A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions. A controlled study of the effect of neck school in medical secretaries. Simple educational intervention to improve the recovery from acute whiplash: results of a randomized, controlled trial. No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home-care personnel. Patient compliance in back and neck pain. Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial. Efficacy of a patient-educational booklet for neck-pain patients with workers' compensation: a randomized controlled trial. Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference. Randomized trial of therapeutic massage for chronic neck pain. Active treatment of chronic neck pain: a prospective randomized intervention. Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident.
Concealed allocation, multicenter, single-blind, randomized controlled clinical trial.
                To assess the efficacy of an educational video in the tertiary prevention of persistent WAD symptoms following rear-end motor vehicle collisions (MVCs).
                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.
                Consecutive patients presenting to four tertiary care emergency departments following rear-end MVCs were eligible. Following informed consent, patients were allocated, using central randomization, 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 standardized questionnaires. 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.
                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).
                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. The effect of "neck school" on neck and shoulder disorders was studied in medical secretaries. A neck school reinforced with compliance enhancing measures (group B) was compared with a traditional neck school (group A) and a control group (group C). The results show that ergonomical knowledge was good even before the secretaries attended the neck schools and that compliance was significantly higher for group B. When comparisons were made within groups some improvements on neck and shoulder fatigue and pain were noted, particularly for group B. When workload was controlled no significant group differences were found. No differences were noted for range of neck motion, or sick leave in any group. Our conclusion is that neck schools, despite good compliance, appear to be of limited clinical value for prevention of neck and shoulder disorders. To determine if an educational intervention in the acute stage of whiplash injury may improve the recovery rate.
                Consecutive subjects were randomized to one of two treatment groups: educational intervention or usual care. The intervention group received an educational pamphlet based on the current evidence. The control group did not receive these materials but received usual emergency department care and a standard nondirected discharge information sheet. Both groups underwent follow-up by telephone interview at two weeks and three months. The primary outcome measure of recovery was the patient's response to the question, "How well do you feel you are recovering from your injuries?"
                A total of 112 subjects agreed to participate. Age, gender, precollision employment level and health, initial symptoms, collision parameters, and emergency treatments were similar between the groups. At two weeks postcollision, 7.3% in the treatment group reported recovery compared with 8.8% in the control group (absolute risk difference, -1.5%; 95% confidence interval = -12.6% to 9.7%). At three months postcollision, 21.8% in the treatment group reported complete recovery compared with 21.0% in the control group (absolute risk difference, 0.8%; 95% confidence interval = -14.4% to 16.0%). At three months, there were no clinically or statistically significant differences between groups in severity of remaining symptoms, limitations in daily activities, therapy use, medications used, lost time from work, or litigation.
                An evidence-based educational pamphlet provided to patients at discharge from the emergency department is no more effective than usual care for patients with grade 1 or 2 whiplash-associated disorder. The effects of two different prevention programmes on: (1) reported neck, shoulder and back pain, (2) perceived physical exertion at work and perceived work-related psychosocial factors, were evaluated by questionnaires after 12 and 18 months. Female nursing aides and assistant nurses (n = 282) working in the home-care services, were randomly assigned to one of three groups for: (1) individually designed physical training programme, (2) work-place stress management, (3) control group. Results revealed no significant differences between the three groups. However, improvements in low back pain were registered within both intervention groups for up to 18 months. Perceived physical exertion at work was reduced in the physical training group. Improvements in neck and shoulder pain did not differ within the three groups. Dissatisfaction with work-related, psychosocial factors was generally increased in all groups. As the aetiology of neck, shoulder and back disorders is multifactorial, a combination of the two intervention programmes might be preferable and should be further studied. nan Regular physical exercise is a cornerstone in rehabilitation programs, but adherence to comprehensive exercise remains low. This study determined the effectiveness of small daily amounts of progressive resistance training for relieving neck/shoulder pain in healthy adults with frequent symptoms; 174 women and 24 men working at least 30 h per week and with frequent neck/shoulder pain were randomly assigned to resistance training with elastic tubing for 2 or 12 minutes per day 5 times per week, or weekly information on general health (control group). Primary outcomes were changes in intensity of neck/shoulder pain (scale 0 to 10), examiner-verified tenderness of the neck/shoulder muscles (total tenderness score of 0 to 32), and isometric muscle strength at 10 weeks. Compared with the control group, neck/shoulder pain and tenderness, respectively, decreased 1.4 points (95% confidence interval -2.0 to -0.7, p<0.0001) and 4.2 points (95% confidence interval -5.7 to -2.7, p<0.0001) in the 2-minute group and 1.9 points (95% confidence interval -2.5 to -1.2, p<0.0001) and 4.4 points (95% confidence interval -5.9 to -2.9, p<0.0001) in the 12-minute group. Compared with the control group, muscle strength increased 2.0 Nm (95% confidence interval 0.5 to 3.5Nm, p=0.01) in the 2-minute group and 1.7Nm (95% confidence interval 0.2 to 3.3 Nm, p=0.02) in the 12-minute group. In conclusion, as little as 2 minutes of daily progressive resistance training for 10 weeks results in clinically relevant reductions of pain and tenderness in healthy adults with frequent neck/shoulder symptoms. Trial registration: www.isrctn.org/ISRCTN60264809. In generally healthy adults with frequent neck/shoulder muscle pain, as little as 2 minutes of daily progressive resistance training reduces pain and tenderness.
                Copyright Â© 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Randomized, parallel-group trial.
                To compare the effect of 3 early intervention strategies following whiplash injury.
                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.
                Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and randomized 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.
                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.
