This study aimed to identify factors related to change in pain and disability after a 3-month internet-supported neck-specific exercise program (NSEIT) with four physiotherapy visits or the same exercise program (NSE) supervised by a physiotherapist twice a week for individuals with persistent whiplash-associated disorders (WAD) grade II or III.
This is a secondary analysis, based on a prospective, randomized, single-blind, controlled trial. Participants (n = 140), aged 18 to 63 years with WAD grade II or III, whiplash injury sustained >6 months to 5 years prior to study entry and with persistent neck pain and disability were included. They were randomized into two groups (n = 70 in each group); 3-months NSEIT with four physiotherapy visits or the same exercise program (NSE) supervised by a physiotherapist twice a week in three months. The program contained also information about the musculoskeletal anatomy of the neck, neurophysiological pain education, and strategies for dealing with neck pain relapse.
Multivariate data analyses (orthogonal partial least square [OPLS]) were used to investigate factors related to change in the dependent variables: neck pain measured with the Visual Analogue Scale, and neck-related disability measured with the Neck Disability Index and Patient Specific Functional Scale.
There were no significant differences between the groups. In both NSEIT and NSE, improvements in the following factors were related to improvements in pain and disability at 3- and 15 months follow-up: anxiety and depression, cognitive failure, pain catastrophizing, self-efficacy, fear avoidance beliefs, cervical range of motion, headache, and symptom satisfaction (R2=0.31-0.37; Q2=0.25-0.30; CV-Anova p0.001-0.0001). No significant multivariate models could be built using baseline values for the separation of clinically improved versus non-improved patients regarding pain or disability.
After three months of NSEIT or NSE, improvements in several psychological and physical measures were related to improvements in neck pain and disability in both groups. Baseline factors could not predict improved versus non-improved in pain and disability and there is still a need for further research to investigate factors that could predict outcomes in individuals with chronic WAD.
The results indicate that improvement in pain and disability are interrelated with improvement in psychological and physical factors and neck-specific exercises delivered in two different ways can be used in treatment of chronic WAD.
Exercise therapy
Rehabilitation
