Physiotherapist-delivered stress inoculation training integrated with exercise versus physiotherapy exercise alone for acute whiplash-associated disorder (StressModex): a randomised controlled trial of a combined psychological/physical intervention

Sterling, Michele; Smeets, Rob; Keijzers, Gerben; Warren, Jacelle; Kenardy, Justin

doi:10.1136/bjsports-2018-100139

Cited by 104Musculoskeletal pain and rehabilitationAutomotive and Human Injury BiomechanicsTraumatic Brain Injury Research

Physiotherapist-delivered stress inoculation training integrated with exercise versus physiotherapy exercise alone for acute whiplash-associated disorder (StressModex): a randomised controlled trial of a combined psychological/physical intervention

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Sterling, Michele, Smeets, Rob, Keijzers, Gerben, Warren, Jacelle, Kenardy, Justin·2019·British Journal of Sports Medicine

DOI 10.1136/bjsports-2018-100139

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Abstract

Objective: There are few effective treatments for acute whiplash-associated disorders (WAD). Early symptoms of postinjury stress predict poor recovery. This randomised controlled trial (StressModex) investigated whether physiotherapist-led stress inoculation training integrated with exercise is more effective than exercise alone for people with acute WAD. Methods: 108 participants (<4 weeks) at risk of poor recovery (moderate pain-related disability and hyperarousal symptoms) were randomly assigned by concealed allocation to either physiotherapist-led stress inoculation training and guideline-based exercise (n=53) or guideline-based exercise alone (n=55). Both interventions comprised 10 sessions over 6 weeks. Participants were assessed at 6 weeks and at 6 and 12 months postrandomisation. Analysis was by intention to treat using linear mixed models. Results: The combined stress inoculation training and exercise intervention was more effective than exercise alone for the primary outcome of pain-related disability at all follow-up points. At 6 weeks, the treatment effect on the 0–100 Neck Disability Index was (mean difference) −10 (95% CI −15.5 to −4.48), at 6 months was −7.8 (95% CI −13.8 to −1.8) and at 12 months was −10.1 (95% CI −16.3 to −4.0). A significant benefit of the stress inoculation and exercise intervention over exercise alone was also found for some secondary outcomes. Conclusion: A physiotherapist-led intervention of stress inoculation training and exercise resulted in clinically relevant improvements in disability compared with exercise alone—the most commonly recommended treatment for acute WAD. This contributes to the case for physiotherapists to deliver an early psychological intervention to patients with acute WAD who are otherwise at high risk of a poor outcome. Trial registration number: ACTRN12614001036606.

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Authors: Sterling, M., Smeets, R., Keijzers, G., Warren, J., & Kenardy, J.
Affiliations: Griffith University (AU)
Maastricht University (NL)
The University of Queensland (AU)
Corresponding author: Sterling, Michele
ORCID: Sterling, Michele
Smeets, Rob
Keijzers, Gerben
Warren, Jacelle
Kenardy, Justin
Venue: British Journal of Sports Medicine
Publisher: BMJ
Published: 2019-01-19
Volume: 53
Issue: 19
Pages: 1240-1247
ISSN: 0306-3674 (ISSN-L)
1473-0480
DOI: 10.1136/bjsports-2018-100139
OpenAlex: W2908567203
Cited by: 104
References: 46
Citations by year: 2026: 17 · 2025: 17 · 2024: 12 · 2023: 13 · 2022: 11 · 2021: 18 · 2020: 11 · 2019: 5
FWCI: 6.97
Type: journal article
Language: en
Open access: green
cris.maastrichtuniversity.nl
Licence: other-oa
Locations: British Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, other-oa)
Bond University Research Portal (Bond University) (submittedVersion)
HighWire Press Open Archive (submittedVersion)
Griffith Research Online (submittedVersion, other-oa)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders: National Health and Medical Research Council
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Automotive and Human Injury Biomechanics
Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords: whiplash-associated disorders, stress inoculation training, physiotherapy exercises, psychological intervention, pain-related disability, hyperarousal symptoms, neck disability
MeSH terms: Adult, Exercise Therapy, Female, Humans, Male, Middle Aged, Pain Measurement, Stress, Psychological, Whiplash Injuries, Physical Therapy Modalities, Pain Management, Physical Therapists

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Physiotherapist-delivered stress inoculation training integrated with exercise versus physiotherapy exercise alone for acute whiplash-associated disorder (StressModex): a randomised controlled trial of a combined psychological/physical intervention

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