Soft-collar use in rehabilitation of whiplash-associated disorders - A systematic review and meta-analysis

• Published in: Musculoskeletal science & practice 2021-10, Vol.55, p.102426-102426, Article 102426
• Main Authors: Christensen, Steffan Wittrup McPhee, Rasmussen, Michael Bo, Jespersen, Christoffer Lund, Sterling, Michele, Skou, Søren Thorgaard
• Format: Article
• Language: English
• Subjects: Acute; Neck pain; Soft-collar; Subacute; WAD; Whiplash
• ISSN: 2468-7812; 2468-7812
• DOI: 10.1016/j.msksp.2021.102426

Active rehabilitation of Whiplash Associated Disorders (WAD) is favoured over passive modalities such as soft-collars. However, the effectiveness of soft-collar use remains unclear. To investigate the effectiveness of soft-collar use on pain and disability in WAD. Systematic review. Databases (AMED, CINAHL Complete, Cochrane Library, Embase, Medline, PEDro, PsycINFO, PubMed, SPORTDiscus) were searched for guidelines, reviews and RCTs on soft-collar use as part of WAD treatment. Reference lists of reviews and guidelines were screened for additional RCTs. Study quality was rated using the PEDro-scale and overall quality of evidence with GRADE. Four RCTs (n = 409) of fair-good quality (PEDro-scores) were included with three using a soft collar in addition to other conservative treatment while one study compared soft-collar use to act-as-usual. All studies found that an active or act-as-usual approach was more effective in reducing pain intensity compared to soft-collar use, confirmed by meta-analysis (two RCTs with data: SMD of −0.80 (−1.20, −0.41)). No studies reported disability outcomes while contrasting results were found between groups regarding total cervical range of motion (two RCTs with data: SMD of 0.16 (−0.21, 0.54)) or rotation (two RCTs with data: SMD of 0.54 (−0.19, 1.27)). Overall quality of the evidence was low to very low. All four RCTs favoured an active approach/act-as-usual over soft-collar treatment. However, due to methodological concerns and low certainty of evidence, future studies investigating soft collar use in combination with an active rehabilitation strategy for acute/subacute WAD are needed. •The evidence discouraging soft-collar use in WAD management is not strong.•Only a limited number of RCTs with an appropriate study design exists.•An active approach vs. soft-collar resulted in greater reduction of pain of 2.18 cm.•No difference between treatments was found for cervical range of motion.•While quality of RCTs was fair-good, overall certainty of evidence was low-very low.