Effectiveness of Physiotherapy Following PRP for Chronic Whiplash

This will be a single case with randomized multiple baseline experimental design with enrolment of 3 patients undergoing PRPt, and 3 patients undergoing PRPu following PRP. There will be a variable length baseline (A1) and then a staggered start to provide internal validity - one patient starting at 5 days (post-PRP), one at 8 (post-PRP) and one at 11 days post-PRP, randomly allocated. This study will utilise an A1-B-A2 design: a baseline (A1 no intervention); intervention phase (B); and a no intervention (A2 follow up).

Primary outcome measures will be collected daily during this time period. The baseline phase will be followed by a 6-week intervention period (B). Participants will have 10 one hour sessions over a 6-week period. The intervention will be delivered by an experienced physiotherapist with postgraduate qualifications. During the intervention period, once or twice per week the daily collection of the primary outcome measures will coincide with the delivery of each intervention session. The intervention phase will be followed by a 12-week follow-up phase (A2) where participants will have no contact with the intervention personnel. This follow-up phase is implemented in order to determine the possible duration of improvement post intervention. All outcome measures will be collected at the completion of this 12-week follow-up period.

Secondary outcome measures for generalisation purposes will be collected prior to commencing PRP, at the end of the intervention period (which coincides with the commencement of the no-intervention period), and at the end of the no-intervention period; totalling 3 sampling points throughout the study duration.

Inclusion criteria

• Individuals with Grade II Whiplash Associated Disorder with > 80% relief of familiar neck pain after dual medial branch blocks
• > 12 weeks since injury and failed to respond to previous (> 6 weeks) conservative treatment
• Neck pain on numerical pain rating scale ≥ 4/10
• Neck Disability Index > 28%

Exclusion criteria

• Presence of dizziness symptoms
• Known or suspected serious spinal pathology (e.g. metastatic disease of the spine);
• Confirmed fracture or dislocation at time of injury (i.e., WAD Grade IV)
• Nerve root compromise (i.e., WAD Grade III)
• Spinal surgery in the past 12 months; and
• History of any mental health conditions such as bipolar disorder, psychosis, schizophrenia, anxiety, PTSD or severe depression
• Inability to stop taking anti-inflammatory medications for 3-days prior to, or 10-days following PRP
• Unable to understand +/- complete validated questionnaire items in English