The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial Coping and Recovery in Whiplash-associated Disorders: Early use of Passive Coping Strategies is Associated With Slower Recovery of Neck Pain and Pain-related Disability A Randomized Controlled Trial of Cognitive-behavioral Therapy for the Treatment of PTSD in the Context of Chronic Whiplash Prognostic factors for poor recovery in acute whiplash patients The Risk Assessment Score in Acute Whiplash Injury Predicts Outcome and Reflects Biopsychosocial Factors Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Characterization of Acute Whiplash-Associated Disorders Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. The role of fear of movement in subacute whiplash-associated disorders grades I and II Neck Collar, “Act-as-Usual” or Active Mobilization for Whiplash Injury?: A Randomized Parallel-Group Trial Psychological determinants of quality of life in patients with whiplash associated disorders-a prospective study. Expectations for Recovery Important in the Prognosis of Whiplash Injuries Multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study Are People With Whiplash-Associated Neck Pain Different From People With Nonspecific Neck Pain? Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients Management of acute whiplash: A randomized controlled trial of multidisciplinary stratified treatments A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions Changes in Pain, Disability, and Muscle Activation Patterns in Chronic Whiplash Patients After Ambulant Myofeedback Training Upper trapezius muscle activation patterns in neck–shoulder pain patients and healthy controls Altered spinal kinematics and muscle recruitment pattern of the cervical and thoracic spine in people with chronic neck pain during functional task.
STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization . Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders . However , these findings have not been tested in a r and omized controlled trial . The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders . Methods and Design We design ed a pragmatic r and omized clinical trial . A total of 444 participants ( 148 in each of three arms ) who reside in Southern Ontario , Canada will be recruited from a large insurer . We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders . Participants will be r and omized to  physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario . Our primary outcome , self-rated global recovery and all secondary outcomes ( neck pain intensity , whiplash disability , health-related quality of life , depressive symptomatology and satisfaction with care ) will be measured at baseline by a trial coordinator and at 6 weeks , 3 , 6 , 9 and 12 months follow-up by an interviewer who is blind to the participants ' baseline characteristics and treatment allocation . We will also collect information on general health status , other injuries , comorbidities , expectation of recovery , work status , pain coping , legal representation , and co- interventions . The primary intention-to-treat analysis will compare time to recovery between the three interventions . This trial will have 90 % power at an alpha of 0.05 to detect a 20 % difference in the rate of perceived recovery at one year . Secondary analyses will compare the health outcomes , rate of recurrence and the rate of adverse events between intervention groups . Conclusion The results of this study will provide the public , clinicians and policy makers much needed evidence on the effectiveness of common approaches used to manage whiplash-associated disorders . Trial registration Clinical Trials.gov identifier Objective : Coping is shown to affect outcomes in chronic pain patients ; however , few studies have examined the role of coping in the course of recovery in whiplash-associated disorders ( WAD ) . The purpose of this study was to determine the predictive value of coping style for 2 key aspects of WAD recovery , reductions in neck pain , and in disability . Methods : A population -based prospect i ve cohort study design was used to study 2986 adults with traffic-related WAD . Participants were assessed at baseline , 6 weeks , and 4 , 8 , and 12 months postinjury .  Coping  was measured at 6 weeks using the Pain Management Inventory  , and neck pain recovery was assessed at each subsequent follow-up , using a 100 mm  visual analogue scale ( VAS ) . Disability was assessed at each follow-up using the Pain Disability Index ( PDI ) . Pain recovery was defined as a VAS score of 0 to 10 ; disability recovery was defined as a PDI score of 0 to 4 . Data analysis used multivariable Cox proportional hazards models . Results : Those using high versus low levels of passive coping at 6 weeks postinjury experienced 28 % slower pain recovery and 43 % slower disability recovery . Adjusted hazard rate ratios for pain recovery and disability recovery were 0.72 ( 95 % CI , 0.59 - 0.88 ) and 0.57 ( 95 % CI , 0.41 - 0.78 ) , respectively . Active coping was not associated with recovery of neck pain or disability . Conclusions : Passive coping style predicts neck pain and self-assessed disability recovery . It may be beneficial to assess and improve coping style early in WAD Objectives : Whiplash-associated disorders ( WAD ) are common and involve both physical and psychological impairments . Research has shown that persistent posttraumatic stress symptoms are associated with poorer functional recovery and physical therapy outcomes .  