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Colombi A, Vedani S, Viceconti A, Stapleton C. The quality of reporting in randomized controlled trials investigating exercise for individuals with whiplash-associated disorders; a systematic review. Musculoskelet Sci Pract 2024; 73:103145. [PMID: 39018752 DOI: 10.1016/j.msksp.2024.103145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 06/27/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Whiplash-associated disorders are a common sequela of road traffic accidents. Exercise therapy is considered an effective intervention, and it is recommended for the management of such condition. However, the application of research findings to everyday clinical practice is dependent on sufficient details being reported. OBJECTIVES To explore the quality of reporting in studies investigating the effectiveness of exercise for whiplash-associated disorders. METHODS A literature search was conducted to identify studies testing the effectiveness of exercise for whiplash-associated disorders. Two reporting checklists were used to evaluate reporting completeness. The median positive scores for each study and overall percentage of positive scores for each item were calculated. Percentage agreement and the Cohen's Kappa coefficient were calculated. RESULTS Twenty-one studies were included. According to the Template for Intervention Description and Replication checklist, items were reported appropriately with a median of 29% (range 0-95%, IQR 40.5). The median number of adequately reported items per study was 5 (range 1-10, IQR 3). For the Consensus on Exercise Reporting Template checklist, items were reported appropriately with a median of 29% (range 0-57%, IQR 29). The median number of adequately reported items per study was 4 (range 0-16, IQR 8). Percentage agreement ranged from 57% to 100% while Cohen's Kappa from -0.17 to 1.00. CONCLUSIONS The study reveals significant gaps in the quality of reporting in studies investigating exercise for whiplash-associated disorders as both checklists showed a median reporting adequacy of only 29%. Overall, the inter-rater agreement for both checklists was acceptable.
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Peolsson A, Bahat HS, German D, Peterson G. Results of neck-specific exercise for altered postural sway in individuals with chronic whiplash-associated disorders: a longitudinal case-control study. Sci Rep 2024; 14:15235. [PMID: 38956135 PMCID: PMC11220100 DOI: 10.1038/s41598-024-66176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
Postural sway has not been investigated before or after a neck exercise intervention in individuals with chronic whiplash-associated disorders (WAD). The aim of the study was to investigate postural sway in individuals with chronic WAD grades 2 and 3: (a) compared with healthy matched controls at baseline; (b) after three months of neck-specific exercise and (c) to investigate the correlation between postural sway with self-reported dizziness during motion and balance problems/unsteadiness. This is a longitudinal prospective experimental case-control intervention study. Individuals with WAD (n = 30) and age- and gender-matched healthy volunteers (n = 30) participated. Postural sway was assessed using an iPhone application. Measurements were carried out at baseline, and for those with WAD a second measurement was performed at the three-month follow-up when neck-specific exercise intervention ended. The WAD group performed significantly worse than the healthy group in both pathway and ellipse area double stance eyes closed at baseline (main outcome), but not at the three-month follow-up. The WAD group significantly improved after rehabilitation in both pathway double stance eyes closed and pathway single stance eyes open. The correlation between postural sway and self-rated dizziness during motion and balance problems was low to moderate. One may conclude that postural sway was improved after a neck-specific exercise programme. The study results strengthen earlier findings that individuals with WAD have worse balance outcome when they have to rely on neck proprioception (eyes closed). The study results may be important for the development of improved rehabilitation methods for WAD.
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Affiliation(s)
- Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.
- Occupational and Environmental Medicine Centre, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden.
