Abstract
PurposeThe aim was to evaluate whether neck-specific exercise, with (NSEB) or without (NSE) a behavioural approach, improves health-related quality of life (HRQoL) compared to physical activity prescription (PPA) in chronic whiplash-associated disorders (WAD) grades 2 and 3. A secondary aim was to identify factors associated with HRQoL and HRQoL improvement following exercise interventions.MethodsThis is a secondary analysis of a multicentre randomized clinical trial. Participants (n = 216) with chronic WAD grades 2 and 3 were randomized to 12 weeks of PPA or physiotherapist-led NSE or NSEB. The EQ-5D 3L/EQ-VAS and SF-36v2 physical (PCS) and mental (MCS) component summaries were collected together with several neck-related and psychosocial outcomes at baseline, after 3, 6 and 12 months, and were analysed with linear mixed models (all time points) and multivariate linear regressions (baseline, 6 months).ResultsNSE/NSEB resulted in better outcomes than PPA (EQ-VAS and SF-36 PCS, both groups, p < 0.01) but not in a higher EQ-5D score. Improvement over time was seen in EQ-5D/EQ-VAS for the NSEB group (p < 0.01), and for NSE/NSEB as measured with the PCS (p < 0.01). Factors associated with baseline HRQoL and change to 6 months in HRQoL (R2 = 0.38–0.59) were both neck-related and psychosocial (e.g. depression, work ability).ConclusionNeck-specific exercise, particularly with a behavioural approach, may have a more positive impact on HRQoL than physical activity prescription in chronic WAD grades 2 and 3. HRQoL is however complex, and other factors also need to be considered. Factors associated with HRQL and improvements in HRQoL following exercise are multidimensional.Trial registration number: ClinicalTrials.gov, No. NCT01528579.
Highlights
Neck pain is rated as the 6th leading global cause of years lived with disability, which is higher than for instance diabetes and ischemic heart disease [1]
There was a significant improvement in the Neck-specific exercise with behavioural intervenƟon (NSEB) group from baseline to three months, which was maintained over all time points (F = 5.1, p < 0.01)
EQ-5D Euroqol 5 dimensions health questionnaire, SF-36 Short Form 36 health questionnaire, physical component summary (PCS) Physical component summary, MCS mental component summary, HADS Hospital Anxiety and Depression Scale, PDI Pain disability score, PCSc Pain Catastrophizing Scale, SES Self-Efficacy Scale, VAS Visual Analogue Scale, WAI Work Ability Index, Neck Disability Score (NDI) Neck Disability Index, n.a. not applicable due to variable not included in the final step of the regression. β standardized regression coefficient, b unstandardized coefficient, SE standard error score of 0.03 or 3 mm on the EQ-VAS per HADS point
Summary
Neck pain is rated as the 6th leading global cause of years lived with disability, which is higher than for instance diabetes and ischemic heart disease [1]. People with chronic WAD report worse health than people with non-specific chronic neck pain. Eligibility Assessment 1 (n=7950): LeƩers + two reminders, including basic inclusion/exclusion criteria*, NDI, and VAS, sent to individuals aged 18-63 years, idenƟfied from health care records in six counƟes in the preceding 6-36 months. Eligibility Assessment 2 (n=419): Telephone interviews to confirm inclusion/exclusion criteria and evaluate need for further review of medical files to determine eligibility + a physical examinaƟon to confirm WAD grading (2 or 3) Enrolment. Excluded (n=203) Reasons: Did not meet inclusion criteria: other severe illness/main pain locaƟon (n=42), traumaƟc brain injury (n=3), >3 years since trauma (n=37), previous unresolved neck injury/sick leave > 1 months before trauma (n=11), fracture/luxaƟon/op (n=4), insufficient knowledge of Swedish language (n=16), other (n=12) Declined/unavailable: relocated residence (n= 8), decline to parƟcipate due to lack of Ɵme (n= 37), failed to aƩend physical examinaƟon/unable to contact (n=18).
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