Testing the feasibility of a knowledge translation intervention designed to improve chiropractic care for adults with neck pain disorders: study protocol for a pilot cluster-randomized controlled trial A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): protocol of a randomised, controlled trial. Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients A Combination of Gestalt Therapy, Rosen Body Work, and Cranio Sacral Therapy did not help in Chronic Whiplash-Associated Disorders (WAD) - Results of a Randomized Clinical Trial Coping and Recovery in Whiplash-associated Disorders: Early use of Passive Coping Strategies is Associated With Slower Recovery of Neck Pain and Pain-related Disability Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology Prospective Ten-Year Follow-up Study Comparing Patients With Whiplash-Associated Disorders and Asymptomatic Subjects Using Magnetic Resonance Imaging Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial Neck Collar, “Act-as-Usual” or Active Mobilization for Whiplash Injury?: A Randomized Parallel-Group Trial Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. Development and delivery of a physiotherapy intervention for the early management of whiplash injuries: the Managing Injuries of Neck Trial (MINT) Intervention. Are People With Whiplash-Associated Neck Pain Different From People With Nonspecific Neck Pain? Upper trapezius muscle activation patterns in neck–shoulder pain patients and healthy controls Psychological determinants of quality of life in patients with whiplash associated disorders-a prospective study. A three-group study, internet-based, face-to-face based and standard- management after acute whiplash associated disorders (WAD) – choosing the most efficient and cost-effective treatment: study protocol of a randomized controlled trial A new clinical test for cervicocephalic kinesthetic sensibility: "the fly".
Background Neck pain in adults is common and a leading cause of physical disability . Recently , a guideline was developed for the management of non-specific neck pain ( NSNP ) with an aim to improve the quality of the delivery of chiropractic care . One key guideline recommendation is to undertake multimodal care for patients with NSNP . The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP . Methods / design The design is a cluster-r and omized controlled pilot and feasibility trial . Chiropractors in private practice in Canada will be approached to participate in the study . Thirty consenting chiropractors will be r and omized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group .  Each chiropractor will recruit five neck pain patients ( a total of 150 patients ) into the study . Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars , two online case scenarios , a self-management video on Brief Action Planning , and a printed copy of the practice guideline . Primary feasibility outcomes for both chiropractors and patients include rates of ( 1 ) recruitment , ( 2 ) retention , and ( 3 ) adherence to the intervention . A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors ’ compliance with guideline recommendations ( e.g. exercise and self-care prescriptions ) at study onset and at 3 months . Secondary outcomes include scores of behavioural constructs ( level of knowledge and self-efficacy ) for recommended multimodal care . Clinical outcomes include pain intensity and neck pain-specific disability . Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest ( recruitment , retention , adherence , pain intensity , Neck Disability Index ) . Discussion Results of this study will inform the design of a larger cluster-r and omized controlled trial aim ed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.Trial registration https:// clinical trials.gov/ , Study Design . Concealed allocation , multicenter , single-blind , r and omized controlled clinical trial . Objective . To assess the efficacy of an educational video in the tertiary prevention of persistent WAD symptoms following rear-end motor vehicle collisions ( MVCs ) . Summary of Background Data . Whiplash-associated disorders ( WAD ) are an important and costly health problem . There is a lack of high quality evidence surrounding efficacy of treatments for WAD . Existing research supports active interventions and early return to regular activities . Methods . Consecutive patients presenting to four tertiary care emergency departments following rear-end MVCs were eligible . Following informed consent , patients were allocated , using central r and omization , to receive an educational video plus usual care or usual care alone . The video provided reassurance , and advice about posture , return to regular activities , exercises , and pain-relief methods . Data were collected by telephone using st and ardized question naires . The primary outcome was presence of Persistent WAD Symptoms at 24 weeks postinjury , based on the frequency and severity of neck , shoulder , or upper back pain . The absolute difference in proportion of patients with persistent WAD symptoms