Trauma-focused cognitive-behavioral therapy ( TF-CBT ) has shown moderate effectiveness in chronic pain sample s. However , to date , there have been no clinical trials within WAD . Thus , this study will report on the effectiveness of TF-CBT in individuals meeting the criteria for current chronic WAD and posttraumatic stress disorder ( PTSD ) . Method : Twenty-six participants were r and omly assigned to either TF-CBT or a waitlist control , and treatment effects were evaluated at posttreatment and 6-month follow-up using a structured clinical interview , self-report question naires , and measures of physiological arousal and sensory pain thresholds . Results : Clinical ly significant reductions in PTSD symptoms were found in the TF-CBT group compared with the waitlist at post assessment , with further gains noted at the follow-up . The treatment of PTSD was also associated with clinical ly significant improvements in neck disability , physical , emotional , and social functioning and physiological reactivity to trauma cues , whereas limited changes were found in sensory pain thresholds . Discussion : This study provides support for the effectiveness of TF-CBT to target PTSD symptoms within chronic WAD . The finding that treatment of PTSD result ed in improvements in neck disability and quality of life and changes in cold pain thresholds highlights the complex and interrelating mechanisms that underlie both WAD and PTSD . Clinical implication s of the findings and future research directions are discussed & NA ; The objective of our prospect i ve inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash‐associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident . The study was carried out in a primary health care setting in The Netherl and s and included 125 patients . The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use . The secondary outcome measures included neck pain intensity , work disability and sick leave . The outcomes were assessed at 4 , 12 and 52 weeks after the accident . Prognostic factors were identified by logistic regression analyses . One year after the injury , 64 % of the patients were recovered . Factors related to poor recovery were female gender , a low level of education , high initial neck pain , more severe disability , higher levels of somatisation and sleep difficulties . Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery . The accuracy of the predictions of the prognostic models was high , meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered . These findings add to the growing body of evidence , indicating that socio‐demographic , physical and psychological factors affect short‐ and long‐term outcome after whiplash injury . Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work‐related activities Study Design . One-year prospect i ve study of 141 acute whiplash patients ( WLP ) and 40 acute ankle-injured controls . Objective . This study investigates a priori determined potential risk factors to develop a risk assessment tool , for which the expediency was examined . Summary of Background Data . The whiplash-associated disorders ( WAD ) grading system that emerged from The Quebec Task-Force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining biopsychosocial disability after whiplash and new predictive factors , for example , risk criteria that comprehensively differentiate acute WLP in a biopsychosocial manner are needed . Methods . Consecutively , 141 acute WLP and 40 ankle-injured recruited from emergency units were examined after 1 week , 1 , 3 , 6 , and 12 months obtaining neck/head visual analog scale score , number of nonpainful complaints , epidemiological , social , psychological data and neurological examination , active neck mobility , and furthermore muscle tenderness and pain response , and strength and duration of neck muscles . Risk factors derived ( reduced cervical range of motion , intense neck pain/headache , multiple nonpain complaints ) were applied in a risk assessment score and divided into seven risk strata . Results . A receiver operating characteristics curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90 . Risk strata and number of sick days showed a log-linear relationship . In stratum 1 full recovery was encountered , but for high-risk patients in stratum 6 only 50 % and 7 only 20 % had returned to work after 1 year ( P < 5.4 × 10−5 ) . Strength measures , psychophysical pain measurements , and psychological and social data ( reported elsewhere ) showed significant