Original researchEffects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study
Section snippets
Design
This is a prospective, randomized controlled study of participants with chronic WAD. Patients were randomly assigned to 2 groups: (1) NSEs for 3 months or (2) continued on the WL with no intervention for 3 months (fig 1). Patients who had sought care for WAD in the preceding 3 years were asked to notify the researchers of their interest in participating in the study. Individuals who fulfilled the study criteria participated (60 of 61) after providing written and informed consent (see fig 1).
Results
The between-group results demonstrated that the NSE group had improved significantly more than the WL group regarding the NDI (P=.009), SES (P<.001), and the EQ-5D (P<.01), but not in neck pain (P=.14) and PDI (P=.29) (table 3). Clinically relevant differences were reached for NDI, neck pain, and SES (effect size >.40), with large effect sizes for NDI (.88) and SES (1.26).
In measuring the within-group changes over time, all outcome measures significantly improved in the NSE group (P<.0001). In
Discussion
The present study showed the importance of NSEs, with clear trends of measures. The NSE group showed significant improvements in NDI, SES, and EQ-5D compared with the WL group, with strong clinically relevant group differences in NDI and SES. The other 2 outcome measures, neck pain and PDI, showed insignificant differences between groups, which may be due to the study being underpowered (see table 3). Nonetheless, the NSE group improved in all outcomes over time in contrast to the WL group,
Conclusions
In conclusion, for individuals with chronic WAD, NSEs showed many benefits over being on a WL for care. Thus, specific exercise may be an important intervention to help individuals with chronic WAD from worsening. Although the results are promising, they should be interpreted with caution because of the low sample size and dropouts. Randomized controlled studies with larger sample sizes are needed to further investigate the role of NSEs in the treatment of chronic WAD, and also to compare NSEs
Acknowledgments
We thank all the physiotherapists at the county councils involved (Östergötland, Sörmland, Jönköping, Västmanland, and Örebro) for their commitment in treating the participants in this study.
References (36)
- et al.
Long-term labour-market performance of whiplash claimants
J Health Econ
(2009) - et al.
Impairments in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients
Man Ther
(2004) - et al.
The relationship between superficial muscle activity during the cranio-cervical flexion test and clinical features in patients with chronic neck pain
Man Ther
(2011) - et al.
Function in patients with cervical radiculopathy or chronic whiplash-associated disorders compared with healthy volunteers
J Manipulative Physiol Ther
(2014) - et al.
Randomized controlled trial of exercise for chronic whiplash-associated disorders
Pain
(2007) - et al.
Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial
Lancet
(2014) The Neck Disability Index: state-of-the-art, 1991-2008
J Manipulative Physiol Ther
(2008)Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale
Pain
(1983)- et al.
Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study
J Pain
(2012) - et al.
Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care
Pain
(2004)
Classification of patients with whiplash associated disorders (WAD): reliable and valid subgroups based on the Multidimensional Pain Inventory (MPI-S)
Eur J Pain
The Pain Disability Index: psychometric properties
Pain
EuroQol: the current state of play
Health Policy
Clinical relevance vs. statistical significance: using neck outcomes in patients with temporomandibular disorders as an example
Man Ther
The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Spine (Phila Pa 1976)
Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
Spine (Phila Pa 1976)
Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management
Spine (Phila Pa 1976)
Cited by (0)
Clinical Trial Registration No.: NCT01547624.
Disclosures: none.