Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries

Lamb, Sarah E; Williams, Mark A.; Williamson, Esther; Gates, Simon; Withers, EJ; Shahrul Mt‐Isa; Ashby, Deborah; Castelnuovo, E; Underwood, Martin; Cooke, M W · 2012 · OpenAlex-citations

DOI: 10.3310/hta16490

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Summary

The Managing Injuries of the Neck Trial (MINT) addresses the lack of robust evidence regarding the clinical effectiveness and cost-effectiveness of treatments for acute whiplash-associated disorders (WAD). Whiplash injuries are common and costly, yet management strategies vary widely. The study aimed to evaluate a stepped-care approach over 12 months, comparing usual care against enhanced psycho-educational interventions in emergency departments (EDs), and assessing the value of physiotherapy for patients with persistent symptoms. The research employed two linked, pragmatic, randomised controlled trials conducted across 15 EDs in 12 NHS trusts in England. In Step 1, EDs were cluster-randomised to provide either usual care advice (UCA) or an active management strategy involving "The Whiplash Book" and specific advice. In Step 2, participants with persistent symptoms at three weeks were individually randomised to receive either a single session of physiotherapist advice or a tailored package of up to six physiotherapy sessions. The primary outcome was the Neck Disability Index (NDI), with secondary outcomes including health-related quality of life (SF-12) and work days lost. A total of 3,851 patients were recruited for Step 1, with follow-up data collected at 2 weeks, 4 months, 8 months, and 12 months. The results indicated that the majority of patients recovered from their injuries, with 18% of the Step 1 cohort developing late whiplash syndrome. There was no statistically or clinically significant difference in outcomes between UCA and active management advice in Step 1 (NDI difference 0.5, 95% CI –1.8 to 2.8). In Step 2, the physiotherapy package produced small but significant improvements in neck disability at 4 months compared to a single advice session (NDI difference –3.2, 95% CI –5.8 to –0.7). Additionally, the physiotherapy package significantly reduced work days lost at 4 months (difference –40.2 days, 95% CI –44.3 to –35.8). However, from a healthcare perspective, the physiotherapy package was not cost-effective at current willingness-to-pay thresholds, as it incurred higher costs without discernible gains in health-related quality of life. The study concludes that enhanced psycho-educational interventions in EDs are no more effective than usual care for reducing the burden of acute whiplash injuries. While a package of physiotherapy offers short-term benefits in neck disability and reduces absenteeism for those with persistent symptoms, it does not justify the additional healthcare costs. The findings suggest that while physiotherapy may be cost-effective at a societal level due to reduced work loss, it is not cost-effective for the NHS. The trial highlights that most whiplash injuries resolve spontaneously, questioning the necessity of intensive early intervention for the general population.

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• post concussion