relation to risk strata . Conclusion . The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury . It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries Abstract Purpose To evaluate the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) for the management of neck pain and associated disorders ( NAD ) , whiplash-associated disorders , and non-specific low back pain ( LBP ) with or without radiculopathy . Methods We systematic ally search ed six data bases from 2000 to 2014 . R and om pairs of independent review ers critically appraised eligible systematic review s using the Scottish Intercollegiate Guidelines Network criteria . We included systematic review s with a low risk of bias in our best evidence synthesis . Results We screened 706 citations and 14 systematic review s were eligible for critical appraisal . Eight systematic review s had a low risk of bias . For recent-onset NAD , evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy . For NAD ( duration not specified ) , oral NSAIDs may be more effective than placebo . For recent-onset LBP , evidence suggests that : ( 1 ) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant ; and ( 2 ) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest . For persistent LBP , evidence suggests that : ( 1 ) oral NSAIDs are more effective than placebo ; and ( 2 ) oral NSAIDs may be more effective than acetaminophen . For recent-onset LBP with radiculopathy , there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo . Finally , different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy . Conclusions For NAD , oral NSAIDs may be more effective than placebo . Oral NSAIDs are more effective than placebo for persistent LBP , but not for recent-onset LBP . Different oral NSAIDs lead to similar outcomes for neck pain and LBP Study Design . An experimental study of motor and sensory function and psychological distress in subjects with acute whiplash injury . Objectives . To characterize acute whiplash injury in terms of motor and sensory systems dysfunction and psychological distress and to compare subjects with higher and lesser levels of pain and disability . Summary of Background Data . Motor system dysfunction , sensory hypersensitivity , and psychological distress are present in chronic whiplash associated disorders ( WAD ) , but little is known of such factors in the acute stage of injury . As higher levels of pain and disability in acute WAD are accepted as signs of poor outcome , further characterization of this group from those with lesser symptoms is important . Material s and Methods .  Motor function ( cervical range of movement [ ROM ] , joint position error [ JPE ] ; activity of the superficial neck flexors [ EMG ] during a test of cranio-cervical flexion ) , quantitative sensory testing ( pressure , thermal pain thresholds , and responses to the brachial plexus provocation test ) , and psychological distress ( GHQ-28 , TAMPA , IES ) were measured in 80 whiplash subjects ( WAD II or III ) within 1 month of injury , as were 20 control subjects . Results . Three subgroups were identified in the cohort using cluster analysis based on the Neck Disability Index : those with mild , moderate , or severe pain and disability . All whiplash groups demonstrated decreased ROM and increased EMG compared with the controls ( all P < 0.01 ) . Only the moderate and severe groups demonstrated greater JPE and generalized hypersensitivity to all sensory tests ( all P < 0.01 ) . The three whiplash subgroups demonstrated evidence of psychological distress , although this was greater in the moderate and severe groups . Measures of psychological distress did not impact on between group differences in motor or sensory tests . Conclusions . Acute whiplash subjects with higher levels of pain and disability were distinguished by sensory hypersensitivity to a variety of stimuli , suggestive of central nervous system sensitization occurring soon after injury . These responses occurred independently of psychological distress . These findings may be important for the differential diagnosis of acute whiplash injury and could be one reason why those with higher initial pain and disability demonstrate a poorer outcome Background Many patients suffer from chronic neck pain following a whiplash injury . A combination of cognitive , behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders . The objective is to present the design of a r and omised controlled trial ( RCT ) aim ed at evaluating the effectiveness of a combined individual physical and cognitive behavioural- grade d activity program on self-reported general physical function , in addition to neck function , pain , disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline . Methods / Design The design is a two-centre , RCT - study with a parallel group design . Included are whiplash patients with chronic neck pain for more than 6 months , recruited from physiotherapy clinics and an out-patient hospital department in Denmark . Patients will be