Randomized controlled trial of exercise for chronic whiplash-associated disorders

Abstract

Whiplash-associated disorders are common and incur considerable expense in social and economic terms. There are no known effective treatments for those people whose pain and disability persist beyond 3 months. We conducted a randomized, assessor-blinded, controlled trial at two centres in Australia. All participants received 3 advice sessions. In addition the experimental group participated in 12 exercise sessions over 6 weeks. Primary outcomes were pain intensity, pain bothersomeness and function measured at 6 weeks and 12 months. Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months. The effect of exercise on the 0-10 pain intensity scale was -1.1 (95%CI -1.8 to -0.3, p=0.005) at 6 weeks and -0.2 (0.6 to -1.0, p=0.59) at 12 months; on the bothersomeness scale the effect was -1.0 (-1.9 to -0.2, p=0.003) at 6 weeks and 0.3 (-0.6 to 1.3, p=0.48) at 12 months. The effect on function was 0.9 (0.3 to 1.6, p=0.006) at 6 weeks and 0.6 (-0.1 to 1.4, p=0.10) at 12 months. High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months. In the short-term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash. Exercise is more effective for subjects with higher baseline pain and disability.

Function in Patients With Cervical Radiculopathy or Chronic Whiplash-Associated Disorders Compared With Healthy Volunteers

“…24,25 To our knowledge, only one previous randomized controlled trial 11 of patients with chronic WAD included Grade III patients. The results of the present study show that there is an urgent need for increased knowledge of the best way to treat this subgroup of WAD patients, suggesting that future randomized controlled trials should also include patients with Grade III WAD.…”

“…2 In recent studies, up to 50% of WAD patients 3,4 and 30% to 100% of postsurgical CR patients 4-9 report personal suffering from prolonged symptoms, with persistent pain, disability, and reduced health-related quality of life (HRQoL). Physical function and treatment have been severely understudied both for CR patients scheduled for surgery 9,10 and for chronic WAD patients, 11 particularly for patients with verified neurological and musculoskeletal findings (WAD Grade III). 11 Evidence of effective physiotherapy is inconclusive because there have been few randomized controlled trials involving these specific groups of patients.…”

“…Physical function and treatment have been severely understudied both for CR patients scheduled for surgery 9,10 and for chronic WAD patients, 11 particularly for patients with verified neurological and musculoskeletal findings (WAD Grade III). 11 Evidence of effective physiotherapy is inconclusive because there have been few randomized controlled trials involving these specific groups of patients. [12][13][14][15] There is an urgent need for increased knowledge of both groups' functioning and health in order to better understand how to tailor successful exercise regimens.…”

Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study

“…Four large randomized controlled trials were identified in the literature [13][14][15][16]. Stewart et al [13] compared a 6-week general exercise and cognitive behavioral program to professional advice of encouragement to resume light activity alone. They found a short-term improvement immediately after treatment in the group with combined exercise and behavioral training.…”

“…After 3 and 6 months, improvements were reported in the two groups that performed NSE when compared to the group that received only a prescription for physical activity. More understanding of the role of NSE as a treatment for WAD is still needed [13,16] to improve rehabilitation potential in patients with more severe problems (WAD grade 3).…”