Alalawi A.1, Heneghan N.1, Peolsson A.2, Rushton A.1, Peterson G.2, Landén Ludvigsson M.2, Schneebeli A.3, Barbero M.3, Falla D.1
1University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 2Linköping University, Department of Medical and Health Sciences, Linköping, Sweden, 3University of Applied Sciences and Arts of Southern Switzerland, Department of Business Economics, Health and Social Care, Manno, Switzerland
Background: More than 60% of individuals with whiplash-associated disorders (WAD) will experience persistent symptoms 6 months after the initial injury. Exercise has been shown to be effective in the management of WAD however, the response to exercise is highly variable. Identifying factors that may predict prognosis and response to exercise interventions in this population could be helpful to optimise rehabilitation. The significance of larger pain extent, observed from the patient's pain drawing, for predicting response to exercise has not been examined, even though expanded distribution of pain is considered a sign of central sensitization which may affect prognosis.
Purpose: To investigate whether pain extent, measured from the patient's pain drawing prior to participation in a neck specific exercise intervention, is associated with ongoing pain and disability 1 and 2 years after the intervention in patients with chronic WAD.
Methods: A secondary analysis of data from a randomized controlled trial of 140 participants with chronic WAD was conducted. Participants completed questionnaires to detail their gender, age, general health, quality of life, psychological features, and pain and disability. In addition, patients completed pain drawings which were subsequently digitized allowing pain extent to be calculated utilising novel software. Participants then completed a 12-week intervention of neck-specific exercises with or without a behavioural approach. The Neck Disability Index (NDI) score was evaluated 1 and 2 years following in the intervention. Descriptive analysis and multiple linear regression analyses were performed to investigate the relationship between pain extent measured at baseline and the NDI score (primary outcome) at both 1 and 2 years post intervention controlling for age and gender.
Results: Seventy percent of the cohort were women with a mean age (SD) of 38.7 (11.5) years, a baseline NDI score of 32.7 (13.0) and pain extent of 6.8% (6.9%). The regression models accounted for 31% and 25% of the variance in NDI scores at the 1 year (p 0.001; 95% CI: 0.34 - 1.13) and 2-year (p=0.034; 95% CI: 0.04 - 1.06) follow-up, respectively.
Conclusion(s): Pain extent was partially predictive of medium and long term neck pain and disability following a neck-specific exercise with or without a behavioural approach in individuals with chronic WAD. This indicates that people displaying a larger distribution of pain are more likely to have continued pain and disability following participation in a neck exercise programme.
Implications: This new knowledge may assist clinicians in predicting the medium to long term outcomes for patients with chronic WAD following specific-neck exercise programmes. This information may be used to inform management planning and tailor interventions to the needs of the individuals.
Funding acknowledgements: N/A
Topic: Musculoskeletal: spine
Ethics approval: Regional Ethics Committee of Linköping, Sweden, School of Sport, Exercise and Rehabilitation Sciences Ethics/Health and Safety Committee, University of Birmingham
All authors, affiliations and abstracts have been published as submitted.
