Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 28, 2022
Date Accepted: May 27, 2023
Efficacy of neck-specific exercise with internet support versus neck-specific exercise at a physiotherapy clinic in chronic whiplash-associated disorders: a multicentre randomised controlled non-inferiority trial
ABSTRACT
Background:
Neck-specific exercises supervised by a physiotherapist twice a week for 12 weeks has shown good results in chronic whiplash-associated disorders (WAD), but the effect of exercise delivered via the internet is unknown.
Objective:
The present study examined whether neck-specific exercises with internet support and four physiotherapist sessions for 12 weeks (NSEIT) is non-inferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE).
Methods:
In this multicentre, randomised, controlled, non-inferiority trial with masked assessors, we recruited adults aged 18 to 63 years with chronic WAD grade II (i.e., neck pain and clinical musculoskeletal signs), or III (i.e., grade II plus neurological signs). Outcomes were measured at baseline, 3- and 15-month follow-up. The primary outcome was change in Neck Disability Index (NDI), with a non-inferiority margin of 7 (percent score). Secondary outcomes were neck and arm pain, physical function, health-related quality of life, and self-rated recovery. The analyses were conducted on an intention-to-treat basis.
Results:
Between April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90%) and 64 (91%), respectively, were followed up at 3 months, and 56 (80%) and 58 (83%), respectively, at 15 months. Between-group differences in NDI were 1.4 (-2.5 to 5.3) and 0.9 (-3.6 to 5.3) at 3 and 15 months, indicating the non-inferiority of NSEIT. In both groups, the NDI significantly decreased over time (NSEIT: mean −10.1 (−13.7 to −6.5, ES=1.33); NSE: −9.3 (−12.8 to −5.7, ES=1.19) at 15 months; P<.01). NSEIT was non-inferior to NSE for most secondary outcomes. No serious adverse events were reported.
Conclusions:
NSEIT is non-inferior to NSE in chronic WAD, with 47-58% of the participants having a sustained clinically important change in disability and ≥ 50% reduction in neck and arm pain at the 15-month follow-up. The results showed that NSEIT was not worse than NSE and could be used as treatment in patients with chronic WAD grade II and III. Clinical Trial: ClinicalTrials.gov (NCT03022812); https://clinicaltrials.gov/ct2/show/NCT03022812
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