Effects of a Novel Web-Based Sensorimotor Exercise Program for Patients With Subacute Whiplash-Associated Disorders: Protocol for a Randomized Clinical Trial.

INTRODUCTION: Whiplash-associated disorder (WAD) often becomes a persistent problem and is one of the leading causes of disability in the world. It is a costly condition for individuals, for insurance companies, and for society. Guidelines for the management of WAD have not been updated since 2014, and the use of computer-based sensorimotor exercise programs in treatment for this patient group has not been well documented. The purpose of this randomized clinical trial is to explore the degree of association between self-reported and clinical outcome measures in WAD. METHODS: Individuals (n = 180) with subacute WAD grades I and II will be randomized into 3 groups using block randomization. The 2 primary intervention groups (A and B) will receive physical therapy involving manual therapy and either a remote, novel, computer-based cervical kinesthetic exercise (CKE) program starting at visit 2 (Group A) or neck exercises provided by the corresponding physical therapist (Group B). These groups will be compared to a "treatment as usual" Group C. Movement control, proprioception, and cervical range of motion will be measured. Neck disability and pain intensity, general health, self-perceived handicap, and physical, emotional, and functional difficulties due to dizziness will be measured using questionnaires. The short-term effects will be measured 10 to 12 weeks after the baseline measurements, and the long-term effects will be measured 6 to 12 months after the baseline measurements. IMPACT: The successful completion of this trial will help guide clinicians in the selection of outcome measures for patients with subacute WAD in the assessment of the short- and long-term effectiveness of treatment combining manual therapy with computer-based CKE compared with manual therapy and non-computer-based exercises. This trial will also demonstrate the potential of using a computer-based intervention to increase the exercise dose for this patient group and how this influences outcomes such as levels of pain and disability in the short and long term.

The long-term course of deficient cervical kinaesthesia following a whiplash injury has a tendency to seek a physiological homeostasis. A prospective study.

BACKGROUND: No research exists for the long-term course of deficient cervical kinaesthesia following a whiplash injury. Prior results depicted two divergent courses of deficient cervical kinaesthesia at 1 year. OBJECTIVES: First, to determine the actual course(s) of untreated deficient cervical kinaesthesia from 1 year to 6-8 years post-collision and second, to investigate the association between the test results versus self-reported disability. DESIGN: A follow-up study was conducted to measure persons who had experienced whiplash from January 2007-September 2009. METHOD: The two clinical tests for cervical kinaesthesia, the Head-Neck Relocation (HNR) test and the Fly test are conceptualised to measure two distinct "percepts" of neck proprioception: position sense and movement sense, respectively. In both tests, the mean error of three trials was calculated for each individual and represented the kinaesthetic accuracy. These values were used for analysis. RESULTS: Forty-one participants out of an initial forty-seven (response rate = 87.2%) were able to participate at the 6-8 years follow-up. The two divergent courses at 12 months had a tendency to seek a physiological homeostasis at the 6-8 years follow-up. Overall, very slight improvements were revealed in disability levels between the 2 assessment points. CONCLUSIONS: Untreated deficient cervical kinaesthesia has a tendency to seek a physiological homeostasis somewhere from 1 year to 6-8 years post-collision. We therefore recommend that cervical kinaesthesia be monitored and treated early, as deficient cervical kinaesthesia may lead to adaptive compensatory patterns secondary to the remaining functional kinaesthetic deficits.

Sincerity of effort versus feigned movement control of the cervical spine in patients with whiplash-associated disorders and asymptomatic persons: a case-control study.

STUDY DESIGN: Cross-sectional design. OBJECTIVES: To investigate whether the Fly Test can be used to differentiate patients with whiplash-associated disorders (WAD) from asymptomatic persons who deliberately feign symptoms and from WAD patients exaggerating symptoms. BACKGROUND: The lack of valid clinical tests makes it difficult to detect a justifiable cause for compensation claims in traumatic neck-pain disorders. METHODS: The Fly Test recorded the accuracy of neck movements in patients with WAD (n = 34) and asymptomatic persons (n = 31). The participants followed a moving "Fly" on a computer screen with a cursor from sensors mounted on the head. Two conditions were tested, sincere versus feigned efforts. In the former, the participants moved their neck as accurately as possible. In the latter, a short text was presented describing a fictitious accident (asymptomatic group) or imagining more intense pain/suffering (WAD group), and the test was performed as affected by these more serious conditions. Amplitude accuracy (AA), time on target (ToT) and jerk index (JI) were compared across patterns, conditions and groups. RESULTS: The sincere effort in the WAD group was significant compared to the feigned effort of the asymptomatic group (p < 0.001). For AA, correct categorization of 81.5% of the performances was made, where a mean score above 5.5 mm differentiated feigned versus sincere efforts in asymptomatic and WAD groups (sensitivity 79.4%, specificity 67.7%). For ToT, score above 11% indicated correctly categorized WAD patients (sensitivity 82.4%, specificity 64.5%). CONCLUSION: The Fly Test can provide clinicians a clue when patients with mild to moderate pain/disability are feigning or exaggerating symptoms.

