Therapeutic Exercise for Chronic Whiplash-Associated Disorders: A Systematic Review of Randomized Controlled Trials on Pain, Disability, and Kinesiophobia.
4 affiliations
- 1Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy.
- 2Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy.
- 3Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero, 73, 94018 Troina, Italy.
- 4A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy.
Abstract
Background/objectives
Chronic whiplash-associated disorders (WAD) are a common cause of persistent neck pain and disability. Therapeutic exercise is widely used, but its effectiveness remains uncertain. This systematic review evaluated the effects of therapeutic exercise, alone or combined with other interventions, on pain, neck-related disability, and kinesiophobia in adults with chronic WAD.Methods
PubMed, PEDro, and the Cochrane Library were searched from inception to December 2025 for randomized controlled trials (RCTs) including adults with chronic WAD (>3 months). Eligible studies compared exercise-based interventions with minimal intervention, usual care, or other active treatments. Primary outcomes were pain and neck-related disability, with kinesiophobia as a secondary outcome. Methodological quality was assessed using the PEDro scale, risk of bias using Cochrane RoB 2, and certainty of evidence using GRADE. Due to heterogeneity, findings were synthesized without meta-analysis using SWiM principles.Results
Six reports representing five independent RCT cohorts (up to 635 unique participants) were included. Interventions included neck-specific exercise, home-based programmes, multimodal rehabilitation, and exercise combined with manual therapy. Exercise generally produced greater short- to medium-term improvements in pain and disability than minimal intervention or advice, whereas comparisons with other active treatments were heterogeneous and statistically inconclusive. Effects on kinesiophobia were inconsistent. PEDro scores ranged from 7-9/10. RoB 2 indicated predominantly some concerns. GRADE certainty was low for pain and disability and very low for kinesiophobia.Conclusions
Therapeutic exercise may improve pain and disability compared with minimal interventions, but evidence certainty is low. Its superiority over other active treatments and effects on kinesiophobia remain uncertain.
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BibTeX
@article{ferlito2026therapeutic,
title = {{Therapeutic Exercise for Chronic Whiplash-Associated Disorders: A Systematic Review of Randomized Controlled Trials on Pain, Disability, and Kinesiophobia.}},
author = {Rosario Ferlito and Giuseppe Lanza and Gianluca Testa and Vito Pavone and Fabio Manfrè and Salvatore Giunta},
journal = {Diseases (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/diseases14100366},
url = {https://europepmc.org/article/MED/42929993},
note = {CC BY},
}
RIS
TY - JOUR
TI - Therapeutic Exercise for Chronic Whiplash-Associated Disorders: A Systematic Review of Randomized Controlled Trials on Pain, Disability, and Kinesiophobia.
AU - Rosario Ferlito
AU - Giuseppe Lanza
AU - Gianluca Testa
AU - Vito Pavone
AU - Fabio Manfrè
AU - Salvatore Giunta
PY - 2026
DA - 2026/10/02
JO - Diseases (Basel, Switzerland)
DO - 10.3390/diseases14100366
UR - https://europepmc.org/article/MED/42929993
AB - Background/objectives Chronic whiplash-associated disorders (WAD) are a common cause of persistent neck pain and disability. Therapeutic exercise is widely used, but its effectiveness remains uncertain. This systematic review evaluated the effects of therapeutic exercise, alone or combined with other interventions, on pain, neck-related disability, and kinesiophobia in adults with chronic WAD.Methods PubMed, PEDro, and the Cochrane Library were searched from inception to December 2025 for randomized controlled trials (RCTs) including adults with chronic WAD (>3 months). Eligible studies compared exercise-based interventions with minimal intervention, usual care, or other active treatments. Primary outcomes were pain and neck-related disability, with kinesiophobia as a secondary outcome. Methodological quality was assessed using the PEDro scale, risk of bias using Cochrane RoB 2, and certainty of evidence using GRADE. Due to heterogeneity, findings were synthesized without meta-analysis using SWiM principles.Results Six reports representing five independent RCT cohorts (up to 635 unique participants) were included. Interventions included neck-specific exercise, home-based programmes, multimodal rehabilitation, and exercise combined with manual therapy. Exercise generally produced greater short- to medium-term improvements in pain and disability than minimal intervention or advice, whereas comparisons with other active treatments were heterogeneous and statistically inconclusive. Effects on kinesiophobia were inconsistent. PEDro scores ranged from 7-9/10. RoB 2 indicated predominantly some concerns. GRADE certainty was low for pain and disability and very low for kinesiophobia.Conclusions Therapeutic exercise may improve pain and disability compared with minimal interventions, but evidence certainty is low. Its superiority over other active treatments and effects on kinesiophobia remain uncertain.
SN - 2079-9721
ER -