Internet-Based vs Traditional Neck Exercises: Psychological Outcomes in Chronic WAD

Overview

This randomized controlled trial secondary analysis compared internet-supported neck-specific exercises (NSEIT) with traditional physiotherapist-led exercises (NSE) in chronic whiplash-associated disorders (WAD). Both interventions led to significant improvements over time in cognitive-behavioral factors and emotional distress, with no differences between groups. Psychological factors did not moderate treatment effects on neck-specific disability.

Background

Chronic whiplash-associated disorders (WAD) often involve persistent neck pain and psychological distress, affecting daily function. Psychological factors such as pain catastrophizing, fear-avoidance beliefs, and emotional distress can influence symptom persistence and recovery. Exercise and patient education are primary treatments, but optimal delivery methods remain uncertain. Internet-based exercise programs may offer a resource-efficient alternative to traditional physiotherapy.

Data Highlights

Key Findings

• No significant differences between internet-based (NSEIT) and traditional physiotherapy-led (NSE) groups in psychological outcomes over 15 months.
• Both groups showed significant improvements in pain catastrophizing, fear-avoidance beliefs, self-efficacy, depression, and anxiety.
• Psychological factors at baseline did not moderate the treatment effect on neck-specific disability.
• The internet-based program required fewer clinic visits but achieved comparable psychological benefits.
• Improvements in cognitive-behavioral and emotional distress measures had small to intermediate effect sizes.

Clinical Implications

Internet-supported neck-specific exercise programs can effectively improve psychological outcomes in chronic WAD, offering a less resource-intensive alternative to traditional physiotherapy without compromising benefits. Clinicians may consider internet-based delivery regardless of patients' baseline psychological profiles, potentially increasing accessibility and adherence. Monitoring psychological factors remains important but may not necessitate treatment stratification based on these factors.

Conclusion

Internet-based neck-specific exercises are as effective as traditional physiotherapist-led programs in improving psychological outcomes in chronic WAD. These findings support the use of internet-supported interventions as a viable treatment modality irrespective of baseline psychological characteristics.

References

1. Lundberg et al. 2023 -- Impact of Internet-Supported versus Traditional Neck-Specific Exercises on Psychological Outcomes in Chronic Whiplash-Associated Disorders