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Objectives:The 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 Methods:A 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.Results:The 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.Discussion:NSE 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.

Measurements of neck strength taken in upright position with the DBC 140 equipment have almost perfect intra- and inter-tester reliability and justify the use of this test procedure. The use of the first measurement in a test series can be recommended for use in clinical practice since it was shown to be the maximal test value and thus, had a very low intra-tester difference. The use of reference values for neck strength when evaluating patients with neck disorders needs to take gender into account.

Neck muscle activity during loaded arm lifts 2 Practice of applications• Evaluating potential impairments in individuals with persistent disorders following cervical surgery will permit a more structured approach to rehabilitative exercise for this understudied group.• Greater muscle mechanical activity levels were observed in the ventral muscles and dorsal multifidus muscle of patients with persistent symptoms following anterior cervical decompression and fusion.• The differences may indicate an altered motor strategy in this group when performing the upper limb task.• The altered motor strategy need to be considered when prescribing exercise for their rehabilitation.Neck muscle activity during loaded arm lifts 3 ABSTRACT Objective: To compare the mechanical activity of the neck muscles during loaded arm lifting tasks in individuals with longstanding disability after anterior cervical decompression and fusion (ACDF) to that of healthy controls.Methods: Ten individuals (mean age 60 years; SD 7.1) who underwent ACDF (10-13 years previously) for cervical disc disease and 10 healthy age-and gender-matched controls participated in the study. Ultrasonography were used to investigate the degree of deformation and deformation rate of ventral and dorsal neck muscles at the C4-segmental level during a single (1 x arm flexion to 120°) and repeated (10 x arm flexion to 90°) loaded arm elevation condition. Results:The ACDF group demonstrated greater deformation and deformation rate of the longus capitis (p=0.02) as well as deformation rate of the sternocleidomastoid (p=0.04) during the 120° arm lift. For repeated 90° arm lift, there was a significant effect of group with higher deformation rate values observed in the longus capitis (p=0.005-0.01) and multifidus (p=0.03) muscles in the ACDF group. Muscle behavior did not change the repeated arm lifts (no group x time interactions) for either the ventral or dorsal muscles. Conclusions:Greater muscle mechanical activity levels were observed in the ventral muscles as well as the multifidus muscle, of patients with persistent symptoms following ACDF.These differences may be indicative of an altered motor strategy in this patient group when performing the upper limb task and may need to be considered when prescribing exercise for their rehabilitation.

BackgroundEvidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice.MethodsPatients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis.ResultsAnalysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education).ConclusionsSupportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.