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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000123
Original Article: PDF Only

The Effect of Neck-specific Exercise with, or without a Behavioral Approach, on Pain, Disability and Self-efficacy in Chronic Whiplash-associated Disorders: A Randomized Clinical Trial.

Ludvigsson, Maria Landén MSc, PT, PhD; Peterson, Gunnel MSc, PT, PhD; O’Leary, Shaun PhD, PT; Dedering, Åsa PhD, PT; Peolsson, Anneli PhD, PT

Open Access
Published Ahead-of-Print
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Abstract

Objectives: The aim of this study was to compare the effect on self-rated pain, disability and self-efficacy of three interventions for the management of chronic Whiplash Associated Disorders (WAD): physiotherapist-led neck-specific exercise, physiotherapist-led neck-specific exercise with the addition of a behavioral approach, or prescription of physical activity.

Methods: Two hundred and sixteen volunteers with chronic WAD participated in this randomized, assessor blinded, clinical trial of three exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index) and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at three and six months.

Results: The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the two neck-specific exercise groups (29-48%) compared to the prescription of physical activity group (5%) at three months. At six months 39-44% of the patients in the two neck-specific groups and 28% in the prescription of physical activity group reported substantial pain reduction. Reduction of disability was also larger in the two neck-specific exercise groups at both three and six months (P<0.02). Self-efficacy was only improved in the neck-specific exercise group without a behavioral approach (P=0.02). However there were no significant differences in any outcomes between the two physiotherapist-led neck-specific exercise groups.

Discussion: Neck-specific exercise resulted in superior outcomes compared to prescription of physical activity in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

(C) 2014 by Lippincott Williams & Wilkins

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