The Effect of Neck-Specific Exercise with or Without a Behavioral Approach in Chronic Whiplash-Associated Disorders: A Systematic Review and Meta-Analysis.

Chronic whiplash-associated disorders describe a cluster of symptoms that result from a sudden neck acceleration/deceleration movement, including pain, musculoskeletal and neurological signs, inducing functional disability. The aim of this study was to compare the effects of physiotherapy treatment based on neck-specific exercises, with or without a behavioral approach, in individuals with whiplash-associated disorders. Computerized research was performed in PubMed, PEDro, National Institute for Health and Care Excellence, and ScienceDirect to identify randomized controlled trials that evaluated the effectiveness of neck-specific exercises, with or without a behavioral approach, for chronic whiplash. For the meta-analysis, the outcomes of pain and disability were assessed. Thirteen studies were included in the systematic review, with a total of 2427 participants of both sexes, with ages between 18 and 63 years. Although interventions with a behavioral approach decreased pain and disability more significantly in 4 and 6 studies when compared to neck-specific exercises without such an approach, respectively, the meta-analysis revealed no differences between them. Although interventions for chronic whiplash-associated disorders based on neck-specific exercises with a behavioral approach seem to be more effective in reducing pain and disability, there is no quantitative difference favoring one over the other.