Patients, aged 17–58, with pain after whiplash injury (>3 mths), and referred to the pain unit for outpatient-based, interdisciplinary rehabilitation ()
(1) Biofeedback training (), eight sessions (twice/wk for four wk) while being active in a self-chosen handicraft. (2) Being active in a self-chosen handicraft on the same terms as group 1 but without biofeedback (). All: 4–6 wk rehabilitation programme consisting of a combination of education, ergonomic interventions, physical training, relaxation techniques, body awareness training, and interventions by psychologist and/or social worker if needed
Canadian occupational performance measure, Multidimensional Pain Inventory, Swedish version
There were no statistically significant differences in effect between groups at 6 mths followup
Patients with chronic pain in cervical spine musculature following motor vehicle accident (WAD), age 19–57, still having symptoms after receiving chiropractic treatments and rehabilitation exercises for > 12 mths ()
(1) Continued chiropractic treatments and standard rehabilitation exercises () (2) Continued chiropractic treatments and were advised to do “phasic neck exercises” (eye-head co-ordination) () All: exercises 5 days a wk for 8 wks
NPDI
The authors do not report any data on statistically significant differences between groups after 8 wk
Patients with chronic whiplash-associated disorder (>3 mths, <2 yrs), classified WADII, age 18–65 ()
(1) Multimodal physiotherapy programme (MPT) (), low-load exercise for reeducating muscle control of the neck flexor and extensor muscles and scapular muscles, posture exercises, kinaesthetic exercises and mobilisation techniques, education including ergonomics, daily living advice, home exercise (2) Self-management programme, education, advice and exercise (SMP) () All: intervention period 10 wks
NPI, VAS**
The MPT group attained a statistically significant greater reduction in reported neck pain and disability (NPI) (), effect size 0.48, measured immediately following treatment
Patients with whiplash injury grade I or II (Quebec Task Force Classification), with persistent neck pain or headache 6–12 mths after the accident ()
(1) Local anesthetic infiltration of tender points in the neck 2 × a wk, in 8 wks, () (2) Physiotherapy, 2 × a wk, in 8 wks: massage, relaxation techniques of myogelotic muscles, instructed in a detailed homeprogram of isometric and low-intensity active isotonic training of neck muscles () (3) Medication: 200 mg flurbiprofen in its slow release preparation once a day. Patients were seen twice a wk by the same study physician during the 8 wks () All: furthermore, in each treatment group patients were randomly allocated to additional cognitive-behavioral therapy (CBT) or no CBT. CBT twice a wk for 8 wks. Each session lasted 60 minutes
Subjective outcome rating (free of symptoms, improved, unchanged, worse), McGill pain questionnaire, VAS), working capacity
There were no statistically significant differences between the 3 different treatment groups measured at 8 wk and at 6 mths followup. There was a statistically significant effect in the short term in female patients in the groups with additional CBT () after 8 wks of treatment in the subjective outcome, but not at 6 mths followup
Patients with chronic WAD, (>3 mths after injury), age 18–60 ()
(1) Physiotherapy with cognitive behavioural components, learning and application of basic physical and psychological skills in everyday activities, besides physiotherapy as in group 2 () (2) Physiotherapy, individualised exercises at home and/or in departments gym, various pain-relieving methods (i.e., TENS, heat) () All: max. 12 individual sessions with the physiotherapist
PDI, NRS, physical measures of pain, disability, coping and self-efficacy
Results revealed no statistically significant differences between groups in self-ratings of disability or pain intensity post treatment or at 3 mths followup
Patients with chronic WAD (>3 mths, <12 mths), classified WAD I–III, having significant pain or disability ()
(1) Advice alone group (), received education, reassurance and encouragement to participate in light activity alone, advice given in one consultation and two follow-up phone contacts (2) Advice and exercise group (), individualised, progressive, submaximal programme designed to improve functional activities, endurance, strength, aerobic, speed, coordination, principles of cognitive behavioral therapy (i.e., setting goals), 12 sessions during 6 wks
Pain intensity and pain bothersomeness rated on a 0–10 box scale, PSFC
Exercise and advice were more effective than advice alone at 6 wks 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, ) at 6 wks and −0.2 (0.6 to −1.0, ) at 12 mths; on the bothersomeness scale the effect was −1.0 (−1.9 to −0.2, ) at 6 wks and 0.3 (−0.6 to 1.3, ) at 12 mths
order to show an effect of an intervention and hereby support the intervention, it requires showing statistical significant difference between groups.
**Secondary outcome measure. VAS: visual analogue scale; NRS: numerical rating scale; VNPS: verbal numeric pain scale; NPQ: Northwick Park neck pain questionnaire; NDI: neck disability index; NPDI: neck pain and disability index; NPDS: neck pain and disability scale; NPDVAS: neck pain and disability visual analogue scale; PSFS: patient-specific functional scale; NPI: Northwick Park neck pain index; SF-36: short-form 36; PPT: pressure pain threshold; ROM: range of movement; RPE: rating of perceived exertion; EMG: electromyographic, HRQoL: health-related quality of life.
