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.

Design An observational, retrospective cohort study reviewing medical records, and a separate consecutive non-randomized study of patient satisfaction.Setting Health care centre in primary care.Participants 432 patients with musculoskeletal disorders, primarily assessed by a physiotherapist. 51 of these patients and 42 patients assessed by a GP answered a patient satisfaction questionnaire.Interventions Primary assessment and management of patients with musculoskeletal disorders.Main outcome measures Data from medical records including a 3-month follow-up, and patient satisfaction questionnaire.Results Eighty-five percent of patients (367/432) did not need to see a GP. Serious pathologies were found among the 6% (26/432) of the patients whom the physiotherapist referred to a GP, while none were found among the other 9% (39/432) who later returned for a GP appointment. Patients assessed by a physiotherapist were more satisfied with the information received about their disorders and about self-care than those assessed by a GP.They also had higher confidence in the physiotherapist's ability to assess their disorder (p<0.002). ConclusionPhysiotherapists can be considered primary assessors of patients with musculoskeletal disorders in primary care as few patients needed additional assessment by a GP, patients with confirmed serious pathologies had been identified by the physiotherapist, and the patients were satisfied with the assessment by the physiotherapist.3

After 1-2 years, participants with chronic whiplash who were randomized to neck-specific exercise, with or without a behavioural approach, remained more improved than participants who were prescribed general physical activity.

By utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in individuals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD. WHAT DOES THIS STUDY ADD?: Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain. When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy. The pain drawing is useful to support psychological screening in people with chronic WAD.