Accepted for/Published in: JMIR Human Factors
Date Submitted: Oct 25, 2024
Open Peer Review Period: Oct 25, 2024 - Dec 20, 2024
Date Accepted: Apr 17, 2025
(closed for review but you can still tweet)
Factors related to pain and disability outcomes after an internet-delivered or physiotherapist-led exercise programme for individuals with chronic whiplash symptoms: secondary analysis of a randomized controlled study
ABSTRACT
Background:
A neck-specific exercise program has shown sustained clinically important changes in pain and disability for approximately 50% of individuals with chronic whiplash-associated disorders (WAD). However, there is limited information about factors related to treatment response.
Objective:
This study aimed to identify factors related to change in pain and disability after a neck-specific exercise program delivered in two different ways for individuals with persistent whiplash-associated disorders (WAD) grade II or III.
Methods:
This is a secondary analysis, based on a prospective randomized controlled multicenter study (RCT). Participants (n = 140) with persistent (≥ 6 months and ≤ 5 years from injury) WAD grade II or III were randomized into a 12-week internet-supported neck-specific exercise program (NSEIT) with four physiotherapy visits or the same exercise program (NSE) supervised by a physiotherapist twice a week for 12 weeks. Multivariate data analyses were used to investigate factors related to change in the dependent variables: neck pain measured with the Visual Analogue Scale, and neck-related disability measured with the Neck Disability Index and the Patient Specific Functional Scale. Outcomes were measured at baseline, 3- and 15-month follow-up.
Results:
There were no significant differences between the groups. In both NSEIT and NSE, improvements in the following factors were related to improvements in pain and disability at three- and 15-month follow-up: anxiety, depression, cognitive failure, pain catastrophizing, self-efficacy, fear avoidance beliefs, cervical range of motion, headache, and symptom satisfaction (R2 = 0.31–0.37; Q2 = 0.25–0.30; CV-ANOVA P < 0.001). No significant models could be built to separate clinically improved versus non-improved patients in terms of pain or disability, based on baseline factors.
Conclusions:
Improvements in both psychological and physical factors were related to improvements in pain and disability after 12 weeks of NSEIT or NSE. The results indicate that these factors are interrelated and can be improved both with NSEIT and with NSE. No baseline factors could predict clinically improved versus non-improved in the present study. Already known risk factors for poor outcomes of neck disability in chronic WAD such as low self-efficacy, fear avoidance beliefs, depressive symptoms, and catastrophizing were improved after NSEIT and NSE. Therefore, we need to identify other factors not included in the present study that can identify those who are non-improved after NSEIT or NSE. Clinical Trial: ClinicalTrials.gov (NCT03022812); https://clinicaltrials.gov/ct2/show/NCT03022812
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