Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study

BMC Musculoskeletal Disorders

Gunnel Peterson⁴  Ann-Sofi Kammerlind⁶  Gun Johansson³  Lars Bernfort⁵  Åsa Dedering⁷  Thomas Overmeer⁸  Maria Landén Ludvigsson²  Anneli Peolsson¹ 

[1] NHMRC CCRE (Spinal Pain, Injury and Health), The University of Queensland, Brisbane, Australia;Rehab Väst, County Council of Östergötland, Motala, Sweden;Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden;Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden;Department of Medical and Health Sciences, Health Care Analysis, Linköping University, Linköping, Sweden;County Council of Jönköping, Jönköping, Sweden;Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden;Center for Health and Medical Physiology, Örebro University, Örebro, Sweden

关键词: Exercise;    Physical therapy;    Rehabilitation;    Spine;    Neck pain;    Whiplash injuries;   

Others  :  1129245
DOI  :  10.1186/1471-2474-14-311

 received in 2013-09-30, accepted in 2013-10-18,  发布年份 2013

【 摘 要 】

Background

Up to 50% of chronic whiplash associated disorders (WAD) patients experience considerable pain and disability and remain on sick-leave. No evidence supports the use of physiotherapy treatment of chronic WAD, although exercise is recommended. Previous randomised controlled studies did not evaluate the value of adding a behavioural therapy intervention to neck-specific exercises, nor did they compare these treatments to prescription of general physical activity. Few exercise studies focus on patients with chronic WAD, and few have looked at patients’ ability to return to work and the cost-effectiveness of treatments. Thus, there is a great need to develop successful evidence-based rehabilitation models. The study aim is to investigate whether neck-specific exercise with or without a behavioural approach (facilitated by a single caregiver per patient) improves functioning compared to prescription of general physical activity for individuals with chronic WAD.

Methods/Design

The study is a prospective, randomised, controlled, multi-centre study with a 2-year follow-up that includes 216 patients with chronic WAD (> 6 months and < 3 years). The patients (aged 18 to 63) must be classified as WAD grade 2 or 3. Eligibility will be determined with a questionnaire, telephone interview and clinical examination. The participants will be randomised into one of three treatments: (A) neck-specific exercise followed by prescription of physical activity; (B) neck-specific exercise with a behavioural approach followed by prescription of physical activity; or (C) prescription of physical activity alone without neck-specific exercises. Treatments will be performed for 3 months. We will examine physical and psychological function, pain intensity, health care consumption, the ability to resume work and economic health benefits. An independent, blinded investigator will perform the measurements at baseline and 3, 6, 12 and 24 months after inclusion. The main study outcome will be improvement in neck-specific disability as measured with the Neck Disability Index. All treatments will be recorded in treatment diaries and medical records.

Discussion

The study findings will help improve the treatment of patients with chronic WAD.

Trials registration

ClinicalTrials.gov identifier: NCT01528579.