and rate ratios were calculated . Changes in pain scores were compared using the Mann-Whitney U test . Results . The  intervention ( n = 206 ) and control ( n = 199 ) groups were similar at baseline ( mean age 38.4 years ; 64 % female ) . Overall , the proportion of subjects with Persistent WAD Symptoms decreased from 89.1 % at baseline to 33.6 % at 24 weeks after injury . At 24 weeks , the proportion of subjects with persistent WAD symptoms in the intervention group was 7.9 % ( 95 % CI , −2.0 , 17.8 ) lower than the control group . The median improvement in pain score at 24 weeks was 3 for the intervention group and 2 for the control group ( P = 0.016 ) . Conclusion . The presence of persistent WAD symptoms following simple rear-end MVCs was high in this sample . The video group demonstrated a trend toward less severe WAD symptoms . We recommend evaluating other educational interventions that could reduce WAD symptoms INTRODUCTION Whiplash-associated disorders ( WAD ) are a huge worldwide health and economic burden . The propensity towards developing into chronic , disabling conditions drives the rise in health and economic costs associated with treatment , productivity loss and compulsory third party insurance cl aims . Current treatments fail to address the well-documented heterogeneity of WAD and often result in poor outcomes . A novel approach is to evaluate whether the care provided according to the estimated risk of poor prognosis improves health outcomes while remaining cost-effective . RESEARCH QUESTIONS ( 1 ) Does a guideline -based clinical pathway of care improve health outcomes after whiplash injury compared to usual care ? ( 2 ) Does risk of recovery have a differential effect on health outcomes for the clinical pathway of care ? ( 3 ) Is the clinical pathway of care intervention cost-effective ? ( 4 ) What are the variations in professional practice between usual care and the clinical pathway of care ? DESIGN Multi-centre , r and omised , controlled trial conducted over two Australian states : Queensl and and New South Wales . PARTICIPANTS AND SETTING 236 people with WAD ( grade I-III , within 6 weeks of injury ) and their primary healthcare providers . INTERVENTION A clinical pathway of care , with care matched to the predicted risk of poor recovery . Participants at low risk of ongoing pain and disability ( hence , predicted to fully recover ) will receive up to three sessions of guideline -based advice and exercise with their primary healthcare provider . Participants at medium/high risk of developing ongoing pain and disability will be referred to a specialist ( defined as a practitioner with expertise in whiplash ) who will conduct a more in-depth physical and psychological assessment . As a result , the specialist will liaise with the original primary healthcare provider and determine one of three further pathways of care . CONTROL Usual care provided by the primary healthcare provider that is based on clinical judgment . MEASUREMENTS Primary ( global rating of change and neck-related disability ) and secondary ( self-efficacy , pain intensity , general health and disability and psychological health ) outcomes will be collected using vali date d scales . Direct ( eg , professional care , transportation costs , time spent for care , co-payments ) and indirect ( eg , lost economic productivity ) costs will be obtained through an electronic cost diary . Health and cost outcomes will be assessed at baseline , 3 , 6 and 12 months after r and omisation . Professional practice outcomes will be evaluated through question naires completed by healthcare providers and their patients at 3 months . PROCEDURE Potential participants ( patients ) will be identified through emergency departments , primary health clinics and advertisements . Eligible participants will complete baseline assessment s and will be categorised into low or medium/high risk of poor recovery using a clinical prediction rule . After this assessment , participants will be r and omly allocated to either a  control group ( n=118 ) or intervention group ( n=118 ) , stratified by risk subgroup and treatment site . The participants ' nominated primary healthcare providers will be informed of their involvement in the trial . Consent will be obtained from the primary healthcare providers to participate and to obtain information about professional practice . Participants in the intervention group will additionally have access to an interactive website that provides information about whiplash and recovery relative to their risk category . ANALYSIS Analysis will be conducted on an intention-to-treat basis . Outcomes will be analysed independently through cross-sectional analyses using generalised linear models methods , with an appropriate link function , to test for an intervention effect , adjusted for the baseline values . The risk category will be tested for its association with treatment effect by adding risk group to the regression equation . Cost-effectiveness will be calculated using utility weights and the result ing measure