Chronic Whiplash Syndrome: Associated Disorders and Physiotherapy Management – A Literature Review

Purpose: The purpose of the current literature review is to present the Whiplash Associated-Disorders through diagnosis, scales, physical examination and to identify the most suitable physiotherapy management of these conditions. The long-term effectiveness of physiotherapy interventions is also examined. Methods: Sixteen randomized controlled trials (RCTs) and seven case-control and cohort studies related to chronic WAD fulfilled the inclusion and exclusion criteria. The design, diagnosis, population, methodology, results, methodological quality and physiotherapy management were examined. The PEDro Scale and the Newcastle-Ottawa Scale were used for the examination of the methodological quality. Results: The methodological quality of the studies used, were high. Significantly important on minimizing the symptoms of chronic WAD were the combination of Exercise therapy & Advice both at 6 and 12 months follow up. Other interventions such as Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not equally effective in the long-term. Conclusion: The most suitable intervention for the physiotherapy management of chronic WAD, with long-term effectiveness was the combination of Exercise & Advice, which was established with various outcome measures, such as NDI, VAS, NRI and SF-36. On the contrary, Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not that effective on minimizing the symptoms of chronic WAD in the long-term.

Long-Term Effects of a Multimodal Physiotherapy Program on the Severity of Somatosensory Tinnitus and Identification of Clinical Indicators Predicting Favorable Outcomes of the Program

Tinnitus, the perception of sound in the absence of external auditory stimuli, is commonly associated with problems of the auditory system. Head and neck disorders can also be involved in tinnitus emergence. In such cases, the term somatosensory tinnitus is used. Physiotherapy treatments have been identified as a promising avenue in the treatment of somatosensory tinnitus.The aim of the study was to explore the effect of a physiotherapy program on the intensity and severity of somatosensory tinnitus and to identify the clinical characteristics of the patients who respond well to this treatment.Quasi-experimental pre–post single-group design.Thirty-one adults with presumed somatosensory tinnitus.All participants received on average ten physiotherapy treatments over six weeks. Treatments included cervical and thoracic mobilizations, as well as muscular strengthening, stretching, postural instruction, and cervical stabilization.Outcomes were measured at baseline, at the end of the physiotherapy program, and three months later. The primary outcomes were the Tinnitus Handicap Inventory and visual analog scales for loudness and annoyance caused by tinnitus.After the last evaluation, participants were divided into two groups: improved and unimproved participants. Participants were considered improved if they (1) showed significant improvement in at least two of the three primary outcome measures and (2) indicated subjective improvement. Thereafter, the baseline characteristics that correctly identify participants susceptible to improve significantly following treatment were determined (Cohen’s effect size d > 0.8).A significant improvement in tinnitus intensity was observed at the end of the program. Of the 31 participants, 14 experienced persistent improvement in the intensity of their tinnitus and were classified as improved. Baseline characteristics strongly associated with tinnitus improvement were no increase in tinnitus when exposed to noise (d = −1.57), no family history of tinnitus (d = −1.16), somatosensory modulation in response to the contraction used to resist pressure applied to the forehead (d = 1.20), and recent onset of tinnitus (d = 1.03).This exploratory study showed that a multimodal physiotherapy program is effective in decreasing the severity of tinnitus, principally in individuals presenting with somatosensory tinnitus in combination with specific clinical characteristics.

Effects of A 3-Month Physiotherapy Intervention in Stable Cervical Dystonia As Add-On to Botulinum Toxin Therapy

Background Treatment of choice for cervical dystonia comprises botulinum neurotoxin therapy. Whether additional physiotherapy can achieve better results is unclear. Objectives To show effects of physiotherapy as an add-on treatment to botulinum neurotoxin therapy. Methods 18 patients participated in this prospective interventional study (DRKS00006562) consisting of 2, 3-month periods. In the first period, usual botulinum toxin was applied. The second period comprised an additional multimodal physiotherapy program. Outcome measures were: range of motion, SF-36, Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), surface electromyography. Results In the comparison first phase vs. second phase patients showed significant improvements in range of motion (flexion/extension: 16.3 ± 25.4; rotation: 19.1 ± 24.6), TWSTRS (severity: 3.8 ± 3.0; disability: 1.7 ± 2.0; pain: 4.4 ± 4,1) and in mental health (SF-36: 5.9 ± 7.5); p <0.05, respectively. No significant changes were seen in the lateral flexion ROM, physical health (SF-36) and the surface electromyography. Conclusion Multimodal physiotherapy is a feasible and save additional treatment option for patients with cervical dystonia. An add-on physiotherapy program can achieve better treatment outcomes. Patients benefited especially with improved range of motion, and reduced pain and severity of symptoms.