r and omised to either a pain management ( control ) group or a combined pain management and training (intervention)group . The control group will receive four educational sessions on pain management , whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months , including guidance in specific neck exercises and an aerobic training programme . Patients and physiotherapists are aware of the allocation and the treatment , while outcome assessors and data analysts are blinded . The primary outcome measures will be Medical Outcomes Study Short Form 36 ( SF36 ) , Physical Component Summary ( PCS ) . Secondary outcomes will be Global Perceived Effect ( -5 to + 5 ) , Neck Disability Index ( 0 - 50 ) , Patient Specific Functioning Scale ( 0 - 10 ) , numeric rating scale for pain bothersomeness ( 0 - 10 ) , SF-36 Mental Component Summary ( MCS ) , TAMPA scale of Kinesiophobia ( 17 - 68 ) , Impact of Event Scale ( 0 - 45 ) , EuroQol ( 0 - 1 ) , craniocervical flexion test ( 22 mmHg - 30 mmHg ) , joint position error test and cervical range of movement . The SF36 scales are scored using norm-based methods with PCS and MCS having a mean score of 50 with a st and ard deviation of 10 . Discussion The perspectives of this study are discussed , in addition to the strengths and weaknesses . Trial registration The study is registered in http://www . Clinical Trials.gov identifier NCT01431261 Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli , maladaptive illness beliefs , inappropriate attitudes , and movement dysfunctions . Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance . This single-case study ( A-B-C design ) with six patients with chronic whiplash associated disorders ( WAD ) was aim ed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms , daily functioning , pain beliefs , and behavior . Periods A and C represented assessment periods , while period B consisted of the intervention ( pain neurophysiology education ) . Results showed a significant decrease in kinesiophobia ( Tampa Scale for Kinesiophobia ) , the passive coping strategy of resting ( Pain Coping Inventory ) , self-rated disability ( Neck Disability Index ) , and photophobia ( WAD Symptom List ) . At the same time , significantly increased pain pressure thresholds and improved pain-free movement performance ( visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test ) were established . Although the current results need to be verified in a r and omized , controlled trial , they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD Summary Fear of movement plays and important role in individuals with subacute whiplash‐associated disorders and it should be directly targeted in treatment . ABSTRACT Fear and avoidance of activity may play a role in fostering disability in  whiplash‐associated disorders ( WAD ) . This study examined the role of fear after WAD and assessed the effectiveness of 3 treatments targeting fear . People still symptomatic from WAD grade I‐II injuries approximately 3 months previously ( n = 191 ) completed question naires ( eg , Neck Disability Index [ NDI ] ) and were r and omized to 1 of the treatments : ( 1 ) informational booklet ( IB ) describing WAD and the importance of resuming activities , ( 2 ) IB + didactic discussion s ( DD ) with clinicians reinforcing the booklet , and ( 3 ) IB + imaginal and direct exposure desensitization ( ET ) to feared activities . DD and ET participants received three 2‐hour treatment sessions . Absolute improvements in NDI were in predicted direction ( ET = 14.7 , DD = 11.9 , IB = 9.9 ) . ETs reported significantly less posttreatment pain severity compared with the IB ( Mean = 1.5 vs 2.3 , P < .001 , d = 0.6 ) and DD ( M = 1.5 vs 2.0 , P = .039 , d = 0.6 ) groups . Reduction in fear was the most important predictor of improvement in NDI ( β = 0.30 , P < .001 ) , followed by reductions in pain ( β = 0.20 , P = .003 ) and depression ( β = 0.18 , P = .004 ) . The mediational analysis confirmed that fear reduction significantly mediated the effect of treatment group on outcome . Results highlight the importance of fear in individuals with subacute WAD and suggest the importance of addressing fear via exposure therapy and /or educational interventions to improve function Study Design . R and omized , parallel-group trial . Objective . To compare the effect of 3 early intervention strategies following whiplash injury . Summary of Background Data . Long-lasting pain and disability , known as chronic whiplash-associated disorder ( WAD ) , may develop after a forced flexion-extension trauma to the cervical spine . It is unclear whether this , in some cases disabling , condition can be prevented by early intervention . Active interventions have been recommended but have not been compared with information only . Methods . Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and r and omized to : 1 ) immobilization of the cervical spine in a rigid collar followed by active mobilization , 2 ) advice to “ act-as-usual , ” or 3 ) an active mobilization program ( Mechanical Diagnosis and Therapy ) . Follow-up was carried out after 3 , 6 , and 12 months postinjury . Treatment effect was measured in terms of headache and neck pain intensity ( 0–10 ) , disability , and work capability . Results . A total of 458 participants were included . At the 1-year follow-up , 48 % of participants reported considerable neck pain , 53 % disability , and 14 % were still sick listed at 1 year follow-up . No significant differences were observed between the 3 interventions group . Conclusion . Immobilization , “ act-as-usual , ” and mobilization had similar effects regarding prevention of pain , disability , and work capability 1 year after a whiplash injury PURPOSE To evaluate whether psychological factors and personality traits influence recovery in terms of quality of life in patients with subacute whiplash associated disorders ( WAD ) . METHOD The data was obtained from a r and omized controlled trial ( RCT ) on 47 patients . The patients completed measures of pain intensity , affective dimension of pain , pain location , psychological stress , heightened somatic awareness , depression , catastrophizing , self-efficacy , fear of movement (re)injury , and physical disability . After three months of physiotherapy interventions , the outcome of quality of life was measured with the Short Form Health survey ( SF-12 ) . All variables were entered in a multiple regression analysis , after controlling for age and sex . RESULTS Forty patients ( 85 % ) completed the trial . The self-efficacy scale ( SES ) was the only variable in the model that significantly explained the fraction of the SF12-score . The correlation between the SES and SF-12 was B = 0.64 ( p < 0.01 ) , and the adjusted R(2 ) was 0.40 ( p < 0.05 ) , which means that 40 % of the variation in the SF12 outcomes was explained by the SES . CONCLUSION In order to improve health-related quality of life in patients with WAD , the present study stresses the importance of targeting self-efficacy . A special effort should be made to enhance these beliefs in the rehabilitation process Background Individuals ' expectations on returning to work after an injury have been shown to predict the duration of time that a person with work-related low back pain will remain on benefits ; individuals with lower recovery expectations received benefits for a longer time than those with higher expectations . The role of expectations in recovery from traumatic neck pain , in particular whiplash-associated disorders ( WAD ) , has not been assessed to date to our knowledge . The aim of this study was to investigate if expectations for recovery are a prognostic factor after experiencing a WAD . Methods and Findings We used a prospect i ve cohort study composed of insurance cl aim ants in Sweden . The participants were car occupants who filed a neck injury cl aim ( i.e. , for WAD ) to one of two insurance companies between 15 January 2004 and 12 January 2005 ( n = 1,032 ) .  Postal question naires were completed shortly ( average 23 d ) after the collision and then again 6 mo later . Expectations for recovery were measured with a numerical rating scale ( NRS ) at baseline , where 0 corresponds to “ unlikely to make a full recovery ” and 10 to “ very likely to make a full recovery . ” The scale was reverse coded and trichotomised into NRS 0 , 1–4 , and 5–10 . The main outcome measure was self-perceived disability at 6 mo postinjury , measured with the Pain Disability Index , and categorised into no/low , moderate , and high disability . Multivariable polytomous logistic regression was used for the analysis . There was a dose response relationship between recovery expectations and disability . After controlling for severity of physical and mental symptoms , individuals who stated that they were less likely to make a full recovery ( NRS 5–10 ) , were more likely to have a high disability compared to individuals who stated that they were very likely to make a full recovery ( odds ratio [ OR ] 4.2 [ 95 % confidence interval ( CI ) 2.1 to 8.5 ] . For the intermediate category ( NRS 1–4 ) , the OR was 2.1 ( 95 % CI 1.2 to 3.2 ) . Associations between expectations and disability were also found among individuals with moderate disability . Conclusions Individuals ' expectations for recovery are important in prognosis , even after controlling for symptom severity . Interventions design ed to increase patients ' expectations may be beneficial and should be examined further in controlled studies Background Whiplash associated disorders ( WAD ) have dramatic consequences for individual and public health . Risk factors for better and worse outcomes are important to optimize management . This study aim ed to determine short- and mid-term associative co-factors of neck pain relief , improved physical functioning , and improved working capacity ( dependent variables ) in patients suffering from whiplash associated disorder who participated in a st and ardized , inpatient pain management program .  