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Randomized Controlled Trial
. 2015 Apr;31(4):294-303.
doi: 10.1097/AJP.0000000000000123.

The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial

Maria L Ludvigsson  1 , Gunnel Peterson, Shaun O'Leary, Åsa Dedering, Anneli Peolsson
Affiliations
Randomized Controlled Trial

The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial

Maria L Ludvigsson et al. Clin J Pain. 2015 Apr.

Abstract

Objectives: The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA).

Materials and methods: A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months.

Results: The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the 2 NSE groups (29% to 48%) compared with the PPA group (5%) at 3 months. At 6 months 39% to 44% of the patients in the 2 neck-specific groups and 28% in the PPA group reported substantial pain reduction. Reduction of disability was also larger in the 2 neck-specific exercise groups at both 3 and 6 months (P<0.02). Self-efficacy was only improved in the NSE group without a behavioral approach (P=0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups.

Discussion: NSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

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Conflict of interest statement

Supported by funding from the Swedish government through the Swedish Research Council in cooperation with the Swedish Social Insurance Agency through the REHSAM foundation Stockholm, Sweden, and the regional Centers for Clinical Research of Östergötland, Linköping, Sweden and Sörmland, Uppsala, Sweden County Councils. A.P. is supported by the Swedish Research Council, Stockholm, Sweden. S.O.L. is supported by a Health Practitioner Research Fellowship (Queensland Health and the University of Queensland, Brisbane, Australia [NHMRC CCRE Spinal Pain, Injury and Health]). The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Participant flow through study. *Whiplash injury in the preceding 6 to 36 months, reported to be the onset of current symptoms, excluding unconsciousness/loss of memory in connection to the whiplash injury, previous neck trauma with unresolved symptoms, previous neck surgery, ongoing malignant disease, severe psychiatric disorders, drug abuse, difficulties understanding the Swedish language. NDI indicates Neck Disability Index; VAS, Visual Analogue Scale; WAD, whiplash-associated disorders.
FIGURE 2
FIGURE 2
Timeframe of specific components of interventions.
FIGURE 3
FIGURE 3
Proportion of responders to treatment in the 3 intervention groups. The proportion of responders reaching clinical important difference in the Neck Disability Index (NDI, cutoff change of ≥5/50), Visual Analogue Scale Bothersomeness (VAS-B, ≥50% reduction), Current Pain Visual Analogue Scale (P-VAS, ≥50% reduction) at the 3- and 6-month follow-up periods is presented. Significant difference between groups at *P=0.02, **P=0.004. NSE indicates neck-specific exercise group; NSEB, neck-specific exercise group with a behavioral approach; PPA, Prescription of Physical Activity group.
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Comment in

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