Original research
Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study

https://doi.org/10.1016/j.apmr.2015.10.087Get rights and content

Highlights

  • The results showed that neck-specific exercises (NSEs) significantly benefited neck disability, self-efficacy, and health-related quality of life compared with the untreated group.

  • There was significant improvement over time in all outcomes for the NSE group, and mostly significant worsening over time for the untreated group.

  • The results indicated that NSEs were more beneficial than no intervention while on a waiting list for individuals with chronic whiplash-associated disorders.

Abstract

Objective

To determine whether 3 months of neck-specific exercises (NSEs) could benefit individuals with chronic whiplash-associated disorder (WAD) who were on a waiting list (WL) for treatment.

Design

A prospective, randomized controlled study.

Setting

Primary health care.

Participants

Individuals (N=41; 31 women, 10 men; mean age ± SD, 38±11.2y) with chronic (6–36mo) WAD, grades 2 and 3, were analyzed.

Interventions

Patients were randomly assigned to NSEs or no treatment for 3 months.

Main Outcome Measures

Neck-specific disability (Neck Disability Index [NDI]), neck pain (visual analog scale), general pain-related disability (Pain Disability Index [PDI]), self-perceived performance ability (Self-Efficacy Scale [SES]), and health-related quality of life (EuroQol 5 dimensions [EQ-5D]) were measured.

Results

NSEs significantly improved the NDI, SES, and EQ-5D compared with WL (P<.01). There was significant improvement (P<.0001) over time in all outcomes for NSEs, and apart from the PDI, significant worsening (P=.002–.0002) over time for the untreated group.

Conclusions

NSEs were more beneficial than no intervention while on a WL for individuals with chronic WAD.

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.

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  • Cited by (0)

    Clinical Trial Registration No.: NCT01547624.

    Disclosures: none.

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