Peolsson A1, Landén Ludvigsson M1,2, Peterson G1,3
1Linköping University, Medical and Health Sciences, Physiotherapy, Linköping, Sweden, 2County Council of Östergötland, Rehab Väst, Motala, Sweden, 3Uppsala University, Centre for Clinical Research Sörmland, Eskilstuna, Sweden
Background: Although whiplash-associated disorders (WAD) and remaining problem thereof is common, the most effective therapy for WAD is unclear.
Purpose: The primary aim was to investigate whether neck-specific exercises with or without a behavioural component would improve neck functioning compared to a prescription of general physical activity for individuals with chronic WAD.
Methods: The study was a prospective, randomized, multicentre study with up to 2-year follow-up, with blinded investigators. 216 patients (66% women, mean age 40 years) with WAD grade 2 and 3 were included. The participants were randomized into one of three treatments: (A) neck-specific exercise (NSE), (B) neck-specific exercise with a behavioural approach (NSEB), or (C) prescription of general physical activity (PPA) alone. The treatments lasted for 3 months. Physical and psychological functioning, pain intensity, work ability, and economic health benefits were investigated. Main outcome was the Neck Disability Index (NDI).
Results: Both neck-specific groups significantly improved compared with PPA in NDI, individually chosen physical activity (PSFS), Catastrophizing (PCS), WAD-grade classification, Enablement (PEI), Health related quality of life (EQ-VAS) and neck muscle endurance. The NSE group was significantly more improved compared with PPA in Anxiety (HADs), Fear of movement (TSK) and Arm pain intensity (VAS; for those with WAD grade 3). The NSEB improved significantly compared with PPA in Disability from pain (PDI), Dizziness (UCLA) and Work ability (WAI). Regarding current neck pain intensity (VAS) all three groups improved without significant differences between them. However, the NSE group used significantly less pain medication compared with PPA. NSE was cost-effective compared to NSEB/ PPA in a societal perspective.
Conclusion(s): Both neck-specific exercise groups significantly improved in most variables, although for PPA there were mostly a tendency for worsening. There were no significant differences between the neck-specific groups, thus the behavioural component, on a group level, did not significantly add to the improvement compared with the neck-specific exercise only.
Implications: Our findings shows that NSE is cost-effective and the results may help to improve treatment guidelines for patients with WAD.
Keywords: Whiplash injuries, Rehabilitation, Exercise
Funding acknowledgements: The Swedish government through the REHSAM Foundation, the Swedish Research Council, County Councils of Östergötland and Sörmland.
Purpose: The primary aim was to investigate whether neck-specific exercises with or without a behavioural component would improve neck functioning compared to a prescription of general physical activity for individuals with chronic WAD.
Methods: The study was a prospective, randomized, multicentre study with up to 2-year follow-up, with blinded investigators. 216 patients (66% women, mean age 40 years) with WAD grade 2 and 3 were included. The participants were randomized into one of three treatments: (A) neck-specific exercise (NSE), (B) neck-specific exercise with a behavioural approach (NSEB), or (C) prescription of general physical activity (PPA) alone. The treatments lasted for 3 months. Physical and psychological functioning, pain intensity, work ability, and economic health benefits were investigated. Main outcome was the Neck Disability Index (NDI).
Results: Both neck-specific groups significantly improved compared with PPA in NDI, individually chosen physical activity (PSFS), Catastrophizing (PCS), WAD-grade classification, Enablement (PEI), Health related quality of life (EQ-VAS) and neck muscle endurance. The NSE group was significantly more improved compared with PPA in Anxiety (HADs), Fear of movement (TSK) and Arm pain intensity (VAS; for those with WAD grade 3). The NSEB improved significantly compared with PPA in Disability from pain (PDI), Dizziness (UCLA) and Work ability (WAI). Regarding current neck pain intensity (VAS) all three groups improved without significant differences between them. However, the NSE group used significantly less pain medication compared with PPA. NSE was cost-effective compared to NSEB/ PPA in a societal perspective.
Conclusion(s): Both neck-specific exercise groups significantly improved in most variables, although for PPA there were mostly a tendency for worsening. There were no significant differences between the neck-specific groups, thus the behavioural component, on a group level, did not significantly add to the improvement compared with the neck-specific exercise only.
Implications: Our findings shows that NSE is cost-effective and the results may help to improve treatment guidelines for patients with WAD.
Keywords: Whiplash injuries, Rehabilitation, Exercise
Funding acknowledgements: The Swedish government through the REHSAM Foundation, the Swedish Research Council, County Councils of Östergötland and Sörmland.
Topic: Musculoskeletal: spine; Musculoskeletal; Disability & rehabilitation
Ethics approval required: Yes
Institution: Linköping University
Ethics committee: Regional ethics committee Linköping
Ethics number: 2010/188-31, 2011/262-32
All authors, affiliations and abstracts have been published as submitted.
