Physiotherapy Management, Coping and Outcome Prediction in Whiplash Associated Disorders (WAD)

Sammanfattning: The aims of the present thesis were to evaluate the management of acute WAD and to develop, describe and evaluate a cognitive behavioural approach for the physiotherapy management of long-term WAD as well as to study the predictors and mediating factors for long-term disability and pain after a whiplash injury. Two approaches for acute and chronic WAD were evaluated in experimental studies. Fifty-nine patients with acute whiplash injury (study I) and 33 patients with chronic WAD (study V), were randomised into experimental and control groups. In addition, three chronic WAD patients participated in an experimental single case study (study IV). Home exercise programmes for patients with acute WAD were used in study I. In study IV a physiotherapy management with integrated components of cognitive-behavioural origin was tried for chronic WAD patients. In study V physiotherapy treatment in primary care units and a physiotherapy management with integrated components of cognitive-behavioural origin was tried for chronic WAD patients. Study I showed that a home exercise programme including training of neck and shoulder range of motion (ROM), relaxation and general advice, appears to be a sufficient treatment for most acute WAD patients. Further, the results of study IV and V suggest that cognitive behavioural components m be useful in physiotherapy treatment for patients with chronic WAD, but its contribution is not yet fully understood. Study III showed that the significance of coping as an explanatory factor for disability increased during the one-year period after a whiplash injury. In study V it was concluded that self-efficacy is related to patients' use of different coping styles. A model to study coping as a mediator between self-efficacy and disability was therefore introduced. In a path-analytic framework, data from subjects in study I were re-analysed to illustrate a theoretical standpoint that emphasises the process of coping. With regard to disability, the proportion of explained variance increased from 39% at three weeks after the accident, to 79% at one-year follow-up. These results also show that coping has a crucial and mediating role between self-efficacy and disability. Positive long- term outcomes in WAD-patients would therefore be improved by, shortly after an accident, boosting self- efficacy and teaching patients to use active, adaptive coping strategies to manage their problems.