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

Overmeer, Thomas; Peterson, Gunnel; Landén Ludvigsson, Maria; Peolsson, Anneli

doi:10.1097/md.0000000000004430

Cited by 42Musculoskeletal pain and rehabilitationAutomotive and Human Injury BiomechanicsMedical Practices and Rehabilitation

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

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Overmeer, Thomas, Peterson, Gunnel, Landén Ludvigsson, Maria, Peolsson, Anneli·2016·Medicine

DOI 10.1097/md.0000000000004430PMC PMC5400316

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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. CONCLUSION: 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.

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GET, exercises with a behavioural approach, CBT, Coping Strategies, Psychological Flexibility, and V.R. had positive effects on pain reduction compared to usual care, while Web-BCPA, EFT, matching therapy to psychological features, and physical cognitive-mindfulness did not affect reducing pain intensity.
“GET, exercises with a behavioural approach, CBT, Coping Strategies, Psychological Flexibility, and V.R. had positive effects on pain reduction compared to usual care (Table 2) [18, 26, 27, 29, 30, 33]. Web-BCPA, EFT, matching therapy to psychological features, and physical cognitive-mindfulness did not affect reducing pain intensity.”
From A Scoping Review of the Evidence regarding Assessment and Management of Psychological Features of Shoulder Pain. (2021) · cites this paper as [29]
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The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders
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Neck-specific exercise with or without a behavioural approach, or prescription of physical activity in chronic whiplash associated disorders
Ludvigsson, M. L. (2016) · Linköping University medical dissertations · doi:10.3384/diss.diva-126782 · Cited by 2 · see citing works

Authors: Overmeer, T., Peterson, G., Landén Ludvigsson, M., & Peolsson, A.
Affiliations: Linköping University (SE)
Corresponding author: Overmeer, Thomas
ORCID: Peterson, Gunnel
Peolsson, Anneli
Venue: Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-08
Volume: 95
Issue: 34
Pages: e4430
ISSN: 0025-7974 (ISSN-L)
DOI: 10.1097/md.0000000000004430
PMC: PMC5400316
OpenAlex: W2515465571
Cited by: 42
References: 47
Citations by year: 2026: 1 · 2025: 7 · 2024: 5 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 7 · 2019: 4 · 2018: 5 · 2017: 4
FWCI: 3.50
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Medicine (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DiVA (Linkoping University) (submittedVersion, other-oa)
KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Automotive and Human Injury Biomechanics
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: chronic whiplash-associated disorders, neck-specific exercise, behavioral approach, pain-related disability, pain catastrophizing, kinesiophobia, anxiety, depression, psychological factors, physiotherapy
MeSH terms: Adolescent, Adult, Anxiety, Depression, Disability Evaluation, Exercise Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Movement, Patient Education as Topic, Phobic Disorders, Whiplash Injuries, Exercise, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome, Neck Pain, Young Adult, Catastrophization

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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

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