Database of movement control in the cervical spine. Reference normal of 182 asymptomatic persons.

In this study, the first normative database of movement control in the cervical spine has been established. For this purpose the Fly Test was used, which is a reliable and valid clinical test capable of detecting deficient movement control of the cervical spine in patients with neck pain and its associated disorders. One hundred and eighty-two asymptomatic persons, eighty-three men and ninety-nine women, aged 16-74 years, divided into six age groups, were recruited. The Fly Test, using a 3-space Fastrak device, recorded the accuracy of cervical spine movements when tracking three incrementally difficult movement patterns. Amplitude accuracy (AA), directional accuracy (DA), and jerk index (JI) were compared across patterns and age groups. A multivariate analysis of variance revealed a significant effect for age (p < 0.001) but not gender (p > 0.05). Lower accuracy for AA and DA in all three movement patterns was observed in the groups of subjects aged 55-64 and 65-74 years, and also for JI in the easy and medium patterns. Knowledge of normative values for the Fly Test is important and useful in identifying impaired movement control and monitoring the effectiveness of treatment interventions in patients with neck pain of traumatic and non-traumatic origin.

Two different courses of impaired cervical kinaesthesia following a whiplash injury. A one-year prospective study.

A longitudinal study was conducted to observe persons with neck pain after motor vehicle collisions. The aims were to reveal the prospective development of cervical kinaesthesia and to investigate the association between the test results and self-reported pain and disabilities. Two different cervical kinaesthetic tests, the Fly test and the Head-Neck Relocation test, measured movement control and the relocation accuracy of the cervical spine, respectively. Self-assessment measures included pain intensity (VAS), neck pain and disability (NDI), fear of re-injury (TAMPA) and psychological distress (GHQ-28). Seventy-four subjects entered the study, but 47 were eligible, as they participated in all 4 measurements at 1, 3, 6 and 12 months post-collision. According to the performances on the two kinaesthetic tests, the subjects could be classified into improvement and non-improvement groups, respectively. The result revealed, for the first time, two different courses of deficient cervical kinaesthesia. About half of the participants showed significant deteriorating performances in both kinaesthetic tests throughout the year (p < 0.002), while the other half improved their performances (p < 0.02). Generally, the relationships between the kinaesthetic tests and the self-assessment scores were not significant, irrespective of the performances on the two kinaesthetic tests. Accordingly, the results of the questionnaires correlated poorly or weakly with the kinaesthetic test results at all assessment points. The need for developing a new questionnaire, capturing the symptoms prevalent in patients with neck pain and cervical sensorimotor impairments is urgent. What determines the two different kinaesthetic courses need to be scrutinised in future research.

"The Fly": a new clinical assessment and treatment method for deficits of movement control in the cervical spine: reliability and validity.

STUDY DESIGN: Test-retest and case-control study designed to detect accuracy of cervical spine movements by comparing 3 incrementally difficult movement patterns. An asymptomatic group, a nontrauma neck pain group, and a group with whiplash-associated disorders, Grade II, were tested (n = 18 in each group). OBJECTIVE: To determine the test-retest reliability and the discriminative validity of the new Fly method. SUMMARY OF BACKGROUND DATA: A lack of reliable and valid measures for grading the deficits of movement control in the cervical spine makes it impossible to prescribe treatment appropriate to each patient's respective impairment level. METHODS: Head tracking of a moving fly which appeared on a computer screen. Easy, medium, and difficult patterns, each of which was repeated 3 times in random order, were tested. Amplitude accuracy (deviation of movements), directional accuracy (time on target, undershoots vs. overshoots) were compared across patterns and groups on 2 occasions, 1 week apart. RESULTS: The intraclass correlation coefficient(2,1) ranged from 0.53 to 0.82 for both variables, except for the subvariable "overshoots" (0.14-0.42). The limits of agreement (LOA) were progressively wider across patterns (easy-medium-difficult) and groups (asymptomatic-nontrauma-whiplash-associated disorder). Analysis of variance with repeated measures revealed significant differences between patterns within each group and between groups respectively for both outcome variables (P < 0.001). CONCLUSION: The Fly method provides reliable and valid measures for movement control of the cervical spine. Higher means and wider LOA across patterns and subject groups are reasoned to be inherent in the new Fly method and the subject groups tested. The wide LOA in the symptomatic groups supports the development of a normative database. The new Fly method can be used both as an assessment and a treatment method and ensures gradual progression in the treatment for deficits of movement control in patients with neck pain.