will be cost per quality -adjusted life year ( QALY ) saved . Professional practice outcomes will be analysed using descriptive statistics . DISCUSSION This research is significant as it will be the first study to address the heterogeneity of whiplash by implementing a clinical pathway of care that matches evidence -based interventions to projected risk of poor recovery . The results of this trial have the potential to change clinical practice for WAD , thereby maximising treatment effects , improving patient outcomes , reducing costs and maintaining the compulsory third party system A classification of injury and a follow-up schedule were proposed by the Quebec Task Force ( QTF ) in 1995 . No general agreement about the clinical usefulness of the WAD-classification or of the suggested follow-up regimen exists . A series of 186 consecutive cases seen in the emergency room during the acute phase after a whiplash injury was prospect ively studied for 1 year . All findings including history and physical findings were recorded using st and ardized QTF protocol s. In one group follow-up visits were done according to the QTF regimen : at 1 , 3 , 6 , 12 weeks and 1 year after the accident ; in a control group no visit was scheduled . The outcome variable was neck pain at 1 year after the accident . After 1 year , 18 % of the total number of patients had significant neck pain . Risk factors for chronic neck pain at 1 year after whiplash injury were : neck pain before the accident and a high degree of emotional distress at the time of the accident ; both factors independently associated with a tenfold increased risk of developing chronic neck pain . Neither the WAD classification nor the QTF follow-up regimen could be linked to a better outcome . In this study the outcome was associated with patient-specific characteristics and not with physical signs of injury , the depth of the initial evaluation or the follow-up regimen The chronic state of whiplash-associated disorder ( WAD ) might be understood as a somatization of existential pain . Intervention aim ed to improve quality of life ( QOL )  seemed to be a solution for such situations . The basic idea behind the intervention was holistic , restoring quality of life and relationship with self , in order to diminish tension in the locomotion system , especially the neck . A psychosomatic theory for WAD is proposed . Our treatment was a short 2-day course with teachings in philosophy of life , followed by 6 to 10 individual sessions in gestalt psychotherapy and body therapy ( Rosen therapy and Cranio Sacral therapy ) , followed by a 1-day course approximately 2 months later , closing the intervention . Two independent institutions did the intervention and the assessment s. In a r and omized , clinical ly controlled setting , 87 chronic WAD patients were included with a median duration of 37 months from their whiplash accidents . One patient never started . Forty-three had the above intervention ( female/male = 36/7 , ages 22—49 , median 37 years ) and another 43 were assigned to a nontreated control group ( female/male = 35/8 , ages 1848 , median 38 ) . Six had disability pension and 27 had pending medicolegal issues in each group . Effect variables were pain in neck , arm , and /or head ; measures of quality of life and daily activities ; as well as general physical or mental health . Wilcoxon test for between-groups comparisons with intention-to-treat analyses was conducted ; the square curve paradigm testing for immediate improvements of health and quality of life was also used . The groups were comparable at baseline . From the intervention group , 11 dropped out during the intervention ( 4 of those later joined the follow-up investigation ) , 22 of the remaining 32 graduated the course , and 35 of the 43 controls did as well . Approximately 3 months later , we found no clinical ly relevant or significant increase in any effect measure . The above version of a quality of life intervention based on alternative therapy had no effect on patients with chronic WAD Objective : Coping is shown to affect outcomes in chronic pain patients ; however , few studies have examined the role of coping in the course of recovery in whiplash-associated disorders ( WAD ) . The purpose of this study was to determine the predictive value of coping style for 2 key aspects of WAD recovery , reductions in neck pain , and in disability . Methods : A population -based prospect i ve cohort study design was used to study 2986 adults with traffic-related WAD . Participants were assessed at baseline , 6 weeks , and 4 , 8 , and 12 months postinjury .  