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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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Timeframe of specific components of interventions.
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Figure 2: Timeframe of specific components of interventions.

Mentions: Participants undertook supervised exercise, and received basic information about the musculoskeletal system of the neck, relevant to the exercise. The exercise program consisted of 2 physiotherapy sessions weekly in addition to home exercise. Initially the program focused on daily gentle unresisted isometric cervical flexion, extension and rotation exercises (about 3 sets of 5 repetitions of each exercise daily at home), aimed at facilitating activity of the deep cervical muscle layers. Exercise was then progressed in each direction with low isometric resistance, increasing the exercise parameters toward 3 sets of 10 repetitions in supine and sitting positions in preparation of the forthcoming gym exercise. The importance of good posture was also emphasized to further facilitate deep cervical muscle function.37 Gradually exercise was introduced in the gym with progressive resistance training with a focus on low-load endurance training, using a weighted pulley for head resistance, or guild board. Progression was made to higher repetitions (up to 3 sets of 30 repetitions) within the symptom tolerance. Although a standardized framework of exercises was followed, progression was tailored to each individual according to their symptomatic response and capability. In this manner participants were encouraged to avoid the aggravation of pain as impaired endogenous pain mechanisms are thought to be present in some individuals with chronic WAD, underpinning recommendations to avoid pain provocation in this group.38 If considered appropriate for an individual, the exercise program could also include exercise for the lower back, abdomen, and scapulae, as well as stretching exercises. Toward the end of the 12-week exercise period participants were encouraged to continue exercise in the home by providing them with resistive exercise bands and a written individualized exercise program also including prescription of general physical activity (Fig. 2).


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)

Timeframe of specific components of interventions.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Timeframe of specific components of interventions.
Mentions: Participants undertook supervised exercise, and received basic information about the musculoskeletal system of the neck, relevant to the exercise. The exercise program consisted of 2 physiotherapy sessions weekly in addition to home exercise. Initially the program focused on daily gentle unresisted isometric cervical flexion, extension and rotation exercises (about 3 sets of 5 repetitions of each exercise daily at home), aimed at facilitating activity of the deep cervical muscle layers. Exercise was then progressed in each direction with low isometric resistance, increasing the exercise parameters toward 3 sets of 10 repetitions in supine and sitting positions in preparation of the forthcoming gym exercise. The importance of good posture was also emphasized to further facilitate deep cervical muscle function.37 Gradually exercise was introduced in the gym with progressive resistance training with a focus on low-load endurance training, using a weighted pulley for head resistance, or guild board. Progression was made to higher repetitions (up to 3 sets of 30 repetitions) within the symptom tolerance. Although a standardized framework of exercises was followed, progression was tailored to each individual according to their symptomatic response and capability. In this manner participants were encouraged to avoid the aggravation of pain as impaired endogenous pain mechanisms are thought to be present in some individuals with chronic WAD, underpinning recommendations to avoid pain provocation in this group.38 If considered appropriate for an individual, the exercise program could also include exercise for the lower back, abdomen, and scapulae, as well as stretching exercises. Toward the end of the 12-week exercise period participants were encouraged to continue exercise in the home by providing them with resistive exercise bands and a written individualized exercise program also including prescription of general physical activity (Fig. 2).

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