| | | | - Dmitry German
- Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Gunnel Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Hendriks E, Coppieters I, Voogt L, Cools W, Ickmans K. Exercise-Induced Hypoalgesia in Patients with Chronic Whiplash-Associated Disorders: Differences between Subgroups Based on the Central Sensitization Inventory. J Clin Med 2024; 13:482. [PMID: 38256616 PMCID: PMC10816827 DOI: 10.3390/jcm13020482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Physical exercise is an important element in the rehabilitation of chronic whiplash-associated disorders, with the physiological process underlying pain reduction called exercise-induced hypoalgesia. In chronic whiplash-associated disorders, exercise-induced hypoalgesia appears impaired, and the research suggests a relationship with symptoms of dysfunctional nociceptive processing, such as central sensitization. This study improves our understanding of exercise-induced hypoalgesia in chronic whiplash-associated disorders by examining the differences between the extent of exercise-induced hypoalgesia in subgroups based on scores on the central sensitization inventory (CSI). METHODS Data were collected from 135 participants with chronic whiplash-associated disorders who completed a set of questionnaires. Pain pressure thresholds and temporal summations were assessed before and after a submaximal aerobic bicycle exercise test. RESULTS We observed no interaction effect between exercise-induced hypoalgesia and the CSI scores for both pain pressure threshold and temporal summation. No overall statistical effect was measured in the analysis of the effect of time. The pain pressure threshold significantly related to the CSI. The temporal summation showed no correlation. CONCLUSIONS During this study, we did not find evidence for a difference in the presence of exercise-induced hypoalgesia when the subgroups were created based on the central sensitization cluster calculator. Limited evidence was found for the influence of CSI scores on the delta pain pressure threshold.
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Affiliation(s)
- Erwin Hendriks
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Rehabilitation Centre Drechtsteden/Haaglanden, Berkenhof 100, 3319 WB Dordrecht, The Netherlands
- Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, The Netherlands
- Unit Physiotherapy, Organizational Part of the Orthopedics Department, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Iris Coppieters
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translation Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Oude Markt 13, 3000 Leuven, Belgium
| | - Lennard Voogt
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, The Netherlands
| | - Wilfried Cools
- Core Facility—Support for Quantitative and Qualitative Research (SQUASH), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium;
| | - Kelly Ickmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
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Mallard F, Wong JJ, Lemeunier N, Côté P. Effectiveness of Multimodal Rehabilitation Interventions for Management of Cervical Radiculopathy in Adults: An Updated Systematic Review from the Ontario Protocol for Traffic Injury Management (Optima) Collaboration. J Rehabil Med 2022; 54:jrm00318. [PMID: 35797062 PMCID: PMC9422871 DOI: 10.2340/jrm.v54.2799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To update the systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration and to evaluate the effectiveness of multimodal rehabilitation interventions for the management of adults with cervical radiculopathy. STUDY DESIGN Systematic review and best-evidence synthesis. METHODS Eligible studies (from January 2013 to June 2020) were critically appraised using the Scottish Intercollegiate Guidelines Network and Risk of Bias 2.0 criteria. The certainty of the evidence was assessed according to Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Four RCTs were deemed acceptable and 1 RCT was considered low quality. In adults with recent-onset cervical radiculopathy, multimodal rehabilitation was associated with a trivial and nonclinically important reduction in neck pain compared with mechanical cervical traction; no differences in disability were reported (1 study, 360 participants, low certainty of the evidence). In adults with cervical radiculopathy of any duration, (i) multimodal rehabilitation may be more effective than prescribed physical activity and brief cognitive-behavioural approach; specifically, a small reduction in arm pain and in function was found (1 study, 144 participants, low certainty of the evidence); (ii) no difference in pain reduction was found between multimodal rehabilitation interventions compared with an epidural steroid injection (1 study, 169 participants, low certainty of the evidence); and (iii) compared with surgery combined with neck exercises, multimodal rehabilitation interventions lead to similar arm pain reduction and improvement in function (1 study, 68 participants, low certainty of the evidence). CONCLUSION The evidence suggests that some multimodal rehabilitation care may provide small and trivial reduction in neck pain or improvement in function to patients with cervical radiculopathy.
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Affiliation(s)
- Fabrice Mallard
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Institut Franco-Européen de Chiropraxie (IFEC), Toulouse, France.
| | - Jessica J Wong
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Institute for Disability and Rehabilitation Research (IDRR)
| | - Nadège Lemeunier
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Equipe constitutive du Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Unité Mixte de Recherche (UMR) 1295, unité mixte Institut national de la santé et de la recherche médicale (INSERM) - Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research (IDRR); Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
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Chrcanovic B, Larsson J, Malmström EM, Westergren H, Häggman-Henrikson B. Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis. Scand J Pain 2022; 22:232-261. [PMID: 34561976 DOI: 10.1515/sjpain-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list. CONTENT The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers. SUMMARY The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability. OUTLOOK Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.
