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Physiotherapist led stress inoculation intervention integrated with exercise for acute whiplash injury

Early management approaches for people with acute whiplash associated disorder (WAD) are only modestly effective. These have mainly been non-specific and have not targeted processes shown to be associated with poor recovery, such as posttraumatic stress symptoms. Targeting and modulating these early stress responses in the early management of acute WAD may improve health outcomes.

Naam project: Physiotherapist led stress inoculation intervention integrated with exercise for acute whiplash injury
Project leader: Prof. M. Sterling (McGriffith University, Goldcoast, Australia)
Projectgroep: Prof. J. Kenardy, Prof. Dr. R.J.E.M. Smeets
Looptijd: 2014-2017

Samenwerkende en deelnemende instituten: Menzies Health Institute Queensland, Centre for National Research on Disability and Rehabilitation Medicine (CONROD), NHMRC CRE in Recovery Following Road Traffic Injury, Griffith University, Australia. 2CONROD, University of Queensland, Australia. 3 Department of Rehabilitation Medicine, Maastricht University and Adelante Centre of Expertise in Rehabilitation Medicine and Audiology Hoensbroek, The Netherlands.

Research Questions: Is Stress Inoculation Training (SIT) integrated with standard physiotherapy exercise and delivered by physiotherapists more effective than physiotherapy exercise alone in reducing neck pain disability in individuals with acute WAD?

Design: StressModEx is a prospectively registered parallel randomised controlled trial with blinded outcome assessment.

Participants and Setting: 100 individuals with grade II or III acute WAD < 4 weeks duration and at least moderate neck pain related disability and hyper-arousal symptoms. Participants are assessed via on-line surveys or in person at a university research laboratory. Interventions are provided at community physiotherapy practices in Brisbane, Gold Coast, Toowoomba and Mackay, Queensland, Australia.

Intervention: Clinical guideline recommended supervised physiotherapy exercise sessions (10 sessions) integrated with 6 (1 per week) SIT sessions. SIT is a cognitive behavioural approach that teaches various general coping strategies to manage stress-related anxiety (i.e. relaxation training, cognitive restructuring, and positive self-statements) and provides important information to injured individuals about the impact of stress on their physical and psychological well-being.

Control: Clinical guideline recommended supervised physiotherapy exercise sessions (10) only.

Measurements: Primary (Neck Disability Index) and secondary (Acute Stress Disorder Scale; Posttraumatic Stress Diagnostic Scale; Depression, Anxiety and Stress Scale; Pain Catastrophising Scale; Pain Self-Efficacy Questionnaire; Coping Strategies Questionnaire; Global impression of recovery; pain intensity; SF36) outcomes will be measured at baseline, 6 weeks, 6 and 12 months post-randomisation.

Analysis: Data analysis will be blinded and by intention-to-treat. Outcomes will be analysed using linear mixed and logistic regression models that will include baseline scores as a covariate, subjects as a random effect and treatment conditions as fixed factors.

Discussion: This study will be the first to address early stress responses following acute whiplash injury through a novel intervention of integrating SIT and physiotherapy exercise.

Current status: Recrutering van patiënten is gaande. Er is een publicatie verschenen:
Ritchie C, Kenardy J, Smeets R, Sterling M. StressModEx - Physiotherapist led stress inoculation training integrated with exercise for acute whiplash injury: study protocol for a randomised controlled trial. Journal of Physiotherapy 2015 Jul;61(3):157. doi: 10.1016/j.jphys.2015.04.003. Epub 2015 Jun 17

Financiering: NHMRC Australia

Type onderzoek: PhD