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Values‐based cognitive behavioural therapy for the prevention of chronic whiplash associated disorders: A randomized controlled trial
Author(s) -
Andersen Tonny Elmose,
Ravn Sophie L.,
Mejldal Anna,
Roessler Kirsten Kaya
Publication year - 2022
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1945
Subject(s) - whiplash , randomized controlled trial , physical therapy , medicine , depression (economics) , anxiety , randomization , pain catastrophizing , chronic pain , intervention (counseling) , neck pain , poison control , psychiatry , alternative medicine , environmental health , pathology , economics , macroeconomics
Background Whiplash is a common traffic‐related injury with up to 50% of those affected continuing to experience symptoms one‐year post‐injury. Unfortunately, treatments have not proven highly effective in preventing and treating chronic symptomatology. The overall aim of this study was to test the effectiveness of an early values‐based cognitive‐behavioural therapeutic intervention (V‐CBT) delivered within 6 months post‐injury in preventing chronic symptomatology compared to wait list controls. Methods The study was a two‐armed randomized controlled trial. Participants ( n = 91) experienced pain, disability and at least one psychological risk factor (e.g. enhanced pain‐catastrophizing) after a whiplash trauma no later than 6 months prior. Participants were randomized to 10 sessions of V‐CBT starting 1 week (group A) or 3 months (group B) post‐randomization. The primary outcome was pain‐related disability, while secondary outcomes were pain intensity, neck‐pain related disability, depression, anxiety, PTSD symptoms, pain‐catastrophizing and kinesiophobia. These were evaluated at baseline and at 3, 6, 9 and 12 months post‐randomization. Results At 3 months, group A demonstrated clinically important effects on all outcomes that were significantly better than group B (waitlist). When group B received the intervention at 6 months, they also demonstrated clinically important effects on all outcomes. However, there was a significant difference at 12 months for the primary outcome, in which group B increased their disability levels, while group A remained stable. Conclusions While this indicates that an intervention window for early prevention of disability after whiplash injury may exist, this needs to be tested in a truly early intervention. Significance An early Values‐based Cognitive Behavioural Therapeutic intervention delivered within 6 months post‐injury (mean days 117) was effective in reducing pain‐related disability and psychological distress compared to the control group that received the intervention later after a three months wait‐list period. The effects were sustained at 12 months follow‐up. The early intervention was significantly more effective in reducing pain‐related disability compared to the control group, indicating that an intervention window for early prevention of disability after whiplash injury may exist.