title: What is the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered either on the Internet or face-to-face for people with acute whiplash associated disorder? A randomized controlled trial.
abstract: OBJECTIVE
  To investigate the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered via the Internet or face-to-face for people with acute whiplash associated disorders.
  
  
  METHODS
  A multicentre, randomized, three-group design, with concealed allocation.
  
  
  METHODS
  A total of 55 participants (37 female), age 18-65, with acute Whiplash Associated Disorder (Grade I-II), recruited at two emergency clinics in Sweden.
  
  
  METHODS
  Before randomization all participants received standard self-care instructions. The Internet and face-to-face groups followed a seven-week behavioural programme involving individual tailoring, via email (Internet group), or in sessions at a physical therapy unit (face-to-face group). The control group only received the self-care instructions.
  
  
  METHODS
  Pain-related disability, pain intensity, self-efficacy in daily activities, catastrophizing and fear of movement/(re)injury. Assessments were performed at baseline (2-4 weeks postinjury) and at three, six and 12 months postintervention.
  
  
  RESULTS
  Both the Internet (n = 16) and face-to-face (n = 14) group showed a larger decrease in pain-related disability than the control group (n = 16); -12 and -11, respectively, compared with -5 in the control group at 12-months follow-up. Significant differences between the groups in overall treatment effect were shown in all outcomes except pain intensity. All groups improved significantly over time in all outcomes, except for fear of movement/(re)injury and catastrophizing in the control group.
  
  
  CONCLUSIONS
  An individually tailored behavioural programme improved biopsychosocial factors in patients with whiplash associated disorders up to 12 months after treatment. Internet-delivered intervention was as effective as clinic-based face-to-face therapy sessions.
authors.affiliation: Department of Neuroscience, Uppsala University, Uppsala, Sweden annika.bring@neuro.uu.se.
authors.forename: Annika
authors.initials: A
authors.lastname: Bring
authors.affiliation: Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Åsenlöf
authors.affiliation: School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, Mälardalen, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Söderlund
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012648:Self Care; D013548:Sweden; D014911:Whiplash Injuries / Q000523:psychology / Q000534:rehabilitation*; D055815:Young Adult
keywords: Acute whiplash; avoidance of activities; behaviour; disability; physical therapy