Effectiveness of Physiotherapy Following PRP for Chronic Whiplash
Condition: Whiplash Injuries; Neck Injuries; Platelet Rich Plasma
MeSH terms: Wounds and Injuries; Whiplash Injuries; Neck Injuries
Study type: Interventional

Summary: 
      The investigators will explore a standardized and previously published evidence-based
      conservative multimodal physiotherapy treatment fulfilling clinical practice guidelines in
      individuals with chronic whiplash-associated disorders (WAD) with facet-mediated pain
      (appropriate response to dual medial branch blocks) undergoing cervical facet joint
      Plasma-Rich Platelet (PRPt) and compare health outcomes to individuals' undergoing cervical
      facet joint PRP with usual care (PRPu), which consists of advice, supervised home exercise
      and pharmacological management for treatment of residual pain. To be clear, the investigators
      are not investigating the efficacy or effectiveness of cervical facet joint PRP - these
      individuals have already consented to proceed with PRP treatment. The investigators are
      evaluating the role of adjuvant conservative multimodal physiotherapy treatment. It must be
      noted that these patients have previously failed to respond to conservative physiotherapy.
      The investigators will use a design which is quite novel in physiotherapy, Single Case
      Experimental Designs (SCEDs). In contrast to an experimental group design in which one group
      is compared with another, participants in single-subject research provide their own control
      data for the purpose of comparison in a within-subject rather than a between-subjects design.
      SCEDs provide a method to determine response and benefit for every individual patient.

      Therefore, the investigators will assess effectiveness of conservative multimodal
      physiotherapy for chronic WAD with facet-mediated pain undergoing cervical facet joint PRP,
      using patients as their own control, in a multiple baseline design.
    

Detailed description: 
      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.
    

Intervention name(s): Multimodal physiotherapy
Intervention type(s): Other
Intervention description(s): Participants will undertake their usual activities for the 5, 8 or 11 day baseline period following PRP. Participants will begin the 6 week intervention period following this period during which time they will participate in 10 sessions with an experienced postgraduate physiotherapist. After these 6-weeks, participants will have no contact with intervention personnel during the 6-week follow-up period.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: A Single Case Experimental Design (SCED) will be used to evaluate the intervention. Participants act as their own controls, and thus are exposed to both the treatment and control conditions. The study will be conducted and reported according to the Singe Case Reporting guidelines in BEhavioural Interventions (SCRIBE). A randomised, concurrent, multiple-baseline A1 (baseline control) - B (intervention)-A2 (follow-up withdrawal) design will be used to meet the methodological recommendations for SCEDs. Participants will be randomly allocated to a 5, 8 or 11 day baseline period during which they will undertake their usual activities. The baseline phase will be followed by a 6-week intervention period during which participants will participate in 10, one hour sessions with an experienced post-graduate trained physiotherapist. The intervention phase will be followed by a 12-week follow-up phase where participants will have no contact with the intervention personnel.
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Physiotherapy