Manual Therapy Dosage Factorial Study

• Quantitative Sensory Testing (QST) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Current Perception Threshold (CPT) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Neck Walk Index (NWI) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Cyclical Reach and Grasp Test (CRGT) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Muscle Biology (cytokine analyses) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Central Breathing Control Test [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Neck Disability Index [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Pain Intensity - Visual Analogue Scale (VAS) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]

• Quantitative Sensory Testing [ Time Frame: During treatment period ]
• Current Perception Threshold [ Time Frame: During treatment period ]
• Neck Walk Index [ Time Frame: During treatment period ]
• Upper Quadrant Reach and Grasp Task [ Time Frame: During treatment period ]
• Muscle Biology (cytokine analyses) [ Time Frame: During treatment period ]
• Central Breathing Control Test [ Time Frame: During treatment period ]
• Neck Disability Index [ Time Frame: During treatment period ]
• Perceived Self-Efficacy [ Time Frame: During time period ]
• Disabilities of the Arm, Shoulder, Hand [ Time Frame: During treatmetn period ]
• Pain Threshold and Tolerance Algometry [ Time Frame: During time period ]

• Global Perceived Effect (GPE) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Disabilities of the Arm, Shoulder, and Hand (DASH) [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Pain Threshold and Pain Tolerance Algometry [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Head Flexion Endurance [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Range of Motion [ Time Frame: Within 24 weeks ] [ Designated as safety issue: No ]
• Quality of Life (SF-36v2) [ Time Frame: within 24 weeks ] [ Designated as safety issue: No ]

This study will determine biological responses to different dosages of neck mobilization intervention in patients, providing opportunities to identify the optimal dosage, predictors of response, outcome measures as well as the longitudinal changes in biology.

Subjects with acute whiplash associated disorders (WAD) II and III with a symptom duration of less than 30 days (acute) or 30 to 90 days (subacute) will be randomly assigned to receive different doses of mobilization. The dosage treatment groups will differ in the number of sessions (1, 2 or 3 times per week) and the duration of treatment (duration of treatment intervention will be 3, 6, or 12 weeks). A zero treatment/week option is included to insure that the impact of any mobilization is included and because previous studies suggest a single mobilization may have a treatment effect.

All patient participants will receive a core standard treatment of education, advice to stay active, and neck/postural stretching and strengthening exercise. All patient participants will receive supervised exercise and advice for the full 12 weeks. All patients will be provided with an instructional CD and exercise brochure to reinforce the whole program.

Follow-up assessments will consist of quantitative sensory testing (vibration threshold; current perception threshold), the Neck Walk Index (NWI), the Upper Cyclical Reach and Grasp Task, muscle biology analyses (cytokine analyses), central breathing control tests (capnography), range of motion, head flexion endurance, and self-report symptoms and disability (Visual Analogue Scale; Neck Disability Index; Disabilities of the Arm, Shoulder, Hand; pain threshold and tolerance algometry; and perceived self-efficacy; SF-36).

Hypothesis: During recovery, patient are expected to transition from an acute painful state to one where they can resume normal activity and add intensive strengthening exercises.

• No Intervention: A
  Zero treatment/3 weeks
• Active Comparator: B
  Frequency of Mobilization:1/week Duration of Mobilization Treatment: 3 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: C
  Frequency of Mobilization: 1/week Duration of Mobilization Treatment: 6 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: D
  Frequency of Mobilization: 1/week Duration of Mobilization Treatment: 12 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: F
  Frequency of Mobilization: 2/week Duration of Mobilization Treatment: 3 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: G
  Frequency of Mobilization: 2/week Duration of Mobilization Treatment:6 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: H
  Frequency of Mobilization: 2/week Duration of Mobilization Treatment: 12 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: J
  Frequency of Mobilization: 3/week Duration of Mobilization Treatment: 3 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: K
  Frequency of Mobilization: 3/week Duration of Mobilization Treatment:6 weeks
  Intervention: Procedure: Mobilization
• Active Comparator: L
  Frequency of Mobilization: 3/week Duration of Mobilization Treatment:12 weeks
  Intervention: Procedure: Mobilization
• No Intervention: E
  Zero treatment/6 weeks
• No Intervention: I
  Zero treatment/12 weeks

Inclusion Criteria:

• acute whiplash associated disorders (WAD) II and III (113) with a symptom duration of less than 30 days or subacute (30 to 90 days)
• pain in the neck but may radiate to the shoulder region or upper extremities or have an associated headache
• pain intensity must be at or above 30 mm on a 100 mm visual analogue scale
• must be a new episode of pain with ,no other occurrences of neck pain requiring treatment in the previous 4 months.

Exclusion Criteria:

• arthritis, neurological diseases, fractures, dislocation, rheumatoid arthritis, long tract signs and malignancy
• conditions that make the provision of neck exercise unsafe

• Canadian Institutes of Health Research (CIHR)
• National Institutes of Health (NIH)
• University of Western Ontario, Canada