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Affiliation(s)
| | - Johan Larsson
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Eva-Maj Malmström
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden
| | - Hans Westergren
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Health Sciences, Lund University, Lund, Sweden
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Simpson P, Holopainen R, Schütze R, O'Sullivan P, Smith A, Linton SJ, Nicholas M, Kent P. Training of Physical Therapists to Deliver Individualized Biopsychosocial Interventions to Treat Musculoskeletal Pain Conditions: A Scoping Review. Phys Ther 2021; 101:6330890. [PMID: 34331758 DOI: 10.1093/ptj/pzab188] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/05/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Current guidelines recommend management of musculoskeletal pain conditions from a biopsychosocial approach; however, biopsychosocial interventions delivered by physical therapists vary considerably in effectiveness. It is unknown whether the differences are explained by the intervention itself, the training and/or competency of physical therapists delivering the intervention, or fidelity of the intervention. The aim was to investigate and map the training, competency assessments, and fidelity checking of individualized biopsychosocial interventions delivered by physical therapists to treat musculoskeletal pain conditions. METHODS A scoping review methodology was employed, using Arksey and O'Malley's framework. Seven electronic databases were searched between January and March 2019, with a bridge search completed in January 2020. Full-text peer-reviewed articles, with an individualized biopsychosocial intervention were considered, and 35 studies were included. RESULTS Reporting overall was sparse and highly variable. There was a broad spectrum of training. More sophisticated training involved workshops combining didactic and experiential learning over longer durations with supervision and feedback. Less sophisticated training was brief, involving lectures or seminars, with no supervision or feedback. Competency assessments and fidelity testing were underperformed. CONCLUSIONS Training in some interventions might not have facilitated the implementation of skills or techniques to enable the paradigm shift and behavior change required for physical therapists to effectively deliver a biopsychosocial intervention. Lack of competency assessments and fidelity checking could have impacted the methodological quality of biopsychosocial interventions. IMPACT This study highlighted problematic reporting, training, assessment of competency, and fidelity checking of physical therapist-delivered individualized biopsychosocial interventions. Findings here highlight why previous interventions could have shown small effect sizes and point to areas for improvement in future interventions. These findings can help inform future research and facilitate more widespread implementation of physical therapist-delivered biopsychosocial interventions for people with musculoskeletal pain and thereby improve their quality of life.
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Affiliation(s)
- Phoebe Simpson
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Riikka Holopainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Robert Schütze
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,Bodylogic Physiotherapy, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Steven J Linton
- Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Michael Nicholas
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Peterson G, Landén 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. [PMID: 34519194 DOI: 10.23736/s1973-9087.21.06518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND More than 40% of individuals with whiplash injury experience persistent neck pain and disability years later, called whiplash-associated disorders (WAD). A randomized controlled trial evaluated three exercise interventions in WAD and found that neck-specific exercise (NSE) and NSE with a behavioral approach (NSEB) significantly improve disability compared to prescribed physical activity (PPA). However, the relationship between neck-related function and disability is inconclusive and needs to be further investigated. AIM The present study compares the effect of NSE, NSEB, and PPA on neck muscle endurance (NME), active cervical range of motion (AROM), grip strength, and pain intensity immediately before and after the physical tests, and neck disability in individuals who are below or above the cut-off for normative reference values regarding NME, AROM, and grip strength. DESIGN Follow-up to a multicenter randomized clinical trial. SETTING Primary healthcare centers and hospital outpatient services. POPULATION The selected population of this study included 216 patients with persistent WAD grades II and III. METHODS This is a secondary analysis including 12 months' follow-up. NME, AROM, grip strength, pain, and self-reported disability were recorded at baseline, 3, 6, and 12 months. Linear mixed models were used, and sub-group analyses evaluated by non-parametric tests. RESULTS NSE and NSEB resulted in greater improvements compared to PPA (P<0.01) in ventral (only males) and dorsal NME, AROM, and pain intensity during testing. We found no significant between-group differences in grip strength and no significant differences between the NSE and NSEB groups. Improvement in disability was seen at the 12-month follow-up of NSE and/or NSEB for individuals both below and above the cut-off reference values for NME and AROM. Individuals in the PPA group below the reference values for NME and AROM reported increasing disability at 12 months compared to baseline. CONCLUSIONS The results suggest that neck-specific exercises (i.e., NSE, NSEB) improve clinical function and decrease disability in chronic WAD compared to PPA, but PPA can increase disability for patients with low neck-related function. CLINICAL REHABILITATION IMPACT Higher neck-related function seems to be important for reduced disability in persistent WAD grades II and III. Neck-specific exercises could lead to higher neck-related function.