Methods Naturalistic , observational , prospect i ve cohort study . Outcome was measured by st and ardized assessment instruments . Co-factors covered sociodemographics , comorbidities , social participation , affective health , and coping abilities . Stepwise , multivariate linear regression analysis was performed at discharge and at the 6-month follow-up . Results All regression models explained high proportions of variance ( 53.3 % – 72.1 % ) . The corresponding baseline level was significantly associated with a change in every dependent variable ( explained variances : 11.4%-56.7 % ) . Pain relief significantly depended on improved function and vice-versa ( 3.4%-14.8 % ) . Improved ability to decrease pain was associated with pain relief at discharge ( 9.6 % ) . Functional improvement was associated with decreased catastrophizing ( 19.4 % ) at discharge and decreased depression ( 20.5 % ) at the 6 month follow-up . Conclusions Pain relief , improved physical function and working capacity were associated with each other . Improved coping ( catastrophizing and ability to decrease pain ) and reduced depression may act as important predictors for pain relief and improved function . These findings offer toe-holds for optimized therapy of chronic WAD Study Design Secondary analysis of a prospect i ve cohort study with cross-sectional and longitudinal analyses . Background The clinical importance of a history of whiplash-associated disorder ( WAD ) in people with neck pain remains uncertain . Objective To compare people with WAD to people with nonspecific neck pain , in terms of their baseline characteristics and pain and disability outcomes over 1 year . Methods Consecutive patients with neck pain who presented to a secondary -care spine center answered a comprehensive self-report question naire and underwent a physical examination . Patients were classified into a group of either those with WAD or those with nonspecific neck pain . We compared the outcomes of baseline characteristics of the 2 groups , as well as pain intensity and activity limitation at follow-ups of 6 and 12 months . Results A total of 2578 participants were included in the study . Of these , 488 ( 19 % ) were classified as having WAD . At presentation , patients with WAD were statistically different from patients without WAD for almost all characteristics investigated . While most differences were small ( 1.1 points on an 11-point pain-rating scale and 11 percentage points on the Neck Disability Index ) , others , including the presence of dizziness and memory difficulties , were substantial . The between-group differences in pain and disability increased significantly ( P<.001 ) over 12 months . At 12-month follow-up , the patients with WAD had on average approximately 2 points more pain and 17 percentage points more disability than those with nonspecific neck pain . Conclusion People referred to secondary care with WAD typically had more self-reported pain and disability and experienced worse outcomes than those with nonspecific neck pain . Caution is required when interpreting the longitudinal outcomes due to lower-than-optimal follow-up rates . Level of Evidence Prognosis , level 2 . J Orthop Sports Phys Ther 2016;46(10):894 - 901 . Epub 3 Sep 2016 . doi:10.2519/jospt.2016.6588 A classification of injury and a follow-up schedule were proposed by the Quebec Task Force ( QTF ) in 1995 . No general agreement about the clinical usefulness of the WAD-classification or of the suggested follow-up regimen exists . A series of 186 consecutive cases seen in the emergency room during the acute phase after a whiplash injury was prospect ively studied for 1 year . All findings including history and physical findings were recorded using st and ardized QTF protocol s. In one group follow-up visits were done according to the QTF regimen : at 1 , 3 , 6 , 12 weeks and 1 year after the accident ; in a control group no visit was scheduled . The outcome variable was neck pain at 1 year after the accident . After 1 year , 18 % of the total number of patients had significant neck pain . Risk factors for chronic neck pain at 1 year after whiplash injury were : neck pain before the accident and a high degree of emotional distress at the time of the accident ; both factors independently associated with a tenfold increased risk of developing chronic neck pain . Neither the WAD classification nor the QTF follow-up regimen could be linked to a better outcome . In this study the outcome was associated with patient-specific characteristics and not with physical signs of injury , the depth of the initial evaluation or the follow-up regimen Summary This r and omised trial showed that multiprofessional stratified management had no effect beyond usual care in reducing transition rates to chronicity in patients with acute whiplash . ABSTRACT Acute whiplash is a heterogeneous disorder that becomes persistent in 40 % to 60 % of cases . Estimates of recovery have not changed in recent decades . This r and omized , single‐blind , controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash ( < 4 weeks postinjury ) could reduce the incidence of chronicity at 6 mo by 50 % compared to usual care . Participants ( n = 101 ) were recruited from accident and emergency centres and the community . It was hypothesized that better recovery rates were achievable if the heterogeneity was recognised and patients received individualised interventions . Patients r and omized to pragmatic intervention ( n = 49 ) could receive pharmaceutical management ( ranging from simple medications to opioid analgesia ) , multimodal physiotherapy and psychology for post‐traumatic stress according to their presentations . The treatment period was 10 wks with follow‐up at 11 weeks and 6 and 12‐months . The primary outcome was neck pain and disability ( Neck Disability Index ( NDI ) ) . Analysis revealed no significant differences in frequency of recovery ( NDI ≤8 % ) between pragmatic and usual care groups at 6 months ( OR 95 % , CI = 0.55 , 0.23–1.29 ) , P = 0.163 ) or 12 mo ( OR 95 % , CI = 0.65 , 0.28–1.47 , P = 0.297 ) . There was no improvement in current nonrecovery rates at 6 mo ( 63.6 % , pragmatic care ; 48.8 % , usual care ) , indicating no advantage of the early multiprofessional intervention . Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12 mo in both groups , suggesting that future research focus on finding early effective pain management , particularly for the subgroup of patients with initial high levels of pain and  disability , towards improving recovery rates Study Design . Concealed allocation , multicenter , single-blind , r and omized controlled clinical trial . Objective . To assess the efficacy of an educational video in the tertiary prevention of persistent WAD symptoms following rear-end motor vehicle collisions ( MVCs ) . Summary of Background Data . Whiplash-associated disorders ( WAD ) are an important and costly health problem . There is a lack of high quality evidence surrounding efficacy of treatments for WAD . Existing research supports active interventions and early return to regular activities . Methods . Consecutive patients presenting to four tertiary care emergency departments following rear-end MVCs were eligible . Following informed consent , patients were allocated , using central r and omization , to receive an educational video plus usual care or usual care alone . The video provided reassurance , and advice about posture , return to regular activities , exercises , and pain-relief methods . Data were collected by telephone using st and ardized question naires . The primary outcome was presence of Persistent WAD Symptoms at 24 weeks postinjury , based on the frequency and severity of neck , shoulder , or upper back pain . The absolute difference in proportion of patients with persistent WAD symptoms and rate ratios were calculated . Changes in pain scores were compared using the Mann-Whitney U test . Results . The  intervention ( n = 206 ) and control ( n = 199 ) groups were similar at baseline ( mean age 38.4 years ; 64 % female ) . Overall , the proportion of subjects with Persistent WAD Symptoms decreased from 89.1 % at baseline to 33.6 % at 24 weeks after injury . At 24 weeks , the proportion of subjects with persistent WAD symptoms in the intervention group was 7.9 % ( 95 % CI , −2.0 , 17.8 ) lower than the control group . The median improvement in pain score at 24 weeks was 3 for the intervention group and 2 for the control group ( P = 0.016 ) . Conclusion . The presence of persistent WAD symptoms following simple rear-end MVCs was high in this sample . The video group demonstrated a trend toward less severe WAD symptoms . We recommend evaluating other educational interventions that could reduce WAD symptoms Objective The aim of this exploratory study was to investigate changes in pain , disability , and muscle activation patterns in patients with chronic whiplash-associated disorder ( WAD ) after 4 weeks of myofeedback training . Methods Eleven WAD patients received ambulatory myofeedback training  , during which upper trapezius muscle activation and relaxation were continuously recorded and processed for 4 weeks . Feedback was provided when muscle relaxation was insufficient . Pain in neck , shoulders , and upper back ( Visual Analogue Scale ) , disability ( Neck Disability Index ) , and muscle activation patterns during rest , typing , and stress tasks ( surface electromyography ) were assessed before and after the 4 weeks of training . Results Pain intensity decreased after 4 weeks of training . Clinical ly relevant changes were found with regard to pain in the neck and upper back region ( 55 % of the patients ) , right shoulder ( 64 % ) , and left shoulder ( 18 % ) . A trend for decreased disability was found which was clinical ly relevant in 36 % of the patients . A remarkable reduction was found in the Neck Disability Index items concerning headache and lifting weights . Overall , muscle activation was