One- and Two-year Follow-up of a Randomized Trial of Neck-specific Exercise with or without a Behavioural Approach Compared with Prescription of Physical Activity in Chronic Whiplash Disorder

Objective:   To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash.

Patients   A total of 216 volunteers with chronic whiplash-associated disorders, grades 2 or 3.

Methods:   Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years.

Results:   Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p ≤ 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p < 0.001), but at 2 years the difference was not significant.

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Conclusion:   After 1-2 years, participants with chronic whiplash who were randomized to neck-specific exercise, with or without a behavioural approach, remained more improved than participants who were prescribed general physical activity.

Keywords:   whiplash; chronic; exercise; randomized; follow-up study; spine; behaviour therapy.

Clinical Trial Registration:   Clinical Trials.gov, NCT01528579

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INTRODUCTION

At 1 year post-injury, 50% of people with whiplash-associated disorders (WAD) still report neck pain. [1] Despite the significant impact of WAD, there is still no clear evidence regarding which treatment is most effective. [2–4] Persistence of symptoms in individuals with WAD has been attributed to both physical and psychosocial factors. [5] It is therefore reasonable to assume that a behavioural approach may be of benefit in the management of chronic WAD, as in chronic back pain. [6] However, impairments and altered patterns of muscle activation [7–11] and muscle deformation [12, 13] in the cervical spine are also features of chronic WAD, suggesting that treatments aimed at improving muscle function might also be of importance. Although exercise is considered a safe treatment for neck pain, with temporary and benign side-effects, its efficacy in the context of chronic WAD remains unclear. [2, 3]

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