Physiotherapist led stress inoculation intervention integrated with exercise for acute whiplash injury: A randomised controlled trial

Exercise and stress inoculation therapy (SIT). SIT: A physiotherapist will provide 6 sessions (1 per week) of SIT, teaching strategies to assist participants in managing acute stress responses. In the first session this will include an educational session about the effects of acute stress following an injury. At subsequent sessions additional strategies will be utilised including progressive muscle relaxation and breath control exercises, simple cognitive behavioural skills to encourage positive coping, and reduce avoidance behaviours, and problem solving skills. SIT consists of three phases: 1. Identify and understanding stress. Identifying specific stressors and how these impact on pain, behaviour, emotions, physical performance and thoughts. 2. Developing skills for managing stress such as relaxation, problem solving and helpful coping self-statements. Participants will practice these skills on a weekly basis with home practice (once/day). The duration of the home practice will be dependant on the participants. It is anticipated that some participants make take longer to complete the home practice than others. 3. Applying skills in various stressful situations to develop tolerance and confidence. All intervention sessions will be for a maximum of 50 minutes. Participants will be provided with a specific app called Stressmod which will be available through the Apple app store and the Android play store to assist with their required daily practice of the taught skills. As part of Stress Inoculation Training (SIT), a complementary smart phone application has been created. StressMod is a mobile application that helps users learn and practice relaxation and stress management techniques. Compliance will be monitored by logging the use of the app. The home practice will take a maximum of 5-10 minutes/day. Exercise:The 6-week exercise program will be carried out under the supervision of the physiotherapist (2 sessions in weeks 1-4 and 1 session in the weeks 5 and 6).The exercise program will comprise specific exercises to improve the movement and control of the neck and shoulder girdles as well as exercises to improve eye/head co-ordination. The exercises will be tailored by the physiotherapist for each individual participant. The exercises are of a low load nature and are designed to be pain free. At the same time, the physiotherapist will guide the participant’s return to normal activities. The program begins with a clinical examination of the cervical muscles and the axio-scapular-girdle muscles and includes tests that assess ability to recruit the muscles in a coordinated manner, tests of balance, cervical kinaesthesia and eye movement control and tests of muscle endurance at low levels of maximum voluntary contraction. The specific impairments that are identified are then addressed with an exercise program that is supervised and progressed by the physiotherapist. This specific treatment program focuses on activating and improving the co-ordination and endurance capacity of the neck flexor, extensor and scapular muscles in specific exercises and functional tasks, and a graded program directed to the postural control system, including balance exercises, head relocation exercises and exercises for eye movement control. Participants will also perform the exercises at home, once/day. Written and illustrated exercise instructions will be provided. A log book will be completed by participants to record compliance with the exercises. Duration of exercises at home will depend on the exercises prescribed by the physiotherapist and the ability of the participant to perform these exercises but will be no longer that 15 minutes/day.