Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis

Bruno Chrcanovic; Johan Larsson; Eva-Maj Malmström; Hans Westergren; Birgitta Häggman-Henrikson

doi:10.1515/sjpain-2021-0064

Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis

Scand J Pain. 2021 Sep 27;22(2):232-261. doi: 10.1515/sjpain-2021-0064. Print 2022 Apr 26.

Authors

Bruno Chrcanovic¹, Johan Larsson², Eva-Maj Malmström^{2

3}, Hans Westergren^{2

4}, Birgitta Häggman-Henrikson⁵

Affiliations

¹ Department of Prosthodontics, Malmö University, Malmö, Sweden.
² Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
³ Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden.
⁴ Health Sciences, Lund University, Lund, Sweden.
⁵ Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.

PMID: 34561976
DOI: 10.1515/sjpain-2021-0064

Abstract

Objectives: Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list.

Content: The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers.

Summary: The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability.

Outlook: Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.

Keywords: exercise therapy; neck pain; randomized controlled trials; rehabilitation; systematic review; whiplash injuries.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Chronic Pain* / complications
Chronic Pain* / therapy
Exercise Therapy / methods
Humans
Neck
Neck Pain / etiology
Neck Pain / therapy
Whiplash Injuries* / complications
Whiplash Injuries* / therapy