title: The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial.
abstract: OBJECTIVE
  The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA).
  
  
  METHODS
  A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months.
  
  
  RESULTS
  The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the 2 NSE groups (29% to 48%) compared with the PPA group (5%) at 3 months. At 6 months 39% to 44% of the patients in the 2 neck-specific groups and 28% in the PPA group reported substantial pain reduction. Reduction of disability was also larger in the 2 neck-specific exercise groups at both 3 and 6 months (P<0.02). Self-efficacy was only improved in the NSE group without a behavioral approach (P=0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups.
  
  
  CONCLUSIONS
  NSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.
authors.affiliation: *Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping †Rehab Väst, County Council of Östergötland, Östergötland ‡Centre for Clinical Research Sörmland, Uppsala University, Uppsala ¶Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Solna #Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden §NHMRC CCRE (Spinal Pain, Injury and Health), The University of Queensland ∥Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Qld, Australia.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Ludvigsson
authors.forename: Gunnel
authors.initials: G
authors.lastname: Peterson
authors.forename: Shaun
authors.initials: S
authors.lastname: O'Leary
authors.forename: Åsa
authors.initials: Å
authors.lastname: Dedering
authors.forename: Anneli
authors.initials: A
authors.lastname: Peolsson
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009333:Neck / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology* / Q000534:rehabilitation*; D010147:Pain Measurement; D055656:Prescriptions / Q000706:statistics & numerical data; D011446:Prospective Studies; D020377:Self Efficacy; D016037:Single-Blind Method; D008061:Whipple Disease / Q000150:complications*; D055815:Young Adult