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Effects of Cognitive Behavior Therapy on Patients with Chronic Whiplash-Associated Disorders: A Systematic Review and Meta-analysis

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Abstract

To determine the effectiveness of cognitive behavioral therapy (CBT) alone and in combination with physical interventions on pain, disability, quality of life, and psychological parameters in patients with chronic whiplash-associated disorders (WADs). Several databases were systematically searched for randomized controlled trials (RCTs). Pooled effects were analyzed as standardized mean differences (SMD) and 95% confidence intervals (CI). We assessed the evidence quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Of the 2287 studies identified, 8 were included in the review, of which, 7 were suitable for meta-analysis. We found moderate-quality evidence that CBT does not provide different degrees of short-term (6 RCTs; SMD, − 0.20; 95% CI, − 0.50 to 0.10) or long-term improvement in disability (3 RCTs; SMD, − 0.18; 95% CI, − 0.46 to 0.10) than is indicated by other types of intervention comparison. Subgroup analyses indicated low-quality evidence that CBT alone has a medium to large effect on short-term improvement in disability (2 RCTs; SMD, − 0.61; 95% CI, − 1.21 to − 0.01) compared with wait-and-see control. Additionally, we found moderate-quality evidence that CBT, combined with physical interventions, has a small effect on long-term improvement in disability (2 RCTs; SMD, − 0.29; 95% CI, − 0.53 to − 0.06) compared with advice alone. No differences were found for pain or long-term quality of life. The study found moderately favorable evidence of the combined effect of physical interventions and CBT against advice alone in long-term disability.

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Authors and Affiliations

  1. Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan

    Yu Kondo & Takahiro Miki

  2. Graduate School, Hokkaido University, Sapporo, Japan

    Takahiro Miki

  3. Graduate School, Saitama Prefectural University, Koshigaya, Japan

    Takahiro Miki

  4. Department of Rehabilitation, Yumenomachi Home Nursing Care and Rehabilitation Service, Chiba, Japan

    Hiroshi Kurakata

  5. Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan

    Tsuneo Takebayashi

  6. Division of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan

    Hiroshi Takasaki

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  1. Yu Kondo
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  2. Takahiro Miki
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  3. Hiroshi Kurakata
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  4. Tsuneo Takebayashi
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Contributions

Conceptualization: YK, TM, HT. Data curation: YK, TM, HK. Formal analysis: YK, TM, HK. Investigation: YK, TM, HK. Methodology: YK, TM, HK, HT. Project administration: MT, TT, HT. Supervision: TT, HT. Visualization: TT. Writing – original draft: YK, TM, HT. Writing – review & editing: TT, HK.

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Correspondence to Takahiro Miki.

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Kondo, Y., Miki, T., Kurakata, H. et al. Effects of Cognitive Behavior Therapy on Patients with Chronic Whiplash-Associated Disorders: A Systematic Review and Meta-analysis. J Rat-Emo Cognitive-Behav Ther 41, 856–879 (2023). https://doi.org/10.1007/s10942-022-00490-y

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