Is the integration of education with exercise beneficial for whiplash-associated disorders? A systematic review and meta-analysis.

Abstract

Objectives: The aim of this study was to compare the effectiveness of exercise combined with educational strategies to exercise alone or educational strategies alone in patients with WAD on pain or disability.

Design: Systematic Review and Meta-Analysis.

Methods: The MEDLINE, Cochrane, Scopus, PEDro, and Web of Science databases were searched. Clinical trials investigating the effects of education and exercise combined on pain and disability in adults diagnosed with WAD. PEDro, RoB2 and GRADE were used to assess methodological quality, risk of bias and certainty of evidence, respectively. Random-effects models were applied for meta-analysis.

Results: Six trials were included in the final review. Education and exercise compared to education alone showed a statistically significant change in pain (MD = -1.00; 95%CI -1.29, -0.71; 2 studies, 212 patients) in the post-treatment period . There was no statistically significant change in pain during the follow-up period. Likewise, education and exercise compared to exercise alone showed a statistically significant change in pain (MD = -0.61; 95%CI -1.00, -0.23; 6 studies, 386 patients), obtained from mid-long follow-up . There was no statistically significant change in pain in the post-treatment period. The resulting significant changes in the pain variable are not clinically relevant. The results show no significant change in disability over any time period. The certainty of the evidence was downgraded to very low for all comparisons.

Conclusion: There are no important clinical differences between a combined exercise and education treatment and an education alone or exercise alone treatment in terms of pain and disability in patients with WAD.