Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury; a randomized controlled study using a hybrid 2 design

Effective treatment in chronic whiplash-associated disorders (WAD) and non-specific neck pain has been lacking.

There is growing evidence that neck-specific exercises (NSE) have a significant effect in chronic WAD and that the exercises can be internet-delivered (NSEIT).We aim to evaluate an implementation strategy in primary care, the diffusion of the method to other neck pain disorders, and the effectiveness of NSEIT and NSE in patients with WAD or non-specific neck pain.The project organization includes experienced researchers in neck pain rehabilitation, multicentre clinical trials, and implementation science.

The team has a large network of contacts with healthcare providers in primary care, essential for implementing research.

The study collection is expected to be finalized in December 2025 and research reporting in December 2026.This is a prospective, cluster-randomized (20 clinics, total of 500 patients), mixed-design study with evaluation after 3 and 12 months. The primary outcome of the implementation is the proportion of patients prescribed NSE/NSEIT.

The primary outcome at the patient level is self-reported neck function. To broaden the knowledge base on the implementation process, we will conduct interviews with physiotherapists.

As internet-based treatment can enhance availability and reduce costs, the results will bridge the gap between research and clinical practice and give guidance on large-scale implementation of exercise interventions in primary care.