                Immobilization, "act-as-usual," and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury. A randomized controlled trial of an educational booklet for patients with first-time neck pain.
                To assess the clinical impact of a novel educational book on patients' functional outcomes and beliefs about neck pain.
                Previous research has shown that a novel education booklet (The Back Book) had a positive impact on patients with low back pain' beliefs and clinical outcomes. The current study sought to evaluate the efficacy of a similar education booklet (The Neck Book) for neck-pain patients.
                Workers' compensation patients were given either the experimental booklet, a traditional booklet or no booklet. The primary outcome measures, collected at 2-weeks, 3-months, and 6-months after baseline, were The Fear Avoidance Beliefs Questionnaire and The Neck Pain and Disability Scale. Health-related functional measures were also collected at these intervals.
                Only 34% (N = 187) of an original cohort of patients (N = 522) had data for all of the follow-up periods. For these 187 patients, repeated-measures analyses of covariance, using the baseline measure as the covariate, revealed no significant differences among the 3 groups on any of the outcome measures at any of the follow-up periods. For example, at 6-months, the experimental booklet, traditional booklet, and no-booklet groups reported The Neck Pain and Disability Scale mean scores (SDs) of 31.3 (15.5), 35.3 (17.0), and 31.8 (15.6), respectively. Similarly, there were no significant effects for The Fear Avoidance Beliefs Questionnaire scores-35.9 (21.5), 40.3 (22.1), and 38.0 (23.4), respectively.
                This study demonstrates that the educational booklets studied were not associated with improved outcomes in patients with neck pain receiving workers' compensation. Whether these results would apply to a nonworkers' compensation population requires further study. The loss of many patients to follow-up also makes any other firm conclusions more difficult to determine. Firstly, to compare the effectiveness of a brief physiotherapy intervention with "usual" physiotherapy for patients with neck pain. Secondly, to evaluate the effect of patients' preferences on outcome.
                Non-inferiority randomised controlled trial eliciting preferences independently of randomisation.
                Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire.
                268 patients (mean age 48 years) with subacute and chronic neck pain, who were referred by their general practitioner and randomly assigned to a brief physiotherapy intervention (one to three sessions) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy, at the discretion of the physiotherapist concerned.
                The Northwick Park neck pain questionnaire (NPQ), a specific measure of functional disability resulting from neck pain. Also, the short form 36 (SF-36) questionnaire, a generic, health related, quality of life measure; and the Tampa scale for kinesophobia, a measure of fear and avoidance of movement.
                At 12 months, patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group (mean difference 1.99, 95% confidence interval 0.45 to 3.52; P = 0.01). Although the result shows a significant inferiority of the intervention, the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention (below 1.2 points of NPQ score). Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy.
                Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain. Patients with a preference for the brief intervention may do at least as well with this approach. Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further. Little is known about the effectiveness of therapeutic massage, one of the most popular complementary medical treatments for neck pain. A randomized controlled trial was conducted to evaluate whether therapeutic massage is more beneficial than a self-care book for patients with chronic neck pain.
                Sixty-four such patients were randomized to receive up to 10 massages over 10 weeks or a self-care book. Follow-up telephone interviews after 4, 10, and 26 weeks assessed outcomes including dysfunction and symptoms. Log-binomial regression was used to assess whether there were differences in the percentages of participants with clinically meaningful improvements in dysfunction and symptoms (ie, >5-point improvement on the Neck Disability Index; >30% improvement from baseline on the symptom bothersomeness scale) at each time point.
                At 10 weeks, more participants randomized to massage experienced clinically significant improvement on the Neck Disability Index [39% vs. 14% of book group; relative risk (RR)=2.7; 95% confidence interval (CI), 0.99-7.5] and on the symptom bothersomeness scale (55% vs. 25% of book group; RR=2.2; 95% CI, 1.04-4.2). After 26 weeks, massage group members tended to be more likely to report improved function (RR=1.8; 95% CI, 0.97-3.5), but not symptom bothersomeness (RR=1.1; 95% CI, 0.6-2.0). Mean differences between groups were strongest at 4 weeks and not evident by 26 weeks. No serious adverse experiences were reported.
                This study suggests that massage is safe and may have clinical benefits for treating chronic neck pain at least in the short term. A larger trial is warranted to confirm these results. A randomized comparative study with single-blind outcome assessments.
                To compare the efficacy of a multimodal treatment emphasizing proprioceptive training (ACTIVE) with activated home exercises (HOME) and recommendation of exercise (CONTROL) in patients with nonspecific chronic neck pain.
                The efficacy of active exercises and passive physiotherapy for neck trouble has been somewhat disappointing in the previous few studies.
                Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjective pain and disability, cervical ranges of motion, and pressure pain threshold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment included a lecture regarding care of the neck with a recommendation to exercise.
                The average self-experienced total benefit was highest in the ACTIVE group, and the HOME group rated over the CONTROL group (P < 0.001). Differences between the groups in favor of the ACTIVE treatment were recorded in reduction of neck symptoms and improvements in general health and self-experienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor.
                Regarding self-experienced benefit, the multimodal treatment was more efficacious than activated home exercises that were clearly more efficacious than just advising. No major differences were noted in objective measurements of cervical function between the groups, but the content validity of these assessments in chronic neck trouble can be questioned. A single-blinded, randomized treatment study with a follow-up period of 6 months.
                To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident.
                Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain.
                Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period.
                There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache.
                The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.
With the exception of one trial, this review has not shown effectiveness for educational interventions, including advice to activate, advice on stress-coping skills, workplace ergonomics and self-care strategies. Future research should be founded on sound adult learning theory and learning skill acquisition.