Coping  was measured at 6 weeks using the Pain Management Inventory  , and neck pain recovery was assessed at each subsequent follow-up , using a 100 mm  visual analogue scale ( VAS ) . Disability was assessed at each follow-up using the Pain Disability Index ( PDI ) . Pain recovery was defined as a VAS score of 0 to 10 ; disability recovery was defined as a PDI score of 0 to 4 . Data analysis used multivariable Cox proportional hazards models . Results : Those using high versus low levels of passive coping at 6 weeks postinjury experienced 28 % slower pain recovery and 43 % slower disability recovery . Adjusted hazard rate ratios for pain recovery and disability recovery were 0.72 ( 95 % CI , 0.59 - 0.88 ) and 0.57 ( 95 % CI , 0.41 - 0.78 ) , respectively . Active coping was not associated with recovery of neck pain or disability . Conclusions : Passive coping style predicts neck pain and self-assessed disability recovery . It may be beneficial to assess and improve coping style early in WAD Objective : To compare two different home exercise programmes for patients with acute whiplash-associated disorders ( WAD ) . A further aim was to describe the initial prognostic variables related to self-reported pain at six months follow-up . Design : A r and omized treatment study with a follow-up period of six months . Setting s : The study was undertaken in an orthopaedic clinic at a university hospital . Subjects : A total of 59 symptomatic ( neck pain , stiffness , etc . ) patients with acute whiplash injury . Interventions : Patients were r and omized to a regular treatment group ( RT group ) and an additional-exercise treatment group ( AT group ) . Main outcome measures : Pain Disability Index ( PDI ) , Self-Efficacy Scale ( SES ) , Coping Strategies Question naire ( CSQ ) , neck range of motion ( ROM ) , head posture , kinaesthetic sensibility , visual analogue scale ( VAS ) . Results : Patients given an additional exercise did not improve more than patients with regular treatment . Only one CSQ item , ‘ Ability to decrease pain ' , showed a significant difference between the groups in its pattern of change over time : the AT group had a significant increase between three and six months whilst values in the RT group decreased . Nonsymptomatic patients at six months follow-up were characterized by initially better self-efficacy , lower disability and significantly different patterns in the use of ‘ behavioural coping strategies ' when compared with symptomatic patients . The nonsymptomatic patients also reported more frequent training than symptomatic patients , i.e. they complied better with the treatment regime . Conclusion : This home exercise programme , including training of neck and shoulder ROM , relaxation and general advice seems to be sufficient treatment for acute WAD patients when used on a daily basis . Additionally , patients reporting low self-efficacy and high disability levels may profit from more attention initially , as these psychological factors are significant predictors of pain at long-term follow-up Study Design . A prospect i ve 10-year follow-up study of patients with whiplash-associated disorders ( WAD ) and asymptomatic volunteers . Objective . To clarify long-term impact of whiplash injury on patient 's symptoms and on magnetic resonance imaging ( MRI ) findings of the cervical spine . Summary of Background Data . Long-term prognosis of WAD has not been fully eluci date d. Methods . Between 1993 and 1996 , we conducted cross-sectional comparative study of 508 acute WAD patients and 497 asymptomatic volunteers , all of whom underwent MRI of the cervical spine .  For this follow-up study , 133 WAD patients and 223 control subjects were recruited again . All participants underwent follow-up MRI and physical examination , and answered to question naires regarding neck symptoms . Evaluation of MRI included decrease in signal intensity of discs , posterior disc protrusion , disc space narrowing , and foraminal stenosis using 2 to 4 numerical grade s. Increase in the numerical grade s by one or more was considered to be progression of degenerative changes . Results . Progression of decrease in signal intensity was observed in 109 WAD patients ( 82.0 % ) , and 132 control subjects ( 59.2 % ) , ( age , sex adjusted odds ratio [ OR ] : 3.06 ) , posterior disc protrusion in 101 ( 75.9 % ) and in 155 ( 69.5 % ) ( OR = 1.46 ) , disc space narrowing in 33 ( 24.8 % ) and in 59 ( 26.5 % ) ( OR = 0.98 ) , and foraminal stenosis in 6 ( 4.5 % ) , and in 20 ( 9.0 % ) ( OR = 0.52 ) , respectively . Neck pain was observed in 34 WAD patients ( 25.6 % ) and 22 control subjects ( 9.9 % ) ( P < 0.0001 ) . There was no statistically significant correlation between neck pain and progression in each MR finding in either group . Conclusion . The results of this study suggest that , although some WAD patients are more likely to suffer from long-lasting neck pain , MRI findings can not explain the symptoms Background Many patients suffer from chronic neck pain following a whiplash injury . A combination of cognitive , behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders . The objective is to present the design of a r and omised controlled trial ( RCT ) aim ed at evaluating the effectiveness of a combined individual physical and cognitive behavioural- grade d activity program on self-reported general physical function , in addition to neck function , pain , disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline . Methods / Design The