The effect of neck-specific exercise with or without a behavioral approach on psychological factors in chronic whiplash-associated disorders: A randomized controlled trial with a 2-year follow-up. Issue 34 (August 2016)

• Record Type: Journal Article
• Authors: Overmeer, Thomas; Peterson, Gunnel; Landén Ludvigsson, Maria; Peolsson, Anneli
• Other Names: Jellad. Anis section editor.
• Is Part Of: Medicine. Volume 95:Issue 34(2016)
• Publication Date: 2016-08
• Subjects: behavioral medicine -- exercise therapy -- neck -- spine -- whiplash injuries; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000004430
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Background: To investigate the effect of neck-specific exercise with (NSEB) or without (NSE) a behavioural approach and prescribed physical activity (PPA) on general pain disability and psychological factors in chronic whiplash-associated disorders (WAD), grade 2 and 3, with a 2-year follow-up. Methods: A randomized controlled multi-centre study of 3 exercise interventions (NSE, NSEB or PPA) including a 2-year follow-up. A total of 216 volunteers with chronic WAD were recruited and 194 were analyzed, mean age 40.4 (Standard Deviation [SD] 11.4). Measures of general pain disability, pain catastrophizing, anxiety and depression, and kinesiophobia were evaluated at baseline, and 3, 6, 12 and 24 months with linear mixed models. Results: General pain disability decreased by 28% in the NSEB group from baseline to 3 months ( P < 0.001) and the improvements in disability were maintained over time (6, 12 and 24 months P < 0.01) compared to the NSE ( P > 0.42) and PPA groups ( P > 0.43). Pain catastrophizing decreased in the NSE group from baseline to 6 and 12 months ( P < 0.01) and in the NSEB group from baseline to 3 and 24 months ( P < 0.01) compared to the PPA group ( P > 0.82) that showed no change over time. The NSE group improved in kinesiophobia over time from baseline to12 months ( P < 0.01) compared to the NSEB ( P = 0.052) and the PPA groups ( P > 0.74). Anxiety decreased over time from baseline to 12 and 24 months in the NSE group ( P > 0.02), but not in the NSEB ( P > 0.25) or the PPA ( P > 0.50) groups. The PPA had no effect on general disability or any of the measured psychological factors. Conclusion: This randomised controlled trial with a 2-year follow-up shows that physiotherapist-led neck-specific exercise with or without the addition of a behavioural approach had superior outcome on general disability and most psychological factors compared to the mere prescription of physical activity.