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
2016 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, no 34, e4430Article in journal (Refereed) Published
Malardalen Univ, Sch Hlth Care & Social Welf, Physiotherapy Dept, Vasteras, Vastmanland, Sweden.;Univ Orebro, Ctr Hlth & Med Psychol, Orebro, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden..
Ludvigsson, Maria Landen
Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.;Linkoping Univ, Dept Rehabil, Cty Council Ostergotland, Rehab Vast, S-58183 Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, S-58183 Linkoping, Sweden..
Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden..
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.
Place, publisher, year, edition, pages
2016. Vol. 95, no 34, e4430
behavioral medicine, exercise therapy, neck, spine, whiplash injuries
IdentifiersURN: urn:nbn:se:uu:diva-305944DOI: 10.1097/MD.0000000000004430ISI: 000384032900027PubMedID: 27559950OAI: oai:DiVA.org:uu-305944DiVA: diva2:1044548