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Affiliation(s)
- Gunnel Peterson
- Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden - .,Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden -
| | - Maria Landén Ludvigsson
- Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Department of Rehabilitation and Department of Health, Medicine and Caring Sciences, Linköping University, Rehab Väst, Region Council of Östergötland, Motala, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden
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Artificial intelligence prediction of the effect of rehabilitation in whiplash associated disorder. PLoS One 2020; 15:e0243816. [PMID: 33332408 PMCID: PMC7746175 DOI: 10.1371/journal.pone.0243816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022] Open
Abstract
The active cervical range of motion (aROM) is assessed by clinicians to inform their decision-making. Even with the ability of neck motion to discriminate injured from non-injured subjects, the mechanisms to explain recovery or persistence of WAD remain unclear. There are few studies of ROM examinations with precision tools using kinematics as predictive factors of recovery rate. The present paper will evaluate the performance of an artificial neural network (ANN) using kinematic variables to predict the overall change of aROM after a period of rehabilitation in WAD patients. To achieve this goal the neck kinematics of a cohort of 1082 WAD patients (55.1% females), with mean age 37.68 (SD 12.88) years old, from across Spain were used. Prediction variables were the kinematics recorded by the EBI® 5 in routine biomechanical assessments of these patients. These include normalized ROM, speed to peak and ROM coefficient of variation. The improvement of aROM was represented by the Neck Functional Holistic Analysis Score (NFHAS). A supervised multi-layer feed-forward ANN was created to predict the change in NFHAS. The selected architecture of the ANN showed a mean squared error of 308.07–272.75 confidence interval for a 95% in the Monte Carlo cross validation. The performance of the ANN was tested with a subsample of patients not used in the training. This comparison resulted in a medium correlation with R = 0.5. The trained neural network to predict the expected difference in NFHAS between baseline and follow up showed modest results. While the overall performance is moderately correlated, the error of this prediction is still too large to use the method in clinical practice. The addition of other clinically relevant factors could further improve prediction performance.
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Smith AC, Albin SR, Abbott R, Crawford RJ, Hoggarth MA, Wasielewski M, Elliott JM. Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery. Sci Rep 2020; 10:11471. [PMID: 32651447 PMCID: PMC7351986 DOI: 10.1038/s41598-020-68452-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/22/2020] [Indexed: 02/08/2023] Open
Abstract
Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixty-one participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1–Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD.
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Affiliation(s)
- Andrew C Smith
- School of Physical Therapy, Regis University, Denver, CO, USA
| | | | - Rebecca Abbott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Mark A Hoggarth
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Faculty of Medicine and Health, The Northern Sydney Local Health District, The Kolling Institute, The University of Sydney, St. Leonards, NSW, 2065, Australia.
