Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial
Hiu Kwan Lo, Venerina Johnston, Maria Landén Ludvigsson , Gunnel Peterson , Thomas Overmeer , Michael David, Anneli Peolsson
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, 4072 Brisbane, Australia
Objective: To investigate the efficacy of exercise interventions and factors associated with changes in work ability for people with chronic whiplash-associated disorders.
Design: Secondary analysis of a single-blind, randomized multi-centre controlled trial.
Setting: Interventions were conducted in Swedish primary care settings.
Patients: A total of 165 individuals with chronic whiplash-associated disorders grade II–III.
Methods: Participants were randomly allocated to neck-specific exercise, neck-specific exercise with a behavioural approach, or prescribed physical activity interventions. Work ability was evaluated with the Work Ability Index at baseline, 3, 6 and 12 months.
Results: The neck-specific exercise with a behavioural approach intervention significantly improved work ability compared with the prescribed physical activity intervention (3 months, p = 0.03; 6 months, p = 0.01; 12 months, p = 0.01), and neck-specific exercise at 12 months (p = 0.01). Neck-specific exercise was better than the prescribed physical activity intervention at 6 months (p = 0.05). An increase in work ability from baseline to one year for the neck-specific exercise with a behavioural approach group (p < 0.01) was the only significant within-group difference. Higher self-rated physical demands at work, greater disability, greater depression and poorer financial situation were associated with poorer work ability (p < 0.01).
Conclusion: This study found that neck-specific exercise with a behavioural approach intervention was better at improving self-reported work ability than neck-specific exercise or prescribed physical activity. Improvement in work ability is associated with a variety of factors.
Most people who have sustained a whiplash injury return to, or remain in, work. However, some people with whiplash injury experience ongoing problems, with difficulty performing pre-injury work duties. This study investigated the efficacy of 3 different exercise interventions on self-reported work ability for individuals with chronic whiplash. Compared with prescribed physical activity, a 3-month neck-specific exercise intervention with a behavioural approach (including education on managing relapses and stress) was significantly better at improving work ability immediately after the intervention, and at 6- and 12-month follow up. The neck-specific exercise intervention with a behavioural approach was also more effective than neck-specific exercise alone after 12 months. Poorer work ability was associated with high physical demands at work, disability, depression and poorer financial situation. Physical therapists can improve work ability for individuals with chronic whiplash through a specific exercise regime with a behavioural approach.
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