title: The effect of neck-specific exercise with or without a behavioral approach on psychological factors in chronic whiplash-associated disorders: A randomized controlled trial with a 2-year follow-up.
abstract: BACKGROUND
  To investigate the effect of neck-specific exercise with (NSEB) or without (NSE) a behavioural approach and prescribed physical activity (PPA) on general pain disability and psychological factors in chronic whiplash-associated disorders (WAD), grade 2 and 3, with a 2-year follow-up.
  
  
  METHODS
  A randomized controlled multi-centre study of 3 exercise interventions (NSE, NSEB or PPA) including a 2-year follow-up. A total of 216 volunteers with chronic WAD were recruited and 194 were analyzed, mean age 40.4 (Standard Deviation [SD] 11.4). Measures of general pain disability, pain catastrophizing, anxiety and depression, and kinesiophobia were evaluated at baseline, and 3, 6, 12 and 24 months with linear mixed models.
  
  
  RESULTS
  General pain disability decreased by 28% in the NSEB group from baseline to 3 months (P < 0.001) and the improvements in disability were maintained over time (6, 12 and 24 months P < 0.01) compared to the NSE (P > 0.42) and PPA groups (P > 0.43). Pain catastrophizing decreased in the NSE group from baseline to 6 and 12 months (P < 0.01) and in the NSEB group from baseline to 3 and 24 months (P < 0.01) compared to the PPA group (P > 0.82) that showed no change over time. The NSE group improved in kinesiophobia over time from baseline to12 months (P < 0.01) compared to the NSEB (P = 0.052) and the PPA groups (P > 0.74). Anxiety decreased over time from baseline to 12 and 24 months in the NSE group (P > 0.02), but not in the NSEB (P > 0.25) or the PPA (P > 0.50) groups. The PPA had no effect on general disability or any of the measured psychological factors.
  
  
  CONCLUSIONS
  This randomised controlled trial with a 2-year follow-up shows that physiotherapist-led neck-specific exercise with or without the addition of a behavioural approach had superior outcome on general disability and most psychological factors compared to the mere prescription of physical activity.
authors: Physiotherapy Department, School of Health, Care and Social Welfare, Mälardalen University, Västerås Centre for Health and Medical Psychology, Örebro University, Örebro Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping Centre for Clinical Research Sörmland, Uppsala University, Uppsala Rehab Väst, County Council of Östergötland, Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Sweden.
authors: Thomas
authors: T
authors: Overmeer
authors: Gunnel
authors: G
authors: Peterson
authors: Maria
authors: M
authors: Landén Ludvigsson
authors: Anneli
authors: A
authors: Peolsson
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology; D058443:Catastrophization / Q000209:etiology; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D015444:Exercise; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D019547:Neck Pain / Q000209:etiology / Q000628:therapy*; D010353:Patient Education as Topic; D010698:Phobic Disorders / Q000209:etiology; D016037:Single-Blind Method; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D055815:Young Adult