lower and muscle relaxation was higher after the training period with the largest differences during rest . Clinical ly relevant changes in surface electromyography parameters were found in a minority of patients . Conclusion Four weeks of ambulant training may be beneficial in reducing pain and disability levels and normalizing muscle activation patterns in chronic WAD patients . A r and omized-controlled study is recommended to further explore the effects of myofeedback training This study aim ed at investigating whether patients with neck – shoulder complaints from different aetiologies ( work-related musculo-skeletal disorders , WMSD ; whiplash associated disorders , WAD ) show comparable muscle activation patterns , characterised by higher activation and lower relaxation levels of the trapezius muscles compared to healthy controls . Twenty healthy controls , 21 WMSD and 20 WAD patients with non-acute neck-shoulder pain were recruited for this cross-sectional study .  Surface electromyography ( sEMG ) recordings were performed at the upper trapezius muscles during reference contractions , st and ardised computer tasks ( typing and unilateral stress task ) , and rest measurements . sEMG was continuously recorded during these measurements .  Outcome measures were root mean square ( RMS ) to study muscle activity , and relative rest time ( RRT ) to study muscle relaxation . Statistical analysis comprised the bootstrap technique and Kruskall – Wallis tests . Results showed no clear evidence for abnormal muscle activation patterns in WMSD and WAD patients compared to healthy controls . However , a tendency was observed for higher RMS levels during the reference contractions and computer tasks in both patient groups compared to healthy controls , and lower RRT levels at the non-dominant side during stress . Both patient groups also showed larger variability in RMS and RRT values . This variability has more often been reported in literature and may suggest the existence of subgroups of pain patients with corresponding different muscle activation patterns not related to aetiology . Future research may focus on identifying these subgroups of patients with neck-shoulder pain Knowledge on the spinal kinematics and muscle activation of the cervical and thoracic spine during functional task would add to our underst and ing of the performance and interplay of these spinal regions during dynamic condition . The purpose of this study was to examine the influence of chronic neck pain on the three-dimensional kinematics and muscle recruitment pattern of the cervical and thoracic spine during an overhead reaching task involving a light weight transfer by the upper limb . Synchronized measurements of the three-dimensional spinal kinematics and electromyographic activities of cervical and thoracic spine were acquired in thirty individuals with chronic neck pain and thirty age- and gender-matched asymptomatic controls . Neck pain group showed a significantly decreased cervical velocity and acceleration while performing the task . They also displayed with a predominantly prolonged coactivation of cervical and thoracic muscles throughout the task cycle . The current findings highlighted the importance to examine differential kinematic variables of the spine which are associated with changes in the muscle recruitment in people with chronic neck pain . The results also provide an insight to the appropriate clinical intervention to promote the recovery of the functional disability commonly reported in patients with neck pain disorders
Overall , as a therapeutic intervention , structured patient education was equal or less effective than other conservative treatments including massage , supervised exercise , and physiotherapy .
However , structured patient education may provide small benefits when combined with physiotherapy .
Either mode of delivery ( ie , oral or written education ) provides similar results in patients with recent WAD .
Results suggest that structured patient education alone can not be expected to yield large benefits in clinical effectiveness compared with other conservative interventions for patients with WAD or NAD .
Moreover , structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care .
These benefits are small and short lived
BACKGROUND CONTEXT In 2008 , the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders recommended patient education for the management of neck pain .
However , the effectiveness of education interventions has recently been challenged .
PURPOSE To up date the findings of the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of structured patient education for the management of patients with whiplash-associated disorders ( WAD ) or neck pain and associated disorders ( NAD ) .
OUTCOME MEASURES Self-rated recovery , functional recovery ( eg , disability , return to activities , work , or school ) , pain intensity , health-related quality of life , psychological outcomes such as depression or fear , or adverse effects .