ABSTRACT:Psychological treatments are increasingly being developed and delivered using platforms such as mobile applications, online modules, virtual reality, and artificial intelligence chatbots. This scoping review aimed to examine how digital psychological interventions deliver outcomes that are valuable not only for patients but also for clinicians and the broader health system. Peer-reviewed studies evaluating digital psychological interventions for adults with chronic primary pain and chronic primary or secondary musculoskeletal pain were included. Seven databases were searched: PubMed, Embase, CINAHL, Web of Science, Scopus, PsycInfo, and Cochrane. Screening was conducted independently by 2 reviewers, with a third reviewer providing consensus in cases of conflict. After screening, 108 articles met the eligibility criteria, reporting on 81 distinct interventions. Outcomes were mapped to the quadruple aim of health care to assess for improvements in population health, patient experiences, clinician experiences, and cost-efficiency. All interventions demonstrated improved health outcomes for people living with pain, with most also assessing patient experiences (n = 65, 80.2%). Few measured clinician experiences (n = 22, 27.2%) or cost-effectiveness (n = 8, 9.9%). Only 2 interventions reported outcomes that addressed all 4 quadrants of the quadruple aim of health care. At the time of review, a third of the interventions (n = 27, 33.3%) were available for use in real-world settings. Overall, current evaluations demonstrated positive impact on population health, patient experience, and access to psychological care. However, limited understanding remains on how clinicians are supported to refer and implement these treatments, as well as the costs of integrating them into routine care.

ABSTRACT:Around 50% of individuals with minor to moderate motor vehicle crash injuries experience adverse health outcomes up to 2 years postinjury, yet the associations between preinjury health on postinjury outcomes are unclear. Understanding these associations could support risk stratification and inform targeted interventions for individuals at risk of poor postinjury outcomes. In this review, we synthesized the available evidence on these associations. We identified relevant observational studies using an electronic search of 6 databases. We assessed risk of bias using Quality in Prognosis Studies, conducted random-effects meta-analyses where possible, and provided a narrative synthesis where meta-analysis was not possible. We included 58 articles (32 study populations, n = 27,167) and conducted meta-analyses on data from 13 studies (n = 7829). Meta-analyses and narrative syntheses showed that preinjury pain doubled the odds of acute/subacute (adjusted odds ratio 2.02 [95% confidence interval 1.21-3.36]) and chronic (adjusted odds ratio 2.28 [95% confidence interval 1.52-3.43]) postinjury pain. Preinjury mental health conditions consistently predicted later mental health problems. Limited evidence indicated that preinjury pain was associated with subsequent mental health problems and perceived poor recovery, whereas preinjury mental health conditions were associated with later pain, physical disability, and lower quality of life. Across outcomes, associations with preinjury general health were absent or inconsistent; evidence for preinjury physical health, sleep, and history of injury was sparse. The certainty of evidence ranged from very low to moderate. In conclusion, evidence generally suggests that preinjury physical and psychological vulnerabilities may contribute to poor postinjury outcomes. Preinjury pain is the most robust predictor of postinjury pain, and preinjury mental health conditions may predispose individuals to later mental health problems.

