Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology

Objective: To compare two different home exercise programmes for patients w ith acute whiplash-associated disorders (WAD). A further aim was to describ e the initial prognostic variables related to self-reported pain at six mon ths follow-up. Design: A randomized treatment study with a follow-up period of six months. Settings: The study was undertaken in an orthopaedic clinic at a university hospital. Subjects: A total of 59 symptomatic (neck pain, stiffness, etc.) patients w ith acute whiplash injury. Interventions: Patients were randomized to a regular treatment group (RT gr oup) and an additional-exercise treatment group (AT group). Main outcome measures: Pain Disability Index (PDI), Self-Efficacy Scale (SE S), Coping Strategies Questionnaire (CSQ), neck range of motion (ROM), head posture, kinaesthetic sensibility, visual analogue scale (VAS). Results: Patients given an additional exercise did not improve more than pa tients with regular treatment. Only one CSQ item, 'Ability to decrease pain ', showed a significant difference between the groups in its pattern of cha nge over time: the AT group had a significant increase between three and si x months whilst values in the RT group decreased. Nonsymptomatic patients a t six months follow-up were characterized by initially better self-efficacy , lower disability and significantly different patterns in the use of 'beha vioural coping strategies' when compared with symptomatic patients. The non symptomatic patients also reported more frequent training than symptomatic patients, i.e. they complied better with the treatment regime. Conclusion: This home exercise programme, including training of neck and sh oulder ROM, relaxation and general advice seems to be sufficient treatment for acute WAD patients when used on a daily basis. Additionally, patients r eporting low self-efficacy and high disability levels may profit from more attention initially, as these psychological factors are significant predict ors of pain at long-term follow-up.