Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial

Authors

  • Gunnel Peterson Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden
  • Emma Nilsing Strid University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  • Margaretha Jönsson Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
  • Jesper Hävermark Centre for Clinical Research, Development and Education, County Council Uppsala, Sweden
  • Anneli Peolsson Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden; Occupational and Environmental Medicine Centre and Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden

DOI:

https://doi.org/10.2340/jrm.v56.34785

Keywords:

telemedicine, rehabilitation, whiplash injuries, neck pain, spine

Abstract

Objective: To compare the effects of a neck-specific exercise programme with internet support and 4 physiotherapist sessions (NSEIT) and the same neck-specific exercises supervised by a physiotherapist (NSE) on neck muscle endurance and cervical range of motion.

Design: Randomized controlled trial.

Patients: A total of 140 participants with chronic whiplash-associated disorders grade II or grade III were randomly assigned to the NSEIT or NSE groups.

Methods: Outcomes were changes in active cervical range of motion, cranio-cervical flexion test, neck muscle endurance, and neck pain, at 3- and 15-month follow-ups.

Results: There were no significant differences between the NSEIT and NSE groups. There was a significant group-by-time inter-action effect in active cervical range of motion flexion/extension where the NSEIT group improved to 3-month follow-up, but the NSE group did not. Both groups were significantly improved over time in all other outcomes (p < 0.001) at 3- and 15-month follow-ups, with effect size between 0.64 and 1.35 in active cervical range of motion, cranio-cervical flexion test, dorsal neck muscle endurance, and neck pain, and effect size between 0.22 and 0.42 in ventral neck muscle endurance.

Conclusion: Both NSE and NSEIT led to improved neck function. Depending on the patients’ needs, either NSE or NSEIT could be used as treatment for patients with chronic whiplash-associated disorders.

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References

Carroll LJ, Holm LW, Hogg-Johnson S, Cote P, Cassidy JD, Haldeman S, et al. Course and prognostic factors for neck pain in whip-lash-associated disorders (WAD): results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 2009; 32: S97–S107.

https://doi.org/10.1016/j.jmpt.2008.11.014 DOI: https://doi.org/10.1016/j.jmpt.2008.11.014

Gustafsson M, Stigson H, Krafft M, Kullgren A. Risk of permanent medical impairment (RPMI) in car crashes correlated to age and gender. Traffic Injury Prev 2015; 16: 353–361.

https://doi.org/10.1080/15389588.2014.940459 DOI: https://doi.org/10.1080/15389588.2014.940459

Shearer HM, Carroll LJ, Côté P, Randhawa K, Southerst D, Varatharajan S, et al. The course and factors associated with recovery of whiplash-associated disorders: an updated systematic review by the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur J Physiother 2021; 23: 279–294.

https://doi.org/10.1080/21679169.2020.1736150 DOI: https://doi.org/10.1080/21679169.2020.1736150

Krogh S, Kasch H. Whiplash injury results in sustained impairments of cervical muscle function: a one-year prospective, controlled study. J Rehabil Med 2018; 50: 548–555.

https://doi.org/10.2340/16501977-2348 DOI: https://doi.org/10.2340/16501977-2348

Stenneberg MS, Rood M, de Bie R, Schmitt MA, Cattrysse E, Scholten-Peeters GG. To what degree does active cervical range of motion differ between patients with neck pain, patients with whiplash, and those without neck pain? A systematic review and meta-analysis. Arch Phys Med Rehabil 2017; 98: 1407–1434.

https://doi.org/10.1016/j.apmr.2016.10.003 DOI: https://doi.org/10.1016/j.apmr.2016.10.003

Stenneberg MS, Scholten-Peeters GGM, den Uil CS, Wildeman ME, van Trijffel E, de Bie RA. Clinical characteristics differ between patients with non-traumatic neck pain, patients with whiplash-associated disorders, and pain-free individuals. Physiother Theo-ry Pract 2021; 38: 2592–2602.

