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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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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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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.

Mentions: With regard to the proportion of responders as indicated by change in NDI score, there was no significant difference between groups (P=0.23) in the proportion of responders at 3 months (40% NSE, 43% NSEB, 21% PPA), however, at 6 months the difference was significant (P=0.02) between groups (28% NSE, 54% NSEB, and 21% PPA) (Fig. 3).


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)

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.
© Copyright Policy
Related In: Results  -  Collection

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

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.
Mentions: With regard to the proportion of responders as indicated by change in NDI score, there was no significant difference between groups (P=0.23) in the proportion of responders at 3 months (40% NSE, 43% NSEB, 21% PPA), however, at 6 months the difference was significant (P=0.02) between groups (28% NSE, 54% NSEB, and 21% PPA) (Fig. 3).

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