Background & Aims
Whiplash is the most common non hospitalised injury after motor vehicle crashes [1] with posttraumatic stress disorder (PTSD) symptoms being highly prevalent in this population [2, 3]. Although with modest effect, exercise and activity maintenance are the recommended treatment for people with whiplash-associated disorders (WAD) [4]. However, people with WAD and associated PTSD seem to not benefit from exercise when delivered as a stand-alone treatment [5]. Trauma-focused cognitive behavioural therapy is the most effective treatment for PTSD [6], but there has been limited research on the combination of this therapy modality and exercise in people with WAD and associated PTSD[5, 9]. Thus, this nested qualitative study aimed to explore the experiences and perceptions of patient participants in a randomised controlled multicentre trial that investigated the effectiveness of combined trauma-focused cognitive behavioural therapy and exercise compared with supportive therapy and exercise[9].
Methods
We conducted 23 semi-structured interviews with trial participants. Eleven participants were from Australia and twelve from Denmark. Fifteen received the trauma-focussed cognitive behavioural therapy and exercise intervention, and eight received the supportive therapy and exercise intervention. We used a reflexive thematic analysis [10] for data analysis underpinned by a constructivism paradigm, considering knowledge as constructed from participants subjective experience
Results
Preliminary findings show most participants perceived the combined psychological treatment and exercise as beneficial, with a mention of it being “the future of whiplash” treatment. Participants acknowledged whiplash had physical and mental factors healthcare providers needed to address early. Overall, participants seemed more satisfied with the psychological than the physiotherapy treatment, with no clear differences between the type of psychological therapies. The psychological treatment helped participants reframe thoughts about their injury and trauma, put things into perspective, and accept the need for long term treatment. A good patient-therapist relationship was paramount to the trial’s satisfaction. Feeling safe, being taken seriously and able to easily talk were regarded as important. Finally, participants’ personal and social aspects such as financial difficulties after the accident, social system barriers, and contextual factors played a limiting role in their recovery.
Conclusions
Our preliminary findings indicate that the combination of psychological treatment (e.g., trauma-focused cognitive behavioural therapy or supportive therapy) and exercise was highly accepted by trial participants. Participants had more perceived benefit with psychological treatment, but there seemed to be no clear difference between the type of psychological therapies. A good relationship with the therapists was more important than the type of therapy provided, which supported the findings of the quantitative trial results. Future studies could explore detailed therapist-delivered treatments to better understand the overlaps between psychological therapies and explore the combination of psychological treatment and exercise therapy as an early intervention for people with whiplash and PTSD.
References
1.Connelly, L.B. and R. Supangan, The economic costs of road traffic crashes: Australia, states and territories. Accid Anal Prev, 2006. 38(6): p. 1087-93.
2.Heron-Delaney, M., et al., A systematic review of predictors of posttraumatic stress disorder (PTSD) for adult road traffic crash survivors. Injury, 2013. 44(11): p. 1413-1422.
3.Ravn, S.L., et al., Trajectories of posttraumatic stress symptoms after whiplash: A prospective cohort study. European Journal of Pain, 2019. 23(3): p. 515-525.
4.Guidelines for the management of acute whiplash-associated disorders – for health professionals, S.I.R. Authority, Editor. 2014: Sydney.
5.Dunne, R.L., J. Kenardy, and M. Sterling, A Randomized Controlled Trial of Cognitive-behavioral Therapy for the Treatment of PTSD in the Context of Chronic Whiplash. The Clinical Journal of Pain, 2012. 28(9).
6.Bhutani, G., et al., Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychological Medicine, 2020. 50(4): p. 542-555.
7.Hegberg, N.J., J.P. Hayes, and S.M. Hayes, Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation. Front Psychiatry, 2019. 10: p. 133.
8.Campbell, L., et al., Psychological Factors and the Development of Chronic Whiplash-associated Disorder(s): A Systematic Review. Clin J Pain, 2018. 34(8): p. 755-768.
9.Andersen, T.E., et al., Trauma-focused cognitive behavioural therapy and exercise for chronic whiplash with comorbid posttraumatic stress disorder: a randomised controlled trial. PAIN, 2021. 162(4).
10.Braun, V. and V. Clarke, Thematic analysis : a practical guide. 2022, London: SAGE Publications Ltd.
Presenting Author
Karime Mescouto
Poster Authors
Karime Mescouto
PhD
RECOVER Injury Research Centre, The University of Queensland
Lead Author
Sophie Lykkegaard Ravn and PhD
Department of Psychology, University of Southern Denmark, DK
Lead Author
Tonny Andersen
University of Southern Denmark
Lead Author
Michele Sterling
RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia
Lead Author
Rachel Elphinston
The University of Queensland
Lead Author
Leone Bennett
The University of Queensland
Lead Author
Topics
- Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science