Background: A substantial proportion of patients with whiplash injuries develop chronic\ud symptoms. However, the best treatment of acute injuries to prevent long-term problems is\ud uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice\ud and education at their initial visit to the emergency department (ED), followed by review at three\ud weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised\ud controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus\ud usual advice when patients first attend the emergency department; 2. referral to physiotherapy\ud versus reinforcement of advice for patients with continuing symptoms at three weeks.\ud Methods: Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design\ud in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in\ud participating emergency departments and are sent a study questionnaire within a week of their ED\ud attendance. Three thousand participants will be included. Patients with persisting symptoms three\ud weeks after their ED attendance are eligible to join an individually randomised study of\ud physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be\ud randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the\ud Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to\ud work and normal activities. An economic evaluation is being carried out.\ud Conclusion: This paper describes the protocol and operational aspects of a complex intervention\ud trial based in NHS emergency and physiotherapy departments, evaluating two components of a\ud stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations,\ud with the first stage being cluster randomised and the second individually randomised
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