【 授权许可】

   
2013 Peolsson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]The Whiplash Commission Final Report: Sandviken. 2005. [http://www.whiplashkommissionen.se/pdf/WK_finalreport.pdf webcite]. Accessed March 4, 2012
• [2]Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, Côté P, Guzman J, Peloso P, Nordin M, Hurwitz E, van der Velde G, Carragee E, Haldeman S: 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 2008, 33:S52-S59.
• [3]Association of British Insurers: Fair, independent, objective – ABI publishes proposals to curb the UK’s whiplash epidemic. https://www.abi.org.uk/News/News-releases/2013/03/Fair-Independent-Objective--Abi-Publishes-Proposals-To-Curb-The-Uks-Whiplash-Epidemic webcite. Accessed October 20, 2013
• [4]Styrke J, Stålnacke BM, Bylund PO, Sojka P, Björnstig U: A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in the northern Sweden. Phys Med Rehabil 2012, 4:739-747.
• [5]Cassidy JD, Carroll LJ, Côté P, et al.: Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 2000, 342:1179-1186.
• [6]Rodriques AA, Barr KP, Burns SP: Whiplash: pathophysiology, diagnosis, treatment and prognosis. Muscle Nerve 2004, 29:768-781.
• [7]Rebbeck T, Sindhusake D, Cameron ID, Rubin G, Feyer A-M, Walsh J, Gold M, Schofield WN: A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population. Inj Prev 2006, 12:93-98.
• [8]Carroll L, Holm L, Hogg-Johnson S, Cote P, Cassidy D, Haldeman S, Nordin M, Hurwitz E, Carragee E, van der Velde G, Peloso P, Guzman J: 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 2008, 33:583-592.
• [9]Leth-Petersen S, Rotger GP: Long-term labour-market performance of whiplash claimants. J Health Econ 2009, 28:996-1011.
• [10]Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Ziess E: Scientific monograph of the Quebek task force on whiplash-associated disorders: redefining whiplash and its management. Spine 1995, 20:1S-73S.
• [11]Sterner Y, Gerdle B: Acute and chronic whiplash disorders – a review. J Rehab Med 2004, 36:193-210.
• [12]Seferiadis A, Rosenfeld M, Gunnarsson R: A review of treatment interventions in whiplash-associated disorders. Eur Spine J 2004, 13:387-397.
• [13]Woodhouse A, Vasseljen O: Altered motor control patterns in whiplash and chronic neck pain. BMC Musculoskel Disord 2008, 9:1-10. BioMed Central Full Text
• [14]Stewart MJ, Maher CG, Refshauge KM, et al.: Randomized controlled trial of exercise for chronic whiplash-associated disorders. Pain 2007, 128:59-68.
• [15]Söderlund A, Lindberg P: Cognitive behavioural components in physiotherapy management of chronic whiplash associated disorders (WAD) – a randomized group study. G Ital Med Lav Ergon 2007, 29:A5-A11.
• [16]Nijs J, van Oosterwijck J, De Hertogh W: Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome? Clin Rheumatol 2009, 28:243-251.
• [17]Verhagen AP, Scholten-Peeters G, van Wijngaarden S, de Bie RA, Bierma-Zeinstra SMA: Conservative treatment for whiplash. Cochrane Database Syst Rev 2007, 4:4.
• [18]Swedish Council on Health Technology Assessment (SBU): Back pain, Neck pain. An evidence based review. (In Swedish) (Ont i ryggen, ont i nacken: en evidensbaserad kunskapssammanställning). Nr 145/2, chapter 14–17. Stockholm: SB Offsett AB; 2000.
• [19]Bunketorp L, Lindh M, Carlsson J, Stener-Victorin E: The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders – a randomized controlled trial. Clin Rehabil 2006, 20:201-217.
• [20]Vikne J, Oedegaard A, Laerum E, Ihlebaek C, Kirkesola G: A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims. J Rehab Med 2007, 39:252-259.
• [21]Jull G, Sterling M, Kenardy J, Beller E: Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash? A preliminary RCT. Pain 2007, 129:28-34.
• [22]Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B: A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 4 - noninvasive interventions for chronic WAD. Pain Res Manag 2010, 15:313-322.
• [23]Carlsson AM: Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983, 16:87-101.
• [24]Vernon H, Mior S: The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 1991, 14:409-415.
• [25]Peolsson A, Hedlund R, Ertzgaard S, Öberg B: Intra-and inter-tester reliability and age- and sex-specific range of motion of the neck. Physiother Canada 2000, 52:233-242.
• [26]Wibault J, Vaillant J, Vuillerme N, Dedering Å, Peolsson A: Using the cervical range of motion (CROM) device to assess head repositioning accuracy in individuals with cervical radiculopathy in comparison to neck healthy individuals. Man Ther 2013, 18:403-409.
• [27]Capuano-Pucci D, Rheault W, Aukai J, Bracke M, Day R, Patrick M: Intratester and intertester, reliability of the cervical range of motion device. Arch Phys Med Rehabil 1991, 72:338-340.
• [28]Peolsson A, Almkvist C, Dahlberg C, Lindqvist S, Pettersson S: Age- and sex-specific reference values of a test of neck muscle endurance. J Manipulative Physiol Ther 2007, 30:171-177.
• [29]Peolsson A, Hedlund R, Öberg B: Intra- and inter-tester reliability and reference values for hand strength. J Rehab Med 2001, 33:36-41.
• [30]Kammerlind A-S, Ledin T, Ödkvist L, Skargren E: Influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss. Clin Rehabil 2006, 20:142-148.
• [31]Johansson G, Jarnlo G-B: Balance training in 70-year-old women. Physiother Theory Pract 1991, 7:121-125.
• [32]Tait RC, Chibnall JT, Krause S: The pain disability index: psychometric properties. Pain 1990, 40:171-182.
• [33]Honrubia V, Bell TS, Harris MR, Baloh RW, Fisher LM: Quantitative evaluation of dizziness characteristics and impact on quality of life. Am J Otology 1996, 17:595-602.
• [34]Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L: The pain catastrophizing scale: further psychometric evaluation with adult samples. J Behavioral Med 2000, 23:351-365.
• [35]Stratford P, Gill C, Westaway M, Binkley J: Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Canada 1995, 47:358-363.
• [36]Altmaier ERD, Kao C, Lehmann T, Weinstein J: Role of self-efficacy in rehabilitation outcome among chronic low back pain patients. J.Counsel Psychol 1993, 36:725-733.
• [37]Dzewaltowski D: Toward a model of exercise motivation. J Sport Exerc Psychol 1989, 11:251-269.
• [38]Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003, 35:1381-1395.
• [39]Roelofs J, Sluiter JK, Frings-Dresen MH, Goossens M, Thibault P, Boersma K, Vlaeyen JW: Fear of movement and (re)injury in chronic musculoskeletal pain: evidence for an invariant two-factor model of the Tampa scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples. Pain 2007, 131:181-190.
• [40]Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67:361-370.
• [41]Brooks RG, Jendteg S, Lindgren B, Persson U, Björk S: EuroQol: health-related quality of life measurement. Results of the Swedish questionnaire exercise. Health Policy 1991, 18:37-48.
• [42]Sullivan M, Karlsson J, Ware J: The Swedish SF-36 health survey-I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med 1995, 41:1349-1358.
• [43]de Zwart BC, Frings-Dresen MH, van Duivenbooden JC: Test-retest reliability of the work ability index questionnaire. Occup Med 2002, 52:177-181.
• [44]Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R: The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med 2004, 58:1483-1499.
• [45]Howie JG, Heaney DJ, Maxwell M, Walker JJ: A comparison of a patient enablement instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract 1998, 15:165-171.
• [46]Swedish Council on Health Technology Assessment (SBU’s) assignment on treatment uncertainties. http://www.sbu.se/sv/Publicerat/Sok-kunskapsluckor/Kunskapsluckor/Fysisk-traning-inom-halso--och-sjukvardens-ram-vid-otillracklig-fysisk-aktivitet-hos-vuxen-med-kronisk-smarta/ webcite
• [47]NHS Evidence from the UK Database of Uncertainties about the Effects of Treatments (DUETs). http://www.library.nhs.uk/duets/ViewResource.aspx?resID?=?412800&tabID?=?297&catID= webcite. 14509
• [48]NHS Evidence from the UK Database of Uncertainties about the Effects of Treatments (DUETs). http://www.library.nhs.uk/duets/ViewResource.aspx?resID?=?332541&tabID?=?297 webcite