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One- and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioural approach compared with prescription of physical activity in chronic whiplash disorder
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.ORCID iD: 0000-0002-3259-3133
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.ORCID iD: 0000-0003-2492-0306
Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0002-6075-4432
2016 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 1, 56-64 p.Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Objective: To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash. Design: Follow-up of a randomized, assessor blinded, clinical trial. Patients: A total of 216 volunteers with chronic whiplash associated disorders, grades 2 or 3. Methods: Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years. Results: Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p <= 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p < 0.001), but at 2 years the difference was not significant. Conclusion: After 1-2 years, participants with chronic whiplash who were randomized to neck-specific exercise, with or without a behavioural approach, remained more improved than participants who were prescribed general physical activity.

Place, publisher, year, edition, pages
FOUNDATION REHABILITATION INFORMATION , 2016. Vol. 48, no 1, 56-64 p.
Keyword [en]
whiplash; chronic; exercise; randomized; follow-up study; spine; behaviour therapy
National Category
Health Sciences Physiotherapy
Identifiers
URN: urn:nbn:se:liu:diva-126145DOI: 10.2340/16501977-2041ISI: 000370307600009PubMedID: 26660722OAI: oai:DiVA.org:liu-126145DiVA: diva2:911986
Note

Funding Agencies|Swedish government through the REHSAM Foundation; Swedish Research Council; regional Center for Clinical Research; County Council of Ostergotland; Centre for Clinical Research Sormland at Uppsala University; Medical Research Council of Southeast Sweden; Uppsala-Orebro Regional Research Council, Sweden

Available from: 2016-03-15 Created: 2016-03-15 Last updated: 2017-11-30
In thesis
1. Neck-specific exercise with or without a behavioural approach, or prescription of physical activity in chronic whiplash associated disorders
Open this publication in new window or tab >>Neck-specific exercise with or without a behavioural approach, or prescription of physical activity in chronic whiplash associated disorders
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Although 50% of those who suffer a whiplash injury still report neck pain after one year, there is a lack of knowledge about effective treatment for chronic whiplash associated disorders (WAD). Exercise is potentially useful, but the response to exercise in chronic WAD is highly variable between individuals and factors associated with good outcomes as well as the cost-effectiveness are unknown.

Aim: The general aim of this thesis was to evaluate the effect on  self-reported disability/ functioning, pain and selfefficacy of three different exercise interventions in chronic WAD grade 2 and 3, and to determine the cost-effectiveness of these interventions.

Material and methods: A total of 216 participants with chronic WAD took part in this randomized, assessor blinded, controlled, clinical trial. Participants were randomized to either neck-specific exercise without (NSE), or with a behavioural approach (NSEB), or prescription of physical activity (PPA) for 12 weeks. Evaluations of change scores and proportion of clinically relevantly improved participants regarding disability/functioning (Neck Disability Index (NDI)/Patient Specific Functional Scale (PSFS)), pain (Visual Analogue Scale of current neck pain (VAS-P), pain bothersomeness (VAS-B)) and Self-efficacy (Self-Efficacy Scale (SES)) were made after 3, 6, 12 and 24 months. Secondary analyses were made, regarding factors associated with clinically relevant improvements in disability, pain and regarding cost-effectiveness.

Results: Disability was more improved in the NSE/NSEB groups (NDI, P=0.02) than the PPA group, which reported no improvement, at 3 and 6 months, results remaining at 12 and 24 months (p ≤ 0.02). Functioning (PSFS) was also more improved in the NSE/NSEB groups than the PPA group at 3 months, in the NSEB compared to the PPA group at 6 months, and the NSE compared to the PPA groups at 12 and 24 months. The proportion of participants reaching clinically relevant improvement regarding NDI and PSFS was also larger in the NSE/NSEB groups at all time points (P<0.05), except NDI at 3 months and PSFS at 24 months. There were no differences between groups in VAS-P, VASB or SES change scores. The proportion of participants with clinically relevant reduction in VAS-P and VAS-B was however higher (P<0.02) in the NSE/NSEB groups compared with the PPA group at 3 and 12 months. Self-efficacy was only improved in the NSE group but without any between-group differences. There were no significant differences in any outcomes between the NSE/NSEB groups.

The only significant factor associated with both clinically relevant improvements in disability and neck pain both at 3 and 12 months was participation in the NSE group, with odds up to 5.3 times higher than in the PPA group. Different baseline features were associated with the improvements depending on the outcome and time point examined. From a societal perspective, NSE was the cost-effective option.

Conclusion: Physiotherapist-led neck-specific exercise resulted in better outcomes than prescription of physical activity regarding disability, functioning, and pain. The observed benefits of adding a behavioural approach to neck-specific exercise were inconclusive, and NSE was the cost-effective option from a societal perspective. Factors associated with clinically relevant improvements after exercise interventions in chronic WAD differed whether disability or neck pain was the outcome, but also differed in the short and long term. Participation in the NSE group was the only factor associated with both outcomes after both 3 and 12 months.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 82 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1509
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-126782 (URN)10.3384/diss.diva-126782 (DOI)978-91-7685-839-4 (ISBN)
Public defence
2016-05-20, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research CouncilRegion ÖstergötlandMedical Research Council of Southeast Sweden (FORSS)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2016-04-06Bibliographically approved

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Landén Ludvigsson, MariaPeterson, GunnelPeolsson, Anneli

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