https://doi.org/10.1080/09593985.2021.1962464 DOI: https://doi.org/10.1080/09593985.2021.1962464

Rebbeck T. The role of exercise and patient education in the noninvasive management of whiplash. J Orthop Sports Phys Ther 2017; 47: 481–491.

https://doi.org/10.2519/jospt.2017.7138 DOI: https://doi.org/10.2519/jospt.2017.7138

Michaleff ZA, Maher CG, Lin CW, Rebbeck T, Jull G, Latimer J, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet 2014; 384: 133–141.

https://doi.org/10.1016/S0140-6736(14)60457-8 DOI: https://doi.org/10.1016/S0140-6736(14)60457-8

de Zoete RMJ, Nikles J, Coombes JS, Onghena P, Sterling M. The effectiveness of aerobic versus strengthening exercise therapy in individuals with chronic whiplash-associated disorder: a randomised single case experimental design study. Disabil Rehabil 2023; 45: 3519–3528. DOI: https://doi.org/10.1080/09638288.2022.2127937

https://doi.org/10.1177/1357633X241235982

Ludvigsson ML, Peterson G, Dedering A, Peolsson A. One- and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioural approach compared with prescription of physical activity in chronic whiplash disorder. J Rehabil Med 2016; 48: 56–64.

https://doi.org/10.2340/16501977-2041 DOI: https://doi.org/10.2340/16501977-2041

Malfliet A, Kregel J, Coppieters I, De Pauw R, Meeus M, Roussel N, et al. Effect of pain neuroscience education combined with cogni-tion-targeted motor control training on chronic spinal pain: a randomized clinical trial. JAMA Neurol 2018; 75: 808–817.

https://doi.org/10.1001/jamaneurol.2018.0492 DOI: https://doi.org/10.1001/jamaneurol.2018.0492

Stewart MJ, Maher CG, Refshauge KM, Herbert RD, Bogduk N, Nicholas M. Randomized controlled trial of exercise for chronic whip-lash-associated disorders. Pain 2007; 128: 59–68.

https://doi.org/10.1016/j.pain.2006.08.030 DOI: https://doi.org/10.1016/j.pain.2006.08.030

Peolsson A, Landen Ludvigsson M, Tigerfors AM, Peterson G. Effects of neck-specific exercises compared to waiting list for individu-als with chronic whiplash-associated disorders: a prospective, randomized controlled study. Arch Phys Med Rehabil 2016;97: 189–195. https://doi.org/10.1016/j.apmr.2015.10.087 DOI: https://doi.org/10.1016/j.apmr.2015.10.087

Liew BXW, Scutari M, Peolsson A, Peterson G, Ludvigsson ML, Falla D. Investigating the causal mechanisms of symptom recovery in chronic whiplash-associated disorders using Bayesian networks. Clin J Pain 2019; 35: 647–655.

https://doi.org/10.1097/AJP.0000000000000728 DOI: https://doi.org/10.1097/AJP.0000000000000728

Peterson G, Landen Ludvigsson M, Peolsson A. Neck-related function and its connection with disability in chronic whiplash-associated disorders: secondary analysis of a randomized controlled study. Eur J Phys Rehabil Med 2021; 57: 607–619.

https://doi.org/10.23736/S1973-9087.21.06518-7 DOI: https://doi.org/10.23736/S1973-9087.21.06518-7

Peterson G, Nilsson D, Trygg J, Peolsson A. Neck-specific exercise improves impaired interactions between ventral neck muscles in chronic whiplash: a randomized controlled ultrasound study. Sci Rep 2018; 8: 9649.

https://doi.org/10.1038/s41598-018-27685-7 DOI: https://doi.org/10.1038/s41598-018-27685-7

Law L, Kelly JT, Savill H, Wallen MP, Hickman IJ, Erku D, et al. Cost-effectiveness of telehealth-delivered diet and exercise interven-tions: a systematic review. J Telemed Telecare 2024; 30: 420–437.

