The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial

Ludvigsson, Maria Landén; Peterson, Gunnel; Peolsson, Anneli

doi:10.1007/s11136-018-2004-3

Cited by 15 publications

(13 citation statements)

References 47 publications

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“…It could be the lack of neck-specific exercise or the lack of guidance. Nevertheless, this is consistent with other outcomes from the main study, such as general health-related quality of life 38 , neck disability 39 , self-reported work ability 40 , pain catastrophising, anxiety and kinesiophobia 41 , where there was also a trend for the PPA group towards deterioration over time. However, as seen in Fig.…”

Section: Discussionsupporting

confidence: 89%

Neck-specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1-year follow-up of a randomised clinical trial

Ludvigsson

Peterson

Peolsson

2020

Sci Rep

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Up to 90% of people with neurological deficits following whiplash injury report chronic symptoms. A recent unique study of neck-specific exercise showed positive results (post-intervention at 12 weeks), regarding arm pain and neurological deficits in people with chronic whiplash associated disorders (WAD). This 1-year follow-up of that randomised controlled study with assessor blinding aimed to examine whether neck-specific exercise with (NSEB) or without (NSE) a behavioural approach has longterm benefits over physical activity prescription (PPA) regarding arm pain and neurological deficits (n = 171). Interventions were: NSE, NSEB, or PPA. Follow-up of arm pain, paraesthesia bothersomeness (questionnaires) and clinical neurological tests were performed after 3, 6 and 12 months and analysed with Linear Mixed Models and General Estimating Equations. The NSE and/or NSEB groups reported significantly less pain and paraesthesia bothersomeness as well as higher odds of normal key muscle arm strength and of normal upper limb neural tension over the year (all p < 0.03), compared with PPA. In conclusion, results suggest that neck-specific exercise with or without a behavioural approach may have persisting long term benefits over PPA regarding arm pain and clinical signs associated with neurological deficits in chronic WAD. Whiplash-associated disorders (WAD) present a significant public health problem with an incidence of at least 300 per 100,000 1. After a whiplash injury resulting in neurological deficits (e.g. abnormal reflexes, reduced muscle strength and/or altered sensibility), the recovery rate is low. After 1 year, up to 90% still report pain and other symptoms 2-4. Individuals with neurological deficits, (WAD grade 3 5), also suffer more than those without 2,6. In clinical practice, antidepressants, analgesics/non-steroidal anti-inflammatory drugs and muscle relaxants are often prescribed despite the lack of evidence to support the use of either for radiating pain 7. Disc protrusions/ prolapses may cause neurological deficits in WAD. Furthermore, prolapses seem to progress over time in WAD 8. A brachial plexus traction injury 9 may be another cause. A recent MRI-study reports that morphological changes in the brachial plexus and median nerve can be found in people with chronic arm and neck pain following a whiplash injury, even without loss of reflexes or key muscle strength 10. Protective shoulder elevation, which may reduce brachial nerve tension 11 and thus also reduce arm pain, is common on the painful side. Altered muscle function 12 and difficulty in relaxing the trapezius muscle, as detected with electromyography/ultrasound, are reported in WAD 13. Dysfunction of predominantly the deep cervical muscles in WAD 14-16 could be another explanation for the increased activity of superficial muscles. Control of intersegmental motion, and thus stability, depends on the deep muscle layers 17. Ligaments may account for only 25% of the cervical stability 18 , and the deep muscles are thus of great importance in maint...

