Effectiveness of physiotherapy in chronic whiplash individuals with and without posttraumatic stress: a pilot series of Single Case Experimental Designs (SCEDs)

Advice booklet All patients will be provided with an advice booklet Whiplash Injury Recovery: A Self Help Guide (2nd edition), co-authored by Prof Sterling and published by the Motor Accident Insurance Commission (MAIC), Qld. It provides information about whiplash, assurance about prognosis and advice to stay active and resume working; as well as information on correct posture, with pictorial descriptions of specific neck and upper limbs exercises and information on resuming functional daily activities. This second edition of the booklet was written based on consumer and health care professional feedback via focus groups. The booklet is based on the recommendations of the current Australian Guidelines for Whiplash Management (TRACsa, 2008). Conservative Multimodal Physiotherapy The 4-week exercise program will be carried out by the honors students under the supervision of the experienced physiotherapist (2 sessions per week). The exercise program will comprise specific exercises to improve the movement and control of the neck and shoulder girdle. Exercises will be tailored by the physiotherapist for each individual participant. The exercises will be of a low load nature and 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 and axio-scapular-girdle muscles and includes tests that assess an individual’s ability to recruit the muscles in a coordinated manner, and tests of muscle endurance at low levels of maximum voluntary contraction. The specific impairments identified are then addressed with an exercise program that is supervised and progressed by the physiotherapist. This specific treatment program as described in Jull et al (2008) focuses on activating and improving the coordination and endurance capacity of neck flexor, extensor and scapular muscles in specific exercises and functional tasks, and a graded program directed to the postural control system including exercises for balance, head relocation and eye movement control. Participants will also perform the exercises at home, once per day. Written and illustrated exercise instructions will be provided. A log book will be completed by participants to record compliance with the exercises. The exercise program follows the current Australian guidelines for the management of chronic whiplash (TRACsa, 2008). Physiotherapists providing the intervention and control Physiotherapy honours students who successfully complete a face-to-face, trial specific training workshop run by Prof Michele Sterling (MS) will provide the therapeutic interventions for this study. They will be supervised by a physiotherapist experienced in the management of whiplash injured individuals. The physiotherapy exercise sessions will be audited twice per honours student/physiotherapist (face to face by MS) to check for adherence to the exercise protocol.