Landén Ludvigsson M.1,2, Peterson G.1, Peolsson A.1
1Linköping University, Department of Medical and Health Sciences, Physiotherapy, Linköping, Sweden, 2County Council of Östergötland, Rehab Väst, Motala, Sweden
Background: Effective treatment of people with neurological deficits after a whiplash injury (whiplash associated disorders, WAD, grade 3) remains a scientific gap of knowledge. Even though the majority of those with grade 3 never recover, they are rarely included in studies of chronic WAD. Furthermore there are indications that milder neurological deficits may be present also in people with chronic WAD grade 2. Previous research indicate that individuals with WAD grade 2 and 3 may improve in self-rated disability from neck-specific exercise, but not from general physical activity prescription. Whether improvements of neurological symptoms, and not just self-rated measures can also be expected is however unknown.
Purpose: The aim of this study was to examine whether clinical findings of neurological deficits in chronic WAD improve following neck-specific exercise with or without a behavioural approach, and whether there is a difference between neck-specific exercise or physical activity prescription in that regard.
Methods: This was a randomized clinical trial with assessor blinding, comparing 171 individuals classified as either WAD grade 2 or 3, suffering from possible neurological deficits after a whiplash injury, at least 6 but no more than 36 months pre-inclusion. Participants were randomized to physiotherapist-led neck-specific exercise either with or without a behavioural approach or prescription of physical activity. Patient graded arm pain on a 100 mm VAS-scale and sensibility, muscle strength and tendon reflexes were tested clinically at baseline, post intervention (at 3 months) and after 1 year.
Results: Also in individuals classified as grade 2 (supposedly without neurological deficits), sensory disturbances were found in a majority of individuals. The proportion of participants with sensory disturbances in both grades was significantly reduced over time following the neck-specific exercise with or without a behavioural approach (p 0.04), but not following physical activity prescription (p=0.28). There were significantly more participants in the two physiotherapist-led neck-specific exercise groups who had regained normal upper extremity muscle strength at 3 and 12 months (p=0.04), and normal reflexes at 3 months (p=0.04) compared to in the prescription of physical activity group. Arm pain was significantly lower in the neck-specific group (p=0.02), compared to the physical prescription group.
Conclusion(s): Neck-specific exercise with or without a behavioural approach can help reducing signs of neurological deficits in individuals with chronic WAD.
Implications: These results support implementing neck-specific exercise for individuals with neurological deficits in chronic WAD.
Funding acknowledgements: The Swedish Research Council, the REHSAM foundation,the regional Centers for Clinical Research of Östergötland and Sörmland County Councils, Sweden.
Topic: Musculoskeletal: spine
Ethics approval: The study was approved by the Regional Ethics Committee of Linköping University, Sweden (Dnr 2010/188-31)
All authors, affiliations and abstracts have been published as submitted.
