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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.

Ludvigsson ML, Peterson G, O'Leary S, Dedering Å, Peolsson A - Clin J Pain (2015)

Bottom Line: 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.However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups.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.

View Article: PubMed Central - PubMed

Affiliation: *Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping †Rehab Väst, County Council of Östergötland, Östergötland ‡Centre for Clinical Research Sörmland, Uppsala University, Uppsala ¶Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Solna #Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden §NHMRC CCRE (Spinal Pain, Injury and Health), The University of Queensland ∥Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Qld, Australia.

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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Related in: MedlinePlus

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.
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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.

Mentions: Potential participants were identified from health care registers of 6 Swedish counties, including primary health care centers, specialist orthopedic clinics, and hospital outpatient services. Participants were screened for eligibility by a 4-step process (Fig. 1). This process included: (1) an initial screening letter (sent to 7950 potential participants) that contained study information, basic inclusion/exclusion criteria (Fig. 1), as well as a NDI34 and pain VAS measure, and a prepaid return envelope; (2) a telephone interview; (3) checking of medical records if uncertainty existed regarding medical history; (4) clinical physical examination by a blinded experienced physiotherapist (mean, 18 y experience) to classify the disorder as either a WAD grade 2 (neck pain and clinical findings) or WAD grade 3 (addition of neurological signs).31 In preparation for the study, test-leaders had practical sessions together to ensure standardized performances of the tests were employed before any participants were recruited. The criteria of neurological signs was met if patients reported arm pain or paresthesia without other known causes, together with at least 2 positive physical examination findings indicating neurological deficit in the same dermatome/myotome.36 In addition, when arm symptoms were present in the supine test position, alteration of symptoms by manual neck traction at the corresponding cervical vertebral levels was also a mandatory finding to further strengthen the assumption that the symptoms were neck induced.


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.

Ludvigsson ML, Peterson G, O'Leary S, Dedering Å, Peolsson A - Clin J Pain (2015)

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.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352069&req=5

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.
Mentions: Potential participants were identified from health care registers of 6 Swedish counties, including primary health care centers, specialist orthopedic clinics, and hospital outpatient services. Participants were screened for eligibility by a 4-step process (Fig. 1). This process included: (1) an initial screening letter (sent to 7950 potential participants) that contained study information, basic inclusion/exclusion criteria (Fig. 1), as well as a NDI34 and pain VAS measure, and a prepaid return envelope; (2) a telephone interview; (3) checking of medical records if uncertainty existed regarding medical history; (4) clinical physical examination by a blinded experienced physiotherapist (mean, 18 y experience) to classify the disorder as either a WAD grade 2 (neck pain and clinical findings) or WAD grade 3 (addition of neurological signs).31 In preparation for the study, test-leaders had practical sessions together to ensure standardized performances of the tests were employed before any participants were recruited. The criteria of neurological signs was met if patients reported arm pain or paresthesia without other known causes, together with at least 2 positive physical examination findings indicating neurological deficit in the same dermatome/myotome.36 In addition, when arm symptoms were present in the supine test position, alteration of symptoms by manual neck traction at the corresponding cervical vertebral levels was also a mandatory finding to further strengthen the assumption that the symptoms were neck induced.

Bottom Line: 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.However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups.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.

View Article: PubMed Central - PubMed

Affiliation: *Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping †Rehab Väst, County Council of Östergötland, Östergötland ‡Centre for Clinical Research Sörmland, Uppsala University, Uppsala ¶Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Solna #Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden §NHMRC CCRE (Spinal Pain, Injury and Health), The University of Queensland ∥Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Qld, Australia.

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.

Show MeSH
Related in: MedlinePlus