Are psychological interventions effective for the management of neck pain and whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
In 2008, the lack of published evidence prevented the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force [NPTF]) from commenting on the effectiveness of psychological interventions for the management of neck pain.



This study aimed to update findings of the NPTF and evaluate the effectiveness of psychological interventions for the management of neck pain and associated disorders (NAD) or whiplash-associated disorders (WAD).



This study used systematic review and best-evidence synthesis.



Randomized controlled trials, cohort studies, and case-control studies comparing psychological interventions to other non-invasive interventions or no intervention were the samples used in this study.



The outcome measures are (1) self-rated recovery; (2) functional recovery; (3) clinical outcomes; (4) administrative outcomes; and (5) adverse effects.



We searched six databases from 1990 to 2015. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers used the Scottish Intercollegiate Guidelines Network criteria to critically appraise eligible studies. Studies with a low risk of bias were synthesized following best evidence synthesis principles. This study was funded by the Ontario Ministry of Finance.



We screened 1,919 articles, 19 were eligible for critical appraisal and 10 were judged to have low risk of bias. We found no clear evidence supporting relaxation training or cognitive behavioral therapy (CBT) for persistent grades I-III NAD for reducing pain intensity or disability. Similarly, we did not find evidence to support the effectiveness of biofeedback or relaxation training for persistent grade II WAD, and there is conflicting evidence for the use of CBT in this population. However, adding a progressive goal attainment program to functional restoration physiotherapy may benefit patients with persistent grades I-III WAD. Furthermore, Jyoti meditation may help reduce neck pain intensity and bothersomeness in patients with persistent NAD.



We did not find evidence for or against the use of psychological interventions in patients with recent onset NAD or WAD. We found evidence that a progressive goal attainment program may be helpful for the management of persistent WAD and that Jyoti meditation may benefit patients with persistent NAD. The limited evidence of effectiveness for psychological interventions may be due to several factors, such as interventions that are ineffective, poorly conceptualized, or poorly implemented. Further methodologically rigorous research is needed.
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. Electronic address: heather.shearer@uoit.ca.
Heather M
HM
Shearer
School of Public Health, University of Alberta, 4075 RTF, 8308-114 Street, Edmonton, AB, T6G 2E1, Canada.
Linda J
LJ
Carroll
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
Jessica J
JJ
Wong
Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St., Toronto, Ontario, M2H 3J1, Canada.
Pierre
P
Côté
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, M2H 3J1, Canada.
Sharanya
S
Varatharajan
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
Danielle
D
Southerst
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
Deborah A
DA
Sutton
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, M2H 3J1, Canada.
Kristi A
KA
Randhawa
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
Hainan
H
Yu
Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada.
Silvano A
SA
Mior
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Leslie Dan Pharmacy Building, University of Toronto, 6th Floor, Room 658, 144 College Street, Toronto, Ontario, M5S 3M2, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada; Institute for Work and Health, 481 University Ave, Toronto, Ontario, M5G 2E9, Canada.
Gabrielle M
GM
van der Velde
Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 63 Downing Street, New York, 10014, USA.
Margareta C
MC
Nordin
Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St., Toronto, Ontario, M2H 3J1, Canada.
Maja
M
Stupar
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
Anne L
AL
Taylor-Vaisey
D000328:Adult; D015331:Cohort Studies; D006801:Humans; D019547:Neck Pain / Q000209:etiology / Q000534:rehabilitation*; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D000078202:Systematic Reviews as Topic; D014911:Whiplash Injuries / Q000150:complications / Q000534:rehabilitation*
Neck pain and associated disorders; Outcome; Psychological intervention; Recovery; Systematic review; Whiplash-associated disorders