'Perceived threat', or the anticipation of harm/loss associated with injury may influence persistent pain. Changes in perceived threat over time, and its association with pain interference and distress over time are unknown. This study recruited 138 patients (mean (SD) age 41.1(14.8), 65% female) with isolated extremity injuries within three weeks of injury and re-assessed them at 6 weeks, 3 and 6 months. Group-based trajectory modelling was used to identify trajectories of perceived threat, pain interference, anxiety, depression and post-traumatic stress symptoms, and to examine their interrelationships. Logistic regression explored baseline predictors of perceived threat trajectory group membership. Identified trajectory groups were: 1) perceived threat (improving low (37%), improving medium (42.2%) and stable high (20.8%)); 2) pain interference (improving moderate to mild (59.4%) and improving severe to moderate (40.6%)); 3) anxiety symptoms (none (79.2%) and stable moderate to severe (20.8%)); 4) depressive symptoms (none (22.7%), improving mild to none (57.1%) and stable moderate to severe (20.2%); and 5) PTSD (stable low (65.2%), stable moderate (21.2%) and improving (13.7%)). Strong linkages were identified between the low perceived threat and mild pain interference and distress symptom trajectories, and between the stable high perceived threat and the severe to moderate pain interference trajectories. Higher baseline pain intensity (OR[95%CI]= 1.46[1.13-1.90]) and anxiety (OR[95%CI]= 1.08[1.01-1.16]) predicted membership to the stable high perceived threat trajectory group. Findings suggest perceived threat reflects both trait-like and dynamic features. Patients with high, stable perceived threat are likely to have worse pain interference, but not necessarily worse psychological distress. PERSPECTIVE: Following an extremity injury, most adults show low or improving perceived threat, pain interference, and distress over six months. About one in five experience persistently high perceived threat, associated with greater pain interference but not consistently with psychological distress. High perceived threat may mark patients with more complex recovery patterns.

By focusing on unwanted but necessary service experiences such as medical procedures, this research steps beyond conventional customer experience literature. It reframes the delivery of healthcare services within a customer experience management framework, highlighting the many healthcare-controlled touchpoints, presence of decision-deferral, and diminished power in customer choice. Survey data from a large sample of Australian hysterectomy patients was used to identify two personas that reflected differences in the co-created customer journey. An 'I choose' persona was more inclined to include customer-owned touchpoints, interacting with friends and family, whereas an 'I accept' persona almost exclusively used healthcare-controlled touchpoints. Findings suggest that if patients are successfully supported through negative touchpoints, they can have high levels of satisfaction with even the most unwanted customer experiences. Patients who defer their decisions are more dissatisfied with the experience.

ABSTRACT:Developmental trajectories for neck disability after whiplash injury have been identified. Their relationship to cold and mechanical sensitivity trajectories is not known. We aimed to (1) identify recovery trajectories of cold and mechanical sensitivity, (2) explore their codevelopment with disability trajectories, (3) identify predictors of sensitivity trajectories, and (4) explore codevelopment of cold and mechanical sensitivity trajectories. Participants (n = 233) were assessed at <1, 3, 6, and 12 months after whiplash injury. Outcomes were cold pain detection threshold (CPT at neck), pressure pain detection thresholds (PPT, neck C5, and tibialis anterior), and the Neck Disability Index. We used group-based trajectory models to identify postinjury recovery trajectories and multinominal logistic regression to explore associations between baseline characteristics and trajectory membership. We identified the following trajectory groups: CPT (low [50.0%], moderate [29.7%], and high [20.4%] sensitivity); PPT C5 (low [10.8%] and high [89.2%] sensitivity); and PPT tibialis anterior (low [23.9%], moderate [39.0%], and high [37.1%] sensitivity); all were stable over the 12 months. There was good correspondence between disability and cold sensitivity trajectory groups but not for mechanical sensitivity; cold and mechanical sensitivity trajectories were not well associated. Higher baseline pain predicted membership of the high cold sensitivity trajectory (RR 1.27, 95% CI 1.01-1.59) and hyperarousal symptoms predicted membership of the moderate cold sensitivity trajectory (RR 1.17, 95% CI 1.01-1.36). We found no associations between baseline characteristics and mechanical sensitivity. There is an interplay between cold allodynia, pain, and hyperarousal symptoms in development of ongoing disability after whiplash injury. Different mechanisms likely underlie cold and mechanical sensitivity.

Background Mental health symptoms are commonly experienced after sustaining an injury in a motor vehicle crash (MVC). Around 80% of MVCs are classified as minor to moderate (e.g., whiplash, sprains, strains), yet around half experience mental health impairments one-year post-injury. The prevalence, frequency, and determinants of mental health service use after these injuries are unclear. Methods A systematic literature review was conducted. Searches for primary studies reporting the prevalence of mental health practitioner interactions or medicines use after minor to moderate MVC injury were conducted in six databases (CINHAL, MEDLINE, Embase, Scopus, Web of Science, and PsycINFO). The primary outcome is the period prevalence of mental health service use. Secondary outcomes were determinants and patterns of service use. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Findings from eligible studies were reported in subgroups of mental health service type, injury severity, and follow-up period. Results From 4087 identified records, 12 studies were included. Prevalence of service use varied from 0.5% to 83% over time periods from <12 weeks to 106 months. Most studies (n = 9) included data from cohorts with mixed injury types. Studies were largely (11/12) retrospective cohort studies conducted in Victoria, Australia, with a single register-based cohort study in Sweden. Five studies reported psychological therapies, four examined medication use, and three included a mix. Determinants of mental health service use included female sex, seeking common law compensation, and soft tissue injury. Frequency was reported by eight studies, timing to first service was reported by one, and duration of care was reported by one. Conclusions Prevalence increased with longer follow-up periods and was higher for psychological therapies than medications. However, estimates varied substantially due to differing outcome definitions, study designs, and cohort characteristics. Improvements in recording and reporting of mental health service use will lead to enhanced understanding of mental health service use, supporting more effective service planning and delivery, and ultimately contributing to better health outcomes after MVC injury.

BackgroundIn most countries, men complete suicide at twice the rate of women; masculinity plays an important role in placing men at a greater risk of suicide. This study identifies and describes trends in the topics discussed within the masculinity and suicide literature and explores changes over time.MethodsWe retrieved publications relating to masculinity and suicide from eight electronic databases and described origins in the field of research by reference to the first decade of publications. We then explored the subsequent evolution of the field by analysis of the content of article titles/abstracts for all years since the topic first emerged, and then separately by three epochs.ResultsWe included 452 publications (1954-2021); research output has grown substantially in the last five years. Early publications framed suicide in the context of severe mental illness, masculinity as a risk factor, and suicidality as being aggressive and masculine. We observed some differences in themes over time: Epoch 1 focused on sex differences in suicidality, a common theme in epochs 2 was relationship to work and its effect on men's mental health and suicidality, and epoch 3 had a focus on help-seeking in suicidality.ConclusionThe research field of masculinity and suicide is growing strongly, as evidenced by recent increase in publication volume. The structure, content and direction of the masculinity and suicide research are still evolving. Researchers must work with policymakers and practitioners to ensure that emerging findings are translated for use in programs designed to address suicide in boys and men.

INTRODUCTION:Previous reviews of mobile messaging for individuals with musculoskeletal pain have shown positive effects on pain and disability. However, the configuration of digital content, method of presentation and interaction, dose and frequency needed for optimal results remain unclear. Patient preferences concerning such systems are also unclear. Addressing these knowledge gaps, incorporating evidence from both experimental and observational studies, may be useful to understand the extent of the relevant literature, and to influence the design and outcomes of future messaging systems. We aim to map information that could be influential in the design of future mobile messaging systems for individuals with musculoskeletal pain conditions, and to summarise the findings of efficacy, effectiveness, and economics derived from both experimental and observational studies. METHODS AND ANALYSIS:We will include studies describing the development and/or use of mobile messaging to support adults (≥18 years) with acute or chronic musculoskeletal pain. We will exclude digital health studies that lack a mobile messaging component, or those targeted at other health conditions unrelated to the bones, muscles and connective tissues, or involving surgical or patients with cancer, or studies involving solely healthy individuals. Our sources of information will be online databases and reference lists of relevant papers. We will include papers published in English in the last 10 years. Two pairs of independent reviewers will screen, select and extract the data, with any disagreements mediated by a third reviewer. We will report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. We will synthesise the findings in a tabular format and provide a descriptive summary. ETHICS AND DISSEMINATION:Formal ethical approval is not required. We will disseminate the findings through publication in a peer-reviewed journal, relevant conferences, and relevant consumer forums. TRIAL REGISTRATION:Open Science Framework https://osf.io/8mzya; DOI: 10.17605/OSF.IO/8MZYA.

Insufficient and deficient vitamin D may be associated with chronic musculoskeletal pain, but study findings are conflicting, and few account for important confounding factors. This cross-sectional study explored the association between serum vitamin D status and chronic musculoskeletal pain in various body sites, adjusting for a wide range and a number of potential confounding factors. Data collected at the baseline assessments of 349,221 UK Biobank participants between 2006 and 2010 were analyzed. Serum 25-hydroxyvitamin D was measured and categorized as <25.0 nmol/L (severe deficiency), 25.0 to 49.9 nmol/L (deficiency), 50.0 to 74.9 nmol/L (insufficiency), and ≥75.0 nmol/L (sufficiency). The outcome was self-reported chronic musculoskeletal pain at any site, neck/shoulder, back, hip, knee, or widespread pain that interfered with usual activities. Potential confounders were identified using directed acyclic graphs and included sociodemographic, lifestyle, psychological factors, and medical comorbidities. Simple models adjusted for age and sex showed significant associations between suboptimal vitamin D status and chronic pain across all sites (odds ratios [ORs] ranged 1.07-2.85). These associations were weakened or became insignificant after accounting for all confounding factors (ORs ≤ 1.01) for chronic regional musculoskeletal pain. Severe vitamin D deficiency remained a significant and positive association with chronic widespread pain after adjusting for all confounding factors (OR [95% confidence interval]: 1.26 [1.07, 1.49]). This study suggests that, while vitamin D status is not a key independent determinant of chronic regional musculoskeletal pain, severe vitamin D deficiency may be associated with chronic widespread pain. PERSPECTIVE: After accounting for various confounders, vitamin D deficiency was not associated with regional musculoskeletal pain. However, the relationship between chronic widespread pain severe vitamin D deficiency remained after confounder adjustment. Use of vitamin D supplements in individuals with chronic widespread pain and severe vitamin D deficiency warrants further exploration.

Historically, telemedicine research is predominantly published in discipline-specific telemedicine journals. However, in recent times the number of publications on telemedicine in clinical journals has increased. Acceptance of telemedicine research by clinical journals indicates a maturing of the telemedicine field. This bibliometric study reviewed telemedicine-related literature published in clinical journals from 2008 to 2018. A search was conducted in PubMed using two types of clinical outlets. (1) Top 20 journals with highest Impact Factor in the field of Medicine. (2) Top five journals with highest Impact Factor in most common Medical Specialty Areas. Analysis showed that there is a steady growth of literature relating to research and non-research publications appearing in clinical journals. Top five journals in the field of Medicine - BMJ, JAMA, Cochrane database, Medical Journal of Australia and Lancet have published 64% (n = 270) of telemedicine-related articles for the study period. Disease areas associated with telemedicine publications are consistent with global disease priorities. The review demonstrated that the most significant increase in telemedicine research published in clinical journals was focused on patient care.

Inflammation is linked with chronic pain but the extent to which this relationship is associated with biopsychosocial factors is not known. We investigated relationships between blood Creactive protein (CRP) and regional chronic pain conditions adjusting for a large range and number of potential confounders. We performed cross-sectional analyses using the UK Biobank (N = 415,567) comparing CRP in people reporting any of 9 types of regional chronic pain with pain-free controls. Using logistic regression modelling, we explored relationships between CRP and the presence of chronic pain, with demographic, socioeconomic, psychological/lifestyle factors, and medical comorbidities as covariates. CRP was higher in chronic pain at any site compared with controls (Females: median [interquartile range] 1.60 mg/L [2.74] vs 1.17 mg/L [1.87], P < .001; Males: 1.44 mg/L [2.12] vs 1.15 mg/L [1.65], P < .001). In males, associations between CRP and all types of chronic pain were attenuated but remained significant after adjustment for biopsychosocial covariates (OR range 1.08-1.49, P <= .001). For females, adjusted associations between CRP and pain remained significant for most chronic pain types (OR range 1.07-1.34, P < .001) except for facial pain (OR 1.04, P = .17) and headache (OR 1.02, P = .07)-although these non-significant findings may reflect reduced sample size. The significant association between CRP and chronic pain after adjustment for key biopsychosocial confounders implicates an independent underlying biological mechanism of inflammation in chronic pain. The presence of yet unknown or unmeasured confounding factors cannot be ruled out. Our findings may inform better-targeted treatments for chronic pain. Perspective: Using a large-scale dataset, this article investigates associations between chronic pain conditions and blood C-reactive protein (CRP), to evaluate the confounding effects of a range of biopsychosocial factors. CRP levels were higher in those with chronic pain versus controls after adjusting for confounders-suggesting a possible independent biological mechanism. (R) 2023 Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc

ABSTRACT:Current pathways of care for whiplash follow a "stepped care model," result in modest treatment outcomes and fail to offer efficient management solutions. This study aimed to evaluate the effectiveness of a risk-stratified clinical pathway of care (CPC) compared with usual care (UC) in people with acute whiplash. We conducted a multicentre, 2-arm, parallel, randomised, controlled trial in primary care in Australia. Participants with acute whiplash (n = 216) were stratified for risk of a poor outcome (low vs medium/high risk) and randomised using concealed allocation to either the CPC or UC. In the CPC group, low-risk participants received guideline-based advice and exercise supported by an online resource, and medium-risk/high-risk participants were referred to a whiplash specialist who assessed modifiable risk factors and then determined further care. The UC group received care from their primary healthcare provider who had no knowledge of risk status. Primary outcomes were neck disability index (NDI) and Global Rating of Change (GRC) at 3 months. Analysis blinded to group used intention-to-treat and linear mixed models. There was no difference between the groups for the NDI (mean difference [MD] [95% confidence interval (CI)] -2.34 [-7.44 to 2.76]) or GRC (MD 95% CI 0.08 [-0.55 to 0.70]) at 3 months. Baseline risk category did not modify the effect of treatment. No adverse events were reported. Risk-stratified care for acute whiplash did not improve patient outcomes, and implementation of this CPC in its current form is not recommended.

Background Whiplash associated disorders (WAD) are the most common non-hospitalised injuries resulting from a motor vehicle crash. Half of individuals with WAD experience ongoing pain and disability. Furthermore, individuals with persistent WAD have lower levels of aerobic capacity and isometric strength compared with age-matched controls. It is not known whether these differences are associated with increased levels of pain and disability, or with reduced physical activity (PA) participation. Objective Our primary aim was to compare PA levels in individuals with persistent WAD with healthy controls. Secondary aims were to: compare objective and subjective measurements of PA; explore factors that may influence PA; and describe proportions of these populations meeting World Health Organisation PA guidelines. Methods Objective (ActiGraph accelerometer; seven days) and subjective (International Physical Activity Questionnaire (IPAQ)) PA data were collected for n = 53 age-matched participants (WAD n = 28; controls n = 25). Results Independent sample t-tests showed no significant difference in objectively measured PA (p>0.05) between WAD and controls. For the subjective measure (IPAQ), controls reported more overall weekly PA (t = 0.219, p<0.05), while WAD participants reported more weekly walking minutes (t = -0.712, p<0.05). Linear regression showed mental health quality-of-life predicted objectively measured moderate intensity PA (R-2 = 0.225, F (2, 44) = 6.379, p<0.004) and subjectively reported overall PA (R-2 = 0.132, F (1, 41) = 6.226, p<0.017). Bland-Altman analyses indicated that subjects over-reported MVPA and under-reported sedentary time using the IPAQ. Conclusions Individuals with WAD had levels of physical and mental health quality-of-life significantly lower than controls and below population norms yet participated in similar levels of PA. Given that increased perceptions of mental health quality-of-life were positively associated with objectively measured MVPA and subjectively reported overall PA, strategies to help people with WAD achieve adequate doses of MVPA may be beneficial. ActiGraph-measured and IPAQ-reported PA were discordant. Hence, IPAQ may not be a reliable measure of habitual PA in WAD.

Introduction Screening for retinopathy of prematurity (ROP) is an important procedure in the prevention of blindness in high-risk preterm infants. In the regionalised healthcare system of Queensland (Australia), outside of the major centres, some preterm infants are cared for in special care nurseries (SCNs). When necessary, infants in these nurseries who are at risk of ROP are transferred to a tertiary hospital for screening by paediatric ophthalmologists. The transport of preterm infants for eye examinations adds risk and incurs significant costs to the health system. Using a cost-minimisation approach, we aimed to compare the costs of the current ROP screening practice with two alternative telemedicine approaches. Methods We constructed a decision analytic model to estimate costs from a health service perspective with a five-year analysis horizon; activity data from a tertiary ROP screening service were used to inform the models. The three models assessed were: (a) a digital retinal photography (DRP)-equipped travelling nurse, (b) equipping SCNs with DRP, and providing training to local nurses, and (c) current practice of infant transfer. In all cases, the tertiary centre provides specialist ophthalmologic review. Results Of the three models, we estimated the most expensive option to be equipping SCNs with DRP and providing training to local nurses (AUD$4114/infant). We found that the current practice of transferring infants was the second most expensive (AUD$1021/infant). The most economical model was the specialist nurse travelling to each SCN with a portable DRP (AUD$363/infant). A sensitivity analysis, which assessed uncertainty and variability around the cost estimates, found that the ranking for the expected costs of the alternative models of care did not change. Discussion This is the first economic and cost-minimisation analysis in Australia to compare the costs of the current screening programme with two alternative telemedicine approaches for screening ROP. Telemedicine programmes that facilitate non-physician screening may improve the cost efficiency of the health system while maintaining the health outcomes for children, and reducing the risk associated with infant transport.

Introduction Digital health - the convergence of digital technologies within health and health care to enhance the efficiency of health-care delivery - is fast becoming an integral part of routine medical practice. The integration of digital health into traditional practice brings significant changes. Logic dictates that for medical practitioners to operate in this new digitally enabled environment, they require specific knowledge, skills and competencies relating to digital health. However, very few medical programmes in Australia and globally include digital health within their regular curriculum. This pilot study aimed to explore medical students' perceptions and expectations of digital health education and training (ET). Methods An online survey and focus groups were used to collect information about medical students' perceptions and expectations relating to digital health and ET relating to this field within the medical programme at the University of Queensland. Sixty-three students took part in the survey, and 17 students were involved in four focus groups. Results Most participants had no formal ET in digital health. Most participants (n = 43; 68%) expressed a willingness to learn about digital health as part of their medical programme. Discussion Primarily, knowledge- and practice-related factors have motivated students to learn about digital health. The analysis of focus group data identified two superordinate themes: (a) drivers of digital health ET and (b) expectations relating to digital health ET. Students agreed that digital health is a relevant field for their future practice that should be taught as part of their regular curriculum.

AbstractBackgroundOverweight or obesity is common in endometrial cancer (EC). This study aimed to examine sociodemographic, clinical, and psychosocial characteristics associated with being discontent with current weight and use of weight control methods among long‐term EC survivors.MethodsWomen diagnosed with early‐stage EC who participated in the Laparoscopic Approach to Cancer of the Endometrium (LACE) trial (n = 516) were invited to complete a long‐term follow‐up survey at least 4.5 years after treatment. Chi‐square test and multivariate logistic regression models adjusted for time since surgery were used to determine factors associated with being discontent with current weight.ResultsOn average 9 years after surgery, 190/259 (73%) of participants were currently discontent with their weight, and 146 (56%) had used one or more weight loss methods during the past 12 months. Women who were discontent with their weight were more likely to be younger than 70 years (p < 0.000), and used one or more weight loss methods ever or during the past 12 months (p < 0.000). Among the weight loss methods used, exercise (40.1%), meal reductions (52.7%), or fat/sugar reductions (48.5%) were much more commonly reported than fasting (2.6%) or designated weight loss programs (2.3%).ConclusionsOur study provides evidence that the majority of long‐term EC survivors in this clinical trial population are discontent with their weight and over half continue to use multiple methods to lose weight each year. These data indicate that health professionals and lifestyle educators need to assess weight issues, and develop a tailored plan to address the specific needs of long‐term survivors to assist them become content with their weight after treatment for EC.

Many people with chronic whiplash associated disorders (WAD) also have symptoms of posttraumatic stress disorder (PTSD), but this is rarely considered in usual predominantly exercise based interventions. We aimed to investigate the effectiveness of combined trauma focused cognitive behavioural therapy (TF-CBT) and exercise compared to supportive therapy (ST) and exercise for people with chronic WAD and PTSD. A randomised controlled multi-centre trial with concealed allocation, assessor blinding, and blinded analysis was conducted. 103 participants with chronic WAD (>3 months and <5 years, grade II) and PTSD were randomised to TF-CBT and exercise (n=53) or ST and exercise (n=50). Both interventions comprised 10 weeks of TF-CBT or ST followed by 6 weeks of exercise. Outcomes were measured at baseline, 10 weeks, 16 weeks, 6 months, and 12 months post-randomisation. Analysis was intention to treat using linear mixed models. There was no difference between the interventions on the primary outcome of neck pain related disability at any time point. At 16 weeks, the treatment effect on the 0-100 Neck Disability Index was 0.59 (95% CI 5.51 to -4.33), at 6 months 1.18 (6.15 to -3.78), and at 12 months 1.85 (6.81 to -3.11). In addition, there was no difference between the interventions for the majority of secondary outcomes at any time. Exceptions were in favour of TF-CBT and exercise, where improvements in PTSD symptoms were found at 16 weeks. From 16 weeks onwards, both groups achieved a clinically important improvement in neck pain related disability. However, both groups remained moderately disabled.

ObjectiveTo compare the effectiveness of different physical exercise interventions for chronic non-specific neck pain.DesignSystematic review and network meta-analysis.Data sourcesElectronic databases: AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus.Eligibility criteriaRandomised controlled trials (RCTs) describing the effects of any physical exercise intervention in adults with chronic non-specific neck pain.ResultsThe search returned 6549 records, 40 studies were included. Two networks of pairwise comparisons were constructed, one for pain intensity (n=38 RCTs, n=3151 participants) and one for disability (n=29 RCTs, n=2336 participants), and direct and indirect evidence was obtained. Compared with no treatment, three exercise interventions were found to be effective for pain and disability: motor control (Hedges’g, pain −1.32, 95% CI: −1.99 to −0.65; disability −0.87, 95% CI: –1.45 o −0.29), yoga/Pilates/Tai Chi/Qigong (pain −1.25, 95% CI: –1.85 to −0.65; disability –1.16, 95% CI: –1.75 to −0.57) and strengthening (pain –1.21, 95% CI: –1.63 to −0.78; disability –0.75, 95% CI: –1.28 to −0.22). Other interventions, including range of motion (pain −0.98 CI: −2.51 to 0.56), balance (pain −0.38, 95% CI: −2.10 to 1.33) and multimodal (three or more exercises types combined) (pain −0.08, 95% CI: −1.70 to 1.53) exercises showed uncertain or negligible effects. The quality of evidence was very low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.ConclusionThere is not one superior type of physical exercise for people with chronic non-specific neck pain. Rather, there is very low quality evidence that motor control, yoga/Pilates/Tai Chi/Qigong and strengthening exercises are equally effective. These findings may assist clinicians to select exercises for people with chronic non-specific neck pain.PROSPERO registration numberCRD42019126523.

Background: Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCTstudy. For individuals with whiplash injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelinesbased clinical pathway of care compared with usual care. Methods: We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planned methods of reporting. Discussion: This paper will provide a detailed description of the planned analyses for the Whiplash ImPaCT trial. (C) 2021 Associacao Brasileira de Pesquisa e Pos-Graduacao em Fisioterapia. Published by Elsevier Espana, S.L.U. All rights reserved.