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Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study

Anneli Peolsson12*, Maria Landén Ludvigsson13, Thomas Overmeer45, Åsa Dedering67, Lars Bernfort8, Gun Johansson9, Ann-Sofi Kammerlind11011 and Gunnel Peterson112

Author Affiliations

1 Department of Medical and Health Sciences, Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden

2 NHMRC CCRE (Spinal Pain, Injury and Health), The University of Queensland, Brisbane, Australia

3 Rehab Väst, County Council of Östergötland, Motala, Sweden

4 School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden

5 Center for Health and Medical Physiology, Örebro University, Örebro, Sweden

6 Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden

7 Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden

8 Department of Medical and Health Sciences, Health Care Analysis, Linköping University, Linköping, Sweden

9 Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden

10 Futurum the academy for Healthcare, Jönköping, Sweden

11 County Council of Jönköping, Jönköping, Sweden

12 Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden

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BMC Musculoskeletal Disorders 2013, 14:311  doi:10.1186/1471-2474-14-311

Published: 30 October 2013



Up to 50% of chronic whiplash associated disorders (WAD) patients experience considerable pain and disability and remain on sick-leave. No evidence supports the use of physiotherapy treatment of chronic WAD, although exercise is recommended. Previous randomised controlled studies did not evaluate the value of adding a behavioural therapy intervention to neck-specific exercises, nor did they compare these treatments to prescription of general physical activity. Few exercise studies focus on patients with chronic WAD, and few have looked at patients’ ability to return to work and the cost-effectiveness of treatments. Thus, there is a great need to develop successful evidence-based rehabilitation models. The study aim is to investigate whether neck-specific exercise with or without a behavioural approach (facilitated by a single caregiver per patient) improves functioning compared to prescription of general physical activity for individuals with chronic WAD.


The study is a prospective, randomised, controlled, multi-centre study with a 2-year follow-up that includes 216 patients with chronic WAD (> 6 months and < 3 years). The patients (aged 18 to 63) must be classified as WAD grade 2 or 3. Eligibility will be determined with a questionnaire, telephone interview and clinical examination. The participants will be randomised into one of three treatments: (A) neck-specific exercise followed by prescription of physical activity; (B) neck-specific exercise with a behavioural approach followed by prescription of physical activity; or (C) prescription of physical activity alone without neck-specific exercises. Treatments will be performed for 3 months. We will examine physical and psychological function, pain intensity, health care consumption, the ability to resume work and economic health benefits. An independent, blinded investigator will perform the measurements at baseline and 3, 6, 12 and 24 months after inclusion. The main study outcome will be improvement in neck-specific disability as measured with the Neck Disability Index. All treatments will be recorded in treatment diaries and medical records.


The study findings will help improve the treatment of patients with chronic WAD.

Trials registration identifier: NCT01528579.

Whiplash injuries; Neck pain; Spine; Rehabilitation; Physical therapy; Exercise