design is a two-centre , RCT - study with a parallel group design . Included are whiplash patients with chronic neck pain for more than 6 months , recruited from physiotherapy clinics and an out-patient hospital department in Denmark . Patients will be r and omised to either a pain management ( control ) group or a combined pain management and training (intervention)group . The control group will receive four educational sessions on pain management , whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months , including guidance in specific neck exercises and an aerobic training programme . Patients and physiotherapists are aware of the allocation and the treatment , while outcome assessors and data analysts are blinded . The primary outcome measures will be Medical Outcomes Study Short Form 36 ( SF36 ) , Physical Component Summary ( PCS ) . Secondary outcomes will be Global Perceived Effect ( -5 to + 5 ) , Neck Disability Index ( 0 - 50 ) , Patient Specific Functioning Scale ( 0 - 10 ) , numeric rating scale for pain bothersomeness ( 0 - 10 ) , SF-36 Mental Component Summary ( MCS ) , TAMPA scale of Kinesiophobia ( 17 - 68 ) , Impact of Event Scale ( 0 - 45 ) , EuroQol ( 0 - 1 ) , craniocervical flexion test ( 22 mmHg - 30 mmHg ) , joint position error test and cervical range of movement . The SF36 scales are scored using norm-based methods with PCS and MCS having a mean score of 50 with a st and ard deviation of 10 . Discussion The perspectives of this study are discussed , in addition to the strengths and weaknesses . Trial registration The study is registered in http://www . Clinical Trials.gov identifier NCT01431261 Study Design . R and omized , parallel-group trial . Objective . To compare the effect of 3 early intervention strategies following whiplash injury . Summary of Background Data . Long-lasting pain and disability , known as chronic whiplash-associated disorder ( WAD ) , may develop after a forced flexion-extension trauma to the cervical spine . It is unclear whether this , in some cases disabling , condition can be prevented by early intervention . Active interventions have been recommended but have not been compared with information only . Methods . Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and r and omized to : 1 ) immobilization of the cervical spine in a rigid collar followed by active mobilization , 2 ) advice to “ act-as-usual , ” or 3 ) an active mobilization program ( Mechanical Diagnosis and Therapy ) . Follow-up was carried out after 3 , 6 , and 12 months postinjury . Treatment effect was measured in terms of headache and neck pain intensity ( 0–10 ) , disability , and work capability . Results . A total of 458 participants were included . At the 1-year follow-up , 48 % of participants reported considerable neck pain , 53 % disability , and 14 % were still sick listed at 1 year follow-up . No significant differences were observed between the 3 interventions group . Conclusion . Immobilization , “ act-as-usual , ” and mobilization had similar effects regarding prevention of pain , disability , and work capability 1 year after a whiplash injury Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli , maladaptive illness beliefs , inappropriate attitudes , and movement dysfunctions . Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance . This single-case study ( A-B-C design ) with six patients with chronic whiplash associated disorders ( WAD ) was aim ed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms , daily functioning , pain beliefs , and behavior . Periods A and C represented assessment periods , while period B consisted of the intervention ( pain neurophysiology education ) . Results showed a significant decrease in kinesiophobia ( Tampa Scale for Kinesiophobia ) , the passive coping strategy of resting ( Pain Coping Inventory ) , self-rated disability ( Neck Disability Index ) , and photophobia ( WAD Symptom List ) . At the same time , significantly increased pain pressure thresholds and improved pain-free movement performance ( visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test ) were established . Although the current results need to be verified in a r and omized , controlled trial , they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD This paper describes the development and implementation of a physiotherapy intervention for a large multicentred r and omised controlled trial of the early management of whiplash injuries in a National Health Service setting . Participants were eligible if they were classified as having whiplash-associated disorder grade s I to III and self-referred for treatment within 6 weeks of injury . The intervention development was informed through a variety of methods including the current evidence base , published guidelines , clinician opinion , a pilot study and expert opinion . The intervention was targeted at known , potentially modifiable risk factors for poor recovery , and utilised manual therapy , exercises and psychological strategies . The treatment was individually tailored , with a maximum of six