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10
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Neck-specific exercise for radiating pain and neurological deficits in chronic whiplash, a 1-year follow-up of a randomised clinical trial. Sci Rep 2020; 10:6758. [PMID: 32317700 PMCID: PMC7174359 DOI: 10.1038/s41598-020-62722-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/18/2020] [Indexed: 12/16/2022] Open
Abstract
Up to 90% of people with neurological deficits following whiplash injury report chronic symptoms. A recent unique study of neck-specific exercise showed positive results (post-intervention at 12 weeks), regarding arm pain and neurological deficits in people with chronic whiplash associated disorders (WAD). This 1-year follow-up of that randomised controlled study with assessor blinding aimed to examine whether neck-specific exercise with (NSEB) or without (NSE) a behavioural approach has long-term benefits over physical activity prescription (PPA) regarding arm pain and neurological deficits (n = 171). Interventions were: NSE, NSEB, or PPA. Follow-up of arm pain, paraesthesia bothersomeness (questionnaires) and clinical neurological tests were performed after 3, 6 and 12 months and analysed with Linear Mixed Models and General Estimating Equations. The NSE and/or NSEB groups reported significantly less pain and paraesthesia bothersomeness as well as higher odds of normal key muscle arm strength and of normal upper limb neural tension over the year (all p < 0.03), compared with PPA. In conclusion, results suggest that neck-specific exercise with or without a behavioural approach may have persisting long term benefits over PPA regarding arm pain and clinical signs associated with neurological deficits in chronic WAD.
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11
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Ritchie C, Smith A, Sterling M. Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals. BMC Health Serv Res 2020; 20:260. [PMID: 32228573 PMCID: PMC7106620 DOI: 10.1186/s12913-020-05146-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Individuals with whiplash associated disorder (WAD) frequently experience neck pain in addition to other physical, psychological and social symptoms. Consequently, treatment is sought from a variety of health professionals. The limited data available about health services use in this population are conflicting. This study aimed to characterise health service use in individuals with WAD from a motor vehicle crash. METHODS Medical (general practitioner (GP), medical specialist, emergency services (ED), radiology - x-ray, computed tomography, magnetic resonance imaging, ultrasound) and allied health service (physiotherapy, chiropractor, psychologist, osteopath, occupational therapy) use during acute (< 12 weeks) and chronic (12 weeks to 2 years) post-injury periods were analysed in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 37,315). RESULTS Most WAD claimants had an acute post-injury health service payment (95%, n = 35,348), and approximately one-third (29%, n = 10,871) had a chronic post-injury health service payment. During an acute post-injury period, the most frequently compensated services were for: ED (82% of acute claimants), radiology (56%), and medical specialist (38%). Whereas, physiotherapy (64.4% of chronic claimants), GP (48.1%), and radiology (34.6%) were the most frequently paid services during the chronic period. Females received significantly more payments from physiotherapists (F = 23.4%, M = 18%, z = - 11.3, p < .001, r = 0.13), chiropractors (F = 7.4%, M = 5.6%, z = - 6.3, p < .001, r = 0.13), and psychologists (F = 4.2%, M = 2.8%, z = - 6.7, p < .001, r = 0.18); whereas, males received significantly more medical services payments from medical specialists (F = 41.8%, M = 43.8%, z = - 3.7, p < .001, r = 0.03), ED (F = 74.0%, M = 76.3%, z = - 4.9, p < .001, r = 0.03) and radiology (F = 58.3%, M = 60.1%, z = - 3.4, p < .001, r = 0.02). CONCLUSIONS Individuals with WAD claimed for a range of health services. Radiology imaging use during the acute post-injury period, and physiotherapy and chiropractor service use during the chronic post-injury period appeared concordant with current WAD management guidelines. Conversely, low physiotherapy and chiropractic use during an acute post-injury period, and high radiology and medical specialists use during the chronic post-injury period appeared discordant with current guidelines. Strategies are needed to help inform medical health professionals of the current guidelines to promote early access to health professionals likely to provide an active approach to treatment, and to address unnecessary referral to radiology and medical specialists in individuals with on-going WAD.
