The effectiveness of psychological interventions on pain, disability, and psychological symptoms in whiplash-associated disorders: a systematic review and meta-analysis

Whiplash-associated disorders (WAD) include a range of physical and psychological symptoms, profoundly impacting individuals' quality of life. The effectiveness of psychological interventions in WAD management is still uncertain. Thus, the aim of this study is to investigate the effectiveness of psychological interventions on clinical outcomes (e.g., pain, disability, psychological distress) among individuals with WAD. Are psychological interventions effective in improving clinical outcomes (e.g., pain, disability, psychological distress) among individuals with WAD? Three databases were comprehensively searched for randomized controlled trials (RCTs) that investigated the effects of psychological interventions on pain, disability, depression, stress, anxiety, or fear of movement in patients with WAD compared with control groups receiving usual care or no intervention. Meta-analyses were performed by calculating the weight mean difference (WMD), 95% CI, and P value. The Cochrane Risk of Bias tool (RoB2) was used to assess the risk of bias in the included studies. Eleven RCTs met the inclusion criteria. The pooled analysis indicated a significant improvement in pain scales immediately after the intervention (WMD = 0.96, P < 0.05), and at 3–6 months and 1-year follow-ups. Disability, pain catastrophizing, and kinesiophobia improved significantly at post-intervention and after 3–6 months. In addition, the pooled analysis showed significant improvements in depression, anxiety, self-efficacy, and stress symptoms post-intervention. This systematic review provides varied evidence for the effectiveness of psychological interventions on pain, disability, and psychological symptoms in WAD. These immediate and long-term benefits in favor of psychological interventions are critical in the chronic pain management of WAD. Future research should focus on refining the most effective psychological interventions, considering cultural and contextual factors.