• Maria L Ludvigsson, Gunnel Peterson, Shaun O'Leary, Åsa Dedering, and Anneli Peolsson.
• *Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping †Rehab Väst, County Council of Östergötland, Östergötland ‡Centre for Clinical Research Sörmland, Uppsala University, Uppsala ¶Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Solna #Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden §NHMRC CCRE (Spinal Pain, Injury and Health), The University of Queensland ∥Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Qld, Australia.
• Clin J Pain. 2015 Apr 1; 31 (4): 294303294-303.

ObjectivesThe aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA).Materials And MethodsA total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months.ResultsThe proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the 2 NSE groups (29% to 48%) compared with the PPA group (5%) at 3 months. At 6 months 39% to 44% of the patients in the 2 neck-specific groups and 28% in the PPA group reported substantial pain reduction. Reduction of disability was also larger in the 2 neck-specific exercise groups at both 3 and 6 months (P<0.02). Self-efficacy was only improved in the NSE group without a behavioral approach (P=0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups.DiscussionNSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

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