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Affiliation(s)
- Carrie Ritchie
- Recover Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
| | - Ashley Smith
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, Brisbane, Australia
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12
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Kashfi P, Karimi N, Peolsson A, Rahnama L. The effects of deep neck muscle-specific training versus general exercises on deep neck muscle thickness, pain and disability in patients with chronic non-specific neck pain: protocol for a randomized clinical trial (RCT). BMC Musculoskelet Disord 2019; 20:540. [PMID: 31727085 PMCID: PMC6857347 DOI: 10.1186/s12891-019-2880-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 10/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Altered thickness, cross-sectional area and activity of deep neck muscles have frequently been reported in patients with chronic non-specific neck pain (CNNP). It is claimed that these muscles do not recover spontaneously. These muscles provide a considerable amount of cervical stability. Therefore, various therapeutic exercises have been recommended to recover from resulting complications. However, most exercise protocols do not target deep neck muscles directly. Thus, this might be a reason for long-lasting complications. Accordingly, the purpose of the present study is to discuss a randomized controlled trial (RCT) protocol in which we aim to investigate and compare the effects of neck-specific exercise programmes versus general exercise programmes in patients with CNNP. METHODS A 2*2 factorial RCT with before-after design. Sixty-four participants with CNNP will be recruited into the study. They will be randomly divided into two groups, including specific neck exercise and general exercise. Each exercise programme will be carried out three times a week and will last for 8 weeks. Primarily, dorsal and ventral neck muscle thickness, pain and disability and secondarily, muscle strength, quality of life, sleep quality, fear avoidance and neck range of motion will be assessed at the baseline and immediately at the end of the exercise protocol. DISCUSSION The results of this study will inform clinicians on which type of exercise is more beneficial for patients with CNNP. TRIAL REGISTRATION IRCT2017091620787N2, Sep 16 2017.
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Affiliation(s)
- Pegah Kashfi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Noureddin Karimi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden, Linköping University, Linköping, Sweden
| | - Leila Rahnama
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. .,Department of Physical Therapy, University of North Georgia, Dahlonega, USA.
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13
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Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks. Clin J Pain 2019; 35:647-655. [DOI: 10.1097/ajp.0000000000000728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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14
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Peolsson A, Karlsson A, Ghafouri B, Ebbers T, Engström M, Jönsson M, Wåhlén K, Romu T, Borga M, Kristjansson E, Bahat HS, German D, Zsigmond P, Peterson G. Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study. BMC Musculoskelet Disord 2019; 20:51. [PMID: 30711003 PMCID: PMC6359872 DOI: 10.1186/s12891-019-2433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is insufficient knowledge of pathophysiological parameters to understand the mechanism behind prolonged whiplash associated disorders (WAD), and it is not known whether or not changes can be restored by rehabilitation. The aims of the projects are to investigate imaging and molecular biomarkers, cervical kinaesthesia, postural sway and the association with pain, disability and other outcomes in individuals with longstanding WAD, before and after a neck-specific exercise intervention. Another aim is to compare individuals with WAD with healthy controls. METHODS Participants are a sub-group (n = 30) of individuals recruited from an ongoing randomized controlled study (RCT). Measurements in this experimental prospective study will be carried out at baseline (before intervention) and at a three month follow-up (end of physiotherapy intervention), and will include muscle structure and inflammation using magnetic resonance imaging (MRI), brain structure and function related to pain using functional MRI (fMRI), muscle function using ultrasonography, biomarkers using samples of blood and saliva, cervical kinaesthesia using the "butterfly test" and static balance test using an iPhone app. Association with other measures (self-reported and clinical measures) obtained in the RCT (e.g. background data, pain, disability, satisfaction with care, work ability, quality of life) may be investigated. Healthy volunteers matched for age and gender will be recruited as controls (n = 30). DISCUSSION The study results may contribute to the development of improved diagnostics and improved rehabilitation methods for WAD. TRIAL REGISTRATION Clinicaltrial.gov Protocol ID: NCT03664934, initial release 09/11/2018.
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Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Anette Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Center, and Department of Medical and Health Sciences, Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Radiological Sciences, Linköping University, Linköping, Sweden
| | - Margaretha Jönsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Herrgärdets Vårdcentral, Region Västmanland, Västerås, Sweden
| | - Karin Wåhlén
- Pain and Rehabilitation Center, and Department of Medical and Health Sciences, Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Thobias Romu
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Magnus Borga
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | | | | | - Dmitry German
- Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Peter Zsigmond
- Department of Neurosurgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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