Act as usual

Injury type: Acute/Chronic

Category: Allied Health Options

Rating: Useful

What is it?

Act as usual is a strategy which encourages people with whiplash, especially in the early stages, to continue staying as active as possible within tolerable levels. Encouraging people to stay active and continuing with their normal lives is seen as a means of facilitating normality and participation in activities of daily living during the recovery period. This may be undertaken in a structured manner (check-list based information covering various aspects about whiplash) or in an unstructured conversational manner with a health professional.

How does it work?

It is thought that by encouraging normal activities the emphasis is taken away from the injury itself. Physiologically, it is thought that normal movement patterns may have a positive effect on symptoms of whiplash, such as muscle spasm and pain. Educating people with whiplash about pain behaviours (such as focussing on pain which can enhance pain perception) also helps to prevent the development of ‘fear avoidance’ behaviours in the future.

Is it effective?

There is some high level evidence to suggest that acting as usual, subsequent to whiplash, does lead to certain positive outcomes. A rapid review¹ synthesising evidence from highest level of primary studies, systematic reviews, and well-conducted clinical practice guidelines identified that education and reassurance on returning to normal activities as soon as able in the initial management of whiplash is commonly recommended. Similarly, a systematic review of existing clinical practice guidelines² found that emphasis on staying active, acting as usual and promoting mobility is a widely recognised component of education intervention for acute, subacute and chronic whiplash.

A clinical commentary³ reviewing recommendations from existing clinical practice guidelines across four different countries (Australia, the Netherlands, the United Kingdom, and the United States) reported that education on staying active and returning to usual activities is included in all of the guidelines for acute whiplash. However, the author of this clinical commentary highlighted a weak level of evidence supporting this recommendation. Based on findings from additional studies, the author further argued that a short period of rest or immobilisation may benefit a small proportion of people sustaining whiplash, especially those who may experience physical activity or exercise induced hyperalgesia (i.e. high pain sensitivity). Therefore, this clinical commentary recommended that ‘act as usual’ should be maintained as an intervention for most people but for some, the opposite recommendation (i.e. rest or immobilisation) may achieve better outcomes.   

Are there any disadvantages?

While there were no reported disadvantages or side effects from act as usual, this treatment should be prescribed and monitored by a health professional at regular intervals. If patients’ symptoms are not improving with this approach, health professionals need to review their management plan.

Where do you get it?

Advice to act as usual can be provided by any appropriately qualified health professional including doctors, nurses, physiotherapists and chiropractors.

Recommendations

While there is some evidence to support advice to act as usual within tolerable levels, especially in the early stages, more research is needed to describe its effect in the long term.