Toward Lessening the Rate of Transition of Acute Whiplash to a Chronic Disorder

Jull, Gwendolen; Sterling, Michele; Curatolo, Michele; Carroll, Linda; Hodges, Paul W.

doi:10.1097/brs.0b013e31823883e6

Cited by 19 publications

(11 citation statements)

References 7 publications

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“…Whiplash‐associated disorders (WAD) are a significant public health problem with substantial social and economic costs (Jull et al., ) leaving up to 50% of people with continuous neck pain 1 year after the injury (Carroll et al., ). Still there is no clear evidence of effective treatment (Verhagen et al., ).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with pain and disability reduction following exercise interventions in chronic whiplash

Ludvigsson

Peterson

Dedering

et al. 2015

European Journal of Pain

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What's already known about this topic?• Exercise can be effective for people with chronic whiplash associated disorders (WAD) however the response is highly variable.• Chronic WAD includes heterogeneous physical and psychological impairments. 2 What does this study add?• Factors associated with treatment response in chronic WAD differ in the short and long term, and depend on pain or disability as an outcome.• Psychological factors were not associated with outcome.• Neck-specific exercise increases the odds of pain/disability reduction compared to physical activity prescription. 3 ABSTRACTBackground: Some studies support the prescription of exercise for people with whiplash associated disorders (WAD) however the response is highly variable. Further research is necessary to identify factors which predict response.Methods: This is a secondary analysis of a randomized, multicenter controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioral approach, or prescription of physical activity for 12-weeks. Treatment response, defined as a clinical important reduction of pain or disability, was registered after 3 and 12 months, and factors associated with treatment response were explored using logistic regression.Results: Participation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12 months. Patients in this group had up to 5.3 times higher odds of disability reduction, and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain versus disability). Conclusion:Factors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for individuals with chronic WAD.

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Section: Introductionmentioning

confidence: 99%

Factors associated with pain and disability reduction following exercise interventions in chronic whiplash

Ludvigsson

Peterson

Dedering

et al. 2015

European Journal of Pain

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“… 1 Up to 60% of WAD patients progress to chronicity and experience moderate-to-severe pain and disability. 1 2 Management of acute and chronic WAD is reported of limited success. 3–5 An effective intervention is required, especially for whiplash-associated disorder II (WADII) classified patients (neck complaint and musculoskeletal sign(s)) 6 which reflects ∼93% of patients.…”

Section: Introductionmentioning

confidence: 99%

Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study

et al. 2016

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ObjectiveTo develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI.DesignModified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round.SettingOnline international survey.ParticipantsA purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form.Results36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus.ConclusionsExperts suggested and agreed the underlying principles and treatment components of the ABPI for the management of acute WADII. The ABPI was underpinned by social cognitive theory focusing on self-efficacy enhancement prior to conducting a phase II trial.

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“…[ 4 ] 40%- 60% of WAD patients develop chronicity [ 5 – 11 ] with approximately 30% of patients experiencing moderate to severe pain and disability. [ 12 ] Systematic reviews report limited effectiveness of chronic WAD management. [ 13 – 16 ] Consequently, effective intervention in the acute stage is required to prevent chronicity.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD) II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2015

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ObjectiveTo evaluate the effectiveness of conservative management (except drug therapy) for acute Whiplash Associated Disorder (WAD) II.DesignSystematic review and meta-analysis of Randomised Controlled Trials (RCTs) using a pre-defined protocol. Two independent reviewers searched information sources, decided eligibility of studies, and assessed risk of bias (RoB) of included trials. Data were extracted by one reviewer and checked by the other. A third reviewer mediated any disagreements throughout. Qualitative trial and RoB data were summarised descriptively. Quantitative syntheses were conducted across trials for comparable interventions, outcome measures and assessment points. Meta-analyses compared effect sizes with random effects, using STATA version 12.Data SourcesPEDro, Medline, Embase, AMED, CINAHL, PsycINFO, and Cochrane Library with manual searching in key journals, reference lists, British National Bibliography for Report Literature, Center for International Rehabilitation Research Information & Exchange, and National Technical Information Service were searched from inception to 15th April 2015. Active researchers in the field were contacted to determine relevant studies.Eligibility Criteria for Selecting StudiesRCTs evaluating acute (<4 weeks) WADII, any conservative intervention, with outcome measures important to the International Classification of Function, Disability and Health.ResultsFifteen RCTs all assessed as high RoB (n=1676 participants) across 9 countries were included. Meta-analyses enabled 4 intervention comparisons: conservative versus standard/control, active versus passive, behavioural versus standard/control, and early versus late. Conservative intervention was more effective for pain reduction at 6 months (95%CI: -20.14 to -3.38) and 1-3 years (-25.44 to -3.19), and improvement in cervical mobility in the horizontal plane at <3 months (0.43 to 5.60) compared with standard/control intervention. Active intervention was effective for pain alleviation at 6 months (-17.19 to -3.23) and 1-3 years (-26.39 to -10.08) compared with passive intervention. Behavioural intervention was more effective than standard/control intervention for pain reduction at 6 months (-15.37 to -1.55), and improvement in cervical movement in the coronal (0.93 to 4.38) and horizontal planes at 3-6 months (0.43 to 5.46). For early (<4 days) versus late (>10 days) interventions, there were no statistically significant differences in all outcome measures between interventions at any time.ConclusionsConservative and active interventions may be useful for pain reduction in patients with acute WADII. Additionally, cervical horizontal mobility could be improved by conservative intervention. The employment of a behavioural intervention (e.g. act-as-usual, education and self-care including regularly exercise) could have benefits for pain reduction and improvement in cervical movement in the coronal and horizontal planes. The evidence was evaluated as low/very low level according to the Grading of Recommendations Assessment, ...

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Toward Lessening the Rate of Transition of Acute Whiplash to a Chronic Disorder

Cited by 19 publications

References 7 publications

Factors associated with pain and disability reduction following exercise interventions in chronic whiplash

Factors associated with pain and disability reduction following exercise interventions in chronic whiplash

Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study

The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD) II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

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