Multimodal / Physiotherapy Treatment
Injury type: Acute/Chronic
Category: Allied Health Options
Rating: Useful
What is it?
Multimodal treatment involves the combination of several different types of treatment, usually within the one treatment session. In relation to whiplash, multimodal treatment may include any of the following: active movement; strengthening exercises; muscle re-education; kinaesthetic exercises, posture correction; functional exercises; manual therapy such as manipulation, mobilisation and massage; electrotherapy; advice; education; home exercise programme; medication; and soft collar. Therefore, multimodal treatment is a combination of more than one of these types of treatment.
How does it work?
It is thought that there are various factors that can potentially influence the development and continuation of symptoms after whiplash. Aside from the physical forces involved in causing a whiplash injury, other related factors may include, but are not limited to: physical; psychological and socio-demographic factors. Therefore, the aim of a multimodal treatment programme is to address as many of these potential underlying factors as possible in order to achieve the best outcome. There may also be an increased benefit from providing multiple treatments in conjunction with each other compared to providing those treatments individually.
Is it effective?
There is some evidence from high level research studies to suggest that multimodal treatment is likely to be more effective than providing individual treatments in isolation.
A systematic review1 examined and updated evidence on the effectiveness of multimodal care for the management of patients with whiplash or neck pain. The findings suggest that multimodal care which includes education, exercise and manual therapy may benefit people with grades I-II whiplash. In another systematic review2, a combination of cognitive therapy and neck-specific strengthening exercise was found more effective than prescribed physical activity in reducing pain and disability. However, this combined approach was not more effective than the neck-specific strengthening exercise or cognitive therapy alone.
A systematic review of existing whiplash related clinical practice guidelines3 found that while one guideline recommended consideration of multimodal care (including exercises and/ or advice to stay active, along with individual treatment modalities such as joint mobilisation, relaxation techniques, electrotherapies) for subacute whiplash, another guideline recommended considering such approach for all grades of whiplash. A revised clinical practice guideline4, which was underpinned by a systematic review of literature, also recommended that clinicians should use a multimodal intervention including manual mobilisation techniques plus exercises for patients with whiplash, especially at early phases.
Are there any disadvantages?
There is no evidence to suggest that there are disadvantages associated with multimodal treatment, however potential side effects of each individual treatment should be considered. It is important that the treatment is provided by a qualified professional and that an appropriate assessment is carried out prior to treatment.
Where do you get it?
Multimodal treatment is commonly provided by physiotherapists. Doctors, chiropractors and osteopaths may also provide multimodal treatment.
Recommendations
Treatment consisting of more than one approach, i.e. multimodal, may be more effective than individual treatments provided in isolation. It appears that the intervention commonly consists of at least manual mobilisation techniques and some form of exercise. Multimodal treatment should be based on an individual assessment and provided by a qualified professional.