ArticlePain reports
The mechanisms of effect of a physiotherapist-delivered integrated psychological and exercise intervention for acute whiplash-associated disorders: secondary mediation analysis of a randomized controlled trial.
Article in Pain reports. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Is the integration of education with exercise beneficial for whiplash-associated disorders? A systematic review and meta-analysis.The Journal of manual & manipulative therapy · 2025Pooled it
- Article
- Neuro-immune contributors to persistent musculoskeletal pain: from mechanisms to clinical assessment and management.Musculoskeletal science & practice · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIntegrated psychological and physical treatments can improve recovery for whiplash-associated disorders (WADs). Little is known about how these interventions work.
objectiveTo examine the mechanisms by which a physiotherapist-delivered integrated intervention for acute WAD improves health outcomes.
methodsSecondary analysis using structural equation modelling of a randomized controlled trial comparing integrated stress inoculation training and exercise to exercise alone for acute WAD. Outcomes were disability, pain self-efficacy, pain intensity, and health-related quality of life at 12 months. The intended intervention target and primary mediator, stress was tested in parallel with pain-related coping, an additional cognitive behavioral mediator that significantly improved at posttreatment (Model 1). Stress-related constructs that commonly co-occur with stress and pain were also tested as parallel mediators: depression and pain-related coping (Model 2); and posttraumatic stress and pain-related coping (Model 3).
resultsReductions in stress mediated the effect of the integrated intervention on disability (β = -0.12, confidence interval [CI] = -0.21 to -0.06), pain self-efficacy (β = 0.09, CI = 0.02-0.18), pain (β = -0.12, CI = -0.21 to -0.06), and health-related quality of life (β = 0.11, CI = 0.04-0.21). There was an additional path to pain self-efficacy through pain-related coping (β = 0.06, CI = 0.01-0.12). Similar patterns were found in Models 2 and 3.
conclusionsImprovements in stress and related constructs of depression and posttraumatic stress, and pain-related coping were causal mechanisms of effect in a physiotherapist-delivered integrated intervention. As integrated interventions are growing in popularity, it is important to further personalize interventions for improved benefit.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.