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Peterson G1,2, Landén Ludvigsson M2, Peolsson A2
1Uppsala University, Centre for Clinical Research Sörmland, Eskilstuna, Sweden, 2Linkoping University, Medical and Health Sciences, Linköping, Sweden
Background: Chronic pain and disability affects approximately 50 % after a whiplash injury and are associated with loss of work productivity, increased medical care and other disability-related costs. Reduced cervical range of motion, grip strength and neck muscle endurance may affect work ability and can led to long-term disability. Therefore, it is urgent to develop effective interventions for chronic WAD.
Purpose: To compare the effect of 3 different exercise interventions on active cervical range of motion (ACROM), grip strength and neck muscle endurance (NME) and to investigate if changes in these functional tests are related to a change in neck pain and work ability.
Methods: This prospective randomized clinical trial included 216 individuals with chronic WAD grade II and III. Participants were randomized to three months of exercise; neck-specific exercise (NSE), NSE with behavioral approach (NSEB) or prescribed physical activity (PPA). Active range of motion (AROM) was measured with a cervical range of motion devise (CROM), grip strength was measured with a Jamar dynamometer, and ventral and dorsal NME were measured in seconds. The overall grip strength was calculated from the mean of the dominant and non-dominant handgrip strength. The participants completed a standardized questionnaire including neck pain (Visual Analog Scale [VAS]) and self-reported work ability (Work Ability Index [WAI]). The measurements were collected at baseline, 3, 6 and 12 months. Correlation between ACROM, grip strength, NME, neck pain against WAI were evaluated with Pearson's correlations. Differences between exercise groups were analyzed with linear mixed models.
Results: There were significant between group differences in AROM (flexion-extension, rotation) from baseline to the 12 months follow-up, with improvements in both the NSE (mean; 8°) and NSEB (8° and 10° respectively) groups compared with PPA (- 2°, p 0.05). The NSE group improved also in lateral flexion (4°) as opposed to the PPA group (-3°, p 0.05). There were significant differences in ventral (males only) and dorsal NME, both the NSE and NSEB groups improved compared with the PPA group (p 0.05). There was no significant between group differences in grip strength (p>0.05).
Moderate positive correlations between increase in AROM (r=0.31-0.34), grip strength (r = .36) and increase in WAI were found from baseline to the 12 months follow-up (P 0.01). Small to moderate negative correlations between increased AROM (r=0.30), grip strength (r=0.26) and decreased neck pain were found (p 0.01). There were no correlations between change in NME and change in WAI or neck pain to follow-up at 12 months.
Conclusion(s): The NSE and NSEB groups improved in AROM and NME compared with the PPA group. There were small to moderate correlations between increase in AROM, grip strength and increase in WAI and neck pain.
Implications: Improvement in cervical range of motion and grip strength seem to have some effect on self-reported work ability and neck pain in chronic WAD. Neck-specific exercise could be used to improve cervikal function in longstanding WAD and could be implemented into physical therapy practice.
Keywords: Chronic pain, whiplash-associated disorders, exercise
Funding acknowledgements: Swedish government RS2010/009, Swedish Research Council 2014-2982, Centre for Clinical Research Sörmland at Uppsala University DLL-553281, Uppsala-Örebro Regional-Research-Council Sweden RFR-384651.
Purpose: To compare the effect of 3 different exercise interventions on active cervical range of motion (ACROM), grip strength and neck muscle endurance (NME) and to investigate if changes in these functional tests are related to a change in neck pain and work ability.
Methods: This prospective randomized clinical trial included 216 individuals with chronic WAD grade II and III. Participants were randomized to three months of exercise; neck-specific exercise (NSE), NSE with behavioral approach (NSEB) or prescribed physical activity (PPA). Active range of motion (AROM) was measured with a cervical range of motion devise (CROM), grip strength was measured with a Jamar dynamometer, and ventral and dorsal NME were measured in seconds. The overall grip strength was calculated from the mean of the dominant and non-dominant handgrip strength. The participants completed a standardized questionnaire including neck pain (Visual Analog Scale [VAS]) and self-reported work ability (Work Ability Index [WAI]). The measurements were collected at baseline, 3, 6 and 12 months. Correlation between ACROM, grip strength, NME, neck pain against WAI were evaluated with Pearson's correlations. Differences between exercise groups were analyzed with linear mixed models.
Results: There were significant between group differences in AROM (flexion-extension, rotation) from baseline to the 12 months follow-up, with improvements in both the NSE (mean; 8°) and NSEB (8° and 10° respectively) groups compared with PPA (- 2°, p 0.05). The NSE group improved also in lateral flexion (4°) as opposed to the PPA group (-3°, p 0.05). There were significant differences in ventral (males only) and dorsal NME, both the NSE and NSEB groups improved compared with the PPA group (p 0.05). There was no significant between group differences in grip strength (p>0.05).
Moderate positive correlations between increase in AROM (r=0.31-0.34), grip strength (r = .36) and increase in WAI were found from baseline to the 12 months follow-up (P 0.01). Small to moderate negative correlations between increased AROM (r=0.30), grip strength (r=0.26) and decreased neck pain were found (p 0.01). There were no correlations between change in NME and change in WAI or neck pain to follow-up at 12 months.
Conclusion(s): The NSE and NSEB groups improved in AROM and NME compared with the PPA group. There were small to moderate correlations between increase in AROM, grip strength and increase in WAI and neck pain.
Implications: Improvement in cervical range of motion and grip strength seem to have some effect on self-reported work ability and neck pain in chronic WAD. Neck-specific exercise could be used to improve cervikal function in longstanding WAD and could be implemented into physical therapy practice.
Keywords: Chronic pain, whiplash-associated disorders, exercise
Funding acknowledgements: Swedish government RS2010/009, Swedish Research Council 2014-2982, Centre for Clinical Research Sörmland at Uppsala University DLL-553281, Uppsala-Örebro Regional-Research-Council Sweden RFR-384651.
Topic: Musculoskeletal: spine; Disability & rehabilitation
Ethics approval required: Yes
Institution: Regional Ethics Review Board,
Ethics committee: Faculty of Health Science, Linköping University
Ethics number: Dnr 2010/188-31
All authors, affiliations and abstracts have been published as submitted.
