaluating complex interventions. 

 

Method

Whiplash injuries are very common in the UK. The injury is most comonly caused by rapid deceleration in a road traffic accident (RTA).  Symptoms may range from mild pain and discomfort to pain radiating into the arm and back. The majority of people will recover, usually within the first few months. At 6 months approximately 30% of people will be classified as having late whiplash syndrome that is characterised by symptoms that are sufficient to interfere with work and other activities of daily living. This study will examine a stepped care approach to treatment for whiplash, that recognises not all people require intensive treatment. The usual treatment for whiplash is advice given at the ED, and then at some later point, symptoms are reviewed and further treatment is provided. In this study we will test what type of advice should be given in the ED, and what type of further treatment is most effective. We will be able to make recommendations at the end of the study about which patients should be routinely reviewed and would benefit most from supplementary treatments. We will also examine the costs of the treatments, from the perspective of individual patients, society and the health service. 

 

Funding

 NHS HTA

 

Ethical Approval

Trent Multi-Centre Research Ethics Committee

 

Project Schedule

November 2004 to November 2008

 

ISRCTN Registration

ISRCTN3302125

 

Lead Investigators

Name
Establishment 
Role 
Speciality 
Professor Sallie Lamb  University of Warwick  Chief Investigator  Musculo-skeletal and Health Services Research 
Professor Martin Underwood  University of Warwick  Co-Applicant  Musculo-skeletal medicine and research, General Practice 
Professor Matthew Cooke  University of Warwick  Co-Applicant  Accident and Emergency Care 
Professor Ala Szczepura  University of Warwick  Co-Applicant  Health Services Research and Health Economics 
Professor Deborah Ashby  University of London Co-Applicant  Statistics 
Dr Frances Griffiths University of Warwick Co-Applicant  General Practice
Dr Stephen Joseph University of Nottingham Co-Applicant Health Psychology

  

  

Project Team

Name
Establishment 
Role 
Dr Anil Gumbar University of Warwick  Health Economics
Janet Lowe University of Warwick Trial Recruitment 
Shahrul MtIsa  Barts and The London School of Medicine and Dentistry Statistics
Cheryl Ritchie  University of Warwick  Trial Recruitment
Christopher Rubery University of Warwick  Trial Administration 
Mark Williams  University of Warwick  Trial Co-Ordinator 
Esther Williamson University of Warwick  Research Physiotherapist 
Emma Withers  University of Warwick  Trial Administration 

 

Project Collaborators

Name
Establishment 
Dr Mitam Barooah  Heart of England NHS Foundation Trust 
Dr Peter Doyle Selly Oak Hospital 
Mr Matthew Dunn  Warwick Hospital 
Bridget Gray  John Radcliffe Hospital, Oxford 
Helen Harrison  Kettering General Hospital 
Dr Yasmeen Hasnain  Buckinghamshire Hospital NHS Trust 
Dr Phil Hormbrey  John Radcliffe Hospital, Oxford 
Claire Hunt  Gloucester Royal Hospital 
Sue Kempson Frenchay Hospital, Bristol 
Dr Jason Kendall  Frenchay Hospital, Bristol 
Steve Lodge  Stoke Manderville Hospital 
Mr Steve McCabe  Gloucestershire Hospitals NHS Trust 
Dr Stewart McMorran  Kettering General Hospital 
Melissa Minshull  Royal Gwent Hospital 
Mr Richard Morrell  Alexandra Hospital, Redditch 
Elizabeth Oastler  John Radcliffe Hospital, Oxford 
Dr Francis Richardson  Royal Gwent Hospital 
Dr Magdy Sakr  University Hospitals Coventry and Warwickshire 
Heather Shilliday Countess of Chester Hospital 
Dr John Sloan  Countess of Chester Hospital 
Rachel Trickey  Gloucester Royal Hospital 
Elaine Willmore  Cheltenham General Hospital 
 

 

Publications/Presentations to Date

HTA

HTA Project Information

ISRCTN Register Entry

Physiotherapy Intervention Trial Materials
Page contact: Emma Withers Last revised: Wed 12 Mar 2008
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