Novel Internet Support for Neck-Specific Rehabilitation Improves Work-Related Outcomes to the Same Extent as Extensive Visits to a Physiotherapy Clinic in Individuals with Chronic Whiplash-Associated Disorders: A Prospective Randomised Study.

This paper reports work-related secondary outcomes from a trial powered for the Neck Disability Index, not for Work Ability Score or other work measures. No non-inferiority analysis was performed because clinically relevant improvement data for Work Ability Score in chronic whiplash was unavailable, so no significant group difference is not proof of equivalence. Analyses used complete responders for Work Ability Score at all time points: 55 NSEIT and 57 NSE, while 15 NSEIT and 13 NSE were non-complete responders; non-complete responders were younger, although age was not correlated with change. Participants were recruited through advertisements, had to be able to read and write Swedish, have daily Internet access and be of working age, which may limit transferability to ordinary healthcare populations. Both groups received the same neck-specific rehabilitation programme, exercises and physiotherapist contact, so the contribution of Internet support, the number of visits, exercise content, education or behavioural support cannot be separated. The multicentre design involved many physiotherapists and less control over treatment delivery, although therapists received training and project support. Exercise compliance was self-reported and lower in the Internet group. Fear Avoidance Beliefs Questionnaire work scores were already low at baseline, so there was limited room for improvement. There was no untreated control group because the authors considered it unethical.

Funding came from the Swedish Research Council, the Medical Research Council of Southeast Sweden, the County Council of Östergötland, Landstinget Sörmland and Linköping University. The supplied text does not report author conflicts of interest.

Do not read this as proof that Internet support is equivalent to 24 physiotherapy visits. The work outcomes were secondary, the trial was powered for neck disability rather than work ability, and no non-inferiority analysis was done. Both groups also received the same neck-specific exercises and physiotherapist contact, so the internet component alone cannot be credited.