treatments allowed within the trial protocol over an 8-week period . The intervention was delivered to 300 participants . The amount and types of treatments delivered are described Study Design Secondary analysis of a prospect i ve cohort study with cross-sectional and longitudinal analyses . Background The clinical importance of a history of whiplash-associated disorder ( WAD ) in people with neck pain remains uncertain . Objective To compare people with WAD to people with nonspecific neck pain , in terms of their baseline characteristics and pain and disability outcomes over 1 year . Methods Consecutive patients with neck pain who presented to a secondary -care spine center answered a comprehensive self-report question naire and underwent a physical examination . Patients were classified into a group of either those with WAD or those with nonspecific neck pain . We compared the outcomes of baseline characteristics of the 2 groups , as well as pain intensity and activity limitation at follow-ups of 6 and 12 months . Results A total of 2578 participants were included in the study . Of these , 488 ( 19 % ) were classified as having WAD . At presentation , patients with WAD were statistically different from patients without WAD for almost all characteristics investigated . While most differences were small ( 1.1 points on an 11-point pain-rating scale and 11 percentage points on the Neck Disability Index ) , others , including the presence of dizziness and memory difficulties , were substantial . The between-group differences in pain and disability increased significantly ( P<.001 ) over 12 months . At 12-month follow-up , the patients with WAD had on average approximately 2 points more pain and 17 percentage points more disability than those with nonspecific neck pain . Conclusion People referred to secondary care with WAD typically had more self-reported pain and disability and experienced worse outcomes than those with nonspecific neck pain . Caution is required when interpreting the longitudinal outcomes due to lower-than-optimal follow-up rates . Level of Evidence Prognosis , level 2 . J Orthop Sports Phys Ther 2016;46(10):894 - 901 . Epub 3 Sep 2016 . doi:10.2519/jospt.2016.6588 This study aim ed at investigating whether patients with neck – shoulder complaints from different aetiologies ( work-related musculo-skeletal disorders , WMSD ; whiplash associated disorders , WAD ) show comparable muscle activation patterns , characterised by higher activation and lower relaxation levels of the trapezius muscles compared to healthy controls . Twenty healthy controls , 21 WMSD and 20 WAD patients with non-acute neck-shoulder pain were recruited for this cross-sectional study .  Surface electromyography ( sEMG ) recordings were performed at the upper trapezius muscles during reference contractions , st and ardised computer tasks ( typing and unilateral stress task ) , and rest measurements . sEMG was continuously recorded during these measurements .  Outcome measures were root mean square ( RMS ) to study muscle activity , and relative rest time ( RRT ) to study muscle relaxation . Statistical analysis comprised the bootstrap technique and Kruskall – Wallis tests . Results showed no clear evidence for abnormal muscle activation patterns in WMSD and WAD patients compared to healthy controls . However , a tendency was observed for higher RMS levels during the reference contractions and computer tasks in both patient groups compared to healthy controls , and lower RRT levels at the non-dominant side during stress . Both patient groups also showed larger variability in RMS and RRT values . This variability has more often been reported in literature and may suggest the existence of subgroups of pain patients with corresponding different muscle activation patterns not related to aetiology . Future research may focus on identifying these subgroups of patients with neck-shoulder pain PURPOSE To evaluate whether psychological factors and personality traits influence recovery in terms of quality of life in patients with subacute whiplash associated disorders ( WAD ) . METHOD The data was obtained from a r and omized controlled trial ( RCT ) on 47 patients . The patients completed measures of pain intensity , affective dimension of pain , pain location , psychological stress , heightened somatic awareness , depression , catastrophizing , self-efficacy , fear of movement (re)injury , and physical disability . After three months of physiotherapy interventions , the outcome of quality of life was measured with the Short Form Health survey ( SF-12 ) . All variables were entered in a multiple regression analysis , after controlling for age and sex . RESULTS Forty patients ( 85 % ) completed the trial . The self-efficacy scale ( SES ) was the only variable in the model that significantly explained the fraction of the SF12-score . The correlation between the SES and SF-12 was B = 0.64 ( p < 0.01 ) , and the adjusted R(2 ) was 0.40 ( p < 0.05 ) , which means that 40 % of the variation in the SF12 outcomes was explained by the SES . CONCLUSION In order to improve health-related quality of life in patients with WAD , the present study stresses the importance of targeting self-efficacy . A special effort should be made to enhance these beliefs in the rehabilitation process Background The management of Whiplash Associated Disorders is one of the most complicated challenges with high expenses for the health care system and society . There are still no general guidelines or scientific documentation to unequivocally support any single treatment for acute care following whiplash injury . The main purpose of this study is to try a new behavioural medicine intervention strategy at acute phase aim ed to reduce the number of patients who have persistent problems after the whiplash injury . The goal is also to identify which of three different interventions that is most cost-effective for patients with Whiplash Associated Disorders . In this study we are controlling for two factors . First , the effect of behavioural medicine approach is compared with st and ard care . Second , the manner in which the behavioural medicine treatment is administered , Internet or face-to-face , is evaluated in it 's effectiveness and cost-effectiveness . Methods / Design The study is a r and omized , prospect i ve , experimental three-group study with analyses of cost-effectiveness up to two-years follow-up . Internet – based programme and face-to-face group treatment programme are compared to st and ard-treatment only . Patient follow-ups take place three , six , twelve and 24 months , that is , short-term as well as long-term effects are evaluated . Patients will be enrolled via the emergency ward during the first week after the accident . Discussion This new self-help management will concentrate to those psychosocial factors that are shown to be predictive in long-term problems in Whiplash Associated Disorders , i.e. the importance of self-efficacy , fear of movement , and the significance of catastrophizing as a coping strategy for restoring and sustaining activities of daily life . Within the framework of this project , we will develop , broaden and evaluate current physical therapy treatment methods for acute Whiplash Associated Disorders . The project will contribute to the creation of a cost-effective  behavioural medicine approach to management of acute Whiplash Associated Disorders . The results of this study will answer an important question ; on what extent and how should these patients be treated at acute stage and how much does the best management cost . Trial registration numberCurrent Controlled Trials IS RCT OBJECTIVE To investigate the reliability and discriminative ability of a new test design ed to detect accuracy of neck movements . DESIGN Repeated- measures . Case-control . SETTING University musculoskeletal research clinic in Icel and . PARTICIPANTS Twenty women ( mean age + /- st and ard deviation [ SD ] , 30.8+/-9.1 y ; range , 18 - 49 y ) with chronic whiplash-associated disorders ( WAD ) grade s I and II ( duration , 6 mo-6 y ) , with current pain score on a visual analog scale of 46.8+/-21.8 , and a disability score on the Northwick Park Neck Pain Disability Index of 45%+/-14 % . Twenty asymptomatic women ( mean age + /- SD , 29.3+/-8.6 y ; range , 18 - 48 y ) with no history of whiplash or insidious onset neck pain served as controls . INTERVENTION A slowly moving object appeared on a computer screen and traced an unpredictable movement path that the subjects were required to follow by moving their heads . Three r and omly ordered movement patterns were tested . MAIN OUTCOME MEASURE A new software program connected to a 3Space Fastrak system  was used to measure the mean absolute error ( in millimeters ) of 3 trials in each movement pattern . RESULTS The mean differences ( + /-2 SD ) between days 1 and 2 were.01+/-.64 mm for the asymptomatic group and .33+/-1.80 mm for the WAD group . The between-day intraclass correlation coefficients were between.60 and .77 for the asymptomatic group and .79 and .86 for the WAD group . Repeated- measures analysis of variance revealed a significant difference between groups ( P=.02 ) . The Tukey post hoc test showed significant between-group differences for each movement pattern ( P</=.05 ) . In each successive trial , a slight improvement for the asymptomatic group and a slight worsening for the WAD group were detected . CONCLUSIONS Better reliability was detected for the asymptomatic group than for the WAD group . The test could discriminate between the asymptomatic group versus the chronic WAD group
For workers with persistent neck and shoulder pain , evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone ( grade s I-III NAD ) .
A multimodal approach including manual therapy , self-management advice , and exercise is an effective treatment strategy for both recent-onset and persistent neck pain
OBJECTIVE The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders ( NADs ) and whiplash-associated disorders ( WADs ) .
This guideline replaces 2 prior chiropractic guidelines on NADs and WADs .