Neck Muscle Activation in Patients With Long Standing Problems After a Whiplash Trauma Registered With Ultrasound With Speckle Tracking

Today there is evidence for that neck specific exercises reduce neck pain problems in patients with mechanical neck pain. However, there is a lack of consensus on how to optimize neck exercises and dosages in neck rehabilitation. More knowledge is needed to determine which and how muscles are activated in exercises thought to be neck-specific. There is neither enough knowledge of differences in neck muscle activation between patients with long standing neck problems after a whiplash trauma and healthy controls nor if the neck muscle function improved with specific neck exercises. One approach would be a real time study of deformation and deformation rate in different layers of neck muscles in patients with residual long-term neck pain and disability after a whiplash trauma. The purpose of the present study was to investigate deformation and deformation rate in different layers of dorsal and ventral neck muscles (including upper and middle part of trapezius muscle) during rest and during different exercises; arm flexion until 120 degrees, repeated arm flexion until 90 degrees, low loaded neck extension, low loaded neck muscle endurance test, shoulder elevation. Forty patients with long standing (more than 6 months but less than 3 years)patients and 40 controls matched for age and gender will be included for comparisons between patients and healthy in neck muscle activation. The investigators also include 60 patients with whiplash trauma, of those 30 patients will be randomized to A. neck specific exercises in a 3 months period and B. will 30 be on a waiting list for 3 months. Measurements are performed at baseline and at 3 months follow-up. Those patients who fulfilled the 3 months period of neck specific exercises will also be asked for a 6 months follow-up.

Study Overview

• Status: Completed
• Conditions: Whiplash Associated Disorder
• Intervention / Treatment: Other: Neck specific exercises

• Study Type: Interventional
• Enrollment (Anticipated): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Östergötland
    • Linköping, Östergötland, Sweden, SE-58183
      • Anneli Peolsson

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 63 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• WAD II and III
• Age 18-63 years
• Remaining problems
• Right handed
• Pain on right or on both sides.

Exclusion Criteria:

• Myelopathy
• Earlier fracture or luxation of the cervical column, earlier neck injury
• Spinal tumour
• Spinal infection
• Surgery in the cervical column
• Malignity
• Systemic disease or other disease or another injury contraindicated to perform the treatment program or the measurements
• Diagnosed severe psychiatric disorder
• Unconscious in connection to the trauma
• Known drug abuse
• Lack of familiarity with the Swedish language

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Neck Specific exercises; 3 months of neck specific exercises for 30 patients.	Other: Neck specific exercises; Neck specific exercises 2 times/week for 3 month at a physiotherapist. Home exercises.; Other Names: Physiotherapy with neck specific exercises
No Intervention: Waiting list; Thirty patients on the waiting list for 3 month before they have their intervention
No Intervention: Healthy controls; Forty healthy controls. Comparisons between forty included WAD patients and 40 healthy controls matched for age and gender will be investigated at baseline.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Speckle tracking analysis of muscle function	Measured with medical ultrasonography	Baseline and at 3 and 6 months follow-up. The outcome measure is going to report a change over time.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Background data	Background data of age, gender, social situation, work, work situation, sick-leave, income, pain history, debute of symptoms, about the accident, earlier treatment, other diseases or pain problems, expectations of treatment	Baseline
Symptom satisfaction		Baseline and at 3 months follow-up. The outcome measure is going to report a change over time.
Pain intensity on visual analogue scale (VAS)	Symptoms in general, Neck, Arm, Headache	Baseline and at 3 months follow-up. The outcome measure is going to report a change over time.
Dizziness/ unsteadiness on visual analogue scale		Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Pain distribution on drawing		Baseline and at 3 months follow-up. The outcome measure is going to report a change over time.
Pain Disability Index		Baseline and at 3 months follow-up. The outcome measure is going to report a change over time
Neck Disability Index		Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Tampa Scale of Kinesiophobia (TSK-11 short version)		Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Pain Catastrophizing Scale		Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Hospital Anxiety and Depression Scale		Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Euroquol	Euroquol 5D and thermometer	Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Exercise Self-Efficacy Scale	"How confident you are to exercise when things get in the way" Exercise self-efficacy scale is a six item scale with a five point scale (1=not at all confident and 5=completely confident).	Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Self-Efficacy Scale	"People´s beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives" Self-efficacy scale (by Altmaier) is a 20 item, 11 point scale (0=not at all confident, 10=completely confident).	Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Work Ability Index		Baseline and at 3 month follow-up. The outcome is going to report a change over time.
Physical Activity level		Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.
Physical Outcome Measures	Active range of motion of the neck, Head repositioning accuracy, hand strength, neck muscle endurance, sharpened Romberg, walking in a figure of eight, neurological examination: reflexes, sensibility and motor function	Baseline and at 3 month follow-up. The outcome is going to report a change over time.
SF-36		Baseline and at 3 month follow-up. The outcome measure is going to report a change over time.

Collaborators and Investigators

• Sponsor: Linkoeping University
• Investigators: Study Chair: Anneli Peolsson, Assoc. Prof., Linkoeping University

Publications and helpful links

General Publications

• Peolsson A, Landen Ludvigsson M, Tigerfors AM, Peterson G. Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study. Arch Phys Med Rehabil. 2016 Feb;97(2):189-95. doi: 10.1016/j.apmr.2015.10.087. Epub 2015 Oct 26.
• Landen Ludvigsson M, Peterson G, Jull G, Trygg J, Peolsson A. Mechanical properties of the trapezius during scapular elevation in people with chronic whiplash associated disorders--A case-control ultrasound speckle tracking analysis. Man Ther. 2016 Feb;21:177-82. doi: 10.1016/j.math.2015.07.009. Epub 2015 Aug 5.

Study record dates

Study Major Dates

• Study Start: February 1, 2011
• Primary Completion (Actual): December 1, 2015
• Study Completion (Actual): December 1, 2015

Study Registration Dates

• First Submitted: February 28, 2012
• First Submitted That Met QC Criteria: March 4, 2012
• First Posted (Estimate): March 8, 2012

Study Record Updates

• Last Update Posted (Actual): March 13, 2017
• Last Update Submitted That Met QC Criteria: March 10, 2017
• Last Verified: March 1, 2017

More Information

Terms related to this study

• Keywords: Coordination; Activity; Spine; Neck; Muscles
• Additional Relevant MeSH Terms: Wounds and Injuries; Neck Injuries; Whiplash Injuries
• Other Study ID Numbers: Ultrasound on neck muscles WAD

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED