Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial.
Gunnel Peterson, Emma Nilsing Strid, Margaretha Jönsson and 2 others
PMID 39072427WHAT IT FOUND
Internet-supported neck exercises achieved the same improvements in range of motion and endurance as twice-weekly physiotherapy.
Both groups improved equally, so the internet option is a valid alternative to frequent clinic visits for chronic whiplash.
Key findings
01There was no significant difference between the internet-supported group and the supervised clinic group for any measure of neck movement, muscle endurance, or pain.
02Both groups showed significant improvements in cervical range of motion, deep neck muscle activation, and neck muscle endurance from baseline to follow-up.
03Participants in the supervised clinic group reported higher compliance with exercises (94%) compared to the internet group (75%), yet both groups improved to the same extent.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This paper reports secondary outcomes; the primary outcome (disability) was analyzed elsewhere, so conclusions about functional capacity may not align with overall disability changes. The dropout rate at 15 months was high (29%) in both groups, though missing data analyses showed no significant differences between completers and non-completers. Compliance was significantly lower in the internet group, suggesting that self-directed adherence is harder to maintain than supervised adherence, even if outcomes were similar in this cohort.
Declared interests
The authors declare no conflicts of interest. Funding was provided by Swedish research councils and county councils, with no role for funders in study design, analysis, or manuscript preparation.
The easy way to misread this
Do not assume that internet delivery is superior because it requires fewer visits. The study showed equivalence in outcomes, not superiority, and the internet group had significantly lower compliance, meaning the 'less is more' approach worked here only because the exercises themselves were effective, not because the delivery method was better.