https://doi.org/10.1177/1357633X211070721 DOI: https://doi.org/10.1177/1357633X211070721

van Vugt VA, de Kruif AJ, van der Wouden JC, van der Horst HE, Maarsingh OR. Experiences of patients and physiotherapists with blended internet-based vestibular rehabilitation: a qualitative interview study. BJGP Open 2020; 4: bjgpopen20X101092.

https://doi.org/10.3399/bjgpopen20X101092 DOI: https://doi.org/10.3399/bjgpopen20X101092

Peolsson A, Landen Ludvigsson M, Peterson G. Neck-specific exercises with internet-based support compared to neck-specific exer-cises at a physiotherapy clinic for chronic whiplash-associated disorders: study protocol of a randomized controlled multicentre trial. BMC Musculoskelet Disord 2017; 18: 524.

https://doi.org/10.1186/s12891-017-1853-1 DOI: https://doi.org/10.1186/s12891-017-1853-1

Peterson G, Peolsson A. Efficacy of neck-specific exercise with internet support versus neck-specific exercise at a physiotherapy clinic in chronic whiplash-associated disorders: multicenter randomized controlled noninferiority trial. J Med Internet Res 2023; 25: e43888.

https://doi.org/10.2196/43888 DOI: https://doi.org/10.2196/43888

World Health Organization. Global recommendations on physical activity for health 2010. Geneva: World Health Organization, 2010.

Peterson GE, Landen Ludvigsson MH, O’Leary SP, Dedering AM, Wallman T, Jonsson MI, et al. The effect of 3 different exercise ap-proaches on neck muscle endurance, kinesiophobia, exercise compliance, and patient satisfaction in chronic whiplash. J Manipu-lative Physiol Ther 2015; 38: 465–476 e4.

https://doi.org/10.1016/j.jmpt.2015.06.011 DOI: https://doi.org/10.1016/j.jmpt.2015.06.011

Williams MA, Williamson E, Gates S, Cooke MW. Reproducibility of the cervical range of motion (CROM) device for individuals with sub-acute whiplash associated disorders. Eur Spine J 2012; 21: 872–878.

https://doi.org/10.1007/s00586-011-2096-8 DOI: https://doi.org/10.1007/s00586-011-2096-8

Jorgensen R, Ris I, Falla D, Juul-Kristensen B. Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain. BMC Musculoskelet Disord 2014; 15: 408.

https://doi.org/10.1186/1471-2474-15-408 DOI: https://doi.org/10.1186/1471-2474-15-408

Edmondston SJ, Wallumrod ME, Macleid F, Kvamme LS, Joebges S, Brabham GC. Reliability of isometric muscle endurance tests in subjects with postural neck pain. J Manipulative Physiol Ther 2008; 31: 348–354.

https://doi.org/10.1016/j.jmpt.2008.04.010 DOI: https://doi.org/10.1016/j.jmpt.2008.04.010

Peolsson A, Almkvist C, Dahlberg C, Lindqvist S, Pettersson S. Age- and sex-specific reference values of a test of neck muscle endurance. J Manipulative Physiol Ther 2007; 30: 171–177.

https://doi.org/10.1016/j.jmpt.2007.01.008 DOI: https://doi.org/10.1016/j.jmpt.2007.01.008

Lemeunier N, da Silva-Oolup S, Olesen K, Shearer H, Carroll LJ, Brady O, et al. Reliability and validity of self-reported quest-ionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3–a systematic review from the CADRE Collaboration. Eur Spine J 2019; 28: 1156–1179.

https://doi.org/10.1007/s00586-019-05949-8 DOI: https://doi.org/10.1007/s00586-019-05949-8

Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum, 1988.

