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

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.