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Section: Discussionsupporting

confidence: 89%

Neck-specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1-year follow-up of a randomised clinical trial

Ludvigsson

Peterson

Peolsson

2020

Sci Rep

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“…It is important to also recognize these findings support previous preliminary cross-sectional work involving patients with varying levels of chronic WAD-related disability and healthy controls across two cultures (United States 1 and Sweden 7 ); where different insurance schemes and medical/rehabilitative options may influence recovery. While larger proportions of MFI in the multifidus muscles have been attributed to severe WAD, further prospective investigations, with larger sample sizes, are required to identify an element of pre-existing organic origins [19][20][21] , specific injury mechanisms underlying MFI 22,23 , biomechanical consequences [24][25][26][27][28] and their relationships to the further development of MFI with a long-term goal of informing clinical trials; exercise in particular 29 .…”

Section: Discussionmentioning

confidence: 99%

Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

Smith

Albin

Abbott

et al. 2020

Sci Rep

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Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixtyone participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1-Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD. Various investigations across three continents (United States 1-3 , Australia 2,4-6 , and Sweden 7,8) have used similar manual segmentation methods with magnetic resonance imaging (MRI) to demonstrate widespread fatty infiltrates in the neck muscles of individuals with acute and chronic whiplash associated disorders (WAD). Comparably high levels of muscle fat infiltration (MFI) were not identified in individuals who (i) had recovered or reported lower levels of WAD-related disability 1,3,4,7,8 , (2) had chronic non-traumatic neck pain 9 , or (3) those without a history of neck disorders 10. Knowledge of a precise mechanism for MFI expression and distribution (e.g. extra-or intra-fascicular MFI) would provide a target for clinical remediation of any adverse symptoms; but this is largely unknown. There remains conjecture in the literature about what constitutes extra-or intra-fascicular MFI, which likely centres on our ability to reliably distinguish the epimysium/perimysium and associated muscle fascicles on MRI. Some have proposed standardised, anatomical definitions of regions of interest in quantifying spinal muscle composition 11,12 , which we concede can be difficult for the cervical spine (eg transversospinal muscles like multifidus).

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“…All continuous variables (i.e. variables 1 to above) were assessed at baseline, 3, 6, and 12 months follow-up, with the exception of the Hospital Anxiety and Depression Scale anxiety sub-score (HAD_A), Hospital Anxiety and Depression Scale depression sub-score (HAD-D), and Tampa Scale for Kinesiophobia (TSK) which were not measured at 3 months [40]. The maximum proportion of missing data was at 39.4% for the WAI data at 12 months follow-up.…”

Section: Approach To Sample Selectionmentioning

confidence: 99%

Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks

Liew

Scutari

Peolsson

et al. 2019

The Clinical Journal of Pain

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Objectives: The present study's objective is to understand the causal mechanisms underpinning the recovery of individuals with whiplash-associated disorders (WAD). We applied Bayesian Networks (BN) to answer two study aims: 1) to identify the causal mechanism(s) of recovery underpinning neck-specific exercise, and 2) quantify if the cyclical pathway of the fear avoidance model (FAM) is supported by the present data. Methods: We analysed a prospective cohort dataset of 216 individuals with chronic WAD. Fifteen variables were used to build a BN model: treatment group (neck-specific exercise with or without a behavioural approach, or general physical activity), muscle endurance, range of motion, hand strength, neck proprioception, pain catastrophizing, fear, anxiety, depression, self-efficacy, perceived work ability, disability, pain intensity, sex, and follow-up time. Results: The BN model showed that neck pain reduction rate was greater after neck-specific exercise compared to physical activity prescription (β = 0.59 points/month [P < 0.001]) only in the presence of two mediators: global neck muscle endurance and perceived work ability. We also found the following pathway of variables that constituted the FAM: anxiety, followed by depressive symptoms, fear, catastrophizing, self-efficacy, and consequently pain Conclusion: We uncovered two mediators which explained the mechanisms of effect behind neck-specific exercise, and proposed an alternative FAM pathway. The present study is the first to apply BN modelling to understand the causal mechanisms of recovery in WAD. In doing so, it is anticipated that such analytical methods could increase the precision of treatment in individuals with chronic WAD.

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The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial

Abstract: ClinicalTrials.gov, No. NCT01528579.

Cited by 15 publications

References 47 publications

Neck-specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1-year follow-up of a randomised clinical trial

Neck-specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1-year follow-up of a randomised clinical trial

Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks

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