Zou H, Lu Z, Zhao P, Wang J, Wang R. Efficacy of telerehabilitation in patients with nonspecific neck pain: a meta-analysis. J Tele-med Telecare 2024 Mar 1. [Online ahead of print] DOI: 10.1177/1357633X241235982 DOI: https://doi.org/10.1177/1357633X241235982

Ozel M, Kaya Ciddi P. The effectiveness of telerehabilitation-based structured exercise therapy for chronic nonspecific neck pain: a randomized controlled trial. J Telemed Telecare 2022 May 16 [Online ahead of print].

https://doi.org/10.1177/1357633X221095782 DOI: https://doi.org/10.1177/1357633X221095782

Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. Traffic Injury Prev 2009; 10: 101-112.

https://doi.org/10.1080/15389580802593269 DOI: https://doi.org/10.1080/15389580802593269

Persson M, Sorensen J, Gerdle B. Chronic whiplash associated disorders (WAD): responses to nerve blocks of cervical zygapophy-seal joints. Pain Med 2016; 17: 2162–2175.

https://doi.org/10.1093/pm/pnw036 DOI: https://doi.org/10.1093/pm/pnw036

Peterson G, Nilsson D, Trygg J, Falla D, Dedering A, Wallman T, et al. Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders. Sci Rep 2015; 5: 15289.

https://doi.org/10.1038/srep15289 DOI: https://doi.org/10.1038/srep15289

Schomacher J, Farina D, Lindstroem R, Falla D. Chronic trauma-induced neck pain impairs the neural control of the deep se-mispinalis cervicis muscle. Clin Neurophysiol 2012; 123: 1403–1408.

https://doi.org/10.1016/j.clinph.2011.11.033 DOI: https://doi.org/10.1016/j.clinph.2011.11.033

Kristjansson E, Gislason MK. Women with late whiplash syndrome have greatly reduced load-bearing of the cervical spine: in-vivo biomechanical, cross-sectional, lateral radiographic study. Eur J Phys Rehabil Med 2018; 54: 22–33.

https://doi.org/10.23736/S1973-9087.17.04605-6 DOI: https://doi.org/10.23736/S1973-9087.17.04605-6

Schomacher J, Falla D. Function and structure of the deep cervical extensor muscles in patients with neck pain. Man Ther 2013; 18: 360–366.

https://doi.org/10.1016/j.math.2013.05.009 DOI: https://doi.org/10.1016/j.math.2013.05.009

Bexander CSM, Hodges PW. Cervical rotator muscle activity with eye movement at different speeds is distorted in whiplash. Pm R 2019; 11: 944–953.

https://doi.org/10.1002/pmrj.12059 DOI: https://doi.org/10.1002/pmrj.12059

Rasmussen-Barr E, Halvorsen M, Bohman T, Bostrom C, Dedering A, Kuster RP, et al. Summarizing the effects of different exercise types in chronic neck pain: a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord 2023; 24: 806.

https://doi.org/10.1186/s12891-023-06930-9 DOI: https://doi.org/10.1186/s12891-023-06930-9

Gross AR, Paquin JP, Dupont G, Blanchette S, Lalonde P, Cristie T, et al. Exercises for mechanical neck disorders: a Cochrane review update. Man Ther 2016; 24: 25–45.

https://doi.org/10.1016/j.math.2016.04.005 DOI: https://doi.org/10.1016/j.math.2016.04.005

Peolsson A, Hermansen A, Peterson G, Nilsing Strid E. Return to work a bumpy road: a qualitative study on experiences of work ability and work situation in individuals with chronic whiplash-associated disorders. BMC Public Health 2021; 21: 785.

https://doi.org/10.1186/s12889-021-10821-w DOI: https://doi.org/10.1186/s12889-021-10821-w

Published

2024-07-29

How to Cite

Peterson, G., Nilsing Strid, E., Jönsson, M., Hävermark, J., & Peolsson, A. (2024). Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial. Journal of Rehabilitation Medicine, 56, jrm34785. https://doi.org/10.2340/jrm.v56.34785

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