Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study

Anneli Peolsson, Anette Karlsson, Bijar Ghafouri, Tino Ebbers, Maria Engström, Margaretha Jönsson, Karin Wåhlén, Thobias Romu, Magnus Borga, Eythor Kristjansson, Hilla Sarig Bahat, Dmitry German, Peter Zsigmond, Gunnel Peterson, Anneli Peolsson, Anette Karlsson, Bijar Ghafouri, Tino Ebbers, Maria Engström, Margaretha Jönsson, Karin Wåhlén, Thobias Romu, Magnus Borga, Eythor Kristjansson, Hilla Sarig Bahat, Dmitry German, Peter Zsigmond, Gunnel Peterson

Abstract

Background: There is insufficient knowledge of pathophysiological parameters to understand the mechanism behind prolonged whiplash associated disorders (WAD), and it is not known whether or not changes can be restored by rehabilitation. The aims of the projects are to investigate imaging and molecular biomarkers, cervical kinaesthesia, postural sway and the association with pain, disability and other outcomes in individuals with longstanding WAD, before and after a neck-specific exercise intervention. Another aim is to compare individuals with WAD with healthy controls.

Methods: Participants are a sub-group (n = 30) of individuals recruited from an ongoing randomized controlled study (RCT). Measurements in this experimental prospective study will be carried out at baseline (before intervention) and at a three month follow-up (end of physiotherapy intervention), and will include muscle structure and inflammation using magnetic resonance imaging (MRI), brain structure and function related to pain using functional MRI (fMRI), muscle function using ultrasonography, biomarkers using samples of blood and saliva, cervical kinaesthesia using the "butterfly test" and static balance test using an iPhone app. Association with other measures (self-reported and clinical measures) obtained in the RCT (e.g. background data, pain, disability, satisfaction with care, work ability, quality of life) may be investigated. Healthy volunteers matched for age and gender will be recruited as controls (n = 30).

Discussion: The study results may contribute to the development of improved diagnostics and improved rehabilitation methods for WAD.

Trial registration: Clinicaltrial.gov Protocol ID: NCT03664934, initial release 09/11/2018.

Keywords: Biomarkers; Chronic; Diagnostic imaging; Exercise therapy; Follow-up study; MRI; Neck; Outcome; Physiopathology; Physiotherapy; Randomized; Rehabilitation; Scan; Spine; Ultrasonography; Whiplash injury.

Conflict of interest statement

Ethics approval and consent to participate

The project has been approved by the Regional Ethical Review Board in Linköping, Sweden (dnr 2016/135–31 and 2017/556–32). Participants are included after thorough interviews and patients also undergo a clinical examination. All participants signed informed consent forms.

Consent for publication

Not applicable.

Competing interests

There are no conflicts of interest and the authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The Consort flow diagram

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