The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders - a randomized controlled trial

Abstract

Objective: To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders. Design: A randomized controlled trial with follow-up at three and nine months after randomization. Setting: An interdisciplinary rehabilitation centre. Subjects: Forty-seven patients with subacute disorders following a whiplash trauma. Interventions: Patients were randomized to a supervised training group or a self-administered home training group. Main measures: Primary outcome measures were the Self-Efficacy Scale, the Tampa Scale for Kinesiophobia and the Pain Disability Index. Secondary outcome measures were neck pain intensity, sensory and affective dimensions of pain, pain location and duration, muscle tenderness, grip strength, cervical mobility, sick leave and analgesic consumption. Results: Forty patients (85%) completed the intervention period, and the drop-outs were followed up by intention-to-treat. The results showed that supervised training was significantly more favourable than home training, with a more rapid improvement in self-efficacy (P=0.03), fear of movement/(re)injury (P=0.03) and pain disability (P=0.03) at three months. Further, supervised training significantly reduced the frequency of analgesic consumption (P=0.03). The improvements were partly maintained at nine months, even though there was no amelioration in pain and physical disorders. Despite the favourable outcome, supervised intervention did not reduce sick leave. Conclusions: The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term, but additional research is needed to extend these findings and elucidate treatment strategies that also are cost effective.