Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries.
Health Technol Assess 2012;16(49).
People were diagnosed at ED assessment with whiplash grade I to III. They were randomised to receive the Whiplash Book (developed for an ABI evidence-based guidance project) and or a combination of physiotherapy or neither.
18% went on the have persistent whiplash.
Overall, there was no measurable effect of any intervention at 12 months. Those still in trouble at 3 weeks post accident did benefit very marginally at 4 months.
Having assessed the cost, the authors concluded that:
from a healthcare perspective, the physiotherapy package was not cost-effective at current levels of willingness to pay
Comment:
The medical test of benefit and the medical test of cost effectiveness are both more generous than would be expected at common law; where the balance of probabilities is used to judge facts. Applying the common law standard, the reported beneficial effect of physiotherapy was undetectable.
Self-prescription of a form of care which has no real prospect of contributing to indemnity is at least questionable.
The research supports an argument for reform of self-prescription where there is no foreseeable benefit and, it is a liability policy which is expected to pay.
The data in the research report also suggest that a very high proportion of those diagnosed with whiplash, when assessed against the common law standard, had no detectable injury. In case of soft tissue injury, medical opinion as to injury status is at least questionable.
The research supports an argument for establishing common law criteria for diagnosis when it is a liability policy